A rights based Scotland: where we all have equal access to the right to health

Two of our Commissioners, Dr Anna Black and Jane-Claire Judson, explore what a rights based Scotland means from a public health perspective, in the run-up to International Human Rights Day on 10 December 2021. 

Anna is a GP in Glasgow and Jane-Claire is Chief Executive of Chest, Heart and Stroke Scotland. Both are also non-executive directors of Public Health Scotland. 

The Right to Health

The importance of the right to health has never been more magnified than in the past two years. The COVID-19 pandemic and ongoing pressure on the NHS has exposed many deep rooted and longstanding health inequalities. All of which point to a real time need to ensure the right to health is protected. The pandemic has brought home many truths, a critical one being that our individual and collective health is important and should be actively protected. It affects our ability to survive, to thrive, and to engage with our families, work and society.

The right to the enjoyment of the highest attainable standard of physical and mental health is not a new concept. First articulated in the 1946 Constitution of the World Health Organisation, it was then included in the 1948 Universal Declaration of Human Rights. The right to health does not mean the right to be healthy. That is an impossible goal for any state to achieve. While a state can influence some factors that link to health, some are bound up in biological make up and other factors that the state has little to no control over. But there is much that we do and should have control over. 

The pandemic has highlighted what, in many evidenced ways, we already knew: A key barrier to realising the right to health is health inequality.

Social determinants of health

Our health is determined by the conditions in which we are born, grow, live, work and age. The right to health is therefore inclusive, it includes not just the right to health services, but also to the wide range of things that help us to live in good health. These social determinants of health include housing, education, employment, social support, family income, community, childhood experiences and our access to health services. Case studies developed as part of Scotland’s National Action Plan for Human Rights illustrate different examples of a human rights based approach to health. 

COVID-19 has affected all these social determinants in some shape or form for everyone living in Scotland.  Managing the pandemic required restrictions on all of us, and specific groups were particularly affected. The pandemic has highlighted what, in many evidenced ways, we already knew: A key barrier to realising the right to health is health inequality.

The AAAQ Framework

To tackle health inequalities in a meaningful and sustainable way, services and systems that help us to live long healthy lives should be:

• accessible
• available
• appropriate
• high quality

This is the AAAQ Framework and these are standards that public health aims to deliver if we are to create the fairer, healthier Scotland we all need and want.

To implement this framework and other measures effectively, and fully realise the right to health, we have to take into account how factors affecting health overlap and often compound one another to create greater inequality. These factors include race, class, income, sex, gender, age, sexual orientation, ethnicity, and migration status. This is known as an intersectional approach. 

The right to health can only be realised if an intersectional approach to health inequalities takes place when designing responses to health, and the services we then deliver to address them.

Intersectionality 

Two areas of health which demonstrate the importance of this approach are care homes and the health and social care workforce. Age and being older is an area where discrimination can prevent the right to heath being realised. Throughout the pandemic we have seen the devastation wrought on people who live in care homes and the wider implications for their rights such as the right to a family and private life. This is in addition to the challenges that age related health issues such as dementia, frailty, heart disease, stroke and a variety of other concerns, can bring. Within the health and social care workforce, most frontline healthcare workers are women and on low incomes. Therefore, the impacts of gender, income and health were seen. We know that 30% of the workforce in health and social care has been affected by COVID-19 and that women are more likely to experience Long Covid. 

These two examples demonstrate that the right to health can only be realised if an intersectional approach to health inequalities takes place when designing responses to health, and the services we then deliver to address them. A human rights based approach is paramount and, at the Commission, we have strongly pushed for this to be a fundamental part of the planned public inquiry. 

As we mark International Human Rights Day 2021, it is clear that a rights based Scotland would be a place where health inequalities are tackled and we all have equal access to the right to health. 

A Rights Based Scotland 

In Scotland, several actions recognise the importance of the right to health and the opportunities that have both been created and missed to realise this important right. Scotland’s National Action Plan for Human Rights included a focus on the right to health,; the first Women’s Health Plan was published in August 2021; a National Care Service plan is under development; and the COVID-19 public inquiry is being established. In addition to consulting on many of these, the Commission has also influenced the right to health through consultations regarding vaccination certification (“vaccine passports”) and Anne’s Law.

As we mark International Human Rights Day 2021, it is clear that a rights based Scotland would be a place where health inequalities are tackled and we all have equal access to the right to health. The Commission will continue to urge all possible action to achieve this.