David Werner
Insuring the necessary resources for the human right to health: national and international measures
Address to the Global Assembly on “Advancing the Human Right to Health”
Iowa City, Iowa, April 20-22, 2001
In the 1940s, the United Nations declared Health a Basic Human Right. The World Health Organization was created to help make that Right a reality. But during the next several decades, the Right to Health remained a distant dream for most of the world’s people.
True, great advances were realized in medical science. The Western medical model, with its urban “Disease Palaces,” costly doctors, and commercial pharmaceuticals, was extended into the Third World. But to a large extent, the benefits of Western medicine remained inaccessible to the poor majority living in rural areas and growing city slums.
During the same period (from the 1950s through the 70s), important public health measures to reduce infectious diseases were introduced through national and international campaigns. But, once again, these measures were unequally distributed. Millions of children continued to die from diseases that could have been prevented through clean water, immunization, and good nutrition.
It became clear that poverty and powerlessness were the underlying causes of poor health and early death.
In pursuit of Health for All
Hopes for a breakthrough emerged with the Alma Ata Declaration in 1978. The world’s nations endorsed the goal of “Health for All by the Year 2000,” to be approached through a comprehensive strategy called Primary Health Care. The Declaration not only advocated universal coverage of basic health services, but also called for a “new economic order” to assure that all people could have a standard of living conducive to health. To achieve greater equity in meeting health needs, it called for strong popular participation.
At that time there was lots of optimism. But the year 2000 has come and gone. And today the dream of Health for All seems more distant than ever. A reversal has occured of many advances made in earlier decades. The Third World has seen a resurgence of “diseases of squalor” such as cholera, malaria, tuberculosis, and even plague. New diseases such as AIDS are taking their highest toll in populations whose basic needs and rights remain grievously unmet.
Why is it that the Human Right to Health still remains so far from being realized? What are the necessary resources and prerequisites for this Right to be implemented? And what are the limiting factors?
The World Bank’s “investment in health”
The World Bank — the newest and strongest player in international health — tells us that the key obstacles to approaching Health for All are economic. It points to the poor “cost-effectiveness” of Third World economies and specifically, of their health systems.
The World Bank has a very market-oriented concept of human health. It argues that good health is necessary for economic growth, and vice versa. The Bank’s 1993 publication, “Investing in Health,” advances a master plan for making health care cost-effective. (in terms of keeping a country’s workforce free enough from illnesses to contribute maximally to economic growth). To figure out which health measures merit public support, the Bank invented DALYs, or “Disability Adjusted Life Years.” It calculates how many DALYs can be saved by different interventions. In this scheme, the people of highest value are young adults, who are thought to work hardest. Infants, old people, and disabled persons have less value because they contribute little or nothing to the national economy; therefore they merit less public expenditure for their health (see Figure 1).
International Association of Health Policy 