Health is a Human Right

To be healthy is a human right. It is as basic as right to life. But why? Because, beginning with birth, health improves the chance of survival. In infancy and childhood, good health is essential pre-requisite for physical and mental growth and development. The foundation of our achievements in adult life, the chances of growing to an adult member of the society are greatly influenced by our remaining in good health.

During childhood and adolescence, good health not only prevents avoidable illnesses but also more importantly lets us acquire knowledge, skills, and attitudes necessary for us to lead a socially and economically productive life and to make contribution to personal gains as well as contribute to national advancement. In old age, being in health makes enjoyment of retirement from work a pleasure and we can remain useful members of the society.

Thus, for a variety of reasons, life without assurance of being in health is a violation of the basic right of a citizen. The right to health is not exclusively an individual responsibility as much as it is not a right without any individual obligation and responsibility. Apart from the individual, the State representing the sovereign will of its people has a social contract that among its other duties binds the State with the duty and obligation to create and maintain conditions that are conducive to health of its people. That is not to say the State, by itself, can make everybody enjoy good health nor does it mean that people will not suffer illness.

What the State can do is to empower and enable people; ensure equal access to health information, facilities, and services. A modern democratic State should also establish health equity which means access to, and use of, health information, resources and services by all - and not some - according to need without any economic or social barrier but does not mean equal distribution to each.

The State alone cannot do all this. The people individually and collectively have the right and responsibility to behave and act in a manner that protects and promotes their own health, and that of their families and communities. The people must exercise that right and participate in a responsible manner in institutions and activities that minimise hazards to health and promote maintenance of health. Health after all is a positive state of mind and body; it is not mere absence or cure of illness.

Good health is therefore a shared responsibility that is best performed through mutual partnership between private and public actions. In many emerging states which had been under colonial rule newly-elected governments promise to take healthcare to the doorsteps of everybody. This arises from a misplaced notion of charitable welfare. Unfortunately the promise is not made after determining either the financial or human resources capacity of the state. This promise is seldom fulfilled in actual practice since the resources do not permit even if the will is there. And the political will is often lacking too. It is not even appropriate to try to take healthcare to each doorstep.

Governments making such political pledge also make the mistake of understanding health of the people as a function of healthcare alone which it is not. More often than not, what they continue to do with their limited resources, is to set up western-style prestigious health facilities mostly in urban areas that are costly to build and far too expensive to operate in prevailing resource constraint. When health centres were built in the rural areas, these did not run regularly because of lack of funds, personnel, or supplies since the urban centres consumed most of limited budgets.

The promise of healthcare to everybody remained yet another promise and not a reality. This also widened the already existing inequity of healthcare in many cases.

Universality of Human Rights: A Hotly Debated Issue
There is the age of worldwide awareness of human rights. There are global conventions, Charters and Declarations that spell out human rights. With globalisation and emergence of democracy as the dominant world system, there is world wide acceptance and open debate on the subject of human rights; independent commissions, NGOs, and the media are generating reports and disseminating information on human rights globally. The current debate, inspite of established global covenants, is not devoid of controversies; a major controversy about whether there can or should be a single universal standard of human rights applicable and appropriate for all countries.

It is argued that since the traditions, culture, historical experience, and socio-political systems show plurality, there has to be different definition of human rights in its implementation. Value systems differ and so the concept and principles of human rights realisation could also differ amongst societies. A major issue is whether human rights as articulated by the West is applicable to the East since many social, cultural, and civilisational differences exist across the world.

Why Health in Human Rights?
However, without going into the issue of universality of human rights standards, it is noted that at the present time much of the concern and debate on human rights occur on themes and topics that may be perceived as peripheral if not irrelevant in many societies and countries who have different needs and value systems. Freedom of expression, assembly, gender equality, tolerance of individual norms of behaviour and social conduct etc., abound in human rights debates chiefly though not exclusively in the west.

But there are countries where many fundamental rights and freedoms for example opportunities for education, health, shelter, choice of life are yet to be secured for all. One of these is the subject of this writing: where is health in human rights? Today, in societies rich and poor alike there are wide and unacceptable disparities in health and health care; many remain denied of access to health as a human right.

Of course, health deprivations differ in extent and cause, but the disparities are there whether in industrialised West or in poverty stricken East. Conceptually there has been very little affirmation of health as a human right even though to some it may be of greater importance and of more substance than other better articulated rights. As argued earlier in this text, health is so closely inter linked with human survival and development that common sense as well as wisdom would put health way above other rights concerned with expression of views, assembly or dissent or right to vote.

It could even be argued that health is so basic a right that it need not wait for democracy to be realised. One may not fault too much an autocratic State, as defined by its not being ruled by democratically elected government, if it secures for its people health as a right and thereby assures the survival and development of its people. It could well be that their other rights will then begin to acquire some meaning to them. No right is perhaps an end by itself and does exist in a vacuum when so many other rights are not enjoyed.

Health in this writer's view is a right which ranks above certain other rights as we have come to know these. It is strange that there has been so little evidence of health being put in its rightful place in the global agenda on human rights. The writer draws attention to this void with the plea that all societies especially the newly-emerging democracies put health high on their political and socio-economic agenda, and accept and advocate health in human rights agenda, and that international convention and debates on human rights include direct reference to health with the priority it deserves. Perhaps that would be one component of human rights on which universal agreement and concerted action will be possible.

Can Health Rights be a Start to Achieve Other Rights?
As stated before, it is reasonable to expect health to be a good focal point to rally national and global consensus on human rights. It might break new common ground for international political will and cooperation that is much harder to agree in matters of commerce, trade, and international security. Health right is attainable with relatively modest resources, health is a more benign and non-controversial subject, health is in everybody's interest, health enjoyment and benefits are immediately and directly relevant and meaningful to all.

Is it therefore possible that as a starting point, health rights movement and action will succeed most when rights remain contested? Is it also likely that the expected success with health might well raise confidence and desire to secure other human rights? The answer to both according to this writer is yes, most likely.

In fact, if indeed health is seen to be an established and tangible right, then it might add impetus and rationale to the movement for other rights - the enjoyment of which is also improved by improved health for all. Here I wish to mention for the record that in 1977, the World Health Organisation - the specialised UN agency for health - had launched an universally acclaimed goal of Health for All by the year 2000 to be attained by all its member-states.

Subsequent global events and diversion of resources to numerous conflicts distracted the will and resources of the international community; the goal remains unachieved 20 years after it was launched. But that does not prove the goal or the approach of primary healthcare is any less valid today, or any less attainable. Now in the post-Cold War era, at least some of the dividends of peace and co-operation might be channelled into securing some of the economic and social rights, of which health is probably the least controversial and most promising for co-operation and world peace.

Admittedly, the so-called peace dividends are as yet unfulfilled; conflicts and strife still abound; the world order of justice and cooperation remains elusive. Yet, there has to be hope and some trust in the future of world peace and shared prosperity. Is that too much to expect? Let us hope it is not.

At the national level, human rights organisations and commissions should begin to focus on the issue of right to health as a rallying point to the struggle for realising other human rights. Almost certainly, such a movement will be readily recognised, understood, and gain wide acceptance. It is not for the organisations and commissions on human rights alone, but it is for the elected legislators, policy makers and bureaucrats, the activists, and the civil society at large to take up the "health as a human rights" issue as one with high relevance and priority. Only then will governments and societies jointly move to establish health as a human right. The writer believes that will sensitise the State and the Society to start to define and deliver other components of human rights. Is this an utopian hope?