Words by Teah Zdanowicz and Abby Stewart
Photograph: Matheus Ferrero on Unsplash
Health inequality is a serious issue within society, creating barriers for ethnic minorities, refugees, the LGBTQ+ community, as well as people with disabilities and low-incomes. If the last three years has taught us anything, it is that having access to quality medical advice and treatment is fundamental to ensure we can live a healthy life. COVID-19 didn’t just expose us to the necessity of healthcare, but it also exposed how fragile our current systems are and that some don’t have access at all. The UN says that years of advancement in several fields of healthcare are under danger due to COVID-19’s significant disruption to vital health services, causing a reduction in life expectancy, and aggravation of access disparities between countries and peoples. However, is access to healthcare a human right? And what impact can enshrining this right in legal systems have on the lives of all but more specifically those most marginalised.
Does a right to healthcare exist ?
Yes, a right to health does exist. Both within the UK legal system and international law, a right to health/ medical care does exist. In the UK legal system there is no law which explicitly states that citizens within the UK have a right to healthcare. However, since the UK ratified the European Convention on Human Rights in 1951 and more recently passed the Human Rights Act in 1998, we are entitled to some protections. Importantly the HRA gave further effect to the rights contained in the ECHR by obliging judges to read and interpret the law in a manner compatible with convention rights and made it unlawful for public authorities to act in a manner which conflicts with convention rights. As a result, the National Health Service, which is classed as a public authority, is obliged to act in accordance with the ECHR. It is important to note that the ECHR does not state that access to healthcare is a human right, however its effect on healthcare services in the UK result in healthcare being provided based on human rights, emphasising the value of safeguarding vulnerable peoples, equality, and the freedom to access, receive and share information or ideas on health.
There are a number of positive impacts the ECHR had on human rights and dignity within the UK’s healthcare services:
As a result of Burke, R (on the application of) v General Medical Council & Ors [2005] EWCA Civ 1003 the choice of what is in a patient's best interests is theirs;
As a result of GLASS v. THE UNITED KINGDOM - 61827/00 [2004] ECHR 103 parents' objections to their children's treatment cannot be disregarded by medical personnel;
As a result of H.L. v. THE UNITED KINGDOM - 45508/99 [2004] ECHR 471 legal protections are available to those who are detained for mental health reasons.
In international law a number of different legal instruments include the right to health. The World Health Organisation is the head of the United Nations system's international health directing and coordination organisation. The WHO was first founded in 1946 and within its constitution stated that “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.” One of the most well known and impactful international law documents, the Universal Declaration of Human Rights, also states within Article 25 that ‘1. Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control’.
Within the international law framework, there is also the International Covenant on Economic, Social and Cultural Rights which was first established in 1966. Article 12 of the Covenant states that ‘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’. In accordance with Article 12.2, signatory countries are required to take specific actions to enhance the health of their citizens, including lowering infant mortality and enhancing child health, enhancing workplace and environmental health, preventing, controlling, and treating epidemic diseases, and establishing frameworks to guarantee universal access to medical care in a timely manner for all. The UK is a signatory to the ICESCR, which means that it is bound to protect the right to health, within the context of international law. In international law, there is a principle known as progressive realisation which establishes that the UK, as a signatory to the ICESCR, must take steps to realise this right to the fullest extent of its resources, while acknowledging that realisation may be hampered by a lack of resources and may only be possible over time.
Why access to healthcare is important
The WHO has estimated that globally 3.5 million people, nearly half of the worlds population, do not have access to essential healthcare services. Each country differs in terms of how involved the government is in providing health services for their citizens, for example in the UK, Sweden, Denmark and Finland, ever since World War 2 governments have provided free at the point of use services. However, countries such as the US and South Africa only offer very limited free healthcare services, while most of their citizens pay for all medical expenses. The WHO estimates that due to out of pocket expenses, like expensive procedures or medication, 100 million people are pushed into extreme poverty each year. Limited access to healthcare was already high up on agenda as a crisis which needed concerted effort to fix, however the COVID-19 pandemic only served to exacerbate a crisis which current efforts have proven ineffectual to address and what can only be seen as a denial to a fundamental human right. In the last 100 years the improvements and innovation made in healthcare has resulted in humans living longer than ever before. This can be directly attributed to health advancements like vaccinations, antibiotics, sanitation, and nutrition which have prevented millions of deaths and served as a significant driver of economic growth.
In a study titled ‘What has made the population of Japan Healthy?’ It was assessed that when the government strengthened population health interventions and implemented universal health care in the 1950s and early 1960s, Japan's fatality rates for communicable diseases in children and young adults began to decline and life expectancy at birth improved. Japan is not the only country which has observed the positive effects of UHC. For example, since the implementation of the Health Transformation Programme (HTP) in 2003, Turkey's life expectancy has increased by 4 years, or half a year faster than the average for OECD nations, from 2003 to 2013. Maternal and child health as well as infectious diseases considerably improved after greater investment in the availability of primary care services. By introducing UHC citizens can access healthcare services without the worry of being pushed into financial hardship as a result.
Three interconnected elements are typically recognised to make up universal health coverage (UHC): the population covered, the services offered, and the degree of financial protection from the costs of medical services. Studies conducted by the OECD suggest that:
‘A clear negative relationship exists between out-of-pocket (OOP) payments and life expectancy, suggesting that financial risk protection is associated with health outcomes’.
By looking at the evidence presented it can only be deduced that access to healthcare and the implementation of UHC is important because it is the only way to achieve a society with equal outcomes for all.
What does access to quality healthcare mean and look like?
Providing access to quality healthcare is about inclusivity and equal opportunity, allowing services to be available to everyone, no matter their circumstances. Providing universal health coverage (UHC) allows people to have access to a wide range of health services without facing financial barriers throughout an individual’s life. It also requires workers to have the optimal skills required to carry out various services within the healthcare system and have the resources available to them in order to carry out their job sufficiently. Affordability is a crucial component to having access to healthcare. People often experience financial issues from having to pay for a service, which can put people being at risk of being financially unstable. Unfortunately people end up being forced into poverty due to using savings, assets and borrowing money which has an effect on them and their families livelihoods.The World Bank has been providing financial assistance for countries to reach UHC by 2030 through investing in affordability and quality within primary healthcare services, improving financing in health, and boosting education and the creation of jobs.
Recognition of the struggles of reaching UHC have also been addressed through the Global Monitoring Report, which has highlighted how covid-19 has affected several healthcare issues. However, the World Bank has still made great achievements in providing assistance to many countries worldwide. IDA has provided emergency assistance to Yemen to help with food insecurity and health through its Emergency Health and Nutrition Project which has outreached over 6 million people. Access to mental health support has also been improved through the World Bank providing CBT training to over 100 small organisations in Pakistan, providing them with the tools to support and improve workers mental health.
Another key component to accessing quality healthcare is inclusivity. Healthcare must be inclusive for everyone, especially for refugees and migrants who can experience barriers to healthcare. In reference to the 1951 Refugee Convention refugees are entitled to having similar or comparable healthcare to the general public. As part of the 2030 Agenda for Sustainable Development and the Global Compact on Refugees, UNHCR has helped to support healthcare for refugees through providing and supporting services that deal with various issues that refugees face during and after migration, as well as healthcare services that they are entitled to. Immunisation is a key issue that is a crucial healthcare service that refugees need access to. When refugees have to flee their country their healthcare is postponed, putting their health at risk of a number of health concerns, one of which being immunisation. Refugees are therefore at greater risk of developing diseases such as viral hepatitis and measles that could have been prevented by vaccines. Children are at greatest risk due to a large number of them being classified as zero-dose, which puts them at risk of a number of diseases. According to GAVI, more than 12 million children fall under this category. Therefore, UNHCR partnered with GAVI, The Vaccine Alliance in 2020 to tackle the needs of zero-dose child refugees through collaborating with the community and local partnerships to tackle barriers to access and demand within communities.
Sustainable Development Goal 3: Good Health & Wellbeing
Covid-19 has had a tremendous impact on the progress of Sustainable Development Goal 3 which focuses on good health and wellbeing to “ensure healthy lives and promote well-being for all at all ages”. The Covid-19 pandemic resulted in over 500 million people being infected, as well as over 6 million deaths, creating greater fragility in the healthcare system and threatening the progression of universal health coverage. The disruption of crucial healthcare services has caused a rise in anxiety and depression. The pandemic has had a detrimental impact on mental health.
“In 2020, the global prevalence of anxiety and depression increased by an estimated 25 per cent, with young people and women most affected”.
It has caused disruption to daily life through the closure of schools, work, leisure facilities, and travel which has had an affect on education, socialisation, and job insecurity which subsequently increased food and income insecurity. Vulnerable children have also been at the forefront of this issue, through being subjected to increased forms of violence as the closure of schools has resulted in the loss of a safe space. Inequalities in healthcare have also been exacerbated due to the economic and health impacts of Covid-19 which has hampered the progression of Universal Health Coverage. According to the 2022 SDG report 500 million people were forced into poverty due to having to use their household finances for health costs. Another issue in achieving SDG 3 has been disturbance in the progression towards ending HIV, malaria, and Tuberculosis. There were over 1 million HIV diagnoses and nearly 700,000 malaria deaths in 2020. Actions put in place to stop the spread of covid and increased pressure on health services has ultimately stalled the progress of HIV assistance. All of the SDGs are interdependent, however SDG 3 has a unique significance. Without achieving good health and wellbeing for all it will be impossible to realise other goals like no poverty, gender equality and zero hunger.
Having access to healthcare services will remain essential to the human race forever, without it we cannot realise the potential of ourselves and the world. This blog has outlined the mass inequality that still exists, mainly to those on a low income and those living in low income countries, however there are also many countries taking the steps to provide UCH for all. To provide access to healthcare for all we must take a human rights first approach, which prioritises respect for dignity and access for the most marginalised. Taking a more direct approach, through implementing access to healthcare into the body of domestic human rights, we can make sure no one is left without and achieve SDG 3.
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