Implementation of the right to health has been interpreted by the United Nations Committee on Economic, Social and Cultural Rights (the Committee) to include both entitlements and freedoms.
People are to be free to control their own bodies and health, including their sexual and reproductive health; and to be free from interference with their bodies and health (for instance, medical experimentation against their will, or torture).
People are entitled to the equality of opportunity to enjoy the highest attainable standard of health.
The Committee has fleshed out the meaning of the right to health to incorporate the following elements:
- Availability – Sufficient quantity of functioning public health and health-care facilities, good and services including, at a minimum, safe and potable drinking water; adequate sanitation; hospitals, clinics and other health buildings; trained medical and professional personnel who receive domestically competitive salaries; and essential drugs (General Comment No. 14, para 12(a)).
- Accessibility – All people in the country (regardless of whether they are citizens or not, and especially if they are vulnerable or marginalised), have equitable access to health facilities; goods; and services without discrimination. Accessibility has four overlapping dimensions:
ii. Physical accessibility– health facilities, goods and services and the underlying determinants (eg, safe water and sanitation) must be within safe physical reach for everyone. This is important in a country like Australia with a large physical area, much of it remote, and a dispersed population;
iii. Economic accessibility (affordability)
iv. Information accessibility– this means that health consumers can participate in decisions about their health and have confidentiality of their health information protected.(General Comment No. 14, para. 12(d))
- Acceptability – Health facilities, goods and services should be respectful of medical ethics and be designed to respect confidentiality and improve the health of consumers. They should also be designed to ensure that people receive treatment appropriate for their culture, gender and stage of life (General Comment No. 14, para. 12(c)).
- Quality – Health facilities, goods and services must be scientifically and medically appropriate and of good quality (General Comment No. 14, para. 12(d)).
The right to health is not a right to be healthy – people are free to make choices that are unhealthy. Rather, the right is concerned with the systems, facilities, services and conditions that are necessary for everyone to achieve the highest possible standard of mental and physical health. (General Comment No. 14, para 8.)
The starting point in animating the right to health is seeing that it is interdependentwith other human rights (eg, the right to food; to housing; to work; to education; to dignity; to life; to be free from discrimination; to be free from torture; to privacy; to access information; to associate with others).
A more sophisticated understanding incorporates the underlying structural, economic and social determinants of health. This is sometimes called a ‘social determinants of health’ approach. (An outline of this approach can be found in Social determinants of health: the solid facts, WHO, 2003.) This approach informs local health initiatives such as the Close the Gapcampaign, and the response from Australian governments, Closing the Gap: the Indigenous Reform Agenda.
The objectives of this package are to:
- close the current life expectancy gap within a generation
- halve the gap in mortality rates between Indigenous and non-Indigenous children under five within a decade
- halve the gap in reading, writing and numeracy achievement between Indigenous and non-Indigenous students within a decade
- halve the gap in employment outcomes between Indigenous and non-Indigenous Australians within a decade; in the year before formal schooling, provide all Indigenous children in remote communities with access to early childhood education within five years
- halve the gap for Indigenous students aged 20 to 24 years old in Year 12, or equivalent, attainment rates by 2020.