World Medical Association General Assembly
Seoul, 16 October 2008
“The Right to Health: health and human rights from the United Nations perspective”
Doctor Snaedal, President of the World Medical Association,
Doctor Moon, President Emeritus of the Korean Medical Association,
Ladies and Gentlemen,
I am very pleased to take part in this Scientific Session at the World Medical Association General Assembly. I am greatly heartened that you have chosen to explore the fundamental link between health and human rights during your General Assembly this year. I would also like to commend the efforts of the Korean Medical Association in hosting this meeting here in Seoul. As a Korean national working for human rights within the UN system, I am very proud and grateful to have this opportunity to speak before the World Medical Association, in my home town and on a topic of vital importance for human rights around the world.
As we celebrate the 60th anniversary of the Universal Declaration of Human Rights which falls on 10 December 2008, we must continue to pursue the Declaration’s bold vision of a world where the civil, political, economic, social and cultural rights for all are fully realized without distinction. Under the banner of “justice and dignity for all” and in the context of a year-long campaign to mark the Universal Declaration’s anniversary, the Office of the High Commissioner for Human Rights (OHCHR), has been leading and facilitating a number of activities with this unitary vision of rights and entitlements at their care.
The full realization of the Declaration’s vision requires that we pursue the entire set of rights proclaimed in the Declaration as an indivisible and organic whole, inseparable and interdependent, and all of equal importance. Economic, social and cultural rights cannot be fully achieved where civil and political rights are curtailed and civil and political rights cannot be fully exercised where economic, social and cultural rights are neglected.
More specifically, and of direct relevance to this conference, the full enjoyment of many other human rights strictly depends on the right to health. Regardless of age, ethnic or religious background, socio-economic conditions or gender, adequate access to health care must be granted to all in the event of illness, emergencies or in the normal life cycle of an individual.
Allow me to discuss today crucial aspects of the right to health, or to use the full term “the right to the enjoyment of the highest attainable standard of physical and mental health” under international human rights law, as well as the critical role that health professionals play in giving full effect to this right.
Furthermore, in the broader context of the indivisibility, interdependence and interrelatedness of all human rights, I will discuss the effects on the right to health of poverty and discrimination, in particular discrimination against women. Then, I will draw your attention to the right to health of persons with disabilities in light of the newly adopted Convention on the Rights of Persons with Disabilities.
The right to health as an international norm was articulated for the first time under the auspices of the World Health Organization (WHO) in 1946, with the active engagement of many doctors and health professionals, who were committed to ensuring the quality of life for every human being. WHO’s Constitution of 1946 defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. It further proclaimed that “the enjoyment of the highest standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”.
Two years later, Article 25 of the Universal Declaration of Human Rights affirmed that “everyone has the right to a standard of living adequate for the health of himself and of his family, including food, clothing, housing and medical care and necessary social services”. Since then, the right to health has become widely accepted as a fundamental human right, explicitly recognized in international and regional legal instruments, as well as in national constitutions and domestic laws, giving rise to obligations of the State as duty-bearer, vis-à-vis individuals and groups of individuals as rights-holders.
The 1966 International Covenant on Economic, Social and Cultural Rights provides the most comprehensive articulation on the right to health by recognizing “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” Moreover, it provided guidance on actions to be taken by States to comply with their obligations. These included provisions to give effect to the right to maternal, child and reproductive health; the right to healthy natural and workplace environments; the right to prevention, treatment and control of diseases; and finally, the right to health facilities, goods and services.
Allow me to clarify that, under international human rights law, the right to health both comprises “freedoms” and “entitlements”:
Freedoms include, for instance, the right to be free from non-consensual and uninformed medical treatment, medical experimentation or forced HIV testing. In this context, freedom from torture and other cruel, inhuman or degrading treatment is an important component of the realization and protection of the right to health.
Meanwhile, Entitlements include the right to a system of protection on an equal basis for all; the right to prevention, treatment and control of diseases; access to essential medicines, sexual and reproductive health; and access to information and education about health for everyone, particularly to prevent unhealthy or risky behaviour.
Furthermore, the Committee on Economic, Social and Cultural Rights, which is an expert body that monitors State implementation of the Covenant, has given detailed guidance on the essential and interrelated elements of the steps to be taken by States to guarantee the right to health. The precise application of these steps, however, would depend on the conditions prevailing in each particular State and include:
Availability of facilities, goods and services in sufficient quantities within a State.
Accessibility, including both its physical and financial aspects. Physical accessibility refers to providing safe access to all sectors of the population such as children, elders, persons with disabilities, adolescents and any other specific group. This includes considering accessible formats, tailor-made campaigns and plain language messages which speak to different audiences. Financial accessibility refers to the guarantee that every person would have access in spite of economic constraints, and that special measures will be adopted for the poor and the most vulnerable of a society.
Acceptability: Facilities, goods and services must be acceptable. In other words, these components must be gender-sensitive, culturally appropriate and respectful of medical ethics.
Good quality: facilities, goods and services must be of good quality in scientific and medical terms. The availability of trained health professionals at all levels, trust-worthy laboratories, research institutes and statistical and epidemiological centres are a few of the most critical components.
Ladies and Gentlemen,
The medical and human rights professions share a commitment to non-discrimination and equality. To us all, every person must be equally respected, cared for and protected without distinction and discrimination.
Our professional commitment as practitioners and advocates of non-discrimination is made all the more crucial by the reality in which discrimination, marginalization and poverty continue to present towering challenges to the enjoyment of the right to health in rich and poor societies alike.
Poverty is often both the cause and the effect of marginalization and stigma around the globe, affecting disproportionately the weakest: children, elders, refugees and displaced persons, migrants and persons living with HIV. Neglected tropical diseases flourish among the poorest individuals in some of the world’s poorest sectors of the society.
Maternal and child mortality, are at their highest among the poor, both in developed and developing societies. As it is well known to this audience, many of these conditions are preventable and treatable. Discrimination and inequality against women continue to be at the heart of our challenges, despite decades of norm-building at the international and national levels to protect women from violence and other violations of their rights and dignity. In these situations, health professionals play the essential role of identifying discriminatory policies and practices, helping to document and redress these violations of human rights, and enabling victims to seek justice and remedies.
In many cases, victims suffer from multiple grounds for discrimination. Adolescents and young women are often marginalized not only due to their gender but also to their age and often because of their ethnic, religious or racial minority status. According to the World Bank, one telling indicator is that in 2005 more than half the estimated 5 million people who contracted HIV worldwide were young persons between the ages of 15 and 24, the majority of them young women. Similarly, while nearly 60 percent of young women in developing countries are mothers by the time they reach 25, they often do not receive any or adequate information about family planning, sexual and reproductive health or clear public health messages, mostly as a result of social barriers that do not allow them to access such information. Clearly, maternal health challenges are often primarily a reflection of women’s disadvantaged position, including of women’s lower political and social status in many societies.
Thus, it is of crucial importance that health professionals become ever more in countering discrimination. They can do so, for example, by providing easy to understand, accurate information, based in science, to every patient at all times. They must grant patients privacy and confidentiality, as well as ensure their prior informed consent to treatment. It is also vital that health services be regarded and handled as public goods.
Ladies and gentlemen,
Let me now briefly expand on the role of medical professionals in preventing the some of the most egregious forms of human rights violations, such as torture. As the United Nations Special Rapporteur on the question of torture and other cruel, inhuman or degrading treatment or punishment noted, one of the major challenges in fighting impunity for torture is conducting effective investigations. Effective medical documentation could bring evidence of torture and ill-treatment to light so as to ensure accountability for perpetrators.. In particular, the Special Rapporteur highlights the role of specialized health personnel and the strengthening of forensic medical examination whenever there are grounds to believe that a person could have been the victim of ill-treatment.
While the vast majority of health professionals around the world adhere to the highest ethical standards and contribute to the promotion and protection of human rights, deviations and infringement of deontology have also been noted. In 2005, the former Special Rapporteur on the right to health pointed out that some health professionals “wittingly or unwittingly have been complicit in human rights violations.” Political, legal, economic, social and cultural pressures that may conflict with human rights mean that they sometimes have to make decisions in their daily work. Personal views of health professionals may also influence attitude and practices in ways that may be inconsistent with the rights of patients. For example, in some countries, health professionals, under institutional or societal pressures or out of their own views, deny treatment to marginalized groups, such as immigrants; disclose confidential medical records, or deny sexual and reproductive health information to women and adolescents. Health professionals have also, at times, been subject to pressures to participate in human rights violations including torture, forced sterilizations and female genital mutilation. Decisions made by health professionals can mean the difference between the protection or the violation of human rights.” A/60/348, Paragraphs 8 and 9.
Similarly, various human rights treaty bodies responsible for monitoring compliance of State party obligations under international human rights law have repeatedly drawn the attention of the international community to health personnel and their role in the enjoyment of human rights. For instance, the Committee on Economic, Social and Cultural Rights has received reports on the obstruction of access to legal abortion after rape due to misinformation, lack of clear guidelines, abusive behaviour directed at pregnant rape victims by public prosecutors and health personnel, legal impediments in cases of incest, and lack of access to reproductive health services and education, especially in rural areas and in indigenous communities in different countries See for example, E/C.12/MEX/.
Thus, the former Special Rapporteur on the right to health has consistently advocated for adequate training in human rights for health professionals and the inclusion of such component in medical and nursing school curricula, particularly those charged with implementing public health policies. This would equip doctors and other health professionals with essential tools and knowledge to promote the human rights of their patients, as well as their own.
Health workers themselves are often under threat. This may occur when they are forced to commit violations by societal or State pressure. Due to a lack of knowledge of or access to the human rights system that would protect them, many professionals could solely rely on their own professional ethics to fend off coercion and abuse. Some have suffered and continue to suffer ostracism, persecution, false allegations or detention as a result of defending their patients’ rights. This explains why in several countries the list of human rights defenders under threat includes health professionals, particularly those working with issues of sexual and reproductive health, sexual orientation, HIV/AIDS and prostitutes. We need to ensure that appropriate mechanisms of accountability, access to independent judicial systems and redress avenues, and adequate human rights training are in place for health professionals.
Moving now to a central element of my discussion, let me point out that last May, the Convention on the Rights of Persons with Disabilities and its Optional Protocol came into force. The Convention expresses an understanding of disability as a status limiting participation in society on an equal basis with others, rather than as a purely medical condition, or as a disease that needs to be treated. This transition from a medical to a social approach to disability is referred to as a veritable “paradigm shift”.
We are all too aware that persons with disabilities face numerous barriers including in the enjoyment of their right to health on an equal basis with others. These barriers are not only physical barriers, but more often attitudinal, or systemic. The removal of these barriers is now regarded an obligation of States under the Convention. Thus persons with disabilities must be provided with the same range, quality and standards of health care and programmes as accessible to other persons,, including in the area of sexual and reproductive health and population-based public health programmes from which persons with disabilities are often excluded. States are also required to provide the health services which are specifically needed by persons with disabilities. . Such services must also be located as close as possible to people’s communities, including in rural areas. Moreover, the Convention clarifies that States have the obligation to require health professionals to deliver care of the same quality to persons with disabilities as to others, including on the basis of their free and informed consent. Crucially, States are required to raise awareness of the human rights, dignity, autonomy and needs of persons with disabilities through training and the promulgation of ethical standards for public and private health care.
The Special Rapporteur on the question of torture and other cruel, inhuman or degrading treatment or punishment, in his most recent report to the General Assembly this year A/63/175, Paragraphs 45 to 50. , has documented how persons with disabilities in institutions are frequently subjected to undignified conditions and treatment, as well as physical, mental and sexual violence. Further, the Special Rapporteur denounced the practice of subjecting persons with disabilities to intrusive and irreversible medical treatment (such as sterilization, abortion or electroshock) without their consent. In many cases, such practices when perpetrated against persons with disabilities, remain invisible or justified, and are not recognized as torture or other cruel, inhuman or degrading treatment or punishment.
There is no doubt that medical professionals and health workers have a crucial role to play in protecting persons with disabilities from violence, abuse, cruel, inhuman or degrading treatment and from torture. Perhaps most importantly, exercising the medical profession ethically and responsibly gives effect to several key provisions of the Convention, including the right of every person with disabilities to respect for his or her physical and mental integrity and for individual autonomy. This includes the right to decide whether to accept medical treatment or testing based on their free and informed consent. Clearly, it has become necessary to review policies, protocols and practices in the health sector nationally in light of the Convention. The human rights constituency looks forward to engaging with health professionals in such discussions.
Promoting and securing the right to the highest attainable standard of health is ethical; it is a legal commitment, and a foundation for prosperity, stability and poverty reduction. Progress in health is also at the core of meeting most of the UN Millennium Development Goals (MDGs) and an internationally recognized human rights obligation. Better health is a key to poverty reduction, human rights protection and is a contribution to our collective security. In turn, human rights violations perpetuate inequities in the attainment of better health. A world that is greatly out of balance in matters of health is neither stable nor secure.
For these reasons, the United Nations Secretary-General Ban Ki-Moon has made global health a priority, and identified the strengthening of health systems, women’s and girls’ health and the prevention and eradication of neglected diseases that affect mainly the world’s poor as key priorities for immediate action.
The right to health approach is not about charity, it is about entitlements, freedoms, obligations and accountability. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. National health legislation and policies need to be developed or strengthened to reflect this internationally recognized legal obligation, as well as other relevant new standards including the Convention on the Rights of Persons with Disabilities.
The human rights principles of equality and freedom from discrimination are central to any efforts to improve health. Development includes the MDGs targets which document statistical averages need to be supplemented by the identification of disparities and inequities affecting vulnerable and marginalized groups. The most vulnerable need to be engaged as active participants and engines of change in decision-making processes affecting their health, including at community levels. This not only renders health policies and programmes inclusive but empowers people.
The core value of the human rights based approach to health is that international law holds Governments accountable for implementing the legal commitments undertaken to respect, protect and fulfil the right to the highest attainable standard of health for all. An accountability system requires national legal and regulatory frameworks that translate the right to health into tangible and measurable national standards.
Our concerted efforts are needed to ensure that human rights remain at the core of the global health agenda. I would like to reiterate the support of the Office of the High Commissioner for Human Rights and the United Nations as we strive towards achieving the full enjoyment of the right to the highest adequate standard of health for everyone without discrimination.
I thank you for your attention.