Human Rights and Health

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Top Contributors - Naomi O'Reilly, Jess Bell, Kim Jackson, Vidya Acharya, Kirenga Bamurange Liliane and Carin Hunter  

Introduction

The Universal Declaration of Human Rights, adopted in 1948 following the Second World War, is generally agreed to be the foundation of international human rights law and represents the universal recognition that basic rights and fundamental freedoms are inherent to all human beings, inalienable and equally applicable to everyone, and that every one of us is born free and equal in dignity and rights regardless of our nationality, place of residence, gender, national or ethnic origin, colour, religion, language, sexual orientation or any other status.

Health and its value to human life has been recognised as a basic human right in Article 25 of the Universal Declaration of Human Rights, which states that:

"Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control" Universal Declaration of Human Rights

The Constitution of the World Health Organization, which also came into effect in 1948, also recognises health as a basic human right and states that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”.

With numerous nation states endorsing the right to health as part of their constitution, they are legally obliged to safeguard access to quality health in a "timely, acceptable and affordable" manner, whilst ensuring provision for the determinants of health.

"Understanding health as a human right creates a legal obligation on states to ensure access to timely, acceptable, and affordable health care of appropriate quality as well as to providing for the underlying determinants of health, such as safe and potable water, sanitation, food, housing, health-related information and education, and gender equality." World Health Organisation

“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 all other human 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.

Displaced persons are also entitled to all the rights and fundamental freedoms that are spelled out in international human rights instruments. The protection of displaced persons must therefore be seen in the broader context of the protection of human rights.

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 four core components: The AAAQ framework is often used to describe health service delivery and we will use this model to look at rehabilitation in health systems.

Availability

Availability of services requires that public health and healthcare facilities are available in sufficient quantity, taking into account a country’s developmental and economic condition.

In low-resource countries, there are often little or no rehabilitation services available.  Where it is available, rehabilitation is often concentrated in urban centres or is delivered by NGOs which means the services are not integrated into the local health service system.

Accessibility

The health system has to be accessible to all.  Accessibility has four overlapping dimensions:

1. Non-discrimination
   • Health facilities, goods and services must be accessible to all, especially the most vulnerable.
2. Physical accessibility
   • Health facilities, goods and services must be within safe physical reach of all parts of the population.
3. Economic Accessibility (affordability)
   • Health services must be affordable for all. Access can be limited by expense, the need to pay out-of-pocket or long wait times. 
4. Information Accessibility
   • Accessibility includes the right to seek, receive, and impart information concerning health issues. For example, governments must ensure that young people have access to sexual and reproductive health education and information presented in an unbiased manner.

Acceptability

Acceptability requires that health services are ethically and culturally appropriate, i.e. respectful of individuals, minorities, peoples, and communities, and sensitive to gender and life-cycle requirements. Rehabilitation services must be ethically and culturally appropriate to the populations they serve.  Data of more than 280,000 service users over a 30 year period found that fewer women and girls attended rehabilitation across all health conditions.  Further research is indicated to understand the exclusion of women and girls from rehabilitation services as it affects their potential and has a negative impact on their families and greater communities.

Quality

Quality requires that health services must be scientifically and medically appropriate and of the highest quality. Underpinning the quality of rehabilitation services is evidenced-based practice.  Unfortunately, there is a mismatch between where rehabilitation research is conducted, with relatively little being done in low-resource contexts.  A 2020 systematic review of interventions for persons with stroke from low- and middle-income countries found only 62 studies, 44 of which were conducted in India. This exemplifies the lack of rehabilitation research carried out in low- and middle-income contexts.  Another factor limiting the quality of rehabilitation is the inability to access meaningful research. This may be due to a lack of relevancy to the context, articles/research may be blocked by a paywall or there may be a language barrier in terms of reading the research and translating knowledge.

Violations of Right to 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.

Resources

https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health

https://ijrcenter.org/refugee-law/