COVID-19 pandemic that has shattered life everywhere has raised many questions over health status of people, adequacy and accessibility of medical care facilities in the country. Though the world has not experienced this kind of prolonged and extensive damages to normal life suddenly overtaking its enormous capabilities, critics are busy accusing healthcare authorities for shortcomings and lack of planning leaving out people’s behaviour. In the midst of the politics of charges and counter-charges, one important issue that has come up for serious consideration is adding Right to Health as a fundamental right.
In times of epidemics, health at all stages is a matter of public health not restricted to an individual’s personal sphere. It requires attention to the affected and the community around at the same time. Health machinery must be equipped to handle both simultaneously. Hence, right to health is stretched from individual sphere to the entire nation.
COVID-19 will definitely have negative impacts on most of the SDG. Good health and well-being (Goal3) will be one among these. About 70 countries have halted childhood vaccination to take up COVID-19 treatment, care, and prevention. In many places including India even cancer screening, family planning, and non-COVID-19 infectious diseases, and treatment of serious but non-communicable diseases like diabetics were seriously disrupted during the first and second wave of the pandemic.
The Constitution of the WHO (1946) says that, “Enjoyment of highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”. Right to Health was accepted as central to WHO’s very existence and mandate.
The Universal Declaration of Human Rights (1948) includes right to standard of living adequate for health and well-being of individuals which makes it clear that health is dependent on many social-economic factors of life and is not an independent right. Until the Alma-Ata Conference in 1978 declared the goal of “Health for All by the Year 2000”, health did not receive international attention as a priority area though this was the crucial period of post-War reconstruction which included health and standard of living.
Since this conference, access to healthcare is gradually being opened to cover more and more people and has become a prerequisite for development and has given rise to a democratic demand for right to health and that too as a fundamental right.
Right to health is subsumed in Article 21 of the Indian Constitution. In 1992, the Supreme Court relied on international instruments and inferred that health is a fundamental right and not merely absence of sickness. In 1996, SC declared that it is the primary duty of a welfare State to ensure that medical facilities are adequate, and failure to fulfill this obligation would violate fundamental right.
Health Policy of 2017 shifted focus from sickness to preventive care and aims to increase public health expenditure to 2.5% of GDP, promises better access to healthcare while reducing costs. In September 2019, a High Level Group on Health Sector constituted by the 15th Finance Commission recommended that Right to Health be declared a fundamental right and heath be shifted from State to Concurrent List.
Healthcare, which has been dependent all along mainly on individual capacity to pay, is now expected to be provided for all either free or at affordable cost. The demand is relevant in fighting highly communicable epidemic diseases. Right to health actually means right to healthcare. For, health cannot be guaranteed or assured while care can be. Healthcare is a vast area covering many sectors.
“Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures”, says the Constitution of the WHO, thus putting the entire burden on the State. Enjoyment of highest attainable standard of health is one of the fundamental rights of every human being in the concept of WHO at its inception.
The National Health Profile 2015 for India pointed out the crisis in healthcare system which was under great strain. The country was spending just 1.29% of GDP for Health in 2019-20 which was lower than in some of the world’s poorest countries. On an average, every government hospital in India was serving an estimated 61,000 people in India with one bed for every 1,833 people. Every government allopathic doctor was serving a population of over 11,000 people.
However, some satisfaction was derived from Bare Necessities Index (BNI) that showed improvement in access to basic needs such as housing, sanitation, water, power, and cooking gas in all States in the country by 2018. BNI covers 26 basic necessities without which health would remain just a dream. It is developed as a means of assessing economic development using “basic needs approach” components of which comprise elements indispensable for health and wellness.
The pandemic has taught us the importance of sustainability that should be taken seriously. Inequities and vulnerabilities in healthcare system have been exposed in detail as a result of comparative pandemic situation in different areas and segments of the population. They have to be addressed immediately as a top priority. The entire healthcare system will fail unless these two maladies are corrected. Partial healthcare cannot arrest a pandemic.
COVID-19 has rekindled our interest in operationalising “One Health Approach” in India and in launching the National Mission on Biodiversity and Human Well-being.It is so designed as to bring together multiple sectors to pool ideas and work in collaboration for better health services. It aims to reconcile environmental protection, economic prosperity, and societal welfare in India by incorporating biodiversity as a principal consideration in all development programmes and promoting biodiversity science as a discipline in the country. Specific fields such as food safety, pharmaceutical industry and water supply which are basic to health may be considered for joint action.
The National Mission on Biodiversity and Human Well-being aims at greener, healthier, and more sustainable way of life. Involving scientists as well as farmers, government departments as well as voluntary organisations, it can promote health aspects in science, policy and indeed in our consciousness in every sphere of activity. Health is not just appropriate and timely medical attention. It has to be part of our lifestyle. Instead of “rights” approach, we should seek healthy way of life. Governments have to facilitate this.
Very few countries in the world have included right to health in their Constitutions. Among these are Chile, Cuba, and Panama. However, 73 member-States of the UNO have guaranteed a specific right to healthcare. The European Social Charter refers to the right to protection and promotion of health and the African Charter on Human and People’s Rights promises medical services in case of illness. How much of it is practised is a different issue.
Constitutions apart, right to health must as a corollary carry an obligation on the part of the receiver at least in the form of following prescribed norms and regulations. There can be no blanket right or privilege without a duty.