The Right to the Highest
Attainable Standard of Health
in the U.S.
What is Health?
“Health is a state of complete
physical, mental and social
well-being and not merely the
absence of disease or infirmity”
(World Health Organization, Preamble to the WHO
What is the Right to Health?
The right to health is not a right to be healthy,
since no government can guarantee a specific
state of health. Rather, the right to health is the
human right of every person to an effective and
integrated health system encompassing health
care and other determinants of health in order
to achieve the highest attainable standard of
physical and mental well-being.
Universal Declaration of Human Rights (UDHR), Article 25 (1948):
“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
International Covenant on Economic, Social, and Cultural Rights
(ICESCR), Article 12 (1966): “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.”
Constitution of the World Health Organization (WHO), Preamble (1946):
“The enjoyment of the highest attainable standard of health is one of the
fundamental rights of every human being without distinction of race, religion,
political belief, economic or social condition.”
• Universal Declaration of Human Rights (Article 25)*
• American Declaration on the Rights and Duties of Man (Article 11)*
• International Covenant on Economic Social and Cultural Rights (Article
• Convention on the Elimination of All Forms of Racial Discrimination
• Convention on the Elimination of All Forms of Discrimination Against
Women (Articles 12 & 14)
• Convention on the Rights of the Child (Article 24)
*The United States has committed to these Declarations and Conventions
The right to health is more than just health care!
The right to health encompasses all facilities and conditions that are
necessary for good health. These can be divided into two categories:
Medical Care Living Conditions
• Clean and safe food and water
• Sanitary living and working
International Legal Protections
Available - with governments setting up all Accessible - to everyone without
the necessary health facilities throughout discrimination. Health care must be
their territory. These facilities should be economically affordable, physically
provided with water, electricity, trained accessible, and accessible to non-English
personnel receiving domestically speakers (including people who are hearing
competitive salaries, and all the essential impaired). Health care also should give
drugs to serve the entire population. individuals access to relevant information.
Adequate - such that all health facilities,
Acceptable – requiring that health services
goods, and services are scientifically and
are ethically and culturally appropriate, i.e.,
medically appropriate and of good quality,
respectful of individuals, minorities, elderly
with the necessary equipment, skilled
people, and communties, and sensitive to
medical personnel, potable water, adequate
gender and life-cycle requirements.
nutrition, and sanitation.
To ensure the right to health, the United States has the following obligations:
RESPECT – governments must refrain from interfering directly or indirectly with the
enjoyment of the right to health and refrain from taking any retrogressive measures (take-
backs) that are incompatible with the enjoyment of the right to health.
PROTECT – governments must take measures to prevent individuals and third parties,
such as corporations, from interfering in any way with the enjoyment of the right to health.
FULFILL – governments must take deliberate, concrete, and positive measures towards the
progressive realization of the right to health.
TAKE STEPS – governments must take steps to the maximum of their available resources,
with a view to achieving progressively the right to health, based on the resources of the
society as a whole, not only on the resources within the current budget.
MEET MINIMUM CORE – governments must ensure the satisfaction of minimum
essential standards and immediately address extreme situations such as immunization
against major infectious diseases and access to primary health care.
NON-DISCRIMINATION – governments must ensure equity and non-discrimination in
access to health care and to the underlying determinants of health, in order to prevent inferior
health care opportunities and outcomes for particular communities, whether due to class,
race, gender, language, or other factors.
PROTECT MOST VULNERABLE – governments must actively reach out to
marginalized and excluded people, who face the greatest barriers in realizing the right to
Does the U.S. Recognize the Right to Health?
• The US Constitution/Bill of Rights does NOT include any mention of a right
• The U.S. has only signed, NOT ratified, the major treaty recognizing the
right to health, the International Covenant on Economic, Social and
Cultural Rights (ICESCR), signed by the U.S. President Jimmy Carter in
• The U.S. has only signed, NOT ratified the Convention on the Elimination
of all Forms of Discrimination Against Women (CEDAW), signed by U.S.
President Jimmy Carter in 1980.
• The U.S. has also only signed, NOT ratified, the Convention on the Rights
of the Child (CRC), signed by U.S. President Clinton in 1995.
Does the U.S. Recognize the Right to Health?
• The U.S. is bound by the American Declaration of the Rights and Duties
of Man, which calls on all states to preserve the right to health.
• The U.S. is bound by the International Convention on the Elimination of
All Forms of Racial Discrimination (ICERD), which prohibits
discrimination in the realization of the right to health.
• The U.S. has refused to recognize the human right to health in its public
policy and is unique among industrialized nations in not guaranteeing
access to health care.
How is the U.S. failing to
fulfill the right to health?
The U.S. is failing in the following areas:
• Access to health insurance
• Protecting most vulnerable
• Cultural acceptability
• 50 million Americans live in “primary medical care health
professional shortage areas,” according to the federal
government (Grant Makers in Health).
• New York has 122.5 primary care physicians per 100,000
people while Idaho has only 56.7 per 100,000 (Grant
Makers in Health).
• Black and Hispanic communities of all income levels are 4
times as likely as others to have a shortage of doctors
(Komaromy et al, 1996).
Access to Health Insurance
• 45 million Americans do not have health insurance (Sicko).
• 1 out of every 7 Americans goes without insurance
coverage for at least a year at some point in their lives
(National Academies, 2001).
• 18 thousand people die each year because they do not
have health insurance (Sicko).
Even some working people have a hard time getting
• 80% of uninsured children and adults under 65 are
working or live in working families. 13.6 million of the
uninsured work for employers that do not offer health
insurance (National Academies, 2001).
• Medical underwriting leads insurance companies to
reject applicants with either serious or relatively minor
medical conditions, including acne, back pain, or being
20 pounds over or underweight (Andrews, 2007).
Protecting the Most Vulnerable:
• Hispanic children are 3 times more likely than white
children and black children are almost 50% more likely
than white children to be uninsured (Children’s
• Hispanic and black children are almost twice as likely
to be in less than “excellent or very good health”
(Children’s Defense Fund).
Protecting the Most Vulnerable:
Americans with Disabilities
• 28% of people with disabilities have postponed needed
care because of cost, compared to 12% of people
without disabilities (National Organization on Disability,
• While mental illness is as prevalent among minorities as
it is among whites, minorities have less access to and
are less likely to use mental health services, and receive
poorer quality mental health care (U.S. Department of
Health and Human Services, 2001).
• Minorities receive less care and lower quality care than white
patients and this disparity cannot be attributed to differences
in income or insurance level (American Civil Liberties Union,
• The mortality rate from breat cancer among black women is
68% higher than that of white women (American Civil Liberties
• Translation services are not always available at medical
facilities and there are few observed quality standards
for translators (Ku).
• Miscommunications that result from inexperienced
translators can have serious consequences for patients’
health (National Conference of State Legislatures).
• While Western medical practice focuses on the
individual, some communities require that the extended
family play a central role in managing illness (Diversity
• The United States spends more than any other country
on health care. Total health care expenditures in the
U.S. amount to $2 trillion annually (Office of
Congresswoman Betty McCollum).
• The annual cost of health care is expected to reach $4
trillion by 2015 (Office of Congresswoman Betty
• The U.S. ranks below every other industrialized nation in
terms of life expectancy and infant mortality (Office of
Congresswoman Betty McCollum).
• Life expectancy and infant mortality rates in the U.S. are
most similar to those of the United Arab Emirates (Office
of Congresswoman Betty McCollum).
• A baby born in El Salvador has a better chance of
survival that a baby born in Detroit (Sicko).
Why Health as a Human Right?
• Emphasizes the severity of disparities in health care in America by naming it
as a human rights crisis.
• Provides a positive, alternate framework for health policy legitimated by
• Provides a unifying message based on the universality of rights and the right
of communities to participate in decisions that effect their lives
• Empowers individuals as rights-holders and active participants rather than
• Put responsibility and accountability on states as duty bearers with the
obligation to protect, respect, and fulfill the right to health care.
• Offers practical advocacy tools for raising awareness, analyzing policy,
documenting violations and organizing.
International Legal Accountability
• The U.S. has ratified one treaty that addresses the right to
health and the U.N. Committee on the Elimination of Racial
Discrimination (CERD) monitors U.S. compliance with
International Convention on the Elimination of all Forms of
CERD Shadow Reporting
• Countries that have ratified the treaty must submit a report
every four years to CERD. The US government submitted its
latest report in April 2007.
• The Committee accepted Shadow Reports from non-
governmental organizations (NGOs) about U.S. compliance
with CERD until December 2007
• The Committee questioned representatives of the U.S.
government at a session in March 2008 and issued concluding
Domestic Legal Accountability
• Some local governments have adopted human rights treaties
- San Francisco Ordinance on CEDAW.
- Massachusetts Human Rights Bill on CERD, CEDAW and
- Seattle Ordinance on the Kyoto Protocol
• Some federal and state Supreme Court rulings have
referenced human rights treaties, often as the result of
amicus briefs filed by human rights organizations.
Health is a Human Right
Deficiencies in the United States’ current health
care system affects us all. By recognizing and
protecting the Right to Health we can allow for
all people in the U.S. to have access to quality
health care services regardless of income,
race, gender, age, language or other factors
Right to Health Resources
• Agency for Healthcare Research and Quality: http://www.ahrq.gov
• Amnesty International USA: http://www.amnestyusa.org/
• Center for Cross Cultural Understanding: http://www.crosshealth.com/
• Center for Economic and Social Rights: http://cesr.org/
• Children’s Defense Fund: http://www.childrensdefense.org
• Committee on Economic, Social and Cultural Rights: http://www.unhchr.ch/html/menu2/6/cescr.htm
• Everybody In, Nobody Out (EINO): http://www.everybodyinnobodyout.org/
• Families USA: http://www.familiesusa.org/
• National Economic and Social Rights Initiative: http://www.nesri.org
• National Organization on Disability: http://www.nod.org/
• Office of Minority Health: http://www.omhrc.gov
• PBS: The Uninsured in America: www.pbs.org/newshour/indepth_coverage/health/uninsured/index.html
• U.S. Department of Health and Human Services: http://www.hhs.gov/
Discover Human Rights!
Download the Discover
Human Rights toolkits on
the rights to education,
housing, food, and health
which include quizzes, fact
sheets take action ideas,
local organizations working
on these rights, and lesson
plans for teachers!
Get Informed Get Involved Get Others Interested
American Civil Liberties Union, “The Right to Health: Inferior System and Medical Treatment for Minorities and Women,” Race and Ethnicity in America:
Turning a Blind Eye to Injustice, U.S. Violations of the Convention on the Elimination of All Forms of Racial Discrimination, (New York, 2007),
Center for Economic and Social Rights, “The Right to Health in the United States of America: What Does It Mean?” October 2004,
Children’s Defense Fund, “Improving Children’s Health: Understanding Children’s Health Disparities and Promising Approaches to Address Them,”
Diversity Rx, “Why Language and Culture Are Important,” Essentials, http://www.diversityrx.org/HTML/ESLANG.htm.
Grant Makers in Health, “Training the Health Workforce of Tomorrow,” Issue Brief No. 12, http://www.gih.org/usr_doc/healthworkforce.pdf.
Ku, Leighton, Immigrants and Health Care: A National Perspective, PowerPoint presentation, George Washington School of Public Health,
Michelle Andrews, “The Untouchables,” U.S. News & World Report, August 20, 2007, Health section, online edition,
Komaromy, Miriam et al, “The Role of Black and Hispanic Physicians in Providing Health Care for Underserved Populations” abstract, New England
Journal of Medicine 334, no. 20, (May 16, 1996): 1305-1310, https://content.nejm.org/cgi/content/full/334/20/1305.
National Academies, “Health Care Costs, Policies, and Misperceptions Pose Obstacles to Obtaining Insurance,” Press Release, Oct. 11, 2001,
National Conference of State Legislatures, “Language Access: Giving Immigrants A Hand in Navigating the Health Care System,” Immigrant Policy
National Organization on Disability, “Access to Health Insurance,” July 25, 2001,
Office of Congresswoman Betty McCollum, “Health Protection Amendment – Health Care Fact Sheet,” McCollum Introduces Constitutional Amendment
Declaring Health Care a Right, http://www.mccollum.house.gov/vertical/Sites/%7B6CD95013-7C42-4AD8-A464-
Sicko, “Facts about Health Care in America,” http://www.michaelmoore.com/sicko/_media/SiCKO_sickofactoids.pdf.
U.S. Department of Health and Human Services, “Executive Summery,” Mental Health: Culture, Race, and Ethnicity – A Supplement to Mental Health: A
Report of the Surgeon General, Main Findings (Rockville, MD, 2001), http://www.surgeongeneral.gov/library/mentalhealth/cre/execsummary-2.html.