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Special Rapporteur on the right to health
This section contains a non-exhaustive list of issues and references drawn from the work of the mandate in areas considered of special focus:
Current rates of preventable ill-health and deaths among newborns, children under 5 and adults remain unacceptably high. Universal health-care coverage is still a dream for many. The realization of the right to health is impeded by many factors, and most of them are related to inequalities and selective approaches to human rights principles and existing scientific evidence. This can and must be addressed with the strong commitment by States and concerted efforts by all stakeholders.
In the post-2015 agenda, the right to health framework can be a useful and powerful analytical and operational tool for the transition to the Sustainable Development Goals. And the Sustainable Development Goals can be instrumental for the effective and holistic realization of the right to health, if human rights are effectively incorporated in their conceptualization (A/HRC/29/33, 2015).
See the report of the Special Rapporteur to the General Assembly in 2016 on the right to health and Agenda 2030.
Primary care needs to be strengthened as the crucial cornerstone of modern medicine and public health. Without a well-established infrastructure of primary health care, all achievements of modern science and the practice of medicine could be compromised and misused.
When health policy makers choose to make specialized services a priority, those services tend to function without the necessary ethical and human rights safeguards. This leads to barriers in access to services for people and groups who have more health needs, or to the ineffective use of those services or both.
Primary care and the modern public health approach often lose the battle for resources to the biomedical model and vertical programmes of treatment of diseases through specialized health care.
Allocating resources to specialized health care may reinforce power asymmetries and funding imbalances, with the scales often tipping in favour of powerful groups representing vested interests in the health sector and industry.
States, when meeting their obligation to protect, respect and fulfil the enjoyment of the right to health, should be aware of, and be willing and able to address, such power asymmetries. If not, these imbalances may lead to corruptive practices and poor management of the principles of medical ethics and health economics, resulting in negative public health outcomes. States should also provide mechanisms for independent monitoring, which are key to ensuring accountability. (A/HRC/29/33, 2015)
Protection from all forms of violence is a cross-cutting issue in the realization of the right to health. Violence needs to be addressed in a comprehensive and proactive way, not only as a cause of serious violations of human rights, but also as a consequence of a lack of political will to effectively invest in human rights, including the right to health.
It was not until the end of the twentieth century that the close link between violence and health began to be sufficiently understood. Since then, the burden of violence has been documented and the effectiveness of programmes, with particular attention devoted to women and children and community-based initiatives, has been assessed.
Violence is harmful and detrimental to the health and development of human beings, starting from the youngest children. The different forms of violence, including collective violence, do not originate in a vacuum. Violence has roots in unhealthy relationships amongst individuals, and is reinforced by the failure to promote and protect good-quality human relations, starting with relationships between infants and their primary caregivers (see the 2015 report A/HRC/29/33).
The Special Rapporteur believes that a life-cycle approach to the right to health can be one method of identifying the critical elements in the reduction of preventable deaths and the improvement of health indicators, well-being and quality of life.
Such an approach helps identify challenges and opportunities for full realization of the right to health. It is during some important stages of the life course that the right to health needs to be particularly protected, since during those stages there is a greater risk of violations of human rights, including the right to health.
On the other hand, interventions during those critical stages of life open up new opportunities and offer new health protective factors. The life-cycle approach can help in the prevention of chronic diseases in adult life through the effective protection of children from early childhood adversities (A/HRC/29/33, 2015).
The active and informed participation of all stakeholders is a key element of the analytical framework of the right to health.
The meaningful involvement of all actors, in particular civil society, and the empowerment of those who use health-related services, especially the poor and other groups in vulnerable situations, is crucial for the full realization of the enjoyment by everyone of the right to health and other rights.
Civil society plays a key role as agent of change, advocates good practices, provides independent monitoring and, in many instances, provides necessary services. Trustful partnerships between government agencies, State-run health-care services and the non-profit sector, including civil society, constitute one of the cornerstones of effective health systems and act as a guarantee for the effective realization of health-related human rights.
Medical doctors and other health-care professionals also play a crucial role. With the ongoing change of paradigm, from paternalistic top-down medicine to partnership between health-care providers and users, the medical profession should reconsider some of its traditional views. Education in the health-care sector is one important element in that regard. Modern medical doctors need to be not only good clinicians but also effective community leaders, communicators, decision makers and managers (A/HRC/29/33, 2015).
See the report of the Special Rapporteur to the General Assembly in 2019 on a human rights-based approach to health workforce education or go to the report page.
At the heart of the right to the highest attainable standard of health lies an effective and integrated health system, encompassing health care and the underlying determinants of health, responsive to national and local priorities, and accessible to all. A strong health system is an essential element of a healthy and equitable society. The right-to-health approach helps strengthen health systems in the same way as the right to a fair trial helps to strengthen court systems (A/HRC/7/11, 2008 and E/CN.4/2006/48, 2006).
The principles embodied in landmarks of the development of health systems - the Alma-Ata Declaration on Primary Health Care (1978), the Ottawa Charter for Health Promotion (1986), and the Declaration of Astana on Primary Health Care (2018) - remain relevant today. Yet health systems in many countries are failing.
Full realization of the right to health is contingent upon the availability of adequate, equitable and sustainable financing for health, at domestic and international levels.
States have the obligation to:
The contemporary landscape of health financing is characterized by persistent deficits and recurring challenges in financing health systems throughout the world (A/67/302, 2012).
All key elements of health-care systems must be balanced. That includes the relationships between the curative and preventive aspects of health care, so that power asymmetries do not weaken primary care and preventive medicine (A/HRC/29/33, 2015).