Launch of the Lancet report on right to health

WHAT: Launch of the Lancet report on right to health, to mark international day of human rights and 60 year anniversary on the Universal Declaration on Human Rights.

WHEN: 10.30am, UK time, Tuesday 9 December 2008

WHERE: Science Media Centre (housed within Royal Institution of Great Britain), Albemarle Street, London, W1S 4HS

Health systems should have the right-to-health features identified in a special report published on-line today—human rights day and the 60 year anniversary of the Universal Declaration of Human Rights—in The Lancet. Furthermore The Lancet right to health report concludes that such right-to-health features are legally binding and not optional extras and also that governments must be held to account to ensure that health systems have, in practice, the features required by international human-rights law.

60 years ago the Universal Declaration on Human Rights laid the foundations for the right to the highest attainable standard of health—a right that is also integral to subsequent human rights treaties such as the International Covenant on Economic, Social, and Cultural Rights and the Convention on the Rights of the Child. In 2000, an authoritative understanding of the right to health emerged when the UN Committee on Economic, Social, and Cultural Rights working in close collaboration with WHO and others, drafted and adopted general comment 14—that provides a common right-to-health language for talking about health issues and sets out a way of analysing the right to health making it easier for policy makers and practitioners to use.

The right to health is central to the creation of equitable health systems yet this fundamental right is often overlooked by the health sector and the international community—perhaps because they don't know what this right means in practice.

To help overcome this problem, in collaboration with experts around the world, Paul Hunt, former UN Special Rapporteur for the Right to Health and professor of human rights at the University of Essex, and colleagues identified 72 indicators—divided into 15 groups—that reflect some of the right to health features for health systems. The first objective was to encourage awareness of the complementary relationship between health systems and the right to the highest attainable standards of health. Other objectives included: Do countries health systems have relevant right to health features? Are the relevant data available at the global level? Do the data provide a basis to monitor, over time, health systems and the progressive realisation of the right to the highest attainable standard of health?

Hunt and colleagues then collected data for these 72 indicators for 194 countries (generated from the WHO member list of 2000 and those countries listed in the UN Development programme) and used five countries—Sweden, Mozambique, Romania, Peru and Ecuador—as case examples. A key finding of this study is the lack of globally available data for a substantial number of the indicators, which is an important finding in its own right and severely limits monitoring the progress made towards progressive realisation of the right to health.

Some key findings on the globally collected data are listed below:

• Despite the majority of countries ratifying three major human right treaties that include the right to health (the most noticeable exception is the USA) —indicator 1—only 56 countries that have ratified the ICESCR include the right to health in their constitution or other statute—indicator 2. The UK has not done so but as the authors point out, the Department of Health in England, UK, has recently commissioned an assessment of the effectiveness of implementing a human rights approach in health and social care.
• 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. Indicator 3 lists 11 treaty-based grounds of discrimination. The treaty-based grounds of discrimination most commonly protected by law was ethnic origin (122 countries), whereas the least protected was age (13 countries). However, 95 countries protect only five or less treaty-based grounds of discrimination (the UK protects 8) and none protects all 11.
• People with mental illnesses are frequently neglected and discriminated against. Indicator 50 shoes the proportion of the national health budget allocated to mental health. Of 98 countries for which data were available, almost half allocated 2% or less of their national budget to mental health. The UK allocates 10% and the USA 6%.
• Health information is a prominent feature of the right-to-health and so features prominently in the profile of indicators (6-16) particularly maternal and neonatal deaths and the civil registration system. Only 69 countries obtained, centralised, and made these data publicly available. 122 have a civil registration system however many of these are incomplete with fewer than 90% of events registered.
• According to general comment 14, the adoption of a national-public-health strategy and plan of action is a core obligation. 57 countries have done a situational analysis—an essential precondition of a comprehensive health plan. Indicator 22 reports whether the national health plan includes an explicit commitment to universal access to health services, defined as access to primary, secondary, and tertiary physical or mental care. Information for the UK and USA on indicator 22 is not available. Health plans of 15 countries include an explicit commitment to universal access to health services (Antigua and Barbuda, Bahrain, Botswana, Chile, North Korea, Dominican Republic, Honduras, Libya, Mauritius, Mozambique, Peru, Seychelles, Timor-Leste, Uruguay, and Yemen.)
• Despite participation being one of the core requirements of the right to health, no global data were available for indicator 23-- Is there a legal requirement for participation with marginalised groups in the development of a health plan?
• Monitoring, assessment, accountability, and redress is a crucial part of documenting progress towards realising the right to health However global data for these factors were crucially lacking. For example, there was no global data available for indicator 69 that attempted to address quasi-judicial accountability by asking countries if their national human rights institutions with mandates include the right to health

Based on their findings in the report, the authors give 38 specific recommendations for different sectors and actors—WHO and the Office of the High Commissioner for Human Rights, UN agencies, national governments, civil society, research institutes, and donors. For example, the authors recommend that WHO and the Office of the High Commissioner for Human Rights adopt a stewardship role in the collection and collation of data for right-to-health features of a health system and that national governments explicitly recognise the right to health, and right-to-health features, such as access to essential medicines, in the national constitution or statute. Other recommendations include recommending that research institutions assist national governments to do health, and human-rights impact assessments, donors recognise the importance of strengthening health systems in international assistance, and that civil society participates in health system monitoring and planning.

The authors conclude: "Those with responsibilities for health systems are giving inadequate attention to the right-to-health analysis. Our main overarching recommendation is that all those with health-related responsibilities explicitly consider the right-to-health analysis and integrate this human right into their policies and practices with a view to strengthening health systems."

They continue, "This project rests on the conviction that an equitable health system is a core social institution, no less than a fair court system or a democratic political system."

In an accompanying Comment, Navanethem Pillay, The 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."

She continues: "As UN High Commissioner for Human Rights, I share the commitment of the international human-rights machinery to realising 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, 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."

He continues: "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."

An accompanying Editorial says that as clearly demonstrated in The Lancet landmark report, "the right to health is much more than a convenient phrase which health workers, non-governmental organisations, and civil society groups can brandish about in the vague hope that it might change the world. The right to health is a legal instrument—a crucial and constructive tool for the health sector to provide best care for patients and to hold national governments, and the international community, to account."

The Editorial continues: "The 60th anniversary of the UDHR [Universal Declaration of Human Rights] is a fitting occasion for the right to health to be brought in from the cold and be universally recognised and understood as a fundamental human right. There is no longer an excuse for ignoring right-to-health requirements in national and international health policy. Health workers, health policy makers and all who care about the health of individuals, groups, and populations, should mainstream the right to health by using this valuable and practical tool in their everyday practice."

Paul Hunt, Professor of Human Rights, Essex University Colchester paulhunt28@yahoo.co.uk Tel: 01206-828149 and 873775 and Gunilla Backman - Nordic School of Public Health, Gothenberg, Sweden. gunillabackman@yahoo.com Tel: +46 303 51369

Please note: we currently have a server problem, for full pdfs please contact tony.kirby@lancet.com (UK rest of world) or US/Canada Martine Persico (m.persico@elsevier.com)