The right to health and the 60th anniversary of the Universal Declaration on Human Rights

The Lancet has released a special report on the right to health on 10 December 2008, International Human Rights Day, to mark the 60th anniversary of the Universal Declaration on Human Rights.

“Health systems and the right to health: An assessment of 194 countries” (free subscription required) reports on 72 indicators that reflect “right to health” features for health systems. Data were collected for these 72 indicators in 194 countries; five countries — Sweden, Mozambique, Romania, Peru and Ecuador — were used as case examples.

A key finding of the report is the lack of globally available data for a
substantial number of the indicators, which severely limits monitoring
progress made towards progressive realization of the right to health.

Other key findings include:

– Despite the majority of countries ratifying three major human right treaties that include the right to health, only 56 countries that have ratified the International Covenant on Economic, Social, and Cultural Rights include the right to health in their constitution or other statute.

– Recognition of the right to health in international treaties, national constitutions, and other statutes gives rise to the legal obligation for countries to ensure that their health systems have certain right-to-health features and also that the performance and quality of health systems improve over time.

– Non-discrimination is a key right-to-health feature. The treaty-based grounds of discrimination most commonly protected by law was ethnic origin; the least protected was age.

– People with mental illnesses are frequently neglected and discriminated against. Of 98 countries for which data were available, almost half allocated 2% or less of their national budget to mental health.

– Health information is a prominent feature of the right-to-health, particularly maternal and neonatal deaths and the civil registration system.

– The adoption of a national public health strategy and plan of action is a core obligation.

– Monitoring, assessment, accountability, and redress is a crucial part of documenting progress towards realizing the right to health.

Based on their findings, the authors make 38 specific recommendations including:

– WHO and the Office of the High Commissioner for Human Rights should adopt a stewardship role in the collection and collation of data for right-to-health features of a health system.

– National governments should explicitly recognize the right to health, and right-to-health features, such as access to essential medicines, in the national constitution or statute.

– Research institutions should assist national governments to conduct health and human rights impact assessments.

– Donors should recognize the importance of strengthening health systems in international assistance.

– Civil society should participate in health system monitoring and

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