In the era of capitalism, the health of people and the planet is fundamentally challenged. International trade agreements and global economic policies have a great influence on national policies. They can even restrict countries in their ability to structurally improve and strengthen their health care systems. This makes health a shared responsibility at both national and global level, in which equity between and within countries should be a key element. To strengthen this perspective we need to reaffirm health as a human right and put it back in the limelight as such.
Health as a human right Neoliberalism; health as investment in human capital More than economic efficiency Who is responsible? Shared responsibility This blog was written by Global Heath Advocate Myria Koutsoumpa on the occasion of the Global Conference on Primary Health Care, held in Astana, Kazakhstan, on 25-26 October 2018. A first version of this blog was published by Medium.
The 1948 WHO Constitution declares health a fundamental human right and commits to ensuring the highest attainable level of health for all. Thirty years later, in 1978, the Declaration of Alma Ata sets the ‘Health for All’ agenda. Firmly based on these global agreements, the ambition for Universal Health Coverage (UHC) was adopted as a target within the Sustainable Development Goals in 2015. If health, and by extension UHC, is considered a human right, certain essential health services and goods should be guaranteed to each and every human being. However, history shows fluctuations in the approach to health.
With the establishment of neoliberalism as the dominant economic ideology between 1980-1990, focus shifted from equity to efficiency. International financing institutions, like the IMF and the World Bank imposed fiscal and monetary adjustments on countries in order for them to attain economic stability. Examples of these policies are the restructuring of the public sector, the deflation of health personnel and the introduction of the private sector in healthcare. Health is since then often perceived as merely an investment in human capital, leading to more production, more consumption and, therefore, economic growth.
After this narrow perspective on health, in which the human rights approach to health moved to the background, the realisation came about that an ethical consideration in economic efficiency is needed. Between 1990-2000 various international declarations and agreements, like the UN Millennium Declaration, made clear that economic criteria should not dominate the collective decisions on global health. The human rights approach returned and it was clarified that human rights should not be considered in relation to the resources available, but instead the resources should be adapted according to human rights.
With these shifts in the approach to health, the question remains: who is responsible for people’s right to health? Historically the primary obligation lies with the state. According to the United Nations the state has the obligation to “respect”, “protect”, and “fulfil” the right to health. But can this aspiration be equally realized by low-income states? Global and national economic policies affect the resources available and often impose a barrier to the scaling-up of public expenditure in the social sectors. Nevertheless, when we talk about health in resource-scarce settings, we should not focus only on figuring out the most efficient way to allocate the scarce resources. From a global solidarity level we need to ensure that additional resources complement the scarce resources. But also, and this is very important, we need to identify why the scarcity exists in the first place. The reason for this exceeds national boundaries and often lies in the neoliberal global economic order.
Even if according to the UN the right to health is a primary obligation of the state, UHC needs to be viewed outside national borders and rather through the lens of global social justice and shared responsibility. Actors such as high-income states, multilateral organizations and international financial institutions often influence and interfere in national governments’ autonomy over economic policies. Therefore, civil society and governments have a large responsibility to discuss this influence and interference. They should hold these powerful actors accountable for their share in realizing the right to health, and align their actions towards achieving Universal Health Coverage.
Dutch