About the Right to Health
This resource sheet was adapted from excerpts from " The Right to Health: A Resource Manual for NGOs", by Judith Asher. The manual is posted in PDF on the website of the American Association for the Advancement of Science.
Health as a human right
The right to health can be viewed as having two basic components: a right to health care, and a right to health conditions. It should not be seen as a right to be healthy. The state cannot be expected to provide people with protection against every possible cause of ill health or disability. Nor should the right to health be seen as a limitless right to receive medical care for any and every illness or disability that may be contracted. Instead, the right to health should be understood as a right to the enjoyment of a variety of facilities and conditions which the state is responsible for providing as being necessary for the attainment and maintenance of good health.
The International Covenant on Economic, Social and Cultural Rights (ICESCR) was the first human rights treaty to require states to recognize and realize progressively the right to health, and it provides key provisions for the protection of the right to health in international law:
1. The States parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
2. The steps to be taken by the States parties ... to achieve the full realization of this right shall include those necessary for:
(a) The provision for the reduction of the still birth rate and of infant mortality and for the healthy development of the child;
(b) The improvement of all aspects of environmental and industrial hygiene;
(c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases;
(d) The creation of conditions which would assure to all medical services and medical attention in the event of sickness.
ICESCR art 12
Core obligations
The Committee on Economic, Social and Cultural Rights (CESCR), which monitors States parties' implementation of the International Covenant on Economic, Social and Cultural Rights, has adopted General Comment 14 on the right to the highest attainable standard of health (2000). General Comment 14 expands upon Article 12 of the ICESCR, and is the most comprehensive interpretation of the international right to health, and corresponding state obligations, to date.
This is the very least that governments must do immediately.
CESCR General Comment 14 asserts that all states have immediate obligations, including minimum core obligations. Core obligations are intended to ensure that people are provided with, at the very least, the minimum conditions under which they can live in dignity; enjoy the basic living conditions needed to support their health; and be free from avoidable mortality. They serve, in other words, as a minimum or bottom line for responsibilities of states. They require governments to take the basic measures that are needed to enable people to achieve minimum standards of health, including the provision of essential primary health care. They also take into account the fact that health problems associated with poverty and inequity pose the main obstacles to attaining minimal standards of health and well-being for most of the world's population.
Minimum core obligations cannot be subjected to progressive realization. All states, regardless of their level of development, are required to take immediate action to implement them. This can include legislation; the regulation, design and enforcement of policies; and mobilization of the necessary resources.
CESCR General Comment 14 identifies the core obligations that arise from the right to health as including at least the following obligations.
In the case of health care, governments must provide:
- immunization against the major infectious diseases;
- measures to prevent, treat and control epidemic and endemic diseases;
- essential medicines, as defined by WHO's Action Programme on Essential Medicines;
- reproductive, maternal (pre-natal and post-natal) and child health care;
- essential primary health care;
- right of access to health facilities without discrimination, especially for the poor, and otherwise vulnerable and disadvantaged groups;
- equitable distribution of all health facilities, goods and services; and
In the case of underlying determinants of health, governments must provide:
- access to the minimum amount of food that is sufficient, nutritionally adequate and safe, to ensure their freedom from starvation and malnutrition; and
- access to basic shelter, housing and sanitation, together with an adequate supply of safe and potable water.
In the case of health education and information, governments must provide:
- education and access to information about the main health problems in the community, including methods of prevention and control; and
- appropriate training for medical and other health professionals, including education in health and human rights.
When formulating a national health policy, governments must:
- adopt and implement a national public health strategy and plan of action, which is based on epidemiological evidence, and which takes into account the health concerns of the whole population. The strategy and plan of action must be developed through a participatory and transparent process and subject to regular review. Specific objectives and a cost-effective strategy must be adopted for using available resources, as well as methods such as right to health indicators and benchmarks, by which progress can be closely monitored. The process by which the strategy and plan of action are formulated, as well as their content, shall pay particular attention to all the vulnerable or marginalized groups in the population.
Availability, accessibility, acceptability and quality: the four essential standards for evaluating the implementation of state obligations
In order to clarify the implications of adopting a health and human rights approach, the CESCR has state that there are four underlying standards, or criteria, with which states must comply in order to make the right to health meaningful. They are:
- Availability: are the numbers, quality, and distribution of functional public health and health care facilities in the country adequate, taking into account its developmental and economic condition?
- Accessibility: are health facilities, goods and services accessible, both in law and in fact, to everyone, including the poorest and most vulnerable or otherwise disadvantaged groups in the population? Are they within safe physical reach of all sections of the population, including rural communities, ethnic minorities, indigenous populations, women, children, adolescents, older persons, persons with disabilities, and persons living with HIV/AIDS? Are they affordable to everyone? Is everyone able to seek freely, and to receive and to impart health-related information and ideas?
- Acceptability: are all health facilities, goods and services provided in conformity with human rights and medical ethics? Is the dignity of patients or clients respected? Are they culturally appropriate?
- Quality: are all health facilities, goods and services scientifically and medically appropriate and of the highest possible quality? This requires, for example, adequate provision of skilled medical and nursing personnel; scientifically approved drugs and equipment; safe, potable water; and sanitation.
