Health Care as a Human Right Anja Rudiger December 2007

1. NESRI National Economic and Social Rights Initiative Health Care as a Human Right Anja Rudiger December 2007

2. The Human Right to Health • The human right to health entails the right to a system of health protection. • Everyone has the right to enjoy, on an equal basis, a variety of facilities, goods, services, and conditions necessary for the realization of the highest attainable standard of health. • This includes access to appropriate health care, and to the underlying social determinants of health, such as adequate food, housing, and healthy occupational and environmental conditions.

3. How Well Does American Health Care Do • In International Comparison? • Rank 37 in health system performance (top performer: France) • Rank 1 in health expenditure • World Health Organization (2000): United States’ performance is ranked just above Slovenia, but below Costa Rica, Saudi Arabia, and Colombia. Performance refers to how efficiently a health system translates expenditure into positive health outcomes. • Bottom rank in performance comparison between Australia, Canada, Germany, New Zealand, and the United Kingdom (Commonwealth Fund 2007). Top performer: UK. Criteria included quality, access, efficiency, equity, health status, and expenditure.

4. High Costs Don’t Deliver Quality Care • For-profit hospitals maximize profits, not care: • 19% higher payments for care in investor-owned, for-profit hospitals • 2% higher death rates at for-profit hospitals • (New England Journal of Medicine 2004) • Public and not-for-profit hospitals provide better care: • Not-for-profit hospitals consistently perform better than for-profit hospitals. Federal and military hospitals have the highest performance. Quality of care was measured for three common medical conditions: congestive heart failure, heart attack, and pneumonia. (Harvard Medical School 2006)

5. The Human Right to Health Care • The purpose of a health care system is to preserve and improve health. This includes public health and the health of all individuals. • The purpose of a health care system is NOT to sustain an industry, secure financial gains, or promote economic growth.

6. Health Care: Right or Commodity? • Health care is a right, not a commodity. Commodities are restricted to those who sell and purchase them, with sellers seeking to make a profit and consumers limiting their demand based on price. • As holders of a right we are entitled to health care. We are not consumers who choose to buy or not to buy care. • The right to health care confers an obligation on the government to respect, protect, and fulfill this right. This includes holding private insurers and providers accountable for meeting human rights standards.

7. Toward a Health Care System Based on Rights • A health care system must be designed to provide quality, appropriate, comprehensive, and timely care to everyone who needs it. • This should include preventive care, as well as public health initiatives to promote health, but it does not mean preventing the delivery of care to save costs. It is about providing, not limiting care, and about attending to those with health needs, rather than serving the wealthyand rewarding the healthy. • Health care is a public good that must be provided in a way that contributes to positive health outcomes for individuals, communities, and society as a whole, while protecting dignity and ensuring equality.

8. The State of the Health Care Debate • Reorganize the financing of health care: • to reduce costs (public and individual) • to increase access to insurance coverage • Create more consumers to purchase health care as a commodity: • Individual mandates to achieve universal coverage • Tax subsidies to buy insurance from private sellers • Purpose, availability and quality of health care are neglected, as is equitable access to quality care

9. A Normative Framework for Health Care Reform • Changing the terms of the debate: • commodity, privilege, charity  human right • Rethinking the approach to health care reform: • save costs, maintain profits  base financing on public obligation to preserve health • improve management of health care marketplace  ensure equitable provision of quality health care

10. Principles of the Right to Healthcare The right to healthcare means that health facilities, goods and services must be available, accessible, acceptable, and of good quality for everyone, on an equitable basis, everywhere in the country.

11. Availability, Access, Quality, Acceptability • Availabilityof adequate health care infrastructure (e.g. hospitals, trained personnel), goods (e.g. drugs), and services (e.g. primary care, mental health care) in all geographical areas and to all communities. • Accessto healthcare must be universal, guaranteed for all on an equitable basis. Health care facilities, goods and services must be affordable and comprehensive, and physically accessible where and when needed. They must be distributed equitably, with resources allocated and accessed according to needs and health risks. • Qualityof all health care must be guided by quality standards and quality control mechanisms. Care must be medically appropriate and provided in a timely, safe, and patient-oriented manner. • Acceptability and Dignity:Health care facilities and services must respect dignity, provide culturally appropriate care, be responsive to the needs of women, older people, non-English speakers and to those with different ways of life and abilities, and protect confidentiality.

12. Procedural Principles • Non-discrimination: Healthcare is provided without discrimination based on health status, race, ethnicity, gender, sexual orientation, disability, language, religion, national origin, income, or social status. • Participation: Individuals and communities can take anactive role in decisions that affect their health, including in the organization and implementation of healthcare services. • Information and Transparency: Comprehensive health information is easily accessible for everyone, enabling people to preserve their own health and claim quality healthcare services. Institutions or structures that organize, finance or deliver healthcare function in a transparent way. • Accountability: Enforceable accountability mechanisms ensure that private and public agencies are held accountable for protecting the human right to health and healthcare. This includes regulating private healthcare and insurance services and conducting health impact assessments of policies.

13. What Our Human Right to Health Program Will Do • Inject human rights principles into health care reform debates • Use the principles of the right to health care to develop metrics and tools for guiding and assessing reform efforts • Build partnerships with grassroots organizations to work jointly on state-based efforts to improve health care and make it accessible to everyone. • Marshal best practices at state level to generate national momentum for real health care reform guided by the right to health.