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Access to Health Care as a Human Rights Issue

Professor Fons Coomans

Maastricht University

Centre for Human Rights

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Convention on Human Rights and Biomedicine

Article 3, Equitable access to health care

Parties, taking into account health needs and available resources, shall take appropriate measures with a view to providing, within their jurisdiction, equitable access to health care of appropriate quality.

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What are human rights?

Values about the protection of human dignity, laid down in legal texts, that entail rights for individuals and obligations for states.

Rights an individual has, because he/she is a human being.

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Social and Economic Human Rights

• Different definitions:• Rights relating to an adequate standard of living; • Conditions under which people live and work;• Claims to the fulfilment of basic needs;• Claims relating to the quality of life from a material and

immaterial perspective; • Claims relating to opportunities to make a living and

achieve welfare and wellbeing.

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Right to Health as a Human Right

• Universal Declaration on Human Rights (1948) - Art. 25

• Convention on the Elimination of All Forms of Discrimination Against Women (1979) – Art. 12

• Convention on the Rights of the Child (1989) – Art. 24

• International Covenant on Economic, Social and Cultural Rights (1966) – Art. 12

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International Covenant on Economic, Social and Cultural Rights

Article 121. The States Parties to the present Covenant recognize the right of

everyone to the enjoyment of the highest attainable standard of physical and mental health.

2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right include those necessary for:

(a) The provision for the reduction of the still-birth rate and of infant mortality and for the healthy development of the child;

(b) The improvement of all aspects of environmental and industrial hygiene;

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(c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases;

(d) The creation of conditions which would assure to all medical service and medical treatment in the event of sickness.

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The Right to Health:

• Not to be understood as the right to be healthy.

• It is the right to the enjoyment of a variety of facilities, goods services and conditions necessary for the realization of the highest attainable standard of health.

• It contains both freedoms and entitlements.

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Duties for States

• To take steps, individually and through international assistance and cooperation;

• To the maximum of its available resources;

• By all appropriate means;

• Aimed at achieving progressively the full realization of rights.

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Key Features of Access to Health Care

• Relationship with underlying determinants of health.

• Availability of health care goods and services

• Accessibility: four overlapping dimensions:

→ non-discrimination

→ physical accessibility

→ economic accessibility

→ information accessibility

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• Acceptability of health facilities, goods and services

• Quality of health facilities, goods and services

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Key role of non-discrimination

• From an access to health perspective the following prohibited grounds are particularly relevant:

→ physical or mental disability

→ health status

→ sexual orientation

→ social origin

→ sex

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Access to Health Care Related Obligations

• To Respect (negative obligation)

• To Protect (positive obligation)

• To Fulfil (positive obligation)

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Core Obligations

Core obligations to ensure the satisfaction of minimum essential levels of the right to health.

They include, inter alia,

• to ensure the right of access to health facilities, goods and services on a non-discriminatory basis, especially for vulnerable and marginalized groups.

• to provide essential drugs.

• To adopt and implement a national public health strategy and plan of action.

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Relationship with other Rights

• Universal Declaration on the Human Genome and Human Rights, Art. 12 (a)

• Universal Declaration on Bioethics and Human Rights, Art. 15

• UN Women’s Convention, Art. 12 (1)

• Universal Declaration of Human Rights, Art. 27 (1)

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Challenge

To ensure that the application of developments in biology and medicine is in accordance with human rights standards. → to make them ‘human rights proof ’.