HEALTH AND HUMAN RIGHTS: HISTORICAL MILESTONES

'Sadly, the history of medicine is not only a narrative of achievement and historic breakthroughs but also a story of expansive violations of human rights, illustrated far too often by medical practices that cause extraordinary suffering and death for countless numbers of patients' (p.3)¹. These are the words of Dainius Pūras, a professor of child psychiatry and public mental health at Vilnius University, Lithuania, who was the United Nations Special Rapporteur on the Right to Health (2014-July 2020).

Indeed, during the Second World War, the Nazi medical crimes are a grim testimony to how doctors participated in medical research and practice, which were not only unethical but a crime against humanity², leading to the prosecution of the doctors and the establishment of the Nuremberg Code (1947). The Nuremberg Code constitutes ethical standards to which physicians must conform when undertaking experiments on human subjects.

The Holocaust and the horrific events of the Second World War also stimulated interest in the relationship between health and human rights. Solidifying the collective commitment of the global community to promote international peace and prevent conflict, the United Nations adopted the Universal Declaration of Human Rights (UDHR) in 1948. More details on the UDHR can be found on pages 4 to 6 of the E-Book on Human Rights and Social Justice. Art 25.1 of the UDHR recognizes the right to health and states 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'³. The UDHR is an aspirational document of fundamental rights that accrue to a person because they are human. They are minimum standards required for living a life of dignity.

In the same year, 1948, the World Health Organization (WHO) was established after 26 Member States ratified its Constitution. The  WHO Constitution affirmed that 'the enjoyment of the 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'⁴.

Later, after almost two decades, amid the geopolitics of the Cold War, the aspirational concepts of human rights in the UDHR were adopted in two international laws, namely, the International Covenant on Civil and Political Rights (ICCPR) and the International Covenant on Economic, Social, and Cultural Rights (ICESCR). Within this development, the aspiration of 'the right to the enjoyment of the highest attainable standard of health' in the WHO Constitution got embedded in Art 12.1 of the ICESCR. Countries that ratified the ICESCR have a legal obligation to respect, protect, and promote people's right to health. The scope of the right to health in Art 12.1 of the ICESCR is elaborated in another document called General Comment 14 of the right to the highest attainable standard of health (article 12 of the International Covenant on Economic, Social and Cultural Rights)⁵.

Click here for the interactive dashboard that identifies the countries that ratified the ICESCR. Many countries, including Malaysia, have not ratified the ICECSR. However, Malaysia has ratified several other international laws such as the Convention on the Elimination of All Forms of Discrimination against Women, the Convention on the Rights of the Child, and the Convention on the Rights of Persons with Disabilities which uphold the right to health.

Meantime, against the backdrop of a bleak global economic outlook, rising poverty in developing countries, record-high unemployment, staggering inflation rates, soaring oil prices, and the disillusionment with expensive technology-intensive medical care, the International Conference on Primary Health Care in Alma Ata took place in 1978. The Declaration of Alma-Ata also strongly affirmed that health is a fundamental human right and that governments have a responsibility for the health of their people.