European health values are the distinctive set of beliefs about health rights and obligations that reflect European history and identity.
Article 6 of the Treaty on European Union states that the union is “founded on the principles of liberty, democracy, respect for human rights and fundamental freedoms, and the rule of law, principles which are common to the Member States”.
“The European Community aims not only to provide a well functioning internal market for goods, capital and services, it also supports social justice and respect for human dignity, and therefore its internal and external actions should strive to support these values. This is particularly important in the field of health, which is a key element in individual and social well being.” This analysis was clearly understood by the authors of the European Health Strategy 2008-2013, as it was taken directly from the white paper’s staff working document.
A human rights approach is fundamental to European values for health: “In relation to health, a rights-based approach means integrating human rights norms and principles in the design, implementation, monitoring, and evaluation of health-related policies and programmes. These include human dignity, attention to the needs and rights of vulnerable groups, and an emphasis on ensuring that health systems are made accessible to all. The principle of equality and freedom from discrimination is central, including discrimination on the basis of sex and gender roles.” (WHO Glossary of globalization, trade and health terms)
Today, in many countries, there are still remarkable gaps between what is required of the state and what is actually provided – and it is the poor and disenfranchised who suffer the most from those gaps. Article 2 (1) of the International Covenant on Economic, Social and Cultural Rights (the most authoritative interpretation of the right to health – see ICESCR Article 12) recognizes that states have resource constraints and that it necessarily takes time to implement the treaty provisions. Consequently, the right to health is deemed subject to progressive realization. However, a lack of resources cannot justify a state’s failure to respect its obligations to uphold the right to health. In evaluating the implementation of the right to health in a particular state, the question that must be asked is: Was country X unable to provide the health services needed to save the lives of its citizen, or were the political and social forces in the country unwilling to make such services a priority?
The right to health and other human rights are closely related. The indivisibility and interdependence of different human rights are easily seen in the context of poverty. For people living in poverty, “health may be the only asset on which they can draw for the exercise of other economic and social rights, such as the right to work or the right to education.” Seen from the other side, a failure to respect human rights is often associated with harm to human health – such as in violations of the freedom from torture or of the right to adequate housing.
Applying a human rights approach to global health requires:
- assessment of the impact of health policies, programmes and practices on human rights
- taking account of the health impacts resulting from violations of human rights
- seeing health and human rights as inextricably linked and bringing to this notion consideration of the determinants of health and ways in which health issues may be addressed
This approach, seen through the lens of European health values, is applied in the European approach to global health.
The new European Health Strategy calls for Community actions in support of health to be value based. Community actions should be built on “fundamental rights relating to health and health as a global public good. In addition, they should make concrete common values such as equity, participation and empowerment of citizens, and transparency”.
This strategy, from the European Commission, takes its cue from the sentiments of the member states. In June 2006, the ministers of health of the then 25 EU member states adopted common values and principles to guide European Union health systems.
The European values are:
- universality, which means that no-one is denied access to health
- solidarity, which requires countries to ensure that the cost of health and care services are fairly allocated according to the ability to pay, and that services are available to all according to need
- access to quality Care, which means that the quality of care provided should be the highest, patient centred, and responsive to individual need. It should be evidence and ethics based
- equity, which relates to equal access to healthcare according to need, regardless of ethnicity, gender, age, social status or ability to pay
While these values were defined in discussions regarding the future of European health systems, they are also significant for global health. In particular, the importance of addressing gender inequality in global health is a priority for global health. According to the staff working document for the new European Health Strategy:
The large and growing inequities in access to healthcare at the global level also call for EU joint action on global health. At present, the level of public funding for health in the EU is on average some 100 times higher than the level of spending in sub-Saharan Africa. There is a need to expand the concepts of equity and solidarity beyond the EU’s borders and to progress towards universal access to basic healthcare. The EC’s external relations should prioritise addressing health inequities and act in coherence with internal health policies.
More on Health as a Human Right
Health as a Human Right:
Health is a Human Right, indispensable in fulfilling the fundamental Human Rights principle of the inviolability of human dignity. It has been recognised as such in many international treaties and conventions.
For example the constitution of the WHO (1946), in The Universal Declaration of Human Rights (1948), and again in 1966 in the International Covenant on Economic, Social and Cultural Rights (ICESCR)-a legally binding instrument of international law.
According to the ICESCR Article 12:
- 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.
- The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:
(a) The provision for the reduction of the stillbirth rate and of infant mortality and for the healthy development of the child;
(b) The improvement of all aspects of environmental and industrial hygiene
(c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases;
(d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.
The right to health is relevant to all States:
Every State has ratified at least one international human rights treaty recognizing the right to health. The right to health or health care is also referred to in 115 State constitutions. It is frequently associated with access to health care and medical facilities. This is correct, but the right to health includes a wide range of factors that can lead to a healthy life. They include:
- Safe drinking water and adequate sanitation;
- Safe food;
- Adequate nutrition and housing;
- Healthy working and environmental conditions;
- Health-related education and information;
- Gender equity.
“The right to health does not mean the right to be healthy, nor does it mean that poor governments must put in place expensive services for which they have no resources. But it does require governments and public authorities to put in place policies and action plans which will lead to available and accessible health care for all in the shortest possible time. To ensure that this happens is the challenge facing both the human rights community and public health professionals” The UN High Commissioner for Human Rights
As defined by the Office of the UN High Commissioner for Human Rights and the WHO, the right to health embodies unalienable freedoms and entitlements. These include:
- The right to be free from non-consensual medical treatment, such as medical experiments and research or forced sterilization, and to be free from torture and other cruel, inhuman or degrading treatment or punishment.
- The right to a system of health protection providing equality of opportunity for everyone to enjoy the highest attainable level of health;
- The right to prevention, treatment and control of diseases;
- Access to essential medicines;
- Maternal, child and reproductive health;
- Equal and timely access to basic health services;
- The provision of health-related education and information;
- Participation of the population in health-related decision-making at the national and community levels.
Health as a human right therefore defines both a legal obligation and a set of values that are applied in a human rights approach to global health.
Useful Web Sites
- UCL Centre for Philosophy Justice and Health
- University of Essex: Human Rights Centre
- WHO: Health and Human Rights
- The People’s Movement for Human Rights Education: Human Rights and Health
- UN Commissioner for Human Rights
- Every Human Has Rights