The World Health Organisation (WHO) has defined health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."2
Humanity has made considerable progress in improving the state of health in the world. We have learned how to treat and control diseases that used to kill millions. We have improved access to water and sanitation as well as created complex health-care systems. Our knowledge and expertise in health is growing rapidly and we have more resources available for health than ever before.
However, progresses in health have been extremely unequal. A child born today in Sweden can expect to live more than 80 years, but fewer than 72 years if she is born in Brazil, fewer than 63 years if she is born in India, and fewer than 50 years if born in Lesotho. In Ireland, the risk of a woman dying during pregnancy or childbirth is 1 in 47 600; in Afghanistan it is 1 in 8. Our life expectancy and health can dramatically differ depending on where we live and grow; however, magnificent inequalities in health exist not only between countries, but also within countries. A child born in the Calton, a district in the Scottish city of Glasgow, can expect a life 28 years shorter than another child living in Lenzie, a Scottish village only 13 kilometres away. In Bolivia, babies born to women with no education have a 10% chance of dying before age 1, while one born to a woman with at least secondary education has a 0.4% chance. In the United Kingdom the adult mortality rates in poor neighbourhoods are 2.5 times higher than in the least deprived neighbourhoods.3
Dramatic inequalities in health as revealed by statistics cannot be explained by biology. The health differences between and within countries are a result of social and economic policies that determine the environment where people are born, grow, live and work.5 Health inequalities are unfair and can be avoided. In most of the cases it is not even a question of economic growth. While economic growth is important for development, without equal distribution of resources, national economic growth can even deepen health inequalities. The WHO points out that some developing countries such as Cuba, Costa Rica, or Sri Lanka have managed to achieve good levels of health despite a relatively low national economic growth.6 Fighting health inequalities is a matter of social justice and human rights.
Global commitment to health for all is manifested in the Millennium Development Goals. Our governments have promised to achieve eight poverty reduction goals by 2015. However, this global effort will not be possible without the active involvement of civil society. People have to know their rights and the obligations of their governments; it has to be demanded that social and economic policies that are being created or reformed by governments do not deepen health inequalities. Health is not only an aspiration for well-being; it is a human right.
The right to health is recognised in numerous international and regional instruments, starting with the Universal Declaration of Human Rights (Article 25) and including the International Covenant of Social Economic Rights (Article 12), the Convention on the Rights of the Child (Article 6, 24), the Convention on the Elimination of All Forms of Discrimination against Women (Article 10, 11, 12, 14), and the European Social Charter.
The right to health is not to be understood as the right to be healthy: it is impossible to provide protection against every possible cause of human ill-health. It is the right for everyone without discrimination to the enjoyment of different services, facilities and goods as well as appropriate living conditions that are necessary for staying as healthy as possible. The right to health includes not only health-care services but also conditions that determine our health, including: access to safe drinking water, adequate sanitation and housing, adequate food, healthy working and environmental conditions, and access to health-related education and information.7
Question: Should everyone be entitled to medical treatment regardless of their status and economic possibilities?
According to international human rights instruments, health services and facilities have to be available, accessible, acceptable and of good quality for everyone without discrimination.
Availability means that public health-care facilities, goods and services, as well as programmes, have to be available in sufficient quantity within the country.
Accessibility means that health facilities, goods and services have to be physically and economically accessible to everyone without discrimination and there has to be a possibility to seek, receive and impart information concerning health issues. For example, health facilities for young people have to be close to where young people live (including rural areas and small towns), and there has to be public transportation that allows people to reach the health facility easily. The opening times have to be convenient for young people. Health facilities should be free or very cheap, so that young people can afford them. Health-related information, including sexual and reproductive health information, should be easily accessible for young people without discrimination.
Acceptability means that goods and services must be culturally appropriate and respectful of medical ethics. For example, doctors and nurses have to be trained in how to talk to young people and children. The atmosphere in the health centre should be supportive and non-judgemental to young people.
Quality means that health facilities, goods and services must be scientifically and medically appropriate and of good quality8. For example, health information has to be scientifically sound and the services as well as medicines have to be of good quality.
Question: Do asylum seekers and undocumented people have access to health care where you live?
A further important aspect of the right to health is active and informed participation of the population, including young people, in health-related decision making at the community, national and international level.9 The UN Committee on Economic, Social and Cultural Rights explains that "State parties should provide a safe and supportive environment for adolescents that ensures the opportunity to participate in decisions affecting their health, to build life skills, to acquire appropriate information, to receive counselling, and to negotiate the health-behaviour choices they make."10
Young people can and should be strategic partners in activities or programmes that deal with health problems. There are a number of international organisations and networks that work in partnership with young people on different health-related topics, including: the International Federation of Red Cross and Red Crescent Societies, the European Network of Health Promoting Schools, the Youth Peer Education Network, the International Federation of Medical Students Associations, and others.
The European Youth Forum also highlights the role of youth organisations as key stakeholder in developing health policy relevant to young people. In their 2008 policy paper on the health and well-being of young people they write, "They [youth organisations] are a good space to organise consultations among young people and they are the most representative bodies to voice the concerns of a wide range of youth. Many youth organisations have certain competences in the field of health and are therefore adequate partners for these consultations."11
Question: How can you participate in health-related decision making in your community or country?
Human rights require governments to be accountable for their actions: to show, explain and justify how the state has fulfilled its obligations regarding the right to health.
NGOs and activists around the world have used different methods to demand accountability for the right to health, including media campaigns, submitting shadow reports to international treaty bodies, submitting complaints to national, regional and international courts, advocating for health rights before national and regional elections, and actively participating in monitoring initiatives.
How can you hold your government accountable for the right to health?
In Europe, the right to health is upheld in the European Social Charter. The main article that focuses on the right to health is Article 11, which obliges European states to take measures to promote health and to provide health care in case of sickness.
European Social Charter – Article 11 – The Right to Protection of Health
With a view to ensuring the effective exercise of the right to protection of health, the Contracting Parties undertake, either directly or in co-operation with public or private organisations, to take appropriate measures designed inter alia:
1. to remove as far as possible the causes of ill-health
2. to provide advisory and educational facilities for the promotion of health and the encouragement of individual responsibility in matters of health
3. to prevent as far as possible epidemic, endemic and other diseases.
The Charter is monitored by the European Committee of Social Rights. Each year the Committee examines the reports submitted by the state parties and decides whether or not the situation in the country regarding the right to health and other social and economic rights are in conformity with the European Social Charter. In addition to this, some European organisations and national NGOs can submit a collective complaint against the State to the Committee.
The Council of Europe and health
In addition to the continued work on monitoring and implementing the European Social Charter, the Council of Europe assists member states in implementing a "health and human rights for all" approach by taking account of minorities and vulnerable groups with the Committee of Experts on Good Governance in Health care. The European Directorate for the Quality of Medicines and Health Care contributes to the human right of access to good quality medicines through the harmonisation and co-ordination of standardisation, regulation and quality control of medicines, blood transfusion, organ transplantation, pharmaceuticals and pharmaceutical care.
In the constantly changing field of bioethics, the Council of Europe aims to find a balance between freedom of research and protection of individuals. The European Conference of National Ethics Committees promotes co-operation between national ethics bodies in the member states and plays a role in promoting debate in issues raised by developments in biomedical and health sciences. The 1997 Oviedo Convention on human rights and biomedicine established the basic principles of biomedical ethics. There have since been three additional protocols dealing with the prohibition of cloning human beings, organ transplantation and biomedical research.
Having a healthy lifestyle will mean something different for everyone. Generally it can be agreed that a healthy lifestyle is one which enables a person to live life in a way that promotes physical and mental well-being. For young people, there are various risk factors they are exposed to throughout childhood and adolescence that can often lead to poor nutrition, lack of physical activity and/or addictions – all of which have consequences that can continue for the rest of their lives.
For young people who start working very early in life there are occupational health risks which can also lead to sometimes life-long consequences. Across Europe, young people are at least 50% more likely to be hurt at work than older people and are also more likely to suffer from an occupational illness.12
The Council of Europe youth policy also acknowledges the well-being of young people as an important aim of youth policy within the framework of Agenda 2020 on the youth policy of the Council of Europe. This follows the fact that in recent years, a worrying trend in many European countries has been the rise in the consumption of alcohol, drugs and tobacco by young people combined with the worsening of prospects for social and economic autonomy.
Tobacco: Globally, 5.4 million people die from tobacco epidemic every year – more than from HIV/AIDS, malaria and tuberculosis combined. In Europe, smoking is responsible for up to 21% of deaths. On average 24% of young people aged 15 smoke every week13.
Question: Should tobacco be made illegal?
Alcohol: According to WHO, alcohol consumption in Europe is double the world average. Alcohol is the second largest risk factor for death and disability among adults, and the largest risk factor for young people. In Europe, alcohol accounts for 618,000 deaths every year. Excessive drinking contributes not only to ill-health but also to loss of productivity in the educational setting and workplace, criminal damage and violence.14
Drugs: According to the United Nations Office on Drugs and Crime, between 155 and 250 million people worldwide, or 3.5-5.7% of the population aged 15-64, had used illicit drugs at least once in 2009. Cannabis users make up the largest number of illicit drug users; however, in terms of harm, opiates are ranked at the top.15
Question: Do you know what are the consequences for young people who drink excessive alcohol and use illicit drugs?
Obesity: According to WHO, 30-80% of adults in Europe and around 20% of children and adolescents are overweight, and 7% are obese.16 Obesity creates risks for cardiovascular diseases, diabetes, orthopaedic problems and mental disorders. Reports indicate that discrimination, bullying and teasing can be both causes and effects of weight gain.17
It is too easy to say that individuals are totally responsible for their health and hence if they start smoking, eating unhealthy food, or using drugs, it is their choice. Victim blaming is a popular approach to "solving" unhealthy behaviour and unfortunately it is being implemented in health policies and programmes in a number of European countries. Public health specialists argue that if a health policy is ignoring existing inequalities and focuses only on health education and information campaigns, a huge number of people will not be able to enjoy their right to health. For example, a WHO report on obesity in Europe shows that children from families with lower socio-economic status and lower level of education are choosing less healthy food than children from families with more education and a higher socio-economic status.18
Question: Why do you think relatively better-off groups in society are less likely to eat unhealthy foods or suffer from a drug addiction?
Another element that may lead to unhealthy behaviour is values and life goals that are being appreciated in society and promoted by mass media. Western industrialised societies increasingly embrace life goals such as financial success, popularity, power, prestige, social status and consumption. Advertisement campaigns often target young people to think that they are not good enough if they do not have a certain new gadget, or fashionable clothes, do not drink a certain new type of drink, or do not have perfect hair or a perfect body as seen on television. The enormous pressure to look good and to have new things affects young people's mental and physical health adversely. The WHO identified bullying, low self-esteem, social pressures, difficulties in coping with stress and glamorisation of thinness in mass media as risk factors in the development of eating disorders such as anorexia and bulimia.19
Size Zero Model Ban
In 2006, Madrid Fashion Week banned underweight models, with Milan taking the same action directly afterwards. Health organisations and civil society groups have been campaigning for other cities to follow suit with limited success. The Spanish ban started as a result of two young models in South America dying from starvation and anorexia.20
Sexual and reproductive health
Sexual and reproductive health often involve sensitive and controversial issues for young people, their families and health professionals. Adolescents and young people face many challenges related to their sexual and reproductive health. Because of puberty and the rapid psychological development young people go through, they are vulnerable to the pressures of society and their peers in adopting risky health behaviour which often includes risky sexual behaviour. In many societies adolescents' sexuality is a very controversial issue and people question whether young people should receive sexual education outside the family, or whether young people under the age of 18 should receive anonymous counselling or treatment without permission of their parents. Sexual and reproductive health also affects women and men differently.
Question: What views exist in your country that may negatively affect the sexual and reproductive health of young people?
Sexual and reproductive health in numbers
Every minute in the world, at least one woman dies while giving birth, or from complications related to pregnancy; that means 529,000 women a year.21
According to UNFPA, at least 200 million women worldwide want to use, but do not have access to safe and effective family planning methods.
More than a quarter of women who become pregnant each year have abortions; most of these abortions are done in secrecy and performed under unsafe conditions.22
According to an assessment conducted in 2008, 33.4 million people were living with HIV/AIDS, the vast majority in low- and middle-income countries.23 Young people (15-24 years old) accounted for an estimated 40% of all new HIV infections worldwide.
Ill-health becomes a human right violation when it occurs because of the failure of a state to respect, protect or fulfill human rights obligations.24 Our states have a duty to do everything that is possible to protect us from ill-health, including such measures as sexual and reproductive health education, appropriate counselling, accessible and good quality health-care services, as well as programmes that fight stigma, discrimination and dangerous cultural practices.
K.L. v. Peru and freedom from cruel and inhumane treatment
K.L., a 17-year-old girl was pregnant with an anencephalic foetus (a foetus with partial or total absence of a brain that would not survive a birth or would die within a few hours or days after the birth). Although Peruvian abortion law allows abortion in a case when the life or health of the mother is in danger, K.L. was denied an abortion and had to deliver the baby and breastfeed her for the four days she survived.
In 2005, the United Nations Human Rights Committee ruled that Peru had violated K.L.'s right to be free from cruel, inhumane, and degrading treatment (Article 7 of ICCPR) and the right to privacy (Article 17). The Committee held that the State should have provided during and after her pregnancy "the medical and psychological support necessary in the specific circumstances of her case".25
The World Health Organisation (WHO) defines mental health as "a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community."26
According to the WHO, one in four people worldwide will be affected by mental or neurological disorders at some point in their lives.27 Young people are especially at risk of developing mental health disorders as they transition from dependence to independent or adult life. New pressures and changes such as puberty, new relationships, leaving the parental home for the first time, financial instabilities, employment or education-related anxiety can cause high levels of stress, which can lead to mental disorders. Several disorders, such as depression, schizophrenia, eating disorders and substance abuse, are identified as having their onset at a young age.28 In addition to this, suicide is the second leading cause of death among children and young people aged 10-24 worldwide.
It is estimated that only 10-15% of young people with mental health issues receive help from professionals.29 Therefore, it is essential not only to have accessible mental health services, but also to educate the general public about existing professional help as well as to fight stigmatisation and stereotypes that prevent young people from seeking help.
Question: Do you know where a young person can receive youth-friendly mental health care where you live?
Public health spending in high and low income countries mostly benefits the rich rather than the poor. More than 90% of the global production of pharmaceuticals is consumed only by 15% of the world's population. For example, between 1975 and 2004, 1,556 new drugs were approved for the global market. However, only 21 of these were specifically developed for tropical diseases and tuberculosis, even though these diseases account for 11.4% of the global disease burden.31 Tropical diseases such as malaria, leprosy, Chagas disease and others are called neglected diseases, because even though they affect over one billion people worldwide, they are often forgotten because they affect the poorest and the most marginalised communities.32 It is also estimated that in developing countries patients have to pay 50-90% of essential medicines from their own pocket.
Almost two billion people worldwide do not have access to essential medicines. The high cost of medicines is one of the major reasons why people in need cannot get the available medicines they need. The United Nations Special Rapporteur on the right to health argues that improving access to existing medicines could save 10 million lives each year.34
One of the best ways to lower prices and increase access to medicaments is by allowing and promoting generic drugs. A generic drug is a copy of a branded pharmaceutical product. Generics are as effective as their branded counterparts; the biggest difference is the price. It is cheaper to produce a generic drug because manufacturers do not have to cover expenses of drug invention and extensive safety and efficacy clinical trials. Because of the low price, generic drugs are often the only medicines that the people living in poverty can access.
Pharmaceutical companies argue that generic drugs decrease their profits and subsequently affect their ability to invest in researching and developing new drugs. In order to help pharmaceutical companies that discover new drugs to recover the money they spent on drug creation and to allow them to profit from the invention, they are granted a patent. A patent or intellectual property right is a set of exclusive rights granted by a state to an inventor to make, use, sell, and offer to sell or import the invention. The patent usually lasts for twenty years and during this period other companies cannot produce, sell, offer to sell or import the patented drug.
Question: Do pharmaceutical companies have human rights responsibilities?
Intellectual property issues created a huge tension between the global North and South. Developed countries argued for the pharmaceutical industries' right to patent their drugs. Developing countries argued that global intellectual property standards would obstruct their development because they were not well prepared or equipped to benefit from such standards. The international agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) came into force in 1995 and is administrated by the World Trade Organisation (WTO). The legislation was to have a huge impact on the production of generic drugs; therefore the developing countries were given a transition period and were allowed to continue developing generic drugs until 2000, and the least developed countries were granted a transition period until 2016 for pharmaceutical patents and undisclosed information.35
The impact of intellectual property rights on the right to health
"The consequence of TRIPS is that the new, better drugs are only available in countries that have the capacity to cover the high cost. […] It is felt that if the capacity to provide generic, effective, yet cheap anti-AIDS treatment to the developing world exists, then it is immoral not to allow the production of drugs that will save millions of lives."36
AVERT - an international HIV and AIDS charity (www.avert.org)
According to the organisation Médecins Sans Frontières (MSF), many developing countries are under pressure to implement more restrictive conditions in their patent laws than are required by the TRIPS agreement. Even though developing countries are not obliged by international law to toughen their patent laws, very often they have no choice, since restriction clauses come as a part of trade agreements with the United States or the European Union.37
As a reaction to free trade agreement negotiations between the EU and countries in Asia and Latin America, MSF started a campaign called Europe! Hands off our Medicine.
You can find out more about the campaign at: www.msfaccess.org
1 Amartya Sen, "Health in Development," Bulletin of the World Health Organization (1999): 77:620.
2 Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
3 The Commission on Social Determinants of Health, Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Final Report (WHO: 2008).
4 Gill Walt, Health Policy: an introduction to process and power, p.
5 Press release, http://www.who.int/mediacentre/news/releases/2008/pr29/en/index.html
7 Committee on Economic, Social and Cultural Rights, General Comment 14, The right to the highest attainable standard of health (Twenty-second session, 2000). For text see U.N. Doc. E/C.12/2000/4 (2000): A Compilation of General Comments and General Recommendations Adopted by Human Rights Treaty Bodies, U.N. Doc. HRI/GEN/1/Rev.6 at 85 (2003).
8 General Comment 14, supra, n. 7, at, para 12.
9 General Comment 14, supra, n.7, at, para 11.
10 General Comment 14, supra, n.7, at, para 23.
11 European Youth Forum, 2008, Policy Paper on the Health and Well Being of Young People, p. 14.
14 World Health Organization (WHO) (2010) Best practice in estimating the costs of alcohol – Recommendations for future studies, p.
15 United Nations Office on Drugs and Crime (2010), World Drug Report 2010.
16 WHO (2007) The challenge of obesity in the WHO Europe region and the strategies for the response, p. 1.
17 WHO (2007) The challenge of obesity in the WHO Europe region and the strategies for the response, p. 158.
18 WHO (2007) The challenge of obesity in the WHO Europe region and the strategies for the response, p.
19 WHO (2004) Prevention of mental disorders: effective intervention and policy options.
22 United Nations Population Fund; http://www.unfpa.org/rh/planning.htm
24 Paul Hunt, Judith Bueno de Mesquita. (2005) The Right to Sexual and Reproductive Health, University of Essex.
25 K.L. v. Peru, Communication No. 1153/2003, U.N. Doc. CCPR/C/85/D/1153/2003, 2005.
26 WHO (2005) Promoting Mental Health: Concepts, Emerging evidence, Practice: A report of the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and the University of Melbourne. World Health Organization. Geneva.
27 WHO (2001) Mental Health: New Understanding, New Hope.
28 WHO (2010) Mental Health Promotion in Young People – an Investment for the Future.
29 WHO (2010) Mental Health Promotion in Young People – an Investment for the Future.
30 Marmot, M. Health in an unequal world. Lancet, (2006) p. 2,081.
33 Report on Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to development, 31 March 2009, A/HRC/11/12.
34 Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, 11 August 2008, A/63/263, p.15.
Manual for Human Rights Education
with Young People
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