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The Discovery and evolution of Health Rights- Current Concepts Dr. Neelesh Bhandari MBBS(AFMC), MD (Path) P.G.P in Human Rights (IIHR, N. Delhi)
INTRODUCTION The Discovery and Evolution of Health Rights. The concept of Human rights is part of ages old Indian Culture. The Principles of DHARMA and VASUDEV KUTUMBUM as outlined in the Vedas and The Bhagvad Gita form the foundations of Human rights. Human rights Theory has borrowed heavily from Buddhism, besides Hinduism.
The right to the highest attainable standard of health (referred to as the right to health.) was first reflected in the WHO Constitution (1946) and then reiterated in the 1978 Declaration of Alma Ata and in the World Health Declaration adopted by the World Health Assembly in 1998. It has been firmly endorsed in a wide range of international and regional human rights instruments.
The key international human rights treaties and Instruments are
the International Covenant on Economic, Social and Cultural
Rights (ICESCR, 1966) and
the International Covenant on Civil and Political Rights (ICCPR,
1966) further elaborate the content of the rights
set out in the
Universal Declaration of Human Rights (UDHR, 1948),
These covenants( as opposed to declarations) contain legally binding
obligations for the governments that become parties to them.
Together these documents are often called the .
International Bill of Human Rights.
The human right to health is recognized in numerous international instruments. Article 25(1) of the UDHR affirms that “ everyone has a right to a standard of living adequate for the health of himself and his family, including food, clothing, housing, and medical care and necessary social services.” The ICESCR provides the most comprehensive article on the right to health in international human rights law. According to article 12(1) of the Covenant, States Parties recognize “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”, while article 12(2) enumerates, by way of illustration, a number of “ steps to be taken by the States Parties “… to achieve the full realization of this right”.
Article 15 of the International Covenant on Economic, Social and Cultural Rights recognizes “the right of everyone to enjoy the benefits of scientific progress and its applications.” This right places obligations on governments to take the steps necessary to conserve, develop and diffuse science and scientific research, as well as ensure freedom of scientific enquiry. The implications of this right for health issues have only recently begun to be explored, for example, with respect to access to drugs for developing countries.
Countries that Ratified the ICESCR - 142 Countries that Ratified Regional Treaties with a Right to Health - 83 Countries that Recognize a Right to Health in their National Constitutions - 109 National Recognition of a Right to Health in some form or the other is thus Seen in 193 countries.
There has been an increased interest in the role of a human rights framework to mobilize resources for health. The human rights framework provides us with an appropriate understanding of what values should guide a nation’s health policy, A potentially powerful means of moving the health agenda forward.
A rights-based approach to health refers to the processes of: . Using human rights as a framework for health development. . Assessing and addressing the human rights implications of any health policy, programme or legislation. . Making human rights an integral dimension of the design, implementation, monitoring and evaluation of health-related policies and programmes in all spheres, including political, economic and social.
“ The right to health does not mean the right to be healthy, nor does it mean that poor governments must put in place expensive health services for which they have no resources. But it does require governments and public authorities to put in place policies and action plans which will lead to available and accessible Health care for all in the shortest possible time . To ensure that this happens is the challenge facing both human rights community and public health professionals. “ United Nations High Commissioner for Human Rights, Mary Robinson
Health Rights are intricately Linked with many other Rights.
H.R Violations resulting in ill Health-
Torture, Slavery, Harmful Traditional Practices
Reducing Vulnerability to ill health via Human Rights-
Right to Health
Right to Food and Nutrition
Freedom from Discrimination
Right to Education
Promotion of Human rights through Health development
Right to Participation
Freedom From Discrimination
Right to Information
Right to Privacy
In May 2000, The Committee on Economic , Social and Cultural Rights Adopted a general comment on right to Health. The General Comment sets out four criteria by which to evaluate the right to health: (a) Availability . Functioning public health and health-care facilities, goods and services, as well as programmes, have to be available in sufficient quantity. (b) Accessibility . Health facilities, goods and services have to be accessible to everyone without discrimination, within the jurisdiction of the State party. Accessibility has four overlapping dimensions: . Non-discrimination; . Physical accessibility; . Economic accessibility (affordability); . Information accessibility.
c) Acceptability . All health facilities, goods and services must be respectful of medical ethics and culturally appropriate, sensitive to gender and life-cycle requirements, as well as being designed to respect confidentiality and improve the health status of those concerned. (d) Quality . Health facilities, goods and services must be scientifically and medically appropriate and of good quality. The Siracusa Principles allow for limiting of health rights if certain criteria are met.
Mark of quality: the five-way test and its indicators
How are we to decide what is good quality care?
Was something that was indicated, done in an appropriate and timely manner?
2. Was something that was indicated, not done?
3. Was care given at the least cost, risk and inconvenience to the patient?
4. Was care given in a humane and ethical manner?
Were the facts communicated to the patient and his family and were the patient
and his family involved in
the processes of decision making?
What was the patient’s satisfaction with the treatment?
5. What was the outcome of treatment?
Aim is RATIONALITY, AVOIDANCE OF IRRATIONALITY,
COST-EFFECTIVENESS, ETHICAL CONDUCT
AND GOOD COMMUNICATION.
The quality of healthcare is indicated by what the providers prescribe in the form of
DRUGS, TESTS and INTERVENTIONS and by the QUALITY OF DOCUMENTATION.
THE INTERNATIONAL SOCIETY FOR HEALTH AND HUMAN RIGHTS adopted in 1993, with amendments adopted in 1998 ARTICLES OF ASSOCIATION, NAME, SEAT AND DURATION Article 1 1. The name of the Association is: International Society for Health and Human Rights. 2. The seat of the Association is in Utrecht. 3. The Association is established for an unlimited period. There are 24 articles which govern the society and annual year corresponds to a calendar year
Part I - consists of Articles 1 - 4 on the Union and its Territory
Part II - consists of Articles 5 - 11 on Citizenship .
Part III - consists of Articles 12 - 35 on Fundamental Rights .
Articles 14 - 18 on Right to Equality ,
Articles 19 - 22 on Right to Freedom ,
Articles 23 - 24 on Right against Exploitation ,
Articles 25 - 28 on Right to Freedom of Religion ,
Articles 29 - 31 on Cultural and Educational Rights,
Articles 32 - 35 on Right to Constitutional Remedies.
Part IV - consists of Articles 36 - 51 on Directive Principles of State Policy.
Part IV (A) consists of Article 51A - Fundamental Duties of each citizen of India.
Part V - consists of Articles on the Union. (52-151)
Part VI – consists of articles on the States. ( 152-237)
Parts VII – Part XII – Principles of governing.
Art. 15- Freedom From Discrimination
Art. 21- Right to Life and Personal Liberty
THE INDIAN Constitution
The collaboration between PAHO/WHO and the Inter-American Commission on Human Rights (IACHR, the body responsible for overseeing the American Convention on Human Rights) concerning the rights of persons with mental disabilities, is an example of the key role specialized agencies can play within international monitoring mechanisms. PAHO/WHO offers technical opinions and assistance on the interpretation of the American Convention on Human Rights and the American Declaration on the Rights and Duties of Man, in light of international standards on mental disability rights. In turn, the IACHR incorporates these standards into final reports of relevant individual cases and in country reports. As a result of this technical assistance, the IACHR has issued the Recommendation for the Promotion and Protection of the Rights of the Mentally ill.
Every person has a Fundamental Right to timely health care of the best possible
Health rights do not stand alone, but in conjunction with Women's Rights,
Child Rights, Right to Freedom From Discrimination, et al.
All govt. Health policies should aim at attainment of
Universal Fundamental Right to Health.
Public-Private partnerships and the role of NGO,s is very important in this Field.
The Govt. role is limited to protection of Health Rights. ( as opposed to provider)
An important step in this direction is provision of social security nets like
Focusing on Specific Health Rights issues has shown great promise, as in Rights
Of People Living with HIV/AIDS and Rights of People with Mental Illnesses.
Required a “Commission on Health Rights” on national and State Levels.
Health is not a blessing to be wished for but a right to be fought for . There are complex linkages between health and human rights: . Violations or lack of attention to human rights can have serious health consequences Health policies and programmes can promote or violate human rights in the ways they are designed or implemented; Vulnerability and the impact of ill health can be reduced by taking steps to respect, protect and fulfill human rights.