Maintain universal access to health care

Human Rigths Comment
Strasbourg 07/08/2014
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Maintain universal access to health care

Universal access to health care has been undermined by austerity measures and the economic crisis. Cuts in health services and difficult economic and social conditions are beginning to have a measurable impact on the health of the population in many countries. Yet the right to health is guaranteed by international and European human rights instruments. Everyone’s access to health care without discrimination belongs to the core content of this right.

Cuts in health services

Health care spending in Europe began a downward slope in 2010, reversing a long-term trend as documented by the OECD. At the same time, user charges have often gone up, making it more difficult for many population groups to receive the care they need. The WHO has defined universal coverage as access of everyone to health care services without suffering financial hardship in paying for them.

During my visit to Spain in June last year, I reviewed the effects of austerity measures on health services which had previously been based on universal and free access. The crisis had resulted in massive cuts in medical staff and funding of public health centres, the closure of many emergency services and the introduction of co-payment schemes. Undocumented migrants only had access to emergency care. The regional government of Andalusia had set up a mechanism to maintain free and universal access to health care.

In Greece, public health spending was capped at 6% of GDP through the stipulations of international bailout packages, falling clearly below the EU average of 9% in 2010. Recent research on Greece highlights drastic cuts in public hospital budgets, pharmaceutical spending and funding for mental health care along with spiralling out-of-pocket fees. The prevalence of major depression increased 2.5 times between 2008 and 2011 while the number of suicides rose by 45% between 2007 and 2011. Infant mortality increased by 43% from 2008 to 2010 after a long-term fall, raising concerns about access to pre-natal care by pregnant women.

Public health budget cuts in Latvia have also undermined the availability of care. A UN independent expert has pointed out that the number of publicly funded hospitals with inpatient care provision decreased from 88 in 2008 to 39 in 2010 along with increased user fees for services and pharmaceutical products. In 2011, 26.8% of unemployed people and 18.3% of pensioners had to forego the medical treatment or examination they needed on at least one occasion because they could not afford it.

Vulnerable groups

Many vulnerable groups face specific barriers in access to health care. Children’s health was a particular concern during my visit to Spain because of rapidly rising poverty, homelessness and malnutrition among them. The Ombudsman of Catalonia reported that children belonging to disadvantaged social groups faced a six-fold higher risk of mental health problems in comparison with other groups. I have also raised the lack of availability of psychological and psychiatric care for children in Estonia. The WHO has warned of possible life-long effects of extreme poverty on children’s health which may include deficits in cognitive, emotional and physical development.

Discrimination, lack of insurance coverage, homelessness and limited transportation options from remote areas have precluded many Roma from accessing health care, as highlighted by a report published by my Office. In fact, Roma often suffer from significantly lower life expectancy than the national average. Lack of identity documents is another contributing factor as I noted during my visit to “the former Yugoslav Republic of Macedonia”. A programme of health mediators had been put into place for improving the availability of care and promoting preventive measures.

Access to health services is a vital concern to asylum-seekers when the care they need is not available in their countries of origin. I stressed this issue in Denmark where rejected asylum-seekers holding humanitarian status on grounds of their health situation can be expelled once treatment becomes available in the country of origin. Unfortunately, returns may have gone ahead even when it has been unclear whether the medication or treatment required has in fact been within the reach of the persons concerned.

European standards

The “right of everyone to the enjoyment of the highest attainable standard of physical and mental health” is guaranteed by the International Covenant on Economic, Social and Cultural Rights. In Europe, the revised European Social Charter recognises the right to protection of health and the right to social and medical assistance.

In its 2013 conclusions on Spain, the European Committee of Social Rights stressed that the health system must be accessible to the entire population. The Committee also pointed out that the economic crisis could not serve as a pretext for a restriction or denial of access to health care that affects the very substance of this right.

Although the right to health is not part of the European Convention on Human Rights, its provisions on the right to life and the prohibition of torture and inhuman or degrading treatment have been applied in cases related to the quality of care and access to it. For example, the case-law of the European Court of Human Rights on prisoners’ access to health care is quite extensive. The extreme effects of austerity measures on the accessibility of health care could be open to contestation in the Court.

Human dignity

Universal access to health care is about respecting everyone’s human dignity. We should start viewing health inequalities through a human rights perspective by putting the person at the centre of health service delivery. Scotland’s National Action Plan for Human Rights is actively pursuing this approach in on-going reforms of health and social care. By involving the users in the development of care and respecting their right to self-determination we enable individual choices and make services responsive to people’s real needs.

There are good reasons for carrying out reforms to make health services more effective. The rapid demographic changes and technological advances we are currently experiencing will require new responses. It is also important to address wasteful practices and corruption in health care. However, such reforms should not simply amount to cost-cutting exercises. They should always aim to deliver quality care to the entire population without excessive user charges. Governments have a duty to maintain health and social protection floors which are available to everybody at all times.

Nils Muižnieks

More resources:
Parliamentary Assembly: Resolution on Equal access to health care