Health, dignity and human rights
7th Conference of European Health Ministers - Keynote address
Secretary-General, Distinguished Ministers, Friends and colleagues,
You have chosen a critically important theme for your meeting: health, dignity and human rights. Three sets of ideas that are inextricably linked, and that are central to the development of health systems and services, both in Europe and throughout the rest of the world.
Fifty-five years ago, the creators of WHO’s Constitution stated that the enjoyment of the highest attainable standard of health is a fundamental right of every human being. In our daily work – and in yours as health ministers – we are all striving to make this right a reality. Turning aspirations and policies into practice.
Rarely is this easy. The pressures we all are facing are intense. Ageing populations, rapid technological developments, increasing public expectations, all these factors generate pressure to increase health spending.
But convincing colleagues in treasuries and ministries of finance – whose prime concern is macro-economic stability – can be hard.
We have to be able to deliver results. Better health outcomes are what matters in the end. But, how they are achieved, and who benefits, are equally important. This is where human rights, and the right to health can help. We are all engaged in debates about the future of health financing. How do we increase cost-effectiveness in resource allocation and promote efficiency in spending whilst, at the same time, maintaining solidarity in the way we are funding the services?
The key point here is that, while securing adequate financing is critical, ensuring that the burden of costs is shared fairly is equally important.
Similarly, we are not just concerned with access to health care, but with how people are treated when they need services.
We regard responsiveness of health systems – which includes ensuring confidentiality, reducing waiting times, involvement in decision making – as a proper and legitimate goal in its own right.
Here, there is a direct link with human rights. For, at the root of the concern for equality and freedom from discrimination in human rights thinking and practice, lies the notion of human dignity: the equal and inherent value of every human being.
In recent years, we have become clearer as to what the right to health should actually mean. First and foremost, it is an inclusive right: it is not just about health care services – it is also about the underlying determinants of ill health.
These are much broader and include access to safe drinking water, adequate sanitation, a supply of safe and nutritious food, healthy occupational and environmental conditions and access to information, including information about sexual and reproductive health.
At the heart of the primary health care and Health for All movement, which has been so influential in shaping health policies in Europe, lies a concern for equity.
But, we all know that, in every country represented here today, there are groups of people that are missing out on what our health systems have to offer. The human rights framework can help us address the needs of these groups.
The causes of social exclusion are many and varied. Some groups, such as ethnic minorities and the economically disadvantaged get overlooked when we work with national averages. But, there are also those whose needs are obvious, but whose cause is politically unpopular – I think here of irregular migrants, for example.
Paying attention to vulnerable population groups constitutes an essential element in a human rights approach because the right to health demands giving priority attention to those most in need. This is important in itself, but the fact that these rights are part of an internationally recognized legal framework also places an obligation on governments.
The right to health is a goal for which all governments, rich and poor, should strive. Of course, this cannot be achieved overnight. All nations face constraints, in many cases posed by limited resources. This is why the principle of progressive realization is central to the achievement of all human rights.
But, this principle is not an excuse for inaction. The right to health also contains immediate obligations to take concrete, deliberate and targeted steps towards full realization. This is why we need good benchmarks and indicators.
When WHO reviewed national constitutions globally, we found that over half of the countries in the Council of Europe had enshrined health as a human right.
This commitment is expressed in various ways – some constitutions commit the government to providing the best health care that is available and practicable; most recognize health as a right expressed variously in terms such as the right to protection of health, the right to a healthy environment, or the right to social security, medical insurance and medical services.
Within the European Union, the debate on the Convention on the future of Europe and the publication of a draft constitutional treaty, has similarly raised to the forefront the debate on the level of priority afforded to health in the context of Community policies and activities. We welcome the move to include an explicit reference to the fundamental human right to health in the draft constitutional treaty outlining the Union's basic values. Let me end these remarks by looking beyond Europe.
The reality is that public health, as never before, is a priority on the global agenda. This is for the simple reason that so many of the challenges we now face have a global impact, requiring solutions and a global response. We are living in an interconnected and interdependent world.
SARS has been a wake-up call. It has shown us the potential gains from international collaboration, as well as some of the pitfalls when collaboration fails.
But, there are many other issues which should claim our attention. The right of those in developing countries to enjoy better health depends on the actions of all governments, in the north as well as the south. Meeting obligations to provide development finance; building trust in trade negotiations; advancing human development and institution building – which may mean looking hard at our own health service recruitment policies; financing the public goods such as surveillance systems – from which all can benefit, but none can individually afford.
Let me end with a simple message. There can be no real growth without healthy populations.
No sustainable development without tackling disease and malnutrition.
No international security without assisting crisis-ridden countries.
And no hope for the spread of freedom, democracy and human dignity unless we treat health as a basic human right.