What does “health as a right” mean? Per the World Health Organization’s (WHO) Constitution, "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Internationally, health as a fundamental human right was recognized by the WHO’s constitution in 1946. In 1966, Article 12 of the International Covenant on Economic, Social, and Cultural Rights delineated four 4 interrelated core components of this right to health:
- Availability — sufficient quantity of functioning health facilities, goods, and services;
- Accessibility — non-discrimination, physical accessibility, economic accessibility (affordability), and information accessibility.
- Acceptability — respect for medical ethics, culturally appropriate and sensitivity to gender; and
- Quality — safety, effectiveness, people-centered, timely, equitable and integrated.
The framework of the three core functions of public health — assessment, policy development and assurance — provide a roadmap to further the realization of health as a right. In developing and implementing systems to preserve and promote health, per the WHO assessment is key for situational awareness in characterizing.
In recognizing health as a right, by extension, healthcare becomes a must have, and policy development and assurance play key roles to ensure individuals have availability, accessibility, acceptability and quality in healthcare. Healthcare encompasses the provision of services necessary to treat disease and promote health3. Healthcare services delivery and systems development require thoughtful legislation, rules, policy and plans, including community partnerships. Importantly, the U.S., has precedent for considering health as a right and healthcare’s centrality to that right. President Franklin D. Roosevelt included the right to healthcare in his proposed Second Bill of Rights in 1943 and in his State of the Union address in 1944. Following his death, Eleanor Roosevelt took his work and the drafted Second Bill of Rights to the U.N. where it was expanded upon. She became the drafting chairperson for the UN’s Universal Declaration of Human Rights (UDHR), which drew from FDRs work to include the right to health in the Universal Declaration of Human Rights in 1948. At the time, the U.S. and all other nations in the UN adopted these standards2, 4. Similarly, the U.S. signed the aforementioned International Covenant on Economic, Social, and Cultural Rights in 19773.
More recently, with the passage of the Patient Protection and Affordable Care Act (PPACA), the U.S. healthcare system shifted towards the principles of universal healthcare, in keeping with its own historical view of health as a right. As progress continues towards attaining the four core components of health as a right described above through maturing healthcare coverage policy, services delivery and systems developments, the assurance function’s corresponding 10 Essential Services of Public Health- enable equitable access; build a diverse and skilled workforce; improve and innovate through evaluation, research and quality improvement; and build and maintain a strong organizational infrastructure for public health- provide foundational elements, guideposts and checkpoints to maintain forward progress. Industrialized countries around the world have already adopted universal health care systems, providing lessons learned for success and challenges to look to as we continue to build a more accessible, cost- and clinically- effective and equitable system unique to the U.S.
References:
- Binagwaho, A and Mathewos, K, 2023, The Right to Health- Looking Beyond Facilities, Health and Human Rights Journal.
- Gerisch, M., 2018. “Health Care as a Human Right”, American Bar Association Human Rights Magazine Vol 43 No. 3 The State of Healthcare in the United States
- Maruthappu, M., Ologunde, R., Gunarajasingam, A., 2012 online, “Is Health Care a Right? Health Reforms in the USA and their Impact Upon the Concept of Care. Ann Med Surg (Lond). 2013; 2(1): 15–17
- Mollmann, M., 2022. “Healthcare is Human Right- but not in the US”, Harvard Public Health
- https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health
Samar Muzaffar, MD, MPH, FACPM
Regent-at-Large