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"Right to Health Care", or "Right to Health"?
Which is a more precise, or a more useful concept?
There is a substantial amount of work being done internationally around the concept of a "Right to Health". And in most cases that wording has been chosen carefully. Why does Project EINO (and most other US-based organizations positively disposed to the concept) use the alternative formulation of "Right to Health Care"? What are the differences in implication? Which of these does the philosophical or historical basis recommend more strongly? Is there a difference in the two concepts which is important for UHC activists in the US, or are certain strategies more firmly based in one than the other?
The main reason which recommends activists promote the concept of the "Right to Health" is that a very broad range of services, resources and conditions are properly included in this right - certainly much more than just the right to seeing a physician and receiving the prescription for drugs and treatments to treat defined diseases. By properly included we mean both that logically it does not make much sense to demand just restricted medical care while ignoring unhealthy and dangerous conditions including possible preventive interventions. Also we should acknowledge in this "properly included" that the main legal documents addressing this broad concept within the right. Indeed the applicable UN conventions usually address the "Right to Health" and then go on to explain the breadth of their intention. For example see this excerpt from the Convention on the Rights of the Child.
Project EINO agrees that both the international background of calling for the "Right to Health" and the proper inclusion of a broad array of resources and conditions that should be included do recommend this term rather than the use of "Right to Health Care". The "Right to Health Care" is too frequently used in a narrow sense without proper qualification. Some patient advocacy groups go so far as to profess that this right (or patient rights) will be fulfilled by giving everyone some "basic level" of health insurance, or a set of capped possible expenditures for a specified list of diseases. On the other hand it should be noted that even when the "Right to Health" is called for the UN documents almost always continue to explain explicitly the broad range of meaning that is intended.
Why could this broad range not be included with use of "Right to Health Care" so that it is clear that preventive care, conditions conducive to healthy life and work, strong public health measures including health education are all part of care for the health of the public and intended under the term "health care"? At our website EverybodyInNobodyOut , for example, we stress "financial feasibility and stability" as one of our three main principles. Further, in our six additional recommended principles we include a statement on strong public health programs is stressed. The importance of strengthening public health programs (including workplace and living conditions) and is given further discussion in the FAQ. Financial stability will always imply investment in public health programs, in preventive care and in clean, safe environmental conditions for work and life for these investments pay back many-fold in health care savings and improved quality of life/productivity.
Why does Project EINO encourage US activists to call for the "Right to Health Care" if the "Right to Health" is a broader more encompassing concept and more closely parallels the language in the pertinent international legal documents? There are several important reasons:
1) Our reality in 2004 is that the USA stands alone among industrialized nations in not officially acknowledging even the "Right to Health Care" or providing for health care for all its people. So while other nations might want a broader focus now, we need to achieve this one important aspect of enjoying good health right now.
2) We can pursue our pressing current need of establishing the "Right to Health Care" in the USA while we emphasize that financial stability and continuing high quality in a new system of care will require the investments in public health, living conditions etc discussed above, as these provide increasing cost-savings following every year of investment.
3) The concept of "Right to Health" is philosophically weak, despite the foundation it has been given in international documents. Arguing for this health as a right is a little like arguing for a "Right to Deep Understanding" or the "Right to Useful Insights" rather than the "Right to Education". Rights are more easily understood as applying to opportunities and capabilities that can be supported and engendered. They are not easily understood as applying to a state like "being healthy" or having "deep understanding". It is difficult to grasp how a government could acknowledge an obligation to bring its people to (or even measurably toward) such an end state as "being healthy" and which policies would constitute best use of resources for this in general. REF
4) The concept of "Right to Health" may be too broad to be useful strategically, in the USA and also in many other countries. Good arguments can be made that promotion of healthy social life, political life, housing, nutrition, quality transport systems, clean environment, preservation of natural resources, abundant park land and recreational facilities, adequate leisure time, low crime rates, a world at peace and many other aspects of life are all REQUIRED for real health of a human being. Personally, practically all of my values could be argued as being necessary for good health in my opinion. I would love to live in such a world. But I don't think it is helpful to roll up all these issues into just one general demand. The required legal basis, the united public demand and the judicial support would be impossible to achieve for all this at once. At least I don't see how this would work in grassroots organizing for change in the USA -given the enormously powerful corporate lobbies we face as adversaries.
5) Does it make sense to argue for the "Right to Health" while understanding that much of the determination of an individuals health status is fully beyond anything that could be affected by national or state policy (genetic predispositions, "misfortune in contracting disease or having an accident")?
The legal basis for the "Right to Health Care" which resides to a large extent in international documents to which the USA is signatory. Inside the USA these are deemed the "highest law of our land" and can be understood as an essential step, perhaps the most essential step, towards a government providing its people with the opportunity to keep themselves well and productive, able to contribute fully to society. This requires that any genuinely functioning democracy will provide for the "Right to Health Care". It would certainly be outrageous if one nation were to declare itself the leading world example of democracy and yet not recognize the necessity of providing its citizens with the basic requirements to fully participate, not only regardless of disabilities and health misfortunes, but provide them with these requirements by assuring the conditions conducive to maintaining optimal health.
What the Universal Declaration of Human Rights established, which has now been amply accepted in international law, is that economic, social and cultural rights are indissolubly linked with civil and political rights and that both are necessary to enable people to live lives of freedom and dignity. Just as the accused person who is deprived of due process is rendered powerless and therefore unfree-- so is the person who suffers or dies for lack of access to treatment. Conversely, being free from controllable epidemiologic risk factors and able to rely on medical care are as essential to the exercise of a person’s freedom as judicial protections.
Many of the conditions necessary for optimal health beyond medical services and access to health care resources will follow necessarily from the need for financial stability of a system which can assure the opportunity for good health by all residents. For example, poor health education in the schools or poor safety regulation/education in the workplace result in greater costs which in a publicly guaranteed system will ultimately mean a greater burden on taxpayers or society at large. As a system is developed which relies entirely or largely on public funding, the legislature will naturally be inclined to harvest the possible savings in order to put every dollar to full use providing high quality care and health-optimal living and working conditions.
The amplification of legal documents to explicitly include many of these conditions may well follow (with legal argument) from the "Right to Health Care" just as eventually desegregated schools, school lunch programs and school counselors have been established as necessary components to childhood education and development. We take it as a given that the understanding of human rights, and civil rights evolve over time and that political action of the broad population becomes necessary to continue this historical development and progress of democracy.
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