70 years of Human Rights and health: reflections of a brief retrospective13/12/2018
In light of seven decades of the Human Rights Declaration, it’s worth taking a tour of the milestones that mark how this agenda has developed in the international arena, from its roots to today, around aspects that affect health.
Historically, it can be said that global institutional mechanisms for the protection of life, health and human dignity arose from the many lessons that war, and its tragic consequences, left for humanity. These tremendous moments of crisis gave rise to embryonic thoughts about what would eventually come to be transformed into two bodies of law that emerged paralelly (and from similar concerns and anxieties) but that developed along different paths, and with different purposes: (1) International Humanitarian Law (IHL) – here mentioned for its relevance, but which on this occasion will not be addressed – and (2) Human Rights.
To give a brief context, the ideal of citizens’ fundamental rights – as we know them today – arised from the philosophical thoughts of the 18th century, the Independence of the United States and the French Revolution. This last mentioned, a popular movement that brought the defeat of the monarchy in France, established the Declaration of the Rights of Man and of the Citizen, of 1789, based on the principles of “freedom, equality and fraternity”. Since then, the responsibility of a “public force instituted for the benefit of all” has been recognized as responsible to guarantee these rights (Art. 12), and to this day its ideals are the basis of French culture, as well as the inspiration for several movements for human rights, including the Universal Declaration.
From an international perspective, the idea of equal treatment for all wounded in a conflict (the basis of IHL) emerges later, in 1863, from the creation of the Red Cross and its concern with the effects of armed conflict on the population. In 1864, the First Geneva Convention defined a space for humanitarian assistance and protection of the wounded at war, raising international respect for health and human life in conflicts. The three Geneva Conventions that followed, until 1949, defined IHL as an international responsibility of States, and from there that body of law went on its way: guaranteeing humanitarian aid, medical care and respect for life.
The other path, that of Universal Human Rights, arises from the catastrophes observed during World War II, which mobilized the international community to become organized so that the value of life would never again be forgotten, at a global level. From this movement, the United Nations General Assembly in Paris signed the Universal Declaration of Human Rights on December 10th 1948. The document, which has been translated into over 500 languages, contains the 30 articles that establish – for the first time for so many nations – fundamental human rights, which must be protected worldwide and for all, regardless of gender, age, culture , race or ethnicity.
Although the Declaration of Human Rights has no legal force, it establishes an agreement on a “common ideal for all peoples and nations “, which has its responsibility anchored in the sovereignty of States and their duty to protect their population.
Health as a human right
Among those fundamental rights, the Declaration included health in its Article 25, which states that “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care and necessary social services (…) “.
The centrality of health and the social determination for health (social, environmental and cultural aspects that directly impact the well-being of the population) was recognized once again, and more fully, a few decades later, in the International Covenant of Economic, Social and Cultural Rights  (ESCR) (from 1966, entered into force 1978), signed to date by 169 Member States, including all member countries of UNASUR. This Pact seeks to promote and protect, among others, the right of everyone to enjoy the highest attainable standard of physical and mental health in all aspects: work, social protection, housing standards, education and the full enjoyment of their freedoms, among others. It is worth a parenthesis here to mention that the DESC reflect concepts already contemplated by “good living” or “living well”, originating in our South American peoples (for the curious, there is more information here).
Back to our retrospective. That same year, 1978, the right to health agenda gained momentum thanks to the Alma-Ata Conference, organized by the World Health Organization (WHO) and UNICEF. The meeting of 134 States, 67 international organizations and some non-governmental organizations was centered on an inclusive vision on the right to health, with a focus on those most vulnerable – children -, and advocated Primary Care as a way to integral health.
A few decades later, in view of the humanitarian crises that still plagued those most vulnerable, the international community’s eye on urgencies related to human development led the UN member countries to launch the Millennium Development Goals (MDGs) in 2000, a target agenda for 2015, which included health not as a goal in itself, but in a pulverized way, a bit in each of the eight objectives. Although it addresses determinants for health and the eradication of inequality as a goal, the MDGs did not have an integral vision of health . Instead, they addressed some relevant aspects and diseases, without a systemic vision. However, having a guiding framework of the direction we want to reach, as humanity, is important, even if the goals are not necessarily achieved.
In this way, by failing to meet the MDGs, the international community once again gathered around the development debate, and what followed – the 2030 Agenda and its Sustainable Development Goals (SDGs) – brought a broader and more encompassing approach to health, with its 17 objectives ranging from: the end of poverty; access to clean water and sanitation; reduction of inequalities; and promote peace, justice and sound institutions, among others. This agenda is currently being widely promoted by the member States and addresses the reduction of inequities, once again giving attention to the social determination of health.
However, this year, on the 40th anniversary of the Alma Ata Declaration, the Astana Conference – once again organized by WHO to renew the global commitment to Primary Health Care – changed aspects of language that substantially modify the perspective of the content used in Alma Ata and, in this way, brought a very limited approach when renewing the original objective of the member countries, 1978 (read more on the subject here).
The South American perspective
Over time, it is possible to observe that the international agenda on the right to health has been fragmented due to the different lines of thought, visions and approaches to the subject. The division is clear, between those who promote the importance of access, versus those who focus on coverage. Access is based on the ideal of universal and integral health for all, and “good living”, versus the commodification of health, which does not see the human being and its environment in an integral way and instead adopts a a vision that isolates certain measures and diseases, without thinking about the totality of problems and their root causes.
For example, the Astana Declaration of 2018 speaks of “coverage” instead of “access” to Primary Health Care, implying that the responsibility of States must be shared with third parties of the private sector and considering the right to health under a different logic from that in the origins of the Declaration of Human Rights. According to the Declaration, through the ratification of international human rights treaties, States and their governments make a commitment to implementing national measures and laws compatible with their obligations in the treaties.
En el contexto de la región suramericana y desde una perspectiva de la salud en sociedades con altos niveles de desigualdad, el abordaje debe ser con base en la equidad y la universalidad, con enfoque en la responsabilidad del Estado como proveedor de condiciones que protejan los derechos sociales y colectivos inherentes a una vida digna.
In the context of the South American region and from a health perspective in societies with high levels of inequality, the approach should be based on equity and universality, with a focus on the State’s responsibility as a provider of conditions that protect social and collective rights, necessary for a life with difnity.
ISAGS supports and sustains the centrality of States in guaranteeing access to health for all, a vision that is materialized in the development of universal, comprehensive and sustainable health systems that respect the principle of health as a human right . For this reason, among its objectives is the strengthening of governments in health in the region, in order to facilitate the exchange of experiences among the UNASUR countries, from their particularities, and recognizing the decisive role of the State as guardian institution of universal right to health.
By Giovana Lerda
Coordenadora Comunicación & Información ISAGS -UNASUR