1948 and the leap forward in human rights

Health workers in Britain will mark the 60th anniversary of the foundation of the NHS on 5 July. But 2008 also marks the passing of 60 years since another great post-war achievement, one that aimed to transform the health of ordinary people not just in Britain but all over the world.

Both moves were a response to the horrors of the war and both remain all the more remarkable for their positive legacy.

What a year 1948 turned out to be. It was in December 1948 that the Universal Declaration of Human Rights was signed. Some would describe the NHS as Britain's greatest achievement of the 20th century and the Declaration of Human Rights as the world's.

International breakthrough

In 1945, 46 governments said "never again", putting aside individualism and nationalism to draw up the United Nations Charter. A commission "for the promotion of human rights" was also established. It spent three years drafting the declaration. The proposal to introduce an NHS faced political and professional opposition within the UK but imagine the challenges the new UN commission had to overcome in drafting the declaration.

There were differences in linguistic, cultural, political and philosophical values and consideration of the world's major legal systems, philosophies and religious beliefs to contend with. When it came to the final vote, 48 states chose to adopt the declaration and eight abstained.

The declaration contains 30 articles, setting out the human rights and fundamental freedoms to which all men and women are entitled without discrimination. It identifies civil and political rights, such as the right not to be subjected to torture, to equality before the law, to a fair trial, to freedom of movement, to asylum and to freedom of thought, conscience, religion, opinion and expression. It also includes economic, social and cultural rights such as the right to food, clothing, education, work, housing and medical care.

Article 25 of the declaration states:

1 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 and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

2 Motherhood and childhood are entitled to special assistance. All children shall enjoy the same social protection.

Whatever problems and controversies lay ahead and whatever shortcomings would emerge, for the people of Britain a key part of article 25 had, at least on the face of it, been delivered by the creation of the NHS before the declaration had even been signed.

The NHS represented the first time anywhere in the world that healthcare had been made available to a whole population on the basis of citizenship rather than the payment of fees or insurance premiums.

But what of the rest of the world? Has the declaration made a difference and proved its worth? Changes in access to healthcare globally have mirrored evolving access to other services and goods and remain in many countries subject to an ability of the individual to pay.

Life of dignity

That said, there have been some important gains arising from the Declaration. In particular the two covenants adopted in 1966 - the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights - gave formal and legally binding form to the spirit of the declaration among countries ratifying these treaties.

In 2000, the Human Rights Committee established under the second covenant published a "general comment 14" on the right to the highest attainable standard of health, which spelled out some key principles to guide states.

The committee made clear that the right to the highest attainable standard of health contained freedoms - such as the right to control one's health and body, including sexual and reproductive freedom, and the right to be free from interference such as torture, non-consensual medical treatment and experimentation - and entitlements - including the right to a system of health protection that provides equality of opportunity for people to enjoy the highest attainable level of health.

It also suggested the right to health was an "inclusive right extending not only to timely and appropriate healthcare but also to the underlying determinants of health, such as access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions and access to health-related education and information, including on sexual and reproductive health". The committee also noted an "important aspect is the participation of the population in all health-related decision-making at the community, national and international levels".

This illustrates an important point made by many human rights organisations - that human rights are inalienable and indivisible. In other words, you cannot lose them and they only make sense if considered as a package deal.

The innovative and powerful analytical tool provided by general comment 14 is the prism through which healthcare can be viewed. It must be:

Available Public health and healthcare facilities, goods and services, as well as programmes, have to be available in sufficient quantity. This includes trained medical and professional personnel who receive domestically competitive salaries and essential drugs.

Accessible Health facilities, goods and services have to be accessible to everyone, without discrimination, within safe physical reach for all sections of the population, especially vulnerable or marginalised groups, and be affordable for all.

Armed with this analysis, human rights advocates have been reviewing the performance of countries around the world to determine if they are meeting their obligations.

In addition, the UN has been reviewing the extent to which governments are meeting their responsibilities.

A special rapporteur, Paul Hunt, has visited developing countries such as Uganda and wealthier nations such as Sweden to review the way they are implementing their obligations to respect, protect and fulfil the right to health.

It is 60 long years since the adoption of the declaration and its groundbreaking commitment to basic human needs such as healthcare.

This year will see the appointment of a new special rapporteur but the function will continue. Countries will remain under an obligation to ensure citizens can achieve the highest possible state of physical and mental health. There has been a lot done in that time to understand the nature of the human right to health and refine the mechanics of implementing that right.

Basic right

But there remains a huge task ahead - to reduce global maternal mortality from its scandalous level of 500,000 deaths a year; to halt and reverse the growth of the HIV pandemic; and ensure people have access to safe housing, clean water and adequate food.

Those whose lives are better because of growing access to health services and the determinants of health may feel positively supported by the outcome of the work of the commission that reported to the UN in San Francisco in 1948.

However, there remains an obligation on us all to ensure that both the spirit and letter of the rights articulated 60 years ago apply everywhere in the world. The right to healthcare is about as basic as a right can get.