What Health as a Human Right Really Means
October 2, 2019
By Ana V. Diez Roux, MD, PhD, MPH
Last week as part of the Pinning Ceremony that has been a tradition at our School for more than 20 years, new students, faculty and staff received our School’s “health as a human right” pin and recited the preamble of the United Nations Declaration of Human Rights. The ceremony is a way of welcoming new students, faculty and staff to a public health community that at its core, embraces the conviction that population health can only be achieved when human rights are fully achieved. But what does this mean exactly?
It is not uncommon to interpret the phrase “health as a human right” as equivalent to “health care as a human right.” Certainly, universal access to affordable and quality health care is important to health. The principle of health care as a human right has spurred movements across the world (and in the United States) to organize, finance and manage health care systems in ways that guarantee this right. As starkly illustrated by many countries across the globe, from low-income countries with very limited health care services to high income countries (like the United States) that spend significant resources on health care, we are far from achieving the goal of health care as a human right.
But we have known for a long time that many other factors impact health, and that health care alone, although clearly important for some health conditions, has a small impact on population health overall and on inequities in health. Other factors overwhelm the impact of health care, and even affect the effectiveness of health care itself. These other factors are closely linked to the social, economic, and environmental conditions in our societies, to the ways in which we organize ourselves as social beings that we are.
Many of the factors critical to fully guaranteeing the right to health are obvious. Of course there is the most fundamental right of freedom from persecution for religious, political , ethnic or other reasons, still common regrettably in many countries today. And there are factors linked to basic human needs including access to decent housing, clean water, and clean air. Across the world millions of people live in so-called “informal settlements” and many more live in substandard housing (or lack housing altogether) even in high-income countries. Access to clean water remains a global challenge and even in wealthy countries, like the United States, contaminants in water (lead, other chemical substances like PFAS, infectious agents among others) periodically reappear. Air quality has improved in some high-income countries thanks to smart environmental regulation, but it has worsened in many places as a result of economic growth and globalization. And today, environmental regulations are under threat despite their documented beneficial impacts. These facts show that there is still much to do to ensure health as a human right, even in the most basic sense of guaranteeing access to shelter, clean water and air for everyone.
But there is more to health as a human right than access to health care, shelter, water and air, important and fundamental as those are. Health as a human right also implies freedom from discrimination and racism in all its forms including discrimination by gender, race, ethnic origin, religion, political views, immigration status, gender identity and sexual orientation, disability, or age. It includes the right to a safe job, with decent working hours, and benefits (including leave and retirement). It includes protection from environmental hazards including the growing threats of heat and floods. Lasts but not least in includes the right to participate and shape the decisions that affect one’s life. All these things we know are important drivers of health and must be addressed to ensure the right to health.
It seems overwhelming. How can we do all this? But we already do… For many of us, those of us who are privileged in today’s world, health as a human right is a reality. The problem is that it is not a reality for so many others. It is not a reality in many countries of the world, but it is also not a reality in many neighborhoods of our own city, and even just a few blocks from our own School. In many ways health as a human right is today fundamentally about social justice and equity.
It is especially fitting that we launch the year reciting the preamble to the UN Declaration of Human Rights. The challenges are enormous, but humanity has done so much. In fact, the world we have (good and bad) is largely of our own making, which means that making it differently is possible. There is much we can do: in public health we can document, disseminate, and advocate about the links between how we organize our society and our health. The students I watched sitting in the auditorium during the pinning ceremony, the youth climate strikes all over the world last week, and many of the young people I see and talk to, give me hope that a different world, where health truly is a human right, may be possible.