From a public policy perspective, health is not only a healthcare issue; it is fundamentally a matter of human rights, and thus relies on political choices.
The right of everyone to enjoy the highest attainable standard of physical and mental health has been firmly grounded in international law for many years. Many countries also have health as a right enshrined in their constitutions, but in some, mechanisms that make it work for peoples’ health are not in place. In these countries, rules and regulations may be needed to establish the processes by which the right to health can be enforced. It has also been largely documented that health outcomes depend on social determinants, which include the conditions necessary for people to live healthy lives, such as safe housing, access to nutritious food, clean water, education, decent work and social protection.
An internationally agreed framework, the Sustainable Development Goals have placed health and well-being at the centre of global development. However, progress remains uneven. Although significant advances can be seen in the last decades, with important declines in infant and child mortality and infectious disease rates globally, it is being undermined. Misinformation fuels, for instance, vaccine hesitancy, and that combination has led to a resurgence of preventable diseases such as measles in many countries, compromising herd immunity worldwide. Furthermore, poverty, conflict, gender inequality, racism, disability, geographic isolation, discrimination and inequities in access to health care, medicines, vaccines and other health products continue to produce major differences in health outcomes, between countries globally and within countries. The Covid-19 pandemic further exposed such inequities and inequalities.
Turning rights into political choices
Policymakers, health professionals, civil society organisations and communities – all constituencies have roles to play. Decision-making is political in nature, not technical, so ensuring that politicians and policymakers can understand that public health policies should be informed by the best scientific evidence available is a task shared by all. Also, political leaders must decide whether health systems are treated as long-term public investments or primarily as costs to be contained.
In many Latin languages, policies and politics mean the same thing, which is very useful, as many times health professionals separate themselves from the more traditional ‘politics’. But to ensure that health politics work for public health, it is important to support political choices that invest in strengthening non-discriminatory public health systems that are sensitive to the social (and other) determinants of health and that strengthen universal health coverage, including palliative care, and ensure equitable access to medicines, vaccines and other health products, without people experiencing additional financial hardship.
However complex and difficult some situations may seem for us during our lifetime, it is very important to remember what Dubos wrote in 1975: ”One of the characteristics of our times is thus the rapidity with which steps can be taken to change the orientation of certain trends and even to reverse them … It is this resilience which leads me to reject the myth of inevitability and reaffirm that, wherever human beings are concerned, trend is not destiny.”
The right to health
1946: WHO Constitution Preamble establishes that the highest attainable standard of health is a fundamental human right without discrimination, defining health broadly as complete physical, mental and social well-being.
1948: Universal Declaration of Human Rights – Article 25 outlines the right to an adequate standard of living for health and well-being, encompassing food, clothing, housing, medical care and security during circumstances such as sickness or unemployment, alongside special care for motherhood and childhood.
1966: International Covenant on Economic, Social and Cultural Rights – Article 12 recognises the right to the highest attainable standard of physical and mental health, detailing countries’ steps required for reducing infant mortality, improving environmental hygiene, controlling diseases and assuring medical attention during sickness.
