Global Health Action Campaign

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Global Health Action Campaign

The Right to Health

A Conversation with Helen Potts, PhD

Helen Potts, PhD, Chief Program Officer of Health Programs

Physicians for Human Rights has launched its Global Health Action Campaign. Now this program is going to view health issues through the prism of the right to health. Do you think this resonates with people in the United States?

With many it most certainly does. At the same time, I do realize that in the United States civil and political rights tend to have been given more emphasis in the last few decades. Nevertheless, it is an exciting and important challenge. What is frequently forgotten is that the United States was once the driving force behind the recognition of all human rights: economic, social and cultural as well as civil and political.

Could you remind us of that time?

Former First Lady Eleanor Roosevelt led the way. When she served as President and Chair of the United Nations Commission on Human Rights, she chaired the committee that drafted and approved the Universal Declaration of Human Rights (1948). The Declaration includes rights to health, education, and cultural as well as civil and political rights such as life, freedom from arbitrary detention, freedom from torture and freedom of association.

Eleanor Roosevelt went from town to town across the country to ensure that she understood and then advocated for the inclusion of the human rights that citizens of the United States considered essential to ensure a better standard of living, equality of opportunity and human dignity.

What is the “right to health?"

The full name is the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. As this is a bit long, it is frequently shortened to the “right to health” or the “right to the highest attainable standard of health.”

It is a fundamental human right that encompasses both freedoms and entitlements.

The freedoms include the right to participate in decisions about one’s health, including sexual and reproductive freedom, and the right to be free from interference, such as non-consensual medical treatment.

The entitlements include the right to emergency medical services and to the underlying determinants of health, such as freedom from discrimination, and an adequate supply of safe food, and access to safe water and sanitation.

There is a document, called General Comment No. 14, drafted by the UN Committee on Economic, Social and Cultural Rights and released in 2000. Developed after a great deal of consultation with both human rights and health experts, the General Comment has 64 paragraphs which explain in detail the content and obligations contained in the right to health.

What does all that mean?

It means that the state has a bundle of obligations to create the social and environmental conditions for a person to reach her highest attainable standard of health. The challenge is to hold the state to account for these obligations. State accountability is so important.

But more than anything else, we have to show that consideration of the right to health can actually make health policy, programs and projects better. When we view policies, programs and projects through the prism of the right to health, they will be more accessible, sustainable, and robust.

The policies, programs and projects will be more meaningful to the people that they are meant to serve.

So the right to health is more than just a right to healthcare?

It’s more than health care. Your health depends on much more than health care. Of course the right does include timely and appropriate health care, but it also extends to the underlying determinants of health, such as gender, access to health-related education and information, including on sexual and reproductive health, freedom from discrimination, an adequate supply of safe food, nutrition and housing, access to safe water and adequate sanitation and so on.

Is it a right to be healthy?

No. The state cannot fully ensure good health, as it is influenced by some factors which are in whole or in part outside the state’s control, such as individual susceptibility to ill health.

What about personal responsibility? Don’t people have a personal responsibility to look after their health?

The right to health does recognize personal responsibility; all members of society have responsibilities regarding the realization of the right to health. But the state has the ultimate duty to provide the environment in which you can undertake your responsibility.

Where is the right to health found?

It was first set out in the World Health Organisation (WHO) Constitution (1946), and then in the Universal Declaration of Human Rights (1948) though the central formulation is found in the International Covenant on Economic, Social and Cultural Rights (1966).

It is also contained in numerous other human rights treaties that have been created to protect the human rights of particular groups. These groups include children, women, people with disabilities and those who are subject to discrimination on the basis of race.

Where can we find these treaties?

You can find the treaties on the UN Office of the High Commissioner for Human Rights web site.

As you can see from the inclusion of a right to health in the WHO Constitution, the right is not the preserve of the human rights community. Health as a human right was reaffirmed in the Declaration of Alma Ata (1978) and included in several other important WHO documents such as the Ottawa Charter on Health Promotion (1986) and the Jakarta Declaration on Leading Health Promotion into the 21st Century (1997). These declarations can be viewed on the WHO web site.

Are people entitled to be involved in developing health policy and plans?

A central component of the right to health is the right to people to active and informed participation in heath related decisions that affect them. This means participation in the development, implementation, evaluation and review of health programs, strategies and plans.

The notion that participation is essential for the sustainability and responsiveness for health programs is not new. It is a requirement that has been recognized in the health sector for at least 30 years. Indeed, it is present in the 1946 WHO Constitution.

How does the right to health add value by bringing accountability?

Accountability is simply a process that allows the state to explain what it is doing and why. It also provides an opportunity for people to understand why the state has acted the way it has. If it is found that the state has violated the right to health, people are entitled to a remedy.

The process involves monitoring (by the state and by civil society), accountability mechanisms, and remedies.

What does accountability look like when the right to health is implemented?

When you are talking about accountability, it’s not just about blaming government and finding fault. It’s about finding out what works so it can be repeated and what doesn’t work so it can be revised.

While it is often associated with judicial accountability, in practice there are many effective non-judicial forms, such as national human rights institutions and parliamentary committees. Social accountability mechanisms, such as civil society organisations and the media also play an essential role in ensuring accountability.

For example, perhaps there is a health policy that completely ignores public health evidence, say, needle exchange programs: a remedy would be changing the health policy to ensure the introduction of needle exchange programs. Or if it is found that health workers are discriminating against particular groups, then a remedy could be human rights training for the heath workers and monitoring of the health services by people who use the service.

Could you provide examples of where this right has been implemented?

The right to health has to some degree shaped HIV/AIDS policy in several countries, such as South Africa and India. Specifically, it has led to outreach programs for sex workers and access to anti-retroviral drugs and public health information campaigns in those countries and elsewhere.

Also in Brazil for example, many LGBT groups recently participated in the development of a national health plan which specifically addressed the health concerns of these groups.

What’s an example of where this approach may assist in a particular health issue?

Maternal mortality: over 500,000 women per year die in childbirth or from pregnancy-related causes. Most of these deaths are preventable. Many of these deaths are the result of violations of human rights: life, health, non-discrimination and equality.

If you viewed maternal mortality through the prism of human rights, you could develop more robust and effective policies that dealt with discrimination and inequality, access to health services, skilled birth attendants, sexual and reproductive health, and so on.

Where do people find out more about the right to health?

There was a large body of work developed during the mandate of the first UN Special Rapporteur on the right to the highest attainable standard of health – Professor Paul Hunt – at the Human Rights Centre at the University of Essex.

The UN Human Rights Council renewed the mandate in 2008. Anand Grover is the current UN Special Rapporteur on the right to the highest attainable standard of health. You can read about his work on the web site for the Lawyers’ Collective.

There has also been a substantial amount of work undertaken by the WHO and academic institutions such as the François-Xavier Bagnoud Center for Health and Human Rights, which also publishes the open source journal Health and Human Rights: An International Journal.

What’s a Special Rapporteur?

A UN Special Rapporteur is an individual appointed by the UN Human Rights Council to investigate, monitor, advise and report on human rights concerns. Thematic Special Rapporteurs are appointed to address a specific human rights issue, such as trafficking in persons, the right to food, and the right to health. Country Special Rapporteurs are mandated to deal with the human rights situation in a particular country.

Impartiality is essential. Hence, Special Rapporteurs are independent experts who work in their personal capacity, do not represent any government, and do not receive salaries or any other financial compensation for their work. Their work is supported and facilitated by one human rights officer at the Office of the United Nations High Commissioner for Human Rights (OHCHR).

What sorts of things does a Special Rapporteur do?

The activities of a Special Rapporteur include responding to information on specific allegations of human rights violations, sending urgent appeals or letters of allegation to governments asking for clarification, and conducting country visits to investigate the situation of human rights at the country level. Regarding the latter, the Special Rapporteur typically sends a letter to the government requesting to visit the country. If the government agrees, an invitation to visit is extended. Some countries have extended standing invitations. As of October 2008, 63 countries had done so. After the visit, the Special Rapporteur issues a mission report containing findings and recommendations.

The International Federation of Health and Human Rights Organisations (IFFHRO) has developed a guide for civil society on the role of the Special Rapporteur on the Right to Health (PDF).

What are some of the biggest challenges to implementing the right to health?

Lack of political will is a major challenge, as is the lack of understanding of what the right to health does and does not mean.

It’s not about litigation; it’s about involving people in decisions that affect their health. It is about placing people at the center.

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