PHA-Exch> Lancet: The right to health and the 60th anniversary of the Universal Declaration on Human Rights

[Claudio Schuftan]

From: Camila Giugliani giugli at hotmail.com

>
> The Lancet 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" and accompanying editorial and
comments are available at www.thelancet.com (subscription required).
>
> United Nations Secretary-General Ban Ki-moon launched a campaign a year
ago to increase knowledge and awareness of human rights. However, "the
health sector has been strikingly silent, which is tremendously
disappointing given that the foundation for the right to health is laid out
in this historic document," according to an editorial accompanying The
Lancet's report. The editorial attributes this to "the general lack of
understanding about what the right to health is and what it means in
practice…The right to health is a legal instrument - a crucial and
constructive tool for the health sector to provide the best care for
patients and to hold national governments, and the international community,
to account…Health workers, health policymakers, and all who care about the
health of individuals, groups, and the global population, should mainstream
the right to health by using this valuable and practical tool in their
everyday practice." The editorial, "The right to health: From rhetoric to
reality," is available at
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61814-0/fulltext
.
>
> "Health systems and the right to health: An assessment of 194 countries" (
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61781-X/fulltext)
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
planning.
>
> In an accompanying comment, "Right to health and the Universal Declaration
of Human Rights" (
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61783-3/fulltext),
Navanethem Pillay, UN High Commissioner for Human Rights says: "The right to
health is a fundamental part of our human rights and our understanding of a
life in dignity…As UN High Commissioner for Human Rights, I share the
commitment of the international human-rights machinery to realizing the
right to health. Promoting and securing the right to the enjoyment of the
highest attainable standard of health is ethical; it is a legal obligation
and a step towards our fight to end poverty, discrimination, and exclusion."
>
> In another comment, "Why and how is health a human right?" (
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61784-5/fulltext),
Amartya Sen, Professor in Philosophy and Economics at Harvard University,
says: "In doing a special issue on the right to health, The Lancet is
helping to draw attention to an extraordinary important subject that does
not as get much attention as it deserves…There are political, social,
economic, scientific, and cultural actions that we can take for advancing
the cause of good health for all. Indeed, this special issue, which is aimed
at knowledge and understanding of the parameters of the right to health, is
itself a contribution to that splendid cause. In seeing health as a right,
we acknowledge the need for a strong social commitment to good health. There
are few things as important as that in the contemporary world."
>
> Additional comments include:
> - "Rights-based approaches to improve people's health in Peru" (
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61785-7/fulltext)
by Ariel Frisancho and Jay Goulden of CARE Peru.
> - "Gender equality and the right to health" (
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61786-9/fulltext)
by Hedia Belhadj and Aminata Touré of UNFPA - United Nations Population
Fund.
>
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