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 Constitution). 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. International Standards 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 care.” 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.” International Standards • 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 12) • Convention on the Elimination of All Forms of Racial Discrimination (Article 5)* • 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 and Including: • Clean and safe food and water • Sanitary living and working conditions International Legal Protections International Standards 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. Government Obligations 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. Government Obligations 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 health. Does the U.S. Recognize the Right to Health? • The US Constitution/Bill of Rights does NOT include any mention of a right to health. • 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 1977. • 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: • Availability • Access to health insurance • Protecting most vulnerable • Non-discrimination • Cultural acceptability • Adequacy Availability • 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 health insurance. • 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: Children • 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 Defense Fund). • 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, 2001). • 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). Non-discrimination • 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, 2007). • The mortality rate from breat cancer among black women is 68% higher than that of white women (American Civil Liberties Union, 2007). Cultural Acceptability • 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 Rx). Adequacy • 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 McCollum). Adequacy • 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 worldwide recognition. • 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 passive recipients. • 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 Discrimination (ICERD) 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 observations. Domestic Legal Accountability • Some local governments have adopted human rights treaties - San Francisco Ordinance on CEDAW. - Massachusetts Human Rights Bill on CERD, CEDAW and CRC - 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 www.discoverhumanrights.org Bibliography 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), http://www.aclu.org/pdfs/humanrights/cerd_full_report.pdf, 131-132. Center for Economic and Social Rights, “The Right to Health in the United States of America: What Does It Mean?” October 2004, http://cesr.org/ushealthright. Children’s Defense Fund, “Improving Children’s Health: Understanding Children’s Health Disparities and Promising Approaches to Address Them,” http://www.childrensdefense.org/site/DocServer/CDF_Improving_Children_s_Health_FINAL.pdf?docID=1781. 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, http://www.energyofanation.org/03ce4663-a0fd-489e-abad-34b7c05253ca.html?NodeId. Michelle Andrews, “The Untouchables,” U.S. News & World Report, August 20, 2007, Health section, online edition, http://health.usnews.com/usnews/health/articles/070820/20preconditions.b1.htm. 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, http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=10188. National Conference of State Legislatures, “Language Access: Giving Immigrants A Hand in Navigating the Health Care System,” Immigrant Policy Project, http://www.ncsl.org/programs/immig/SHNarticle.htm. National Organization on Disability, “Access to Health Insurance,” July 25, 2001, http://www.nod.org/index.cfm?fuseaction=page.viewPage&pageID=1430&nodeID=1&FeatureID=111&redirected=1&CFID=22542279&CFTOKEN=94239 249. 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- EB8D8679E9C9%7D/uploads/%7B801C4C9F-6CE5-436A-8684-8669D00D2A1E%7D.PDF. 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.
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