Can We Measure The Right To Health?

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The proficiency of national health systems is linked closely to the availability of local resources, which maybe allocated to the healthcare systems.  This relationship is even more critical today due to the financial uncertainties as a result of the global economic crisis. Stakeholders and policy makers are required to make decisions regarding the increasing unemployment rates and the decrease in the Gross Domestic Product (GDP) and related ratio GDP/DD (Domestic Debt). As a result they are sometimes forced to divert funding to sustain employment rather than maintain or improve public health. On the other hand, the increasing rate of unemployment results in a decrease in the contribution to the budget, which would normally cover the desired or needed investments in health care. Also in the last decades  the increase in demand on the services provided by the local national health services due to the ageing population has produced stresses in the financial capacity of national budgets dedicated to healthcare. In fact, according to a recent WHO publication, health systems in many countries are failing and collapsing; too many healthcare systems are inequitable, regressive, and unsafe (WHO. Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva:World Health Organization, 2007). 

Evaluation of the inequalities and the panorama of health systems in Europe has raised several very serious questions:

• What is the standard health system?

or rather rephrasing the comments by the COMMITTEE ON ECONOMIC, SOCIAL AND CULTURAL RIGHTS - CESCR (in the Twenty-second session Geneva, 25 April-12 May 2000 Agenda item 3 The right to the highest attainable standard of health : . 11/08/2000. E/C.12/2000/4. (General Comments)

• How can the right to the highest attainable standard of health be measured?

To better understand the two questions see the article 12 of the general Comment of CESCR below:

The article 12 of the International Covenant on Economic, Social and Cultural Rights


12. The right to health in all its forms and at all levels contains the following interrelated and essential elements, the precise application of which will depend on the conditions prevailing in a particular State party:


(a) Availability. Functioning public health and health-care facilities, goods and services, as well as programmes, have to be available in sufficient quantity within the State party. The precise nature of the facilities, goods and services will vary depending on numerous factors, including the State party's developmental level. They will include, however, the underlying determinants of health, such as safe and potable drinking water and adequate sanitation facilities, hospitals, clinics and other health-related buildings, trained medical and professional personnel receiving domestically competitive salaries, and essential drugs, as defined by the WHO Action Programme on Essential Drugs.


(b) Accessibility. Health facilities, goods and services have to be accessible to everyone without discrimination, within the jurisdiction of the State party. Accessibility has four overlapping dimensions:


Non-discrimination: health facilities, goods and services must be accessible to all, especially the most vulnerable or marginalized sections of the population, in law and in fact, without discrimination on any of the prohibited grounds.


Physical accessibility: health facilities, goods and services must be within safe physical reach for all sections of the population, especially vulnerable or marginalized groups, such as ethnic minorities and indigenous populations, women, children, adolescents, older persons, persons with disabilities and persons with HIV/AIDS. Accessibility also implies that medical services and underlying determinants of health, such as safe and potable water and adequate sanitation facilities, are within safe physical reach, including in rural areas. Accessibility further includes adequate access to buildings for persons with disabilities.


Economic accessibility (affordability): health facilities, goods and services must be affordable for all. Payment for health-care services, as well as services related to the underlying determinants of health, has to be based on the principle of equity, ensuring that these services, whether privately or publicly provided, are affordable for all, including socially disadvantaged groups. Equity demands that poorer households should not be disproportionately burdened with health expenses as compared to richer households.


Information accessibility: accessibility includes the right to seek, receive and impart information and ideas concerning health issues. However, accessibility of information should not impair the right to have personal health data treated with confidentiality.


(c) Acceptability. All health facilities, goods and services must be respectful of medical ethics and culturally appropriate, i.e. respectful of the culture of individuals, minorities, peoples and communities, sensitive to gender and life-cycle requirements, as well as being designed to respect confidentiality and improve the health status of those concerned.


(d) Quality. As well as being culturally acceptable, health facilities, goods and services must also be scientifically and medically appropriate and of good quality. This requires, inter alia, skilled medical personnel, scientifically approved and unexpired drugs and hospital equipment, safe and potable water, and adequate sanitation. (SUBSTANTIVE ISSUES ARISING IN THE IMPLEMENTATION OF THE INTERNATIONAL COVENANT ON ECONOMIC, SOCIAL
AND CULTURAL RIGHTS  General Comment No. 14 (2000) The right to the highest attainable standard of health (article 12 of the International Covenant on Economic, Social and Cultural Rights  

 

 Which one are the underlying determinants of health?

•  How should adequate health facilities, goods, and services be measured: Accessibility?   Affordability? Acceptability? Quality?

To these general questions, others follow as a consequence, e.g.

• How high should the amount of investment on health be in comparison to the GNP?
• What criteria can be followed to understand inequalities, barriers, and levels of  satisfaction?

It is critical to open discussion on this matter and to refer to other articles  of this and the next issues of this web site for greater understanding.

Rodolfo Paoletti, 20 February 2009

 

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