Health and Human Rights

Specific rights relating to health are found in the international human rights documents. Essentially all human rights are interdependent and interrelated, making human rights realization as well as human rights neglect or violation relevant to a number of human rights rather than to a single, isolated right. This interconnectedness becomes evident when one considers that human well being (i.e. health) requires the satisfaction of all human needs, whether physiological, such as the need for air, water, food and sex or social or psychological, such as the needs for love and belonging to friends, family and community. Human rights have to do with the obligations of states to contributing to meeting those needs and to enabling groups and individuals to live in dignity. Following World War II, the United Nations Charter made it clear that member states had obligations with respect to human rights. The human right to health was made explicit in the 1948 Universal Declaration of Human Rights (UDHR), Article 25 of which states: "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 service. . ."

A broad and visionary definition of health is set out in the preamble of the World Health Organization (WHO) "a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity." This holistic view of health underscores the fact that much of the policy that determines health is made outside the conventional health sector and affects the social determinants of health.

Description and definition of the issue

Health and Human Rights Important links exist between health and human rights. These areas of intersection include violence, torture, slavery, discrimination, water, food, housing and traditional practices, to name a few. The UDHR commitment to the human right to health as part of the right to an adequate standard of living was made more explicit in Article 12 of the International Covenant on Economic, Social and Cultural Rights, 1966, (ICESCR). This treaty was adopted at the same time as the International Covenant on Civil and Political Rights (ICCPR). The separation through the covenants into two categories is symptomatic of Cold War tensions in which the Eastern countries prioritized the human rights in the ICESCR while the Western countries championed civil and political rights as the centre of human rights concerns. To date the ICCPR has been ratified by 149 countries and the ICESCR by 149: the United States has signed both but only ratified the ICCPR and China has signed both but only ratified the ICESCR. The text of Article 12 of the ICESCR is the bedrock of the right to health and it reads:

1. The state parties to the present covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
2. The steps to be taken by the states parties to the present covenant to achieve the full realization of this right shall include those necessary for:
3. 1. The provision for the reduction of the still birth rate and of infant mortality and for the healthy development of the child;
   2. The improvement of all aspects of environment and industrial hygiene;
   3. The prevention, treatment and control of epidemic, endemic, occupational and other diseases;
   4. The creation of conditions that would assure to all medical service and medical attention in the event of sickness.
      

There are a number of regional human rights treaties that further define the right to health, including Article 11 of the European Social Charter of 1961 as revised in 1966, Article 10 of the Additional Protocol to the American convention on Human Rights in the Area of Economic, Social and Cultural Rights of 1988, and Article of the African Charter on Human and Peoples’ Rights of 1981, and also several Articles in the constitution of India includes Article 21, 39, and 47. Governments approach their obligations under Article 12 of the ICESCR in different ways and the body in charge of monitoring application of the covenant sought to clarify states’ obligations by realizing an interpretative text called General Comment 14, which it adopted in May 2000. This General Comment stress how the realization of the human right to health relies on the realization of other rights, including the rights to life, food, housing, work, education, participation, enjoyment of the benefits of scientific progress and its application, freedom to seek, receive, and impart information of all kinds, nondiscrimination, prohibition of torture and freedom of association, assembly and movement.

Availability, Accessibility, Acceptability and Quality

The general comment also sets out four criteria by which the right to health can be evaluated:

1.  Availability includes the functioning public health and health care facilities, goods and services, as well as programmes that have to be available in sufficient quantity.
   
2. Accessibility of facilities, goods and services for health requires non-discrimination, physical accessibility, affordability and the adequate information.
   
3. Acceptability requires that all health facilities, goods and services must be respectful of medical ethics and culturally appropriate, sensitive to gender and life-cycle requirements, as well as being designed to respect confidentiality and improve health and health status of those concerned.
4. Quality demands that health facilities, goods and services must be scientifically and medically appropriate and of good quality.

Non-Discrimination

Discrimination because of sex, ethnicity, age, social origin, religion, physical or mental disability, health status, sexual orientation, nationality, civil, political or other status can impair enjoyment of the right to health. Particularly important in this regard are the UDHR, the International Convention on the Elimination of All Forms of Racial Discrimination (CERD) of 1965 and the International Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) of 1979, all of which refer to access to health and medical care without discrimination. Article 10, 12 and 14 of CEDAW affirm women’s equal rights to access of health care, including family planning, appropriate services for reproductive health care and pregnancy and family health care services. The Beijing Declaration and Platform for Action (1995) brings into focus the holistic view of health and the need to include women’s full participation in society as follows: "Women’s health involves their emotional, social and physical well-being and is determined by the social, political and economic context of their lives, as well as by biology. To attain optimal health, equality, including the sharing of family responsibilities, development and peace are necessary conditions." Mainstreaming these principles is also occurring throughout the UN system and through the efforts of non-governmental organisations (NGOs). Women, children, people with disabilities and indigenous and tribal peoples are among the vulnerable and marginalized groups that suffer health problems due to discrimination. An example of elaboration of the right to health as has occurred in the case of women illustrates the increased emphasis on the obligation of Governments to aid in the full realization of the right to health.