Spotlights on Health and Rights

Key topics in the Heilbrunn Department of Population and Family Health

Human Rights

The Right to Health

The World Health Organization defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." The WHO Constitution notes further 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. Enjoyment of this right is vital to all other aspects of a person's life and is crucial to the realization of many other rights."

Several rights relating to health are established in international human rights treaties. The International Covenant on Economic, Social and Cultural Rights (ICESCR) particularly establishes a right to health:

ICESCR, article 12:

  • The States Parties to the Present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
  • 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:
    • The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child
    • The improvement of all aspects of environmental and industrial hygiene
    • The prevention, treatment and control of epidemic, endemic, occupational and other diseases
    • The creation of conditions which would assure access to all medical services and medical attention in the event of sickness.

Questions for Thought

  • What essential elements of the right to health and health services are missing from this article? Why do you think that is?
  • The United States has not ratified the ICESCR. Is there something in article 12 that you think would be a politically controversial commitment for the government of the United States to make?

It is important to note the language "highest attainable standard" of health. This language seems to reflect the idea of "progressive realization" - that is, getting as far as available resources allow. But other provisions of the ICESCR refer to "adequate standard of living" and "adequate food, clothing and housing" rather than the "highest attainable standard". Some experts have suggested that this language reflects the importance of health to human life and dignity and to the enjoyment of other rights. Others have suggested that "adequate" is a more useful term than "highest attainable" because the latter allows governments to suggest that an inadequate standard is the highest they can attain.

Other core human rights treaties specify health rights. For example, the Convention on the Rights of the Child (article 24) has an expansive definition of maternal and child health that includes the obligation not only to reduce child mortality, but also to ensure prenatal and post-natal care for women, access to family planning services, combating malnutrition and ensuring access to clean water, and ensuring that all parents know the advantages of breastfeeding. CEDAW (article 12) mandates governments to ensure equal access to health services for women, including family planning services, and comprehensive services related to pregnancy, including "granting free services where necessary."

To complement these specifications about health in human rights treaties, the ICESCR treaty body (the Committee on Economic, Social and Cultural Rights) in 2000 issued a detailed guideline to member states about the content of the right to health. This document, General Comment 14 of the Committee/E.C.12.2000.4.En), is one that public health professionals should be familiar with. The box below attempts to summarize some important points from General Comment 14.

General Comment no. 14 on the Right to the Highest Attainable Standard of Health (Committee on Economic, Social and Cultural Rights, 2000)

Selected points:

  • The right to health is not the right to be healthy. Rather it is the right to "a variety of facilities, goods, services and conditions" necessary to realize the highest attainable standard of health.
  • A human rights notion of health includes "underlying determinants of health" including water and sanitation, food, housing, good workplace conditions, and "access to health-related education and information, including on sexual and reproductive health."
  • The right to health includes the right to meaningful participation of the population - that is, those who use health services - in health-related decision-making at all levels.
  • Even though the right to health is to be realized progressively, there are certain elements of the right to health that should be expected of all governments, even where resources are scarce. These include the following:
    • Whatever services are available should be offered in a non-discriminatory way.
    • No matter how basic the services are, there should still be mechanisms to ensure meaningful participation of people who use health services in decision-making about services.
    • Governments must define a minimum "core" of services and ensure that it is accessible to all. In most cases, even in resource-poor countries, the core should include such elements as immunization against the major infectious diseases, basic primary health care, access to essential medicines (as defined by WHO), reproductive health services, and access to comprehensive information on major health problems.
    • Governments should have a concrete plan and budget for progressive realization of increasingly higher standards of preventive and curative services.
  • Accessibility of services is an expansive notion that includes affordability, non-discrimination, gender sensitivity, cultural appropriateness, quality and scientific soundness of care and prevention.

Question for Thought

General Comment 14 suggests that the right to health is related to a broad range of other conditions. What do you think is the relationship between the rights listed below and the right to health?

  • The right to privacy (ICCPR)
  • The right to non-discrimination (many human rights treaties)
  • The right to participation (ICCPR)
  • The right to information (ICCPR)
  • Rights to liberty and security of the person (ICCPR)
  • Rights to the benefits of scientific advances (ICESCR)
  • The rights to safe and healthy working conditions (ICESCR)

Question for Thought

General Comment 14 suggests that the right to health is related to a broad range of other conditions. What do you think is the relationship between the rights listed below and the right to health?

Another document of particular relevance to public health is the Declaration of Alma Ata adopted at the 1978 International Conference on Primary Health Care, which affirmed health as a fundamental human right and asserted the need for comprehensive health care services for all people.