The World Health Organization (WHO) recognises the “highest attainable standard of health as a fundamental human right” and yet in Australia health is not usually approached from a human rights perspective.
We tolerate huge inequalities in access to care, health status and life expectancy, such as the eight-year gap in life expectancy between Aboriginal and Torres Strait Islander children (born in 2015-2017) and their non-Indigenous peers.
In this post, following World Humanitarian Day celebrated on August 19th, Dr Lea Merone, Senior Public Health Registrar and PhD scholar, outlines the strong connections between health and human rights.
She argues that taking a human rights-based approach to public health would help reduce inequality and address many of our current health challenges.
Lea Merone writes:
Celebrated annually on August 19th, World Humanitarian Day is directed towards honouring global humanitarian efforts and advocacy for supporting people in crisis. Originally born out of tragedy – the bombing of the UN headquarters in Baghdad 2003, in which 22 humanitarian workers were killed – as a pledge to strengthen humanitarian efforts, World Humanitarian Day was founded.
This year’s World Humanitarian Day has been dedicated to the efforts of women in humanitarian work.
Humanitarianism and human rights have co-existed for centuries but the boundaries are becoming increasingly blurred.
Humanitarianism is concerned with human welfare; humanitarian actions save lives, relieve suffering and maintain dignity. Human rights include the right to life, liberty, freedom from torture, freedom of opinion, the right to an education and employment and many more.
It is increasingly difficult to disentangle the two as humanitarian efforts are often centred where human rights are lacking, either owing to conflict, disaster or political unrest. Many say the cohesion between humanitarianism and human rights is long overdue.
Human rights and public health
Human rights and public health are also inextricably linked, but the relationship less widely acknowledged amongst practitioners.
The World Health Organization (WHO) recognises the “highest attainable standard of health as a fundamental human right”.
Accepting and understanding health as a human right creates a legal obligation on States globally to ensure universal access to timely, acceptable, affordable, quality healthcare and additionally to address the underlying socioeconomic determinants of health such as access to safe, nutritious food and water, appropriate shelter, sanitation, education and gender equality.
A rights-based approach to health requires prioritisation of policy toward those with the greatest need, thus focussing on health equity rather than equality.
A human rights-based approach to health aims to support sustainable development outcomes by addressing inequalities. The core principles of a human-rights based approach are accountability, equality and non-discrimination, and participation.
At the centre of this lies the elimination of inequity and emphasis on both processes and outcomes.
Participation and inclusion mean that people can participate in actions and decisions that impact and are directly meaningful to them.
Alongside this are the core elements of a right to health: availability, accessibility and quality including safety, effectiveness, people-centredness, timeliness, integration, efficiency and – importantly – equity.
Australia’s approach
Without a true human rights-based approach, the health of Australia is arguably stagnant.
Improving the health of populations largely involves addressing the social determinants of health from their root – the political and economic systems underpinning society.
Addressing these systems will mean considering the benefits and harms of capitalism and neoliberalism (often referred to as “supercapitalism”) to human health and inequality.
As Audrey Chapman discusses in her book, Global Health, Human Rights, and the Challenge of neoliberal policies, neoliberal-dominated economics and politics are problematic for human rights and public health.
Indeed, neoliberalism favours promoting free markets over protecting human rights and improving human welfare. The free-market refers to the mode of exchange through buying and selling of goods and services. There is little interference from government in true free-market systems and welfare systems are scarce, if existent at all.
Inequality and health
The governing principles of the free-market differ greatly to those governing human rights in that the free-market is dominated by willingness-to-pay, the concept that a sale price is according to what the good is valued at. In contrast, human rights are guided by needs and concepts of vulnerability, dignity and essential rights.
Market distribution of the free market, consequentially, is grossly unequal and this is a reverberating characteristic of neoliberalism. A foundation of unequal distribution paves the way for an unhealthy society; one in which the social determinants of health are left unaddressed and gaps in life expectancy, health and equality widen.
Is it possible to address the social determinants of health within a neoliberal system?
Audrey Chapman and many human rights theorists believe that neoliberal ideologies and human rights are “conflicting paradigms” and are “fundamentally incompatible”.
These scholars argue that advocates for human rights must take a strong stance against neoliberalism and advocate for an overhaul of global and local political-economic structures. Advocacy involves an element of allowance for freedom of speech.
Emeritus Professor Gillian Triggs, the United Nations Assistant High Commisioner for Protection, argues that the people of Australia do not have personal right to freedom of speech.
The International Covenant on Civil and Political Rights was adopted by the UN in 1966, stating everyone has the right to hold opinions without interference and everyone– including the media – has the right to freedom of expression. In complex but subtle ways, speech impacts on the health of society, in both beneficial and harmful ways.
Freedom of speech is a health issue
Freedom of speech impacts on culture, social norms, public policies and relationships. This can be challenging for both public health professionals and the law.
Whilst freedoms of speech must not be curtailed, the impacts on epidemics such as obesity are not to be overlooked.
Furthermore, the adverse impacts of suppression of freedom of speech and the role of speech in health protection are significant.
Population health is closely related to autonomy; the ability to make choices for oneself. Indeed, the notion of having control over one’s life, or a central locus of control, is integral to individual health.
In this way, freedom of speech is deeply entwined with health, and suppression of this freedom will have adverse effects on a population.
This is where human rights and public health are both companions but are also in conflict; human rights and the right to speech are concepts spawned from neoliberal ideologies that favour little input from governments in transactions.
However, there are those that argue that whilst neoliberal ideologies promised freedom of speech, the reality of neoliberalism is semi-privatised authoritarianism; more oppressive than the system it replaced.
Indeed neoliberalism, is arguably a monster of which we have lost control, central to disasters such as the collapse of ecosystems, the loneliness epidemic and poor public health.
Human rights are central to health
Moving forward, it is time for public health to up its game and alongside advocating for change in the social determinants of health, begin to demand it as a basic human right.
The right to health is central to all human rights.
By acknowledging the centricity of human rights to health, it is possible to advocate from stronger, legal, standpoints and towards building a more sustainable political and economic standpoint that benefits the many, not the few.
