Right to Health

The right to health is protected by international legal instruments such as Article 25 of Universal Declaration of Human Rights and Article 12 of the International Covenant on Economic, Social and Cultural Rights. The right to health encompass both freedoms and entitlements. The freedoms include the right to control one's health and body and the right to be free from interference, such as the right to be free from torture, non-consensual medical treatment and experimentation. The entitlements include timely and appropriate health care and the underlying determinants of health, such as access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions, and access to health-related education and information. Availability, accessibility, acceptability and quality are the four criteria by which the implementation of right to health is to be assessed.

Despite efforts to codify right to health at the international levels, debate about the authenticity of such a right continues. The theory of human rights in its orthodox formulation embraces an ideology of individualism and views economic, social and cultural rights as mere aspirations that every decent society should strive for. They do not accord it the status of a human right. Further, even those who acknowledge right to health, feel disconcerted about some of the assumptions built into the biomedical model that is in vogue. It is premised on the ideology of individualism and assumes that patients can make ‘free’ choices in the marketplace. There is little place for understanding how behaviours are related to social conditions and constraints or as to how communities shape individuals’ lives. Simultaneously, and rather paradoxically, medicine also has a history of paternalism. The patients are often reduced to a ‘case’ or worse still, a mere number in the register. Additionally, in our times medical science is escalating the specialised experts’ sphere of influence – a phenomenon that conjures up the danger of ‘expertocracy’ and thus the extension of the mastery of illness into a form of social control. The legal recognition that treatment-choices are not to be medically dictated is a comparatively recent development. Not all medical practitioners are comfortable with this notion, and most patients, do not seem to recognise the importance of informed choices.

However, despite these disquiet, human rights express, in the broadest sense, basic values such as human dignity and social justice and there is a great belief, at the grass root level, in its liberating potential. It is to be noted that these rights are social guarantees against actual and threatened deprivation and an attempt to restrain economic and political forces that would otherwise be too strong to be resisted. It can ensure that the government will not be party to any action that will hinder accessibility and availability of health care.

The effects of globalisation on human rights are complex and bewildering. Though globalisation is supposed to be a political, social and cultural process, it is primarily economic, and, more often than not, seen in terms of developing markets, deregulating business activities, privatising state enterprises, lowering national barriers and expanding world trade and investment. Neo-liberal reforms advocated by the international financial institutions have gradually whittled away at state authority over economic and social spheres. While civil liberties and formal political rights are generally consistent with the demands of the market place, economic, social and cultural rights are often at odds with these demands.

How do the policies associated with globalisation affect the health sector? First, reduced overall government spending means there is a proportionate decline in spending on health care services. As a consequence special services such as mother and child health services, AIDS prevention work, leprosy or TB control programmes and other primary health care initiatives are adversely affected. In government services that remain after the cutback, user fees are introduced. This method of introducing the market mechanism into the provision of health care obviously makes services less available to the poor. The privatisation of health and hospital services also makes the poor suffer as services become more oriented towards those who can pay. In addition all countries are now obliged to provide, as per the Trade Related Intellectual Property Rights Agreement, within a stipulated time limit, product patents for all products for a minimum of twenty years. There is some evidence to suggest that the effect of strong patents on affordability and accessibility of drugs is significant. The problem is becoming more acute because in countries like India, under the influence of structural adjustment and reforms programmes, national price controls are being systematically done away with. As against this many direct and indirect pharmaceutical price regulations remain in effect in OECD countries. Finally, increasing unemployment and poverty add to the nation's health problems by creating extra demands on reduced government services.
Further, as the borders and regulatory agencies of most governments are caving in, corporations are assuming a stateless quality. TNCs deliberately hide information – as it happened in the case of the addictive potential of tobacco or the side-effects of a legal drug and is also increasingly deciding, by virtue of its control over mass media, as to what shall be made known to people. It also brings in to focus a number of questions such as who is to be held responsible for people dying or suffering because they cannot afford the pharmaceutical product or health care - the state or the TNCs or the WTO or the international financial institutions as they are equally responsible for the current sorry state of affairs in many parts of the world. The human rights discourse should now focus, along with transgressions within States, on violations caused by non-state actors. It is only then right to health will become a reality.

The most hopeful sign came in the form the Peoples’ Health Assembly that assembled in Bangladesh in 2001. The Charter enacted in this Assembly, attended by concerned people, as opposed to states, clearly stated in its Preamble:

Health is a social, economic and political issue and above all a fundamental human right. Inequality, poverty, exploitation, violence and injustice are at the root of ill health and the deaths of poor and marginalised people. Health for all means that powerful interests have to be challenged, that globalisation has to be opposed, and that political and economic priorities have to be drastically changed. … It encourages people to develop their own solutions and to hold accountable local authorities, national governments, international organisations and corporations.


It is this vision that we need to carry forward – it is a difficult dream but not an impossible one.

i People’s Charter For Health; www.pha2000.org accessed in March 2001.