World Health Day ‘My Health, My Right’

The right to health is a fundamental part of human rights and of an understanding of a life with dignity. It is not new. Internationally, it was first articulated in the 1946 Constitution of the World Health Organization (WHO), whose preamble defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. 

The 1948 Universal Declaration of Human Rights also mentioned health as part of the right to an adequate standard of living (art. 25). The right to health was again recognized as a human right in the 1966 International Covenant on Economic, Social and Cultural Rights. Since then, other international human rights treaties have recognized or referred to the right to health or to elements of it, such as the right to medical care. Every State has ratified at least one international human rights treaty recognizing the right to health.

States have committed themselves to protecting this right through international declarations, domestic legislation and policies, and at international conferences. Interestingly, Bunreacht na hEireann does not include health as an explicit fundamental right. Its inclusion was debated in the Oireachtas most recently in 2019 when a draft Bill to amend the Constitution was submitted for debate and ultimately rejected as usually occurs when the opposition table a Bill, however constructed.

World Health Day falls on April 7th ‘My Health, My Right’ was chosen as the theme, it is said, ‘to champion the right of everyone, everywhere to have access to quality health services, education, and information, as well as safe drinking water, clean air, good nutrition, quality housing, decent working and environmental conditions, and freedom from discrimination.’

Notwithstanding the unfortunate paraphrasing of a contested and controversial pro-abortion slogan, the 2024 theme adds little to an understanding of what is at stake when it comes to the practical applicability of such a wide-ranging and ambiguous right. No doubt such a right is aspirational. It is impossible to guarantee a right to health for everyone. As sure as night is day, death – the ultimate in ill-health -comes to us all, and as Benjamin Franklin famously said, nothing is certain in life except ‘death and taxes’.

Those shared certainties are apt when it comes to considering what constitutes the content of a right to health and especially when it comes to the responsibilities of the State as the primary duty bearer in facilitating, if not delivering, that right.

Obviously, this has cost implications, and therefore, taxes. In Ireland, 6.7% of GDP is spent on health says the Central Statistics Office. According to the EU it is just under 5% and the EU average is 7.7%. However, as is well known, Ireland’s GDP is artificially inflated by the presence of multinational headquarters, so it is argued, we are actually above EU average when this is adjusted for. As a total of General Government Expenditure (GGE), health makes up 20%, not an unhealthy amount.

Frequently, the NHS is lauded as being the exemplar of universal health care and the United States  approach favouring privatisation derided in ‘respectable’ circles, yet according to the WHO, the percentage of GGE is higher in the US (22% versus 19%).

Often, the reference made to the ‘highest attainable standard of health’ is as equally indeterminate as the right itself. Under what conditions is this highest attainable standard expected? How high a standard can a person expect to attain? What about contingencies such as genetics, accidents, and indeed the misfortune of contracting illness?

Equally, the right to health is interpreted by UN ‘experts’, academics and advocates as requiring States to make every possible effort, within available resources, to realize the right to health. But there are competing resources. Increasing health spend is considered progressive, but so is education, as is social welfare and social protection– as is more recent acquired responsibilities of the welfare state – such as housing, climate adaptation – with spend on transport and agriculture is increasingly cited as regressive. Which of the rights should get most investment?

Countries where CBM Ireland works to support health provision for people with disabilities have much fewer resources to start with than places like Ireland. The tax base is lower, incomes are lower, thus the absolute government spending is lower. And within that smaller pot of money, the percentage GGE falls typically into single digits, and often lower single digits. In Kenya and Zimbabwe where we work with support from the Irish government, it is 8.2% and 5.2% respectively.

Does this all mean that the right to health is less in Kenya and Zimbabwe, where resources are less, and the ‘highest attainable standard’ would typically be considered lower? Where human rights are considered universal and equal for everyone this surely makes no sense.

Of course, health also correlates to many other individual factors – individual wealth, predilections towards exercise, smoking, or health eating. What is the expectation on governments to intervene to promote what is good and discourage what is bad – and does a right to health then infringe and compete with other inalienable rights and the extent to which freedom maybe be impinged in promotion of the right to health? The Covid-19 pandemic highlighted with great clarity the lengths that the State may go to in protecting health at the expense of freedoms. In hindsight, protecting health in the short-term has a trade-off that has been devasting for many in the medium- and longer-term.

There is also the question of whose health and what type of health comprises an agreed understanding of health. Debates at the margins of the lifecycle see the erosion of rights of some as they compete with an expanding interpretation of the rights of others. ‘Reproductive health rights’ compete with, and are, in rights lexicon, considered to trump the right to life of the unborn child in the modern narrative. The right to ‘dying well’ competes with the resources that could be invested in living well and palliative care. These competing rights are not mutually inclusive. One person's right gets trumped by another's.

The Joint Oireachtas Committee on Disability Matters highlighted that since Ireland ratified the UN Disability Convention, we have regressed in terms of the right to health of people with disabilities. It is often forgotten that there is not an infinite pot of money and that tough decisions have to be made in terms of the public purse, but people with disabilities seem to be at the bottom of the food chain, as the Government and activists champion causes and rhetorical slogans.

With employment of people with disabilities in Ireland the lowest across Europe, inevitably, they pay less taxes. Does this mean that they are not entitled to an equal right to health? Disability inclusive health provision inherently costs more, requiring a greater investment by the State, and by the taxpayer. This is a cost of the social contract and the common good. But are we really committed beyond the rhetoric of rights, to what this means in practice?

When language is reduced to abstractions, which inevitably seems to be where a rights discourse ends up, a conversation about realities, about concessions and compromises, about a shared society, seems to be lost in the ether.

For all, death and taxes, are certainties. What is contested is how much taxes one needs to pay in order to forestall death. Or how much taxes one may be expected to pay to put death on the long finger for others in our shared society.

Dualta Roughneen is the CEO of CBM Ireland. This article appeared in https://www.irishcatholic.com/people-with-disabilities-bottom-of-food-chain-for-irish-budgets/