Health is a human right

Dr Yvan Butera Over half a century later, article 25 of the 1948 Universal Declaration of Human Rights stating: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family…” is still far from being met. Per the World Health Organisation (WHO) data, every year, more than 100 million people suffer due to a lack of access to essential health care, or because paying for health services pushes them into poverty, what, in the public health world, is commonly referred to as ‘catastrophic health expenditure.’ In order to ensure that health is a human right, we need to address the barriers preventing people from accessing health care. One of the starting points is to secure health coverage for all.Good governance and leadership are crucial to achieving universal health coverage (UHC). The WHO definition of universal health coverage (UHC) is when all people can access quality promotive, preventive, curative, and palliative health services without experiencing financial hardships. Let’s go back a step and explore the genesis of the significant number of the world’s population without access to affordable, quality health care. It all started with the cold war outcomes where civil and political rights- such as, right to freedom of speech and vote-became exceedingly prioritised over social rights such as health care and education. The aftereffects of the cold war are intrinsically linked to the underinvestment of many countries in UHC. The 1981 Berg report (“Accelerated Development in Sub-Saharan Africa: A Plan for Action”) that advocated for the increase in international trade from African countries, immensely contributed to the lack of UHC in many African countries. The report promoted outward-looking policies in lieu of inward-looking ones. As a result, the World Bank shifted towards neoliberal policies. The World Bank and IMF issued loans to developing countries that were economically struggling. But there is a catch here, since the balance was tipped towards free trade rather than social needs, these loans were to be received with tied hands. Recipient governments had to venture into structural adjustment programs, where they would eventually shrink their public spending on education, health, and social services to consequently embark on open policies to free trade. These policies were under an umbrella dubbed “The Washington Consensus”. Conjectures such as: “heath is a commodity instead of a human right”, “the private sector should be in the driving seat of health care delivery”, and “demand-and supply will inform health care price setting will lead to positive health outcomes and economic development” were all too commonly proclaimed. Subsequently, The Washington Consensus had a profound negative effect on access to health care and more so for poor people. Good news is that the world leaders have agreed to reverse the trend. The United Nations Sustainable Development Agenda states that global UHC should be attained by 2030. Efforts are being made all over the world to meet the 2030 goal and our job is to hold world leaders accountable to ensure that UHC becomes a top-priority regardless of age, gender, race, religion and purchasing power. Rwanda has understood the importance and impact of UHC both as a social justice principle and an economic development driver as healthy people work harder and better; healthy children are more likely to go to school and stay there longer, which is linked to higher earnings in adulthood. Increasing access to health care contributed, according to Farmer et al., a decline in death during childbirth by 60 per cent, and maternal mortality by 59.5 per cent from 2000-2010. The most recent Demographic and Health Survey reports that ¾ of Rwandan people are covered by health insurance. Given the tumultuous economic world we live in, it is high time we think of financial mechanisms to sustain UHC by encouraging policies such as efficient public financing. Increasing tax on tobacco and alcohol to finance UHC could be a plausible solution as well. As my professor, Dr. Joia Mukherjee, would say “the attainment of human rights is a progressive process”. I believe one would worry about food security, education, and health care in their own home before stepping outside to vote.I don’t want to sound polemical here, weighing civil and political rights versus social rights because the two cannot be mutually exclusive. For any given country to build a strong economy with healthy citizens, leaders and policy makers must keep in mind that civil and political rights will have an impact on social rights and vice versa. “Of all the forms of inequality, injustice in health care is the most shocking and inhumane” Martin Luther King Jr.