PS032 - Human Rights and Health Systems

Every human being is entitled to enjoy the highest attainable standard of health. This session, therefore, discussed the human right to health in relation to the health system.

Opening the session, the chair Claudio Schuftan (Health Consultant, Vietnam) reminded the audience that health and human rights are inter-linked; but that this link was not well recognized until the former Secretary General of the United Nations Kofi Annan declared in 1997 that every agency in the U.N. must adopt a rights-based approach. He asserted that health as a human right is "not just an additional approach or fashion, but needs to be addressed as an ethical and a political enterprise" and should be present throughout all the other approaches.

Martha Kwataine (Malawi Health Equity Network, Malawi) expressed concerns about the heath condition in Africa where people are still suffering and dying from preventable and treatable diseases. Indeed, there are millions of people throughout the world who are still living in poverty and who lack access to health care - both basic services and appropriate medicines. For example, in Malawi, it is common that a patient (with malaria or any other disease) waits in a queue for hours at the health centre before only receiving a pain killer.  

Mrs. Kwataine pointed out that the 'right to health' cannot be achieved without an appropriate health system, which does not mean simply buildings, doctors, nurses, medicines, water and sanitation, but also an equal access for all. Health systems can, when appropriately designed and managed, contribute to achieving the Millennium Development Goals, added Claudio Schuftan. 

The speaker noted that health systems still have to overcome barriers in the way services are organized and financed, and how they reach out to communities. This can be achieved through the orientation of health workers and through dialogue between and interactions with communities. But the key to improving health systems is wider participation in the decision making processes. This is because people's involvement and empowerment creates constituencies to protect the public interests on health issues.

Gunilla Backman (Senior Research Officer to Paul Hunt, the UN Special Rapporteur on the Right to Health, Human Rights Centre, UK) agreed that health systems are vital to support the right to health. She emphasized the following key features and aspects that need to be included in a health system: the well-being of the individual communities and populations at the centre; not an outcome oriented, but a process oriented, i.e. transparent, participatory approach; equity, equality and non-discrimination; respect for cultural differences; medical care and underlying determinants; progressive realization and resources constraints.  

However, Claudio Schuftan emphasized that the government should play a significant role to prepare and implement a national health system and action plan, to secure political commitment, establish the legal provisions and policy frameworks, secure increases in government expenditure on the health sector, re-allocate government resources, remove user fees, etc.

One person in the audience acknowledged that the role of the state is vital but noted that in less developed countries or in politically unstable countries (i.e. Guatemala), governments may not be able to ensure their citizens' right to health is respected.  To respond to this concern, Gunilla Backman stressed that health is an essential, global public good and therefore international organizations act as a 'watch dog'. Having national and international laws related to the right to health is also essential because civil society can always use them to challenge governments in the law courts, Martha Kwataine added. Philippe Chastonay (Professor, Institute of Social and Preventive Medicine, University of Geneva, Switzerland) commented, however, that"in non democratic countries, you have to be a hero in order to promote human rights".

Philippe Chastonay adopts a 'down-to-earth' approach by linking human rights issues directly to the medical field. He used several case studies on human rights violations in psychiatric settings and emphasized that human rights violations are not limited to less developed countries by providing the striking example of Sweden where 66% of patients claimed that they are victims of violence. He believes that teaching human rights in medical school curricula is essential to reduce these human rights violations. In Medical Schools in the European Union, human rights courses in 2005 were mostly optional and not certifying; 62% of medical schools have elements of Human Right in Ethics class and only 21% of medical schools have an independent human rights course (usually optional). Yet, a study among the International Federation of Medical Students Associations (IFSMA) in 46 countries showed that 55% of respondents consider that such training should be compulsory because they are believed to contribute to attitudes in professional health practice respecting human rights.  

All speakers shared the idea that "human rights are not optional" in health care. The right to health can be understood as a right to an effective and integrated health system which is responsive to national and local priorities, accessible to all, staffed with professionals respecting human rights in health practice. In addition, wider participation in the decision making process can introduce further accountability in health systems.