Introduction
Standard of living refers to the objectives that people have with respect to goods and services. In a more specific way, it refers to the level of goods and services desired by people. Here, goods and services mean items that are privately bought and that which are not directly controlled by people but adds to their well-being. Every human has certain fundamental rights which include the right to food, shelter, protection, and another standard of living. Since something which adds to the well being of people is a part of the standard of living, for this reason, the right to health is also included in it; such a right involves the presence and provision of necessary facilities to a person so he can enjoy a healthy life; the presence of safe environment, availability of food with required nutrients, medical facilities such as hospitals, drugs, and medical workforce.
The right to health is considered significant in the developed world and for this reason, numerous efforts have been successfully made but, it is often overlooked in developing countries, as a result, the standard of living of people in these countries is very poor. These people face many health problems and the unawareness of their right to health further aggravates the situation. There is international and regional level, there are bodies, treaties, and agreements that have been designed and implemented for providing people with the best possible rights to health and different countries consider it their duty domestically, to make sure that their citizens enjoy the best health by inculcating the provision of this right in their constitution, even in the developing countries. Where international efforts refer to those efforts that are being carried out at the macro level across the world, regional level refers to those agreements that cover a certain region like Asia or Europe, or the Middle East and domestic efforts are those which are being carried out within a country.
The essay analyzes whether the international framework for the right to living is effective and influential from the aspect of rights to health by assessing the extent to which it has worked towards the fulfillment of the right to health. It discusses the effective efforts being made at the international and regional level for ensuring an adequate right to health, where effectiveness refers to the extent that success is made in achieving objectives and resolving targeted problems. It also discusses how influential the international framework is in terms of the influential organizations in this context, where influential refers to the capacity of creating an effect to achieve the goals without the use of power. To assess the practical effectiveness, the essay briefly discusses the legal dimension of the domain in India and South Africa.
In order to evaluate the effectiveness of the various efforts, the essay sheds light on the role of health care provided by the private sector, the effect of public health policies and local laws, country-specific factors that act as a hindrance in the due efforts, and some of the major health care issues in the developing world.
International, Regional and domestic efforts for the rights to health
Each country is a member of at least a single human rights treaty that is directed towards the rights to health. Right to health can actually be granted through the provision of other rights such as the right to food, housing, etc. the situation is better in the developed countries but in the developing countries that are already poor and face increasing populations are not able to grant their citizens such rights, even if it is a part of their constitution. They have to bear so many other problems that they consider this ‘right to health’ a secondary right that needs attention only when other basic problems are solved. However, the point of realization for these developing countries is that the health problems may prove to be a cause of many other problems such as limitations and disabilities of the workforce affecting the economy. Another thing is that health issues are actually intertwined with many other problems such as poverty, lack of sufficient food and health are all related. If one problem needs to be resolved, the whole list of associated problems needs to be addressed.
Health was traditionally viewed as a private domain. One of the initial laws that include health-related provisions can be traced to the era of industrialization where The Moral Apprentices Act (1802) and Public Health Act (1848) were implemented in the UK for controlling social pressure resulting from meager labor conditions. Health was officially defined as a social issue in 1946 with the creation of the World Health Organization (WHO) and was further confirmed by the 1978 Declaration of Alma-Ata on Primary Health Care, by pledging of the states to gradually develop complete health care systems to assure health maintenance.
In certain scenarios, attaining the highest possible standard of living is difficult as that which is provided to a nation fails to fulfill the minimum -agreed upon by all rights of health due to all people. This happens as various governments in the developing world are not able to cater to the health care and living conditions that will be sufficient for all the citizens, consequently, their nations become a victim of those diseases whose prevention or cure is otherwise possible in developed nations.
Within the international framework, effective efforts are being made to ensure the provision of an adequate and progressively improving standard of living. For achieving this purpose, the international framework has been designed to include the right to adequate health in various agreements of different organizations whose existence is meant to provide solutions for the health issues of the developing world. Some of these organizations exercise great influence on the countries like ‘The Global Fund to Fight AIDS, Tuberculosis and Malaria’ which distributes funds for nationwide projects in those countries where the disease burden is high, and ‘WHO’ which is involved in efforts for improving the methods of health care and creating health care standards for the international community. There are also non-profit organizations which are operating for the same purpose like ‘Project HOPE’, whose mission is to attain continuous progress in health care across the globe through various means; ‘The Soros Foundation’, which makes efforts for improvement in health infrastructure among other initiatives; ‘The Gates Foundation’, which gives grants for various global health initiatives.
World Health Organization is a vital international organization with respect to health rights and exercises the most influence, especially in developing countries. The reason being that its efforts and programs in a certain country are tuned to the requirements of that country. It plans its action after assessing the needs of its people. World Health Organization plans to provide all kinds of support including technical assistance to make sure that the standard of living with respect to health is improved. This is because technical help is very critical especially in developing countries. In addition to that, continuous monitoring is essential and is done to make sure that programs and efforts are implemented effectively. World Health Organisation plans to work in support of different partners such as governments (both central and state), society, and all the parties who may affect the processes directly or indirectly.
Another organization that is a part of the international framework and is quite influential is the World Bank which provides funding for the betterment of the health condition in developing countries as there is a dearth of financing. Although the financing by these organizations is only about 1-2% of total health expenditure, these contributions are considered worthwhile as they provide relevant knowledge, guidance, technology, etc. Besides, to reduce deadly diseases like AIDS, Tuberculosis, and Malaria, Global Fund is another influential actor which also supports the cause and it has provided $27.7 million in support of such activities. Along with the fund provision, the Global Fund takes on the responsibilities of implementation, allocation, and monitoring of the grants as well. These funds have been extra support for a country like South Africa. But unless the society and policymakers together take steps to protest against health violations of human rights, no permanent practices can be adopted.
On a regional level, there have been various treaties and conventions which have effectively recognized various human rights including the right to health. There are courts and bodies like the African Commission on Human and Peoples’ Rights, the Inter-American Court of Human Rights, and the European Committee of Social Rights which contribute a great part in order to protect the right to health. Some of the regional human rights treaties which explicitly include the right to health care:
European Social Charter, 1961: this charter ensures that the right to protection of health is efficiently exercised by binding the Contracting Parties to carry out such measures that can effectively fulfill the purpose.
African Charter on Human and Peoples’ Rights, 1981: Article 16 of this charter specifically deals with the health issue by asserting that all people will have the right to the best attainable condition of health and the involved States will ensure the protection of the health of their citizens and provision of medical attention when required.
Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social and Cultural Rights (the Protocol of San Salvador), 1988: Article 10 of this Protocol is pertinent to health rights where a provision to ‘highest level of physical, mental and social well-being has been assured and States Parties are required to adopt certain measures to guarantee the provision of the best health to citizens.
Other than macro efforts at the international and regional level, there are efforts that are being carried out at a smaller domestic scale. From a legal perspective, the constitution of a country is most important when analyzing what the State provides to its citizens, in this regard, the right to health was first incorporated in local law in the first half of the twentieth century. By now, many states have made the right to health a part of their constitutions, though there are some countries whose legal systems are formed on the basis of common law and they do not give such constitutional rights but implicitly public responsibilities for health is a preamble in many of these constitutions or in their social policies. In India, the constitution guarantees the right to health by putting the main responsibility of health on the shoulders of different states; this means that in reality there is no accountability for the States or a higher authority to ensure that these rights are being provided. The constitution of South Africa also includes the right to a standard of living in which the right to health is included.
Since 1966, the health conditions in the world have improved greatly. The health aspects, for instance, gender-based issues, have been incorporated now in the broad definition of health whereas previously there were great issues of gender discrimination. More focus is placed on the health aspect and different government, non-government and international organizations work towards improving health conditions and hence working on improving standards of living.
Keeping in view the nature of the essay, in general comment 14 of ‘economic, social and cultural rights (ESCR)’, the ‘right to the highest attainable standard of health is emphasized. This right entails biological as well as socio-economic preconditions. It also considers the resources of a state. This covenant not only focuses on treatments and medical facilities rather it emphasizes the basic factors which are essential in the provision of a healthy lifestyle. According to this, the important components of the ‘right to health’ are availability, accessibility (physical, economic, information), non-discrimination, acceptability, and quality of health facilities. Another aspect which has been focused on is that the bad conditions in developing countries should be improved with collaboration for the developed world. As far as the implementation is concerned, the covenant gives states to decide on the best strategies based on their local requirements. The covenant also emphasizes taking help from organizations like World Health Organization (WHO) and UNICEF.
There are various countries in the world that suffer from many health-related problems. High death rates, maternity problems, nutritional issues, lack of safe water facilities, diseases, lack of medical facilities are just some of the many problems.
There is limited access to public health care in developing countries, showing the lack of effectiveness of such efforts in this sector, and for this reason; private providers are at the forefront. The governments of these countries fail to provide common access to care and thus the private sector is the option for healthcare services. The public sector has insufficient funds and hence is unable to provide high-tech facilities for the people. These services are, however, available in the private sector but are quite expensive. Due to the better benefits offered by the private sector, most health professionals want to join this sector rather than the public sector. In South Africa, the divide in the private and public sectors as far as health is concerned is prominent. The private sector caters to only around 18 percent of the South African population, while the impoverished majority only has access to the resource-constrained public health sector, this poses a lot of problems for South Africa which is a poor country.
If strategies for public health policy in developing countries are analyzed, it is visible that they are typified by conflicting views. There are variations with respect to the sources of health sector improvement which results in differences in the goals of the health sector. There is the prevalence of a normative policy which can be attributed to a one-way association with a single goal in the health sector and refutation of the others. Recently, there has been an interest in utilizing cost-effectiveness measures when setting national health policies, such priorities in the health sector provide sub-optimal solutions since the spending in the health sector is low.
Lately, the countries in Southeast Asia and other regions have significantly progressed with respect to funds on health care. There has been effective work yielding a great increase in health care due to economic development, resulting in falling mortality rates of infants and mothers and increased life expectancy. There has been an increase in the numbers of doctors and nurses and in the share of total health expenditures. One of the biggest issues faced by these developing countries is with respect to health care costs and various countries have implemented solutions for cost recovery[15]. But this doesn’t mean that no efforts are being made in this regard. For example, in 2008, the South African Government is said to spend approximately 11 percent of its budget on health plans additional resources to the public health sector for HIV/Aids treatment and prevention and additionally to combat T.B. and child mortality. The budget for the fiscal year 2009/10 would allocate additional funds for increasing the remuneration of health professionals as well as for the revival of public sector hospitals throughout the country.
Some of the local laws in the developing countries have helped in the improvement lead. An influential law is the Indian Patent Act of 1970 which allowed drug manufacturing to develop in India till the end of the patent period. Now, the pharmaceutical industry represents almost 1.5% of GDP. The growth in this industry has been tremendous over the last ten years. This also allowed them to sell the drugs in the Indian market as well as in the foreign market. This greatly helped the industry to develop its roots in India. This development of this industry has resulted in the provision of low-cost medicines to the people.
In South Africa, World Health Organization (WHO) has been convinced by the efforts of the country in preventing malaria, that the apt use of Dichloro-Diphenyl-Trichloroethane (DDT) can in fact be a winning element in fighting the disease that kills many. According to the South African Health Ministry, the disease which previously infected 15 out of every 10 000 people) in 2000 now affected only 2 per 10 000 by the year 2005. South Africa, which was reported to have almost 80 percent of worldwide malaria cases, is fast-moving towards effective control of the disease. Evidence suggests that death cases as a result of malaria reduced dramatically following the use of insecticides indoors.
There are certain country-specific factors that are often a hindrance in the effectiveness of improving conditions in every developing country. For instance, in India, maternity problems, as already mentioned, are widespread and when family planning is advised, a high level of reluctance is faced by the promoters. The people have a traditional belief of having large families and they will not follow anyone who recommends them anything against their values. Another factor is the illiteracy and the unawareness of mothers which is a hindrance in the provision of proper nutrients to their children. Therefore, along with the healthcare facilities, people need to be educated about health requirements. This is because unawareness and lack of knowledge is a major obstacle in the success of many health care programs, processes, and efforts. In South Africa, a study showed that, prior to February 2006, three-quarters of the total expenditure on environmental health services were being funded by local municipalities. However, the concentration of such services was in urban areas and funding in rural communities was not as adequate.
There are also other health issues present in the developing countries, one of them is the migration of health workers. For instance, in India, due to the high demand and available support and facilities, health workers often migrate to industrialized countries. This may be a critical situation for a country like India, where these workers are highly required because of poor healthcare. An inter-governmental organization, Commonwealth Foundation has taken a step forward to address this issue, it will be working in collaboration with the government for the retention of health workers and to provide them with the incentives they are getting after migration.[22] Similarly, in South Africa, the professionals move to the places which offer them better benefits; the number of doctors leaving South Africa is quite large.
Malnutrition makes people and children susceptible to diseases, while infectious diseases also have been known to cause malnutrition, this problem is prevalent in South Africa. Another biggest health issue is that of AIDS in South Africa which has the highest number of victims. For this, National AIDS Council is working on different developmental programs in Botswana. Concrete steps have been taken by the Government of Lesotho to address HIV/Aids and The National AIDS Council in Mozambique ensures a multi-sectoral approach in the prevention of the epidemic. Similarly, facing the challenge of HIV/AIDS is the top priority of Namibia wherein in 2002, 22 percent of all pregnant women suffered from HIV.
Even with international supporters like the U.S. who are playing their part in improving the health conditions in the developing countries; a strong public sector in some of the countries providing health services at national, regional, and local levels there are certain constraints like a limited number of health service providers and the places where this can be implemented effectively and easily. This implicates the need for more joint efforts to solve the health problems through more effective measures in terms of focused planning and resources by mutual discussions and decisions of both the local governments and international bodies.
Conclusion
The population of the world is increasing every day but the provision of rights to health for this population via its citizens is the duty of the country, even the developing ones, whether explicitly or implicitly in its constitution or its preamble. Numerous successful efforts have been made by influential international organizations like WHO, World Bank, and Global Fund which supports this cause not only through funds but also by providing the required technology and others forms of assistance. Besides, there are also public and private bodies working effectively to improve the health conditions in the developing world through various means.
Despite the progress made in the health domain over the last few years, the quality and quantity of health care are disproportionate across regions, there are still a number of health issues present in these countries. The developing countries bear a large portion of the mortality rate due to avoidable circumstances and suffer from problems like malnutrition and AIDS in South Africa, childbirth complications and immigration of professionals and health workers in India, the prevalence of communicable and non-communicable diseases in Fiji, and high mortality rate of children under five in Bangladesh, among others. Even though there have been improvements in the health conditions in some of the underdeveloped countries because of the influence of the international efforts and effectiveness of various efforts at the domestic level, there is still a need for an integrated framework that can provide a solution to the existing problems.
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