“The right to the highest attainable standard of health” requires a set of social criteria that is conducive to the health of all people, including the availability of health services, safe working conditions, adequate housing and nutritious foods. Achieving the right to health is closely related to that of other human rights, including the right to food, housing, work, education, non-discrimination, access to information, and participation.
The right to health includes both freedoms and entitlements.
• Freedoms include the right to control one’s health and body (e.g. sexual and reproductive rights) and to be free from interference (e.g. free from torture and from non-consensual medical treatment and experimentation).
• Entitlements include the right to a system of health protection that gives everyone an equal opportunity to enjoy the highest attainable level of health.
Health policies and programmes have the ability to either promote or violate human rights, including the right to health, depending on the way they are designed or implemented. Taking steps to respect and protect human rights upholds the health sector’s responsibility to address everyone’s health.
Disadvantaged populations and the right to health
Vulnerable and marginalized groups in societies are often less likely to enjoy the right to health. Three of the world’s most fatal communicable diseases - malaria, HIV/AIDS and tuberculosis - disproportionately affect the world’s poorest populations, placing a tremendous burden on the economies of developing countries. Conversely the burden of non-communicable disease – most often perceived as affecting high-income countries is now increasing disproportionately among lower income countries and populations
Within countries – some populations – such as indigenous communities are exposed to greater rates of ill-health and face significant obstacles to accessing quality and affordable healthcare. This population has substantially higher mortality and morbidity rates, due to noncommunicable diseases such as cancer, cardiovascular and chronic respiratory diseases, than the general public. People who are particularly vulnerable to HIV infection – including young women, men who have sex with men, and injecting drug users – are often characterized by social and economic disadvantage and discrimination. These vulnerable populations may be the subject of laws and policies that further compound this marginalization and make it harder to access prevention and care services.
Violations of human rights in the health sphere
Violations or lack of attention to human rights can have serious health consequences. Overt or implicit discrimination in the delivery of health services violates fundamental human rights. Many people with mental disorders are kept in mental institutions against their will, despite having the capacity to make decisions regarding their future. On the other hand, when there are shortages of hospital beds, it is often members of this population that are discharged prematurely, which can lead to high readmission rates and sometimes even death, and also constitutes a violation of their right to receive treatment.
Similarly, women are frequently denied access to sexual and reproductive health care and services in developing and developed countries. This is a human rights violation that is deeply engrained in societal values about women’s sexuality. In addition to denial of care, women in certain societies are sometimes forced into procedures such as sterilization, abortions or virginity examinations.
Human rights-based approaches
A human rights-based approach to health provides strategies and solutions to address and rectify inequalities, discriminatory practices and unjust power relations, which are often at the heart of inequitable health outcomes.
The goal of a human rights-based approach is that all health policies, strategies and programmes are designed with the objective of progressively improving the enjoyment of all people to the right to health. Interventions to reach this objective adhere to rigorous principles and standards, including:
1. Non-discrimination: The principle of non-discrimination seeks ‘…to guarantee that human rights are exercised without discrimination of any kind based on race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status such as disability, age, marital and family status, sexual orientation and gender identity, health status, place of residence, economic and social situation’1.
2. Availability: A sufficient quantity of functioning public health and health care facilities, goods and services, as well as programmes.
3. Accessibility: Health facilities, goods and services accessible to everyone. Accessibility has 4 overlapping dimensions:
• physical accessibility;
• economical accessibility (affordability);
• information accessibility.
4. Acceptability: All health facilities, goods and services must be respectful of medical ethics and culturally appropriate as well as sensitive to gender and life-cycle requirements.
5. Quality: Health facilities, goods and services must be scientifically and medically appropriate and of good quality.
6. Accountability: States and other duty-bearers are answerable for the observance of human rights.
Universality: Human rights are universal and inalienable. All people everywhere in the world are entitled to them.
Policies and programmes are designed to be responsive to the needs of the population as a result of established accountability. A human rights based-approach identifies relationships in order to empower people to claim their rights and encourage policy makers and service providers to meet their obligations in creating more responsive health systems.
WHO has made a commitment to mainstream human rights into healthcare programmes and policies on both national and regional levels, by looking at underlying determinants of health as part of a comprehensive approach to health and human rights. In addition, WHO has been actively strengthening its role in providing technical, intellectual and political leadership on the right to health including:
• strengthening the capacity of WHO and its Member States to integrate a human rights-based approach to health;
• advancing the right to health in international law and international development processes; and
• advocating for health-related human rights, including the right to health.
1 Committee on Economic, Social and Cultural Rights, General comment No. 20, Non-discrimination in economic, social and cultural rights; 2009.