What is the right to health, and what are countries’ obligations in realising it? This paper outlines the right to health in international human rights law, implications for states, risks facing specific groups, and accountability and monitoring mechanisms. All states must: 1) respect the right to health, refraining from interfering directly or indirectly with it; 2) protect this right by preventing third parties from interfering with it; and 3) fulfil it through legislative, administrative, budgetary, judicial, promotional and other measures. Priority obligations are non-discrimination and concrete, deliberate and targeted steps as part of a national strategy.
The right to health is broad, comprising not just the provision of healthcare but a wide range of factors that support healthy lives. These include: safe food and drinking water; adequate sanitation, housing, working and environmental conditions; and health-related education and information. The right to health is dependent on and contributes to the realisation of many other human rights.
Some groups face specific hurdles in relation to the right to health, resulting from a combination of biological or socio-economic factors, discrimination or stigma. These groups include:
- Women: Lack of influence in decision-making, poverty and economic dependence, limited power over their sexual/reproductive lives, and violence all have negative impacts on women’s health.
- Children and adolescents: Children are especially vulnerable to malnutrition, infectious diseases, and as adolescents, to sexual, reproductive and mental health problems. Infants are increasingly at risk from maternally transmitted HIV infection.
- People with disabilities: Health challenges include abuse and exploitation, and difficulties in accessing and affording care and in being treated as rights-holders.
- Migrants: Most countries have defined their health obligations to migrants as ‘essential’ or ’emergency healthcare’, loosely defined concepts providing little protection against discrimination. Migrants have difficulties accessing health information and are particularly vulnerable to sexual abuse, violence, and unsafe and unhealthy working and living conditions.
- People living with HIV/AIDS: The incidence and spread of HIV is disproportionately high among the groups listed here. Addressing discrimination and stigma is essential to halting the progress of infection, as is universal access to care and treatment for those already infected.
All countries have ratified at least one international human rights treaty recognising the right to health, committing themselves to protecting this right. Even if resources are tight, states must ensure that neither they nor third parties adversely interfere with the right to health through discrimination, marketing unsafe drugs, or threatening the affordability or quality of health care through privatisation, poor environmental health or other factors. There is increasing debate about the responsibilities of NGOs, business and other non-state actors.
- States’ core minimum obligation – The Committee on Economic, Social and Cultural Rights has specified that this involves ensuring: the right of access to health facilities, goods and services on a non-discriminatory basis; access to the minimum essential food which is nutritionally adequate and safe; access to shelter, housing and sanitation and an adequate supply of safe drinking water; the provision of essential drugs; and equitable distribution of all health facilities, goods and services.
- Progressive realisation – While not all aspects of the right to health can be realised immediately, states must show that every possible effort is being made.
- Obligations of immediate effect – The International Covenant on Economic, Social and Cultural Rights specifies that some obligations are of immediate effect, in particular the basis of non-discrimination and the obligation to take concrete, deliberate and targeted steps towards the realisation of rights, including the right to health.
- Monitoring and state accountability – States have a responsibility to monitor and measure dimensions of the right to health, and a framework of indicators has been developed by the Office of the UN’s High Commissioner for Human Rights (OHCHR). Monitoring and holding states accountable also takes place at national, regional and international level through a variety of mechanisms and agencies, including the Special Rapporteur of the Commission on Human Rights.
