Public health practitioners and theorists are diverse and have various social goals that they promote, but the unique status of public health can be traced to the fact that most of what it has historically concerned itself with can be classified as the provision of health-related public goods, the author of this paper argues. He asserts that a public goods framework serves as a useful criterion for distinguishing public health from private health, and it explains why public health goals have special urgency. Public health goals, properly understood, generally require collective action to achieve, and can be endorsed by a wide variety of moral and political theories. The public goods account has the further advantage of establishing a relatively clear and distinctive mission for public health. It also allows a consensus of people with different comprehensive moral and political commitments to endorse public health measures, even if they disagree about precisely why they are desirable.
Values, Policies and Rights
The UN General Assembly is currently considering proposals for Sustainable Development Goals (SDGs). SDG 3, focusing on health, specifically includes universal health coverage (UHC) among its targets. The authors argue that while UHC is timely and important, its promotion also entails substantial risks. A narrow focus on UHC could emphasise expansion of access to health-care services over equitable improvement of health outcomes through action across all relevant sectors—especially public health interventions, needed to effectively address non-communicable diseases (NCDs). The challenge for policy makers is observed to be to not merely to improve clinical services, but to achieve equitable health outcome improvements through genuine integration of individual and population-level health promotion and preventative efforts with curative services. Future UHC evaluations should include assessments of the extent to which this integration is accomplished—with particular attention to the distribution of benefits across groups—and not, as major current work be limited to the clinical side.
The Cairo Agenda – a set of international agreements – which came out of the International Conference on Population and Development in 1994, shifted policy focus away from population control. Access to good quality reproductive health care for both women and men was promoted as a right. The more recently agreed Millennium Development Goals (MDGs) however, narrowed the focus down to maternal mortality. While it is crucial to address maternal mortality, it is important to bring reproductive health back into the picture as without this the MDGs will not be met.
This discussion paper presents key elements of the concept of UHC as promoted by the World Health Organisation and reflects them based on Medicu Mundi International’s (MMI) own ambition of Health for All such as stated in the MMI Network Policy. The paper consists of three sections (1) “What is in Universal Health Coverage?” (2) “Financing UHC”, and (3) “UHC and health equity”. MMI argues that if its Network is to promote Universal Health Coverage in view of improving health equity, then it should be willing to be truly involved in the political and ideological battle that will enfold over the coming period. Unless the international community pushes the right to health up in its scale of values and stops considering health as a dependent variable of the global economy, and unless it makes the respect of human rights mandatory and those who violate them legally accountable, UHC is unlikely to yield the expected results. Issues needing further investigation include: Universal Health Coverage and gender equity (almost entirely missing in the current debate); Universal Health Coverage and sustainability; the political economy of Universal Health Coverage; and the transformative power of the UHC concept for social mobilisation and political change towards Health for All.
The right to health has been enshrined in a number of core international and regional human rights treaties, to which WHO African Region Member States are signatories. This therefore imposes an obligation on them to make every possible effort using available resources to respect, protect, fulfil and promote the right to health of their citizens. This study analysed key issues and challenges affecting the realisation of the right to health in African countries. A survey questionnaire was sent by email to the then 46 Member States in the African Region through the WHO Country Representatives, and explored legal, policy and institutional aspects that affect the realisation of the right to health and the main health related human rights issues, and challenges in implementing the right to health. Twenty-five (54%) countries responded. The main findings were that all countries were signatories to at least one human rights treaty that recognises the right to health; all countries had national legislation touching on aspects of the right to health but only 12 countries (48%) had policies or strategies for mainstreaming human rights in healthcare. On issues affecting the realisation of the right to health: 88% identified access to health care services, medical products, and technologies; 52% identified inadequate financing for health; 28% cited marginalisation, stigma and discrimination of some groups and communities; and 24% cited gender-related inequities and violations. Lack of awareness of the right by the general population and health workers was cited by 52% of the respondents. A lot remains to be done towards the realisation of the right to health in the African Region. Member States are encouraged to review their legislation and policies to assess their consistency with human rights standards, and put in place institutional mechanisms and adequate resources that will ensure their implementation, enforcement and monitoring.
The authors propose that applying a robust human rights framework would change thinking and decision-making in efforts to achieve Universal Health Coverage (UHC), and advance efforts to promote women’s, children’s, and adolescents’ health in East Africa, a priority under the Sustainable Development Agenda. Nevertheless, they point to a gap between global rhetoric of human rights and ongoing health reform efforts. This article seeks to fill part of that gap by setting out principles of human rights-based approaches and then applying those principles to questions that countries face in undertaking efforts toward UHC and promoting women’s, children’s and adolescents’ health, particularly to ensure enabling legal and policy frameworks, establish fair financing and priority-setting and provide meaningful oversight and accountability mechanisms. In a region where democratic institutions are weak, the authors argue that the explicit application of a human rights framework could enhance equity, participation and accountability, and in turn the democratic legitimacy of UHC reforms being undertaken in the region.
The authors argue that applying a robust human rights framework would change thinking and decision-making in efforts to achieve Universal Health Coverage (UHC), and advance efforts to promote women's, children's, and adolescents' health in East Africa, a priority under the Sustainable Development Goals. They point to a gap between global rhetoric of human rights and ongoing health reform efforts,. and seeks to fill part of that gap by setting out principles of human rights-based approaches, and then applying those principles to questions that countries undertaking efforts toward UHC and promoting women's, children's and adolescents' health, will need to face. The paper focuses in particular on ensuring enabling legal and policy frameworks, establishing fair financing; priority-setting processes, and meaningful oversight and accountability mechanisms. In a region where democratic institutions are argued to be weak, the authors argue that the explicit application of a meaningful human rights framework could enhance equity, participation and accountability, and in turn the democratic legitimacy of health reform initiatives being undertaken in the region.
In September 2015 Heads of States and Governments will gather at the United Nations (UN) headquarters in New York City to agree on a new set Sustainable Development Goals (SDGs) and a 'global plan of action for people, planet and prosperity'. The latest draft of this declaration which promises to 'transform our world' by 2030 and ensure that no one will be left behind in the process has just recently been released. However, the PHM notes that many of these same governments, particularly the more powerful ones among them, are also currently negotiating new 'free trade' deals that will have far-reaching implications for peoples in both the global North and South and for the future of the world economy and the planet. These agreements as they are currently framed and when adopted side-by-side, will not usher a new dawn for humanity. Instead they are likely to further concentrate power and wealth in the hands of the 1% on the one hand, and deepen the dispossession, exploitation and oppression of peoples and environmental plunder on the other. A call, initiated by the Campaign for People's Goals for Sustainable Development, notes that people will not accept a development agenda that will serve as a vehicle for strengthening corporate power, re-legitimise the global capitalist growth model and perpetuate neoliberal globalisation.
Global and national responses to the COVID-19 pandemic highlight a long-standing tension between biosecurity-focused, authoritarian and sometimes militarised approaches to public health and, in contrast, comprehensive, social determinants, participatory and rights-based approaches. Notwithstanding principles that may limit rights in the interests of public health and the role of central measures in some circumstances, effective public health in a protracted pandemic like COVID-19 requires cooperation, communication, participatory decision-making and action that safeguards the Siracusa principles, respect for people’s dignity and local-level realities and capacities. Yet there is mounting evidence of a dominant response to COVID-19 where decisions are being made and enforced in an overcentralised, non-transparent, top-down manner, often involving military coercion and abuse in communities, even while evidence shows the long-term harm to public health and human rights. In contrast, experiences of comprehensive, equity-focused, participatory public health approaches, which use diverse sources of knowledge, disciplines and capabilities, show the type of public health approach that will be more effective to meet the 21st century challenges of pandemics, climate, food and energy crises, growing social inequality, conflict and other threats to health.
A global coalition of civil society organisations and trade unions presented a report on 'Spotlight on Sustainable Development 2017'. The report provides a comprehensive independent assessment of the implementation of the 2030 Agenda and its Sustainable Development Goals (SDGs). In the 2030 Agenda governments committed to a revitalised Global Partnership between States and declared that public finance has to play a vital role in achieving the SDGs. But in recent decades, the combination of neoliberal ideology, corporate lobbying, business-friendly fiscal policies, tax avoidance and tax evasion has led to a massive weakening of the public sector and its ability to provide essential goods and services. The same corporate strategies and fiscal and regulatory policies that led to this weakening have enabled an unprecedented accumulation of individual wealth and increasing market concentration. The proponents of privatisation and public-private partnerships (PPPs) use these trends to present the private sector as the most efficient way to provide the necessary means for implementing the SDGs. But many studies and experiences by affected communities have shown that privatisation and PPPs involve disproportionate risks and costs for the public sector. PPPs can even exacerbate inequalities, decrease equitable access to essential services and jeopardise the fulfilment of human rights. Therefore, it is high time to counter these trends, reclaim public policy space and take bold measures to strengthen public finance, regulate or reject PPPs and weaken the grip of corporate power on people’s lives. These are indispensable prerequisites to achieve the SDGs and to turn the vision of the transformation of the world, as proclaimed in the title of the 2030 Agenda, into reality. The 160-page report is supported by a broad range of civil society organisations and trade unions, and based on experiences and reports by national and regional groups and coalitions from all parts of the world. Its 35 articles cover all sectors of the 2030 Agenda and the SDGs, and reflect the rich geographic and cultural diversity of their authors.