Better Health For All

The public health community is accused of many things but insurrection is rarely one of them. In fact, insurrection sounds more like something out of Tudor England and the 1536 Pilgrimage of Grace. However, if the public health function were to adopt a rights-based approach to the delivery of health improvement then insurrection may indeed be just around the corner.

But what is a rights-based approach? Human rights are set out in the 1948 Universal Declaration of Human Rights and provide the world’s governments with a code of conduct. This declaration, most notably, covers civil and political rights – for example, the freedom of speech – but there is also a third element of social rights. The latter includes the right to education, an adequate standard of living, basic housing, food AND the highest attainable standard of health. All these rights are of equal standing. They are indivisible from each other, inter-dependent and inter-related. Upset one (eg remove housing) and others (eg health) is upset. Human rights are also backed by legal obligation and can therefore be both challenged and defended in a court of law.

Such rights can be delivered through a set of PANEL principles of Participation, Accountability, Non-discriminatory, Empowering, and Legally-supported. Rights-based services are always Available, Accessible, Acceptable and of high Quality (AAAQ). Social rights also carry the obligation to be realised progressively over time, although resources can be taken into account. It means that where evidence backs intervention and there is low or even no cost to the State, then the Government has a duty to implement the measures. That means a year on year, decade on decade, improvement. Think what that would do to help the population achieve the highest attainable level of health.

The idea of the right to health generating insurrection is not as far-fetched as it sounds. The demand for human rights to be observed and protected is often led by those who are deprived of such rights. Consider the resistance to apartheid as just one example of a movement to overturn injustice on a national scale. Although public health organisations are not human rights organisations per se, it is no stretch of the imagination to see that good public health is good human rights.

Public health organisations and professionals are in an excellent position to encourage the public both to want and to expect better levels of health. Reframing public health messages in terms of the right to health could create the potential for greater public demand and consequently increased political support. A rights-based public health policy might, for example, promote value-added nutrition labels on food and alcohol as information labels to satisfy consumers’ rights to know about the food and alcohol they purchase rather than as a mechanism for tackling obesity which raises objections as a barrier to trade.

The right to health should become a standard tool for the public health profession in its quest for a more equitable and healthier society. Used to its fullest extent it might even lead to the next “Pilgrimage of Grace” by a populace demanding the Government changes a course of action.

Written by Heather Lodge, UK Public Health Network Co-ordinator. The question of how the public health community can make use of the right to health will be on the table for discussion at Public Health England’s conference in September 2018. The session will be chaired by Paul Lincoln with John Coggon of Bristol University and Cath Denholm of NHS Health Scotland providing expert analysis and commentary.