Population Health and Human Rights
In 2004, Mexico launched a reform to achieve universal coverage through a public scheme called Seguro Popular, aimed at their uninsured population. By 2018, before it was dismantled, Seguro Popular was the largest health insurance program in the country, covering 58 million people with a comprehensive set of services ranging from community-based preventive interventions to primary and specialty clinical care. The 2004 reform was guided by a human rights framework: its point of departure was the principle that health care is not a commodity or a privilege, but a social right.
Mexico’s experience illustrates how the abstract notion of human rights can be translated into policies and programs with large positive effects for populations. The concept of human rights offers a framework for addressing a fundamental health policy question: how best to allocate limited health care resources and do so in a way that safeguards other rights associated with the process of care.
The way in which a society protects and promotes human rights shapes public policies, determines the distribution of resources and access to services, and ultimately affects population health.
The study of population health encompasses two main objects of analysis:
- the health conditions affecting a population and
- the organized social response to those conditions, particularly the way in which that response is articulated in the health system, including the principles and rules that determine who has access to which services and at what cost to whom. These services include both clinical and public health interventions.
Since the 19th century, national health systems have sought to provide health services to an increasing proportion of the population, using four eligibility principles:
- purchasing power,
- socially defined priority, and
- social rights.
All these eligibility principles result in only partial coverage, but the ideal of universality has influenced public policy in most countries, though the design and performance of health systems vary widely.
Public health experts have vigorously debated whether societies can guarantee the right to health itself or only to health care. One answer is suggested in the 1946 constitution of the World Health Organization (WHO), which says both that “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being” and that “Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.”
- The first statement recognizes the relative character of the right to health.
- The second statement recognizes the essential link between health and the major means for achieving it.
Therefore, Realizing the right to health care is a principal means for realizing the right to the highest attainable standard of health.
Two main approaches have been proposed for setting that standard:
- One uses a normative criterion that applies everywhere (e.g., the biologic limit of human life).
- The other is based on an empirical criterion: the highest observed level of health within or among countries, as measured by indicators such as life expectancy at birth or infant mortality.
All United Nations member states have recognized the right to health care in various international agreements, and universal health coverage is a target of the Sustainable Development Goals approved by the UN General Assembly in 2015. But less than half of UN member states explicitly recognize this right in their constitutions. Moreover, recognition is clearly not enough.
The realization of the right to health care by everyone regardless of social, economic, or labor status faces multiple challenges. One of the most complex stems from the striking variations in the performance of health systems among countries at similar levels of economic development and health care expenditures.
To advance the realization of the right to health care, certain practical conditions must be met.
- The specific health benefits to which all persons have access must be defined,
- A mechanism must be established empowering people to legally demand such benefits, and
- Financial schemes for fair and sustainable distribution of costs must be adopted.
Implementation of the right to health care can start with what the International Covenant on Economic, Social and Cultural Rights calls “minimum core obligations,” which should be expanded gradually as resources expand.
In addition, monitoring and evaluation mechanisms are required to ensure that initiatives designed to progressively realize the right to health care are on track, according to budgetary and health indicators and analyses of policies and laws.
At a time when all countries face common threats of pandemics, climate change, and social inequality, the universal character of human rights offers a shared opportunity to protect and promote the health of populations worldwide.