From Medscape Public Health & Prevention

Public Health Perspective

You Have the Right to...Health?

Dabney P. Evans, MPH, CHES 

If you are a fan of crime dramas as I am, you've probably heard the familiar expression, "You have the right to remain silent; you have the right to an attorney..." This oft repeated phrase captures a set of rights known as Miranda Rights. As Americans, we are aware of our rights as citizens. We pound our chests and claim our entitlements when those rights are being violated. In a famous 1964 case, Supreme Court Justice Potter Stewart in his opinion statement on obscenity said, "I know it when I see it."[1] Human rights are many times just the opposite. You know it when you don't see it or don't have it; you know it when your rights are being violated. But where do those rights come from, and is the right to health among them?

Human Rights are understood as an arm of international law which includes the United Nations Charter, the 1948 Universal Declaration of Human Rights, the International Covenant on Civil and Political Rights, and the International Covenant on Economic, Social and Cultural Rights. Human rights are a set of beliefs about the societal basis of human well-being and about what people need to maintain their human dignity. Human rights describe the relationships between individuals and society, specifically government. They are a kind of pact; we pledge our allegiance to our country, and governments pledge to respect, protect, and fulfill our human rights.

But what does this have to do with public health? The World Health Organization (WHO) defines health as "...a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."[1] Health can further be understood through the Declaration of Alma-Ata, which states that health is seen as a "social goal whose realization requires the action of many other social and economic sectors in addition to the modern health sector."[2] Every country in the world has signed at least 1 international human rights treaty that address health-related rights.[3]

Enter Human Rights

Human rights provide a system for public health professionals to reconnect with the populations we serve. Human rights are a set of distinct values that are agreed upon around the world. Further, they are codified in international treaties that have been adopted by most countries. By combining human rights principles with public health methods, we find a common language through which we can communicate. We obtain a junction for collaboration and cross-disciplinary education with others familiar with the human rights language. Finally, we discover a set of ethical principles based on human dignity and nondiscrimination.

United Nations Secretary General Kofi Annan has stated, "It is my aspiration that health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." The international human rights documents define the right to health and outline the steps to be taken in order to achieve it. Article 25.1 of the Universal Declaration of Human Rights states, "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, and the right to security in the event of unemployment, sickness, disability, widowhood, old age, or other lack of livelihood in circumstances beyond his control."[4] Article 12.2 of the International Covenant on Economic, Social, and Cultural Rights further outlines, "...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; and
  • The creation of conditions which would assure to all medical service and medical attention in the event of sickness.[4]"

Public health professionals are obligated to work towards the achievement of these objectives in 2 ways. First, if we choose to adopt the principles and rights outlined in the human rights corpus as a set of public health ethics then we are morally bound to focus our efforts towards the fulfillment of the right to health. Second, many public health professionals are employed by federal, state, and local governments. As such, these public health professionals are also state actors. States act as signatories to international treaties and, by extension, state actors are legally bound to respect, protect, and fulfill the rights outlined in the treaties to which the state is a party.

The former United Nations High Commissioner for Human Rights, Mary Robinson, has stated, "The right to health does not mean the right to be healthy...but it does require governments and public authorities to put in place policies and action plans which will lead to available and accessible healthcare for all in the shortest possible time. To ensure that this happens is the challenge facing both the human rights communities and public health professionals."

Many public health professionals around the world have actively been incorporating the principles of human rights into public health practice. In April 2005, 300 of these practitioners will gather in Atlanta, Georgia, for a conference entitled Lessons Learned from Rights-Based Approaches to Health. Cosponsored by the Emory University Institute of Human Rights, CARE USA, the US Centers for Disease Control and Prevention, WHO, Doctors for Global Health, and the human rights offices of the Carter Center, featured speakers will include former US President, Jimmy Carter; former United Nations High Commissioner for Human Rights, Mary Robinson; and United Nations Special Rapporteur on the Right to Health, Paul Hunt. As conference planning chair, I invite you to join us for this exciting conference to learn more about how human rights and health may be incorporated to achieve the challenge set forth by High Commissioner Robinson.

References

  1. WHO. Constitution. In: Basic Documents . 36th ed. Geneva: World Health Organization; 1986.
  2. WHO. Declaration of Alma-Ata. "Health for All" Series no. 1. Geneva: World Health Organization; 1978.
  3. WHO. 25 Questions and Answers on Health and Human Rights. Health and Human Rights Publication Series. July 2002(1). Geneva: World Health Organization; 2002.
  4. Columbia University Center for the Study of Human Rights. (1994). Twenty-Five Human Rights Documents. New York: Columbia University; 1994:6-16.

Acknowledgements

The author wishes to acknowledge the conference planning committee members, the conference cosponsors, and generous donors to the upcoming conference Lessons Learned from Rights-Based Approaches to Health (April 14-16, 2005; Atlanta, Georgia).

Dabney P. Evans, MPH, CHES , Lecturer, Department of Global Health, Rollins School of Public Health; Executive Director, Institute of Human Rights, Emory University; Atlanta, Georgia

Disclosure: Dabney P. Evans, MPH, CHES, has disclosed that she is employed by and received grants for educational activities from Emory University.

Medscape Public Health & Prevention.  2005; 3 (1):  ?2005 Medscape