(Figures referenced are placed at the bottom of the article)
Article 25 of the United Nations’ Universal Declaration of Human Rights (UDHR) dictates to us that ‘Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services… Motherhood and childhood are entitled to special care and assistance.' These words from a 72-year-old document have allowed for great successes, struggles and failures in the world of medicine, economy & politics; it has caused their amalgamation, and dependency on one another, which continues to exist to this day.
First of all, it is important to understand what a human right is, let alone a ‘fundamental human right’ as well as establish what the United Nations meant by a ‘standard of living adequate for the health of [an individual], including medical care…’. The United Nations argue that the UDHR provides a ‘foundation of freedom, justice and peace in the world’ and the entire declaration has been incorporated in the laws of most member-states of the United Nations. However, despite its name, notably the use of ‘universal’, this declaration is not legally binding and thus a country has the ability to disagree with and ignore the set of ‘universal human rights’, which has been the case for Saudi Arabia. The Kingdom has only recognised three human rights resolutions/conventions (the Genocide Convention, the Slavery Convention and the Supplementary Convention on the Abolition of Slavery), proclaiming that the other resolutions, including the UDHR, violated the religion of Islam and its Shari’a law. Saudi Arabia is not the only country or group that has opposed this universal set of human rights; other examples include South Africa and The American Anthropological Association. The fact that various countries have decided to oppose a declaration that is nominally valid universally, and thus also fundamentally, creates an immediate sign of the potential flaws to the creation of the complete list of universal human rights. What’s more, the fact that there was little possibility for legally enforcing the UDHR, limits its viability. In 1966, The International Covenant on Civil and Political Rights does come into existence to allow member-states of the UN to ratify the Universal Human Rights into law; the articles, however, do not mention the importance of healthcare despite mentioning other individual liberties such as Freedom of Religion.
The American Anthropologist Association (AAA) published a statement in 1947, when the UDHR was in its construction, addressing the issues of the entire ‘Universal’ purpose as well as the lack of input and thought put in by the creators of the Declaration. The AAA argues that the UDHR cannot be truly representing universal human rights, as its creation was of Western origin, originating particularly from the United States. However, in that regard, due to the reasons that individuals are able to perceive opinions separate from the general beliefs expressed in their own culture, there is a possibility that universal moral principles do exist, as it implies that culture does not necessarily define one’s morals. The AAA writes, ‘Ideas of right and wrong, good and evil, are found in all societies, though they differ in their expression among different peoples. What is held to be a human right in one society may be regarded as anti-social by another people, or by the same people in a different period of their history.’, which further emphasises how there must be flaws with the UDHR, and that there cannot be a defined set of articles, including the Healthcare right or the Education right, because of the existence of different societies and cultures. The Abortion issue is an example of the conflict between Medicine and Religion (Note that both are equal rights within the UDHR). Therefore, we are seeing the issue that one is forced to prioritise a human right, over another one, which is resultantly infringing on an individual’s rights.
We should now consider whether healthcare is a right or privilege, regardless of the flaws of the UDHR / the concept of having a list of fundamental human rights. Let us say that we agree to the question ‘Is Access to Healthcare a Fundamental Human Right?’ The first issue which comes into place is the genericity of the term, healthcare. At no point, in the World Health Organisation (WHO) Constitution or the UDHR, do we see a clear definition of what type of healthcare must be fundamentally accessible by all 7 billion human beings. As the AAA mentioned, definitions of words differ between different nations, and even within nations. Let’s say that healthcare implies free and open accessibility to a list of health services, without discrimination. The National Health Service of England (NHS) provides free services to all souls (Citizen, temporary visitor, Immigrant) the following:
· A&E services – not including emergency treatment if admitted to hospital
· Family planning services – this does not include abortions or infertility treatment
· Treatment for most infectious diseases, including sexually transmitted infections (STIs)
· Treatment required for a physical or mental condition caused by torture, female genital mutilation (FGM), domestic violence or sexual violence – this does not apply if you have come to England to seek this treatment.
The NHS constitution also writes that its service must be ‘available to all irrespective of age, gender, disability, race, sexual orientation, religion, or belief’ and that access is based on ‘clinical need and not an individual's ability to pay; and that care is never refused on unreasonable grounds.’ Overall, this implies that, despite limitations of the type of healthcare one can receive, the NHS is expected to provide universal healthcare to all souls.
In contrast, according to The Cleiss, the French ‘Liaison Body between the French social security institutions and their foreign counterparts for the implementation of European Regulations and bilateral or multilateral social security agreements’, there is a clear stance that access to healthcare is dependent on one’s country’s relationship with the French Republic; this thus implies the accessibility of this so-called fundamental human right, is very much dependent on the political relationship between countries. The Cleiss website writes ‘Vérifiez auprès de l'organisme de sécurité sociale dont vous relevez s'il prend en charge les soins à l'étranger et dans quelles conditions.’, which, translated to English, informs us that people who visit France, have the prior responsibility to check with their own country’s ‘social security system’ in order to determine whether any costs for Healthcare in France, would be reimbursed; this means that the French organisations & government do not believe that they hold a particular responsibility to provide universal or fully accessible healthcare services to foreign souls. The responsibility, instead, lies in the country of the patient’s origin and the individual. Despite the two country’s similarities, especially economically, we can see two highly different stances towards the idea of universal access to healthcare.
We can further see contrasting views of the importance of healthcare, through an economic perspective. In an article by the American Public Health Association, we read that ‘countries with social democratic regimes, higher public spending, and lower income inequalities have populations with better health’. Therefore, one could determine how important and effective healthcare is, through the examination of public spending towards Health Services. However, this would imply that healthcare comes at a cost, despite potentially being a fundamental right. If Healthcare costs and overall general health (or even considering the responses to COVID-19) positively correlate, this hypothesis would be true; however, if this is not the case, there is an implication that the Economy is not a limiting factor, and therefore healthcare becomes more of a right than a privilege.
Figure 1 shows us the average spending per person for Health Services for different OECD countries. The USA spent £7736 per person, the UK spent £2989 per person, and Israel spent £2021 per person, with the median being £2913. If health services were fundamentally a privilege, one should see a clear difference in the quality of healthcare in countries with a higher spending rate, such as the United States, compared to countries such as Israel. This is not fully the case, as shown in figures 2A, 2B & 2C. High life expectancy is a useful measure in showing ‘a number of factors, including rising living standards, improved lifestyle and better education, as well as greater access to quality health services.’, according to th, Organisation for Economic Co-operation and Development (OECD). We in fact see that Israel has the highest life expectancy at 82.5 years, with the United Kingdom at 81.2 years, and the United States at 78.6 years. Of course, life expectancy is dependent on other factors, such as culture and different lifestyles, but it does begin to emphasise the fact that access to proper healthcare does not have to be reliant on the Economy and is thus more tangible and possible to achieve as a human right. The US’ considerably lower rank in life expectancy, compared to Israel, further shows how money does not, at least always, improve the overall quality of health.
Perhaps, there is an absolutist form of what healthcare is meant to be. Healthcare, as mentioned previously, and its access is purely dependent on the interpretation of a country’s or organisation’s laws and political systems. However, what if the laws of certain or most countries were wrong? Noam Chomsky, for example, argued that all humans have common morals; despite the fact that there are different societies and cultures, Chomsky argues that this does not imply that cultures imply different morals, but is the opposite, or else it would be impossible for humans to acquire or become affiliated with a particular culture/society – Homosexuality was seen, until recently to be a fundamental sin, but is currently normalised, which is due to all humans developing and further understanding their morals. The same could be said for healthcare; many governments could be misinterpreting the true meaning of ‘healthcare’, which is why there is a huge issue regarding the feasibility of allowing universal access to human rights.
A way which governments may be misinterpreting healthcare is by focussing a considerable amount of time, resources and funds, onto the treatment of illnesses, many of which are preventable, instead of taking efforts into educating all beings on how to prevent or protect oneself from contracting an illness. For example, let us consider Type-2 diabetes, which is a preventable illness, that can cause:
· heart disease and stroke
· loss of feeling and pain (nerve damage)
· foot problems – like sores and infections
· vision loss and blindness
· miscarriage and stillbirth
· problems with your kidneys
All of these issues, resulting from Type 2 Diabetes, can come at a large cost, both for oneself and for the provider of the Health Services (in this case, the National Health Service).
According to Diabetes.co.uk, between 2018-19, approximately 3,319,266 in England currently have Diabetes, with around 90% of these patients having preventable Type-2 Diabetes. Note that the main cause of Type-2 diabetes is due to poor diet, especially with excessive consumption of fats and sugars. With the assumption that access to any form of healthcare is a fundamental human right, Health Services, such as England’s National Health Service would be obliged to pay approximately £9,800,000,000 (2017) for the complications and treatments of all patients admitted with this preventable disease. What’s more, due to diabetes's great capability to cause potentially fatal health complications, the NHS is also burdened to fund these; In 2017, approximately £3 Billion, of the approximately £10 billion, was spent for the treatment and operations needed for (Diabetes-caused) Ischaemic heart disease and other Cardiovascular Diseases. These are merely statistics and do not represent the great burden on the doctors, nurses and medical specialists who obliged to care for all these Diabetes patients, as well as other patients.
It is absolutely important that the doctors, and the organisational groups that manage healthcare systems, make the best of efforts to strive to cure any patient who accesses healthcare, but why should the responsibility fall fully on the health service provider and the doctors? Surely, from a Synderesis Principle perspective, which is ‘the innate principle in the moral consciousness of every person which directs the agent to good and restrains him from evil’, it is the right thing that ‘every person’ makes effort to ensure that he/she does not become prone to some of these preventable diseases, in order that they do not unnecessarily burden healthcare providers, and potentially other souls, young or old, male or female. Therefore, this implies how healthcare is primarily about the importance of providing universal education and communication, about how any soul is able to create/adopt a lifestyle that would allow him/her to live a healthy life. If this form of ‘healthcare’ is determined a fundamental right, this would provide global knowledge that could prevent the need for so many people to use healthcare services for preventable diseases, especially those which cause life-long complications. This would also be addressing individual moral principles that every one of us must be taking responsibility for preserving our own health at the best of our abilities – a contrast with the UN or the WHO that have targeted and directed blame on governments and healthcare providers.
Of course, there are also issues regarding having this form of ‘healthcare’ as a fundamental right (or Right from illness). For example, one would be forced to question whether providing highly advanced healthcare services, such as cancer treatment or just quicker ‘privately-insured’ treatment, would still remain a privilege. What’s more, what would healthcare providers do to those who blatantly refuse to follow guidelines that try to ensure the prevention of acquiring illnesses; are healthcare providers still obliged to help these people, regardless of these individuals’ lacking moral principles?
The United Nations UDHR, its covenants for health, and its WHO Constitution, have emphasised the flaws in the concept of human rights and of the meaning of ‘healthcare’, which we were required to explore in order to attempt to answer the question. It is true that there can be many interpretations, due to the multicultural nature of this planet; however, it is also possible to argue that individuals naturally desire pleasure/happiness, by following the Utilitarian perspective, and also that individuals ultimately aim to achieve good, according to the Synderesis Principle. Whilst I agree that (preventative) medicine bestows the onus for healthcare upon the individual; society and its peoples also have a moral responsibility to ensure that they are able to allow access to healthcare, both for themselves but for their families and other dependents, who could even be relying on healthcare access to survive. Perhaps if we all uphold this moral responsibility, there may be potential for universal improvements for our health.
