Human Right Issues And Public Health

Human Right Issues And Public Health
The right to the highest attainable standard of health” implies a clear set of legal
obligations on states to ensure appropriate conditions for the enjoyment of health for all
people without discrimination.
The right to health is one of a set of internationally agreed human rights standards, and
is inseparable or ‘indivisible’ from these other rights. This means achieving the right to
health is both central to, and dependent upon, the realisation of other human rights, to
food, housing, work, education, information, and participation.
The right to health, as with other rights, includes both freedoms and entitlements:
• Freedoms include the right to control one’s health and body (for example, sexual
and reproductive rights) and to be free from interference (for example, free from
torture and non-consensual medical treatment and experimentation).
• Entitlements include the right to a system of health protection that gives everyone
an equal opportunity to enjoy the highest attainable level of health.
Focus on disadvantaged populations
Disadvantage and marginalization serve to exclude certain populations in societies from
enjoying good health. Three of the world’s most fatal communicable diseases – malaria,
HIV/AIDS and tuberculosis – disproportionately affect the world’s poorest populations,
and in many cases are compounded and exacerbated by other inequalities and
inequities including gender, age, sexual orientation or gender identity and migration
status. Conversely the burden of non-communicable diseases – often perceived as
affecting high-income countries – is increasing disproportionately among lower-income
countries and populations, and is largely associated with lifestyle and behaviour factors
as well as environmental determinants, such as safe housing, water and sanitation that
are inextricably linked to human rights.
A focus on disadvantage also reveals evidence of those who are exposed to greater
rates of ill-health and face significant obstacles to accessing quality and affordable
healthcare, including indigenous populations. While data collection systems are often ill-
equipped to capture data on these groups, reports show that these populations have
higher mortality and morbidity rates, due to noncommunicable diseases such as cancer,
cardiovascular diseases, and chronic respiratory disease. These populations may also
be the subject of laws and policies that further compound their marginalization and
make it harder for them to access healthcare prevention, treatment, rehabilitation and
care services.
Violations of human rights in health
Violations or lack of attention to human rights can have serious health consequences.
Overt or implicit discrimination in the delivery of health services – both within the health
workforce and between health workers and service users – acts as a powerful barrier to
health services, and contributes to poor quality care.
Mental ill-health often leads to a denial of dignity and autonomy, including forced
treatment or institutionalization, and disregard of individual legal capacity to make
decisions. Paradoxically, mental health is still given inadequate attention in public
health, in spite of the high levels of violence, poverty and social exclusion that contribute
to worse mental and physical health outcomes for people with mental health disorders.
Violations of human rights not only contribute to and exacerbate poor health, but for
many, including people with disabilities, indigenous populations, women living with HIV,
sex workers, people who use drugs, transgender and intersex people, the health care
setting presents a risk of heightened exposure to human rights abuses – including
coercive or forced treatment and procedures.
Human rights-based approaches
A human rights-based approach to health provides a set of clear principles for setting
and evaluating health policy and service delivery, targeting discriminatory practices and
unjust power relations that are at the heart of inequitable health outcomes.
In pursuing a rights-based approach, health policy, strategies and programmes should
be designed explicitly to improve the enjoyment of all people to the right to health, with a
focus on the furthest behind first. The core principles and standards of a rights-based
approach are detailed below.
Core principles of human rights
Accountability
States and other duty-bearers are answerable for the observance of human rights.
However, there is also a growing movement recognising the importance of other non-
state actors such as businesses in the respect and protection of human rights. (2)
Equality and non-discrimination
The principle of non-discrimination seeks ‘...to guarantee that human rights are
exercised without discrimination of any kind based on race, colour, sex, language,
religion, political, or other opinion, national or social origin, property, birth or other status
such as disability, age, marital and family status, sexual orientation and gender identity,
health status, place of residence, economic and social situation’.
Any discrimination, for example in access to health care, as well as in means and
entitlements for achieving this access, is prohibited on the basis of race, colour, sex,
language, religion, political or other opinion, national or social origin, property, birth,
physical or mental disability, health status (including HIV/AIDS), sexual orientation ,and
civil, political, social or other status, which has the intention or effect of impairing the
equal enjoyment or exercise of the right to health.
The principle of non-discrimination and equality requires WHO to address discrimination
in guidance, policies, and practices, such as relating to the distribution and provision of
resources and health services. Non-discrimination and equality are key measures
required to address the social determinants affecting the enjoyment of the right to
health. Functioning national health information systems and availability of disaggregated
data are essential to be able to identify the most vulnerable groups and diverse needs.
Participation
Participation requires ensuring that all concerned stakeholders including non-state
actors have ownership and control over development processes in all phases of the
programming cycle: assessment, analysis, planning, implementation, monitoring, and
evaluation. Participation goes well beyond consultation or a technical addition to project
design; it should include explicit strategies to empower citizens, especially the most
marginalized, so that their expectations are recognised by the State.
Participation is important to accountability as it provides “...checks and balances which
do not allow unitary leadership to exercise power in an arbitrary manner”.
Universal, indivisible and interdependent
Human rights are universal and inalienable. They apply equally, to all people,
everywhere, without distinction. Human Rights standards – to food, health, education, to
be free from torture, inhuman or degrading treatment – are also interrelated. The
improvement of one right facilitates advancement of the others. Likewise, the
deprivation of one right adversely affects the others.
Core elements of a right to health
Progressive realization using maximum available resources
No matter what level of resources they have at their disposal, progressive realisation
requires that governments take immediate steps within their means towards the
fulfilment of these rights. Regardless of resource capacity, the elimination of
discrimination and improvements in the legal and juridical systems must be acted upon
with immediate effect.
Non-retrogression
States should not allow the existing protection of economic, social, and cultural rights to
deteriorate unless there are strong justifications for a retrogressive measure. For
example, introducing school fees in secondary education which had formerly been free
of charge would constitute a deliberate retrogressive measure. To justify it, a State
would have to demonstrate that it adopted the measure only after carefully considering
all the options, assessing the impact and fully using its maximum available resources.
Core components of the right to health
The right to health (Article 12) was defined in General Comment 14 of the Committee on
Economic, Social and Cultural Rights – a committee of Independent Experts,
responsible for overseeing adherence to the Covenant. (4) The right includes the
following core components:
Availability
Refers to the need for a sufficient quantity of functioning public health and health care
facilities, goods and services, as well as programmes for all. Availability can be
measured through the analysis of disaggregated data to different and multiple stratifiers
including by age, sex, location and socio-economic status and qualitative surveys to
understand coverage gaps and health workforce coverage
Accessibility
Requires that health facilities, goods, and services must be accessible to everyone.
Accessibility has four overlapping dimensions:
• non-discrimination
• physical accessibility
• economical accessibility (affordability)
• information accessibility.
Assessing accessibility may require analysis of barriers – physical financial or otherwise
– that exist, and how they may affect the most vulnerable, and call for the establishment
or application of clear norms and standards in both law and policy to address these
barriers, as well as robust monitoring systems of health-related information and whether
this information is reaching all populations.
Acceptability
Relates to respect for medical ethics, culturally appropriate, and sensitivity to gender.
Acceptability requires that health facilities, goods, services and programmes are people-
centred and cater for the specific needs of diverse population groups and in accordance
with international standards of medical ethics for confidentiality and informed consent.
Quality
Facilities, goods, and services must be scientifically and medically approved. Quality is
a key component of Universal Health Coverage, and includes the experience as well as
the perception of health care. Quality health services should be:
• Safe – avoiding injuries to people for whom the care is intended;
• Effective – providing evidence-based healthcare services to those who need them;
• People-centred – providing care that responds to individual preferences, needs and
values;
• Timely – reducing waiting times and sometimes harmful delays.
• Equitable – providing care that does not vary in quality on account of gender, ethnicity,
geographic location, and socio-economic status;
• Integrated – providing care that makes available the full range of health services
throughout the life course;
• Efficient – maximizing the benefit of available resources and avoiding waste