Health is neither an expenditure nor an investment: Primarily and foremost it is a right.
1. For starters, let us look at what the human right to health care process is: It is an ethical and political enterprise; it is a UN mandate; it is thus not optional; it pursues building people and human rights-centered health systems; it refers to a very specific framework. It is thus not “yet another approach”…
2. Further, let us dispassionately look at what the current reality is: Most health services around the world are, to an important degree, market driven; the health sector is indeed quite profitable. This notwithstanding, private health systems do receive public funds in the form of subsidies and often handsome tax breaks. Moreover, even if state owned, public health systems frequently still serve private production/productivity-centered interests.
People simply need to know this!
3. For people to know, a debate needs to be opened with no further ado on how work-on-health-as-a-human right is to lead to a democratic social movement around vital, strongly-felt health issues in the community. (Be reminded here that “democracy without active participation to foster grassroots social justice is merely a formality”).
4. By applying the human rights-based framework to health, people need to be aware that they will be struggling for an indivisible triad, namely:
• For Universal Coverage: for every person, lifelong.
• For Comprehensive Care: for all health and social needs, for life.
• For Equity in Health: as a matter of social justice, with access to quality services guaranteed at the time needed, with no differences for all who have the same needs.
Each of these three is necessary-but-not-sufficient for the realization of the human right to health!
5. The equity imperative depicted here-above does not pertain or refer to a “minimum”, but to what is fair and just. The equity imperative simply establishes the right(s) of everybody (…which, mind you, are already enjoyed by the privileged individuals or groups in society). The example that comes to mind here is the stark contrast between “child survival” and a “child’s right to a healthy life”: ponder the difference of this contrast in terms of equity –beyond mere (crude) survival.
6. Inequities are thus intolerable differences between groups in relation to set standards when considering health as a human right.
7. The lack of equity in health highlights the fact that there are no real cross-subsidies in our societies: The rich pay proportionately less taxes…and subsidies for safety nets remain token and do not work beyond the short-term since they do not address the root causes of poverty.
8. We have all seen it: As efficiency concerns in public health systems increase, redistributive justice and health-as-a-human-right-concerns decrease or disappear.
Claudio Schuftan, Ho Chi Minh City
cschuftan@phmovement.org