Health is a Human Right: Who is Accountable for its Realization?
By Myria Koutsoumpa, Global Health Advocate, Wemos
Health of the people and the planet is fundamentally challenged in the era of capitalism. We, therefore, need to put health as a human right back in the limelight. Universal Health Coverage (UHC) is firmly based on the 1948 WHO Constitution, which declares health a fundamental human right and commits to ensuring the highest attainable level of health for all, as well as on the Health for All agenda set by the Alma Ata Declaration in 1978. With that in mind, the duty-bearers accountable for its realization need to be identified; and that goes beyond national governments.
During the decades of structural adjustment programmes (1980–1990) and the establishment of neoliberalism as the dominant economic ideology, a shift from focusing on equity to focusing on efficiency seems to have taken place. This can be seen by the restructuring of the public sector, deflation of health personnel and introduction of the private sector in healthcare. Health is often perceived as an investment in the human capital which will result in more production, more consumption and, as a result, economic growth. Under the human rights approach to health, the criterion of efficiency cannot be considered without adding an ethical dimension to it. That became more apparent during the period 1990–2000 and the emergence of relevant international declarations, treaties and agreements for health, which brought forward that economic criteria should not dominate the collective decisions on global health. Human rights should not be considered in relation to the resources available, but it is the resources that should be adapted according to the needs of the realization of human rights. One should not only consider the optimum way of resource-allocation in resource-scarce settings, but rather the causal factors of this very scarcity, constructed by globalized economic activity and market fundamentalism.
The primary obligation to realize human rights and ensure satisfaction of a minimum level of each of them historically relies on the state. When it comes to the right to health, the state namely has three obligations: to “respect”, “protect”, and “fulfil” it, via inter alia appropriate legislative, administrative and budgetary measures (United Nations High Commissioner for Human Rights, 2008). If health, and by extension UHC, is considered a human right, certain essential health services and goods should be guaranteed to each and every human being.
But can this aspirational goal be equally realized by low-income states? National fiscal and monetary policy decisions affect the resources available for realizing citizen’s rights, as proposed by the human rights approach. According to scholars and analysts who have investigated monetary and fiscal policies, macroeconomic policies adopted by governments of several developing countries impose a barrier to the scaling-up of public expenditure in the social sectors, including health.
Nevertheless, even if according to the United Nations the right to health is a primary obligation of the state, UHC needs to be viewed outside national borders and rather through the lens of global social justice and shared responsibility. Powerful actors such as high-income states, multilateral organizations and international financial institutions often interfere and have significant influence on national governments’ autonomy over fiscal and monetary policies. Civil society and governments themselves need to scrutinize and discuss this influence and interference so these powerful actors can be held accountable for their share in realizing the right to health and align their actions towards achieving UHC.
Suggested tweets:
1. We need to look at #UHC through the lens of global #social_justice & #shared_responsibility — not only within national borders.
2. #UHC goes beyond national governments: multilateral organizations & international financial institutions play their part too in determining policies.
