The Right to Health in the Time of COVID-19
By Hina Shaikh and Mark Edberg
First reported to the World Health Organization (WHO) in December 2019 as cases of pneumonia of unknown cause, the novel coronavirus had spread to every continent by late February 2020. By late April, the global numbers were reported as over three million confirmed cases and over 215,000 deaths, with the United States eclipsing other countries in both the number of COVID-19 cases and deaths.
The rising daily toll, alarming as it is, fails to convey the human stories of those fighting to stay alive, fighting to keep others alive, and the rampant shortages of medical capacity, equipment, income and basic survival needs that are so widespread. In many parts of the world, the gravity of the situation is compounded by flagrant government violations of human rights law and accountability. In April, the Secretary General of the United Nations called for human rights to be “front and centre” in guiding worldwide COVID-19 responses. The dire situation is a harsh reminder of the profound linkages between health and human rights, first articulated 74 years ago in the WHO Constitution.
The coronavirus pandemic, with no modern precedent, shows how acutely a globalized, interconnected world renders all nations vulnerable to the spread of disease. While the 1948 Universal Declaration on Human Rights asserts a spectrum of individual rights, including the rights to liberty, freedom, and to work and education, we may be seeing the real significance of the right to health in a new light. Health is critically intersectional because it is not shaped by one factor. It is shaped across populations through a complex web of interacting factors, including biology, socioeconomic status, culture, structural constraints, and discriminatory discourses of race and gender. In the time of COVID-19, it is no longer possible to deny that population health is a public good, and that the right to health crosses paths with principles of human rights, such as non-discrimination and dignity. This time of COVID-19 also shows that because people do not act in isolation and the behaviors of individuals profoundly impact the health of others, the space between individual and community has been drastically diminished.
The collapsing of that space brings us to consider the legal framework underlying the right to health, articulated in the 1946 Constitution of the WHO as:
“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.”
When nations ratify the WHO Constitution, it takes effect as a treaty. Signatory nations are therefore obligated to ensure conditions that protect and provide for the right to the “highest attainable standard of health” without discrimination. In the 1948 Universal Declaration on Human Rights, health is referred to as part of the right to an adequate standard of living:
“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.”
Health as a right appears again in the 1966 International Covenant on Economic, Social and Cultural Rights:
“States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.”
These treaties and declarations, among others, form the body of international human rights law regarding health that nations are obliged to protect. While the burden is on governments to ensure appropriate conditions that protect the right to the “highest attainable standard of health,” the right extends beyond provision of medical care and hospitals. It includes basic needs intrinsic to survival: safe drinking water and food, adequate sanitation, adequate nutrition and housing, healthy working and environmental conditions, and access to health-related information. Such needs call for national public health funding.
The right to health also includes specific entitlements: the right to a system of health protection providing equality of opportunity for everyone to enjoy the highest attainable level of health; the right to prevention, treatment and control of diseases; access to essential medicines; and equal and timely access to basic health services. From a public health perspective, there is wide understanding that these basic needs, or social determinants of health, are necessary in order to meet that standard. However, the current COVID-19 crisis has, if nothing else, peeled open for public view the stark disparities in these determinants of health, in particular as they are outcomes of economic inequality. In the United States, for example, inequalities in our health care system are clear. Some 2.8 million Americans cannot access care because of a lack of health insurance, making COVID-19-related treatment impossible to access.
Unequal access to health resources and to a health-supportive environment contravenes the very principle on which universal human rights were founded: To protect all individuals from discrimination and marginalization and to protect the most vulnerable. In the time of COVID-19, governments are still mandated to provide adequate resources for the realization of the right to health as expressed in human rights law. Speaking in reference to another viral pandemic, the late HIV/AIDS activist and human rights advocate Jonathan Mann stated, “[P]ublic health considers that both disease and society are so interconnected that both must be considered dynamic. An attempt to deal with one, the disease, without the other, the society, would be inherently inadequate.”
In our enduring time of COVID-19, we see this as profoundly true, showing that public health and human rights are inextricably linked.
Hina Shaikh, JD, MPH, is a Research Director at the George Washington University Milken Institute School of Public Health, and Director of Research Operations at the school’s Center for Social Well-Being and Development.
Mark Edberg, PhD, MA, is an Associate Professor at the George Washington University Milken Institute School of Public Health, and Founding Director of the school’s Center for Social Well-Being and Development.
