Health and human rights are inextricably intertwined

Human Rights Day is commemorated every year on 10th December as the anniversary of the adoption of the Universal Declaration of Human Rights ( UDHR) by the United Nations General Assembly on December 10th, 1948. The first sentence of the preamble reads, “Whereas recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world.”Health and human rights are interconnected and their promotion fundamentally and inextricably intertwined. The effects of violations of dignity and physical integrity on health (mental or otherwise) are as crucial as the effects of poor health on dignity. Both the Universal Declaration of Human Rights (UDHR) and the International Covenant on Economic, Social, and Cultural Rights(ICESCR) recognise that health is central to the dignity of the person and the state’s commitment to health of the population as a fundamental human right.
The realisation of other rights is not possible if an individual cannot maintain his/her own health: “Particularly crucial health needs to include the prevention of stillbirths and infant mortality; the improvement of environmental and industrial hygiene; the prevention, treatment, and control of diseases; and the provision of medical care to the sick.
The linkage of health and human rights refers to the understanding that health status is in a large measure determined by the degree to which human rights are enjoyed. It also entails the application of human rights norms to policies and programs of health systems and to the conduct of health practitioners. The approach principally builds upon the scientific discipline of public health, epidemiology, and especially social epidemiology. Multilevel approaches to understanding social determinants of health, the role of social integration, social cohesion, and social networks, and similar concerns of social epidemiology all suggest a human rights context for policies to improve the prospects for vulnerable populations to lead healthy lives.
Poor health and inadequate health care are often related to human rights violations. And violation and underfulfillment of human rights are often due to poor health and lack of access to health care. The link is direct in the case of other basic social and economic human rights, such as the right to a standard of living adequate for the health and well-being of oneself and one’s family. But poverty and lack of health protection are also indirectly linked to failures to secure civil and political rights.
The ICESR, Article 12 reads in part “the States Parties to the present Covenant recognise the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”. The interpretation of this article is elaborated in the General Comment 14, which the Committee on Economic, Social and Cultural Rights issued in 2000. Governments have obligations to respect, protect and fulfil the right to health as well as other human rights.
Human Rights are based on moral universals, their formulation is historically contingent and reflects societal understandings at particular points of history. A commitment to providing basic and adequate health care or other types of positive entitlements is far more appropriate and possible for the late twentieth Century advanced industrial economy than for the Eighteenth Century agrarian economy. We are in a new era of human rights and globalisation. The dramatic changes brought about by the end of the Cold War, partly as a consequence of the wider introduction of communication and information technology and partly as a result of trade liberalisation, prompted a global drive towards neo-liberal economic reforms and democratisation, globalisation of democracy and human rights, in contrast, has often-though not always-contributed to upholding certain civil and political rights. The most visible signs of the globalisation of human rights is the growth of international human rights non-governmental organisations (NGOs), global conferences, and transnational networking. Over the past twenty-five years, women’s civil rights and reproductive rights have found their way into the international legal and human rights agendas. The two most relevant human rights conferences of the 1990s were the 1993 Vienna Second World Conference on Human Rights and the 1995 Beijing Fourth World Conference on the Status of Women. In the Vienna Declaration, for example, for the first time, violence against women was recognised as a human rights abuse. The Beijing Conference set an impressive agenda for promoting human development by addressing gender inequality and women’s rights. Since Alma Ata, there have been some limited successes for global health in human rights-related areas: the elimination or reduction of important communicable diseases; increases in food production and longevity; elimination of some threats to the environment; and reductions in infant and child mortality. Nevertheless, success overall has been grossly inadequate. Critical health problems persist and are growing, and new threats have emerged. The ever-expanding global health crisis knows no borders or boundaries.
The greatest challenges facing our ability to advance the Human Right to health are not medical but cultural, economic, environmental, political, and social. Health is the sum of empowering education, adequate nutrition, safe environments, social support, and community cohesion. Rights are a way to mobilise and empower the disadvantaged, and in many parts of the world this is their principal function. The language of rights makes people conscious of both their oppression and the possibility of change. A human rights approach assumes a trade -off in which the political system provides the security of a health care entitlement in exchange for the people accepting limits on the benefits that are publicly funded.
Further using a human rights approach also implies that the entitlement is universal. This means there is no exclusion from the provisions made to assure health care on any grounds whether purchasing power, employment status, residence, religion, caste, gender, disability, and any other basis of discrimination. But this does not discount the special needs of disadvantaged and vulnerable groups who may need special entitlements through affirmative action to rectify historical inequities suffered by them. Thus establishing universal health care through the human rights route is the best way to fulfil the obligations mandated by international law and domestic constitutional provisions. International law, specifically ICESCR, the Alma Ata Declaration, among others, provide the basis for the core content of right to health and health care. But country situations are very different and hence there should not be a global core content, it needs to be country specific. Because a human right is a universal entitlement, its implementation is measured by the degree to which it benefits those who hitherto have been the most disadvantaged and vulnerable and brings them up to mainstream standards.
A human rights approach to health therefore necessitates both non-discrimination and affirmative action to eliminate historical inequities and patterns of discrimination in access to health services. As entitlements rights are contrasted with privileges, group ideals, societal obligations, or acts of charity, and once legislated they become claims justified by the laws of the state.. The emphasis thus should not be as much on ’respect’ and ’protect’ but on ’fulfil’. For the right to be effective optimal resources that are needed to fulfil the core obligations have to be made available and utilized effectively.
Health professionals have a great stake in the UDHR because human rights and health concerns share the common goals of alleviating suffering and promoting the conditions for health and well-being of all people. These goals represent an ideal that cannot be achieved unless the fundamental rights set forth in the UDHR are recognised, respected, protected, and fulfiled.