U.S. Health Reform and U.S. Health Reform and the Elusive Target of the Elusive Target of Human RightsHuman Rights
John F. Roatch Global Lecture in Social John F. Roatch Global Lecture in Social Policy and Practice, Arizona State Policy and Practice, Arizona State University, March 5, 2010University, March 5, 2010
Lance Gable, JD, MPHLance Gable, JD, MPHAssistant Professor of LawAssistant Professor of LawWayne State University Law SchoolWayne State University Law SchoolDetroit, Michigan, USADetroit, Michigan, [email protected]@wayne.edu
U.S. Health Expenditures, U.S. Health Expenditures, 20072007
Country Expenditures Per Capita
% GDP Maternal mortality rank
Childhood mortality rank
US $ 7,290 17.3 % 34th 40th
Canada $ 4,403 10.1 % 21st 28th
UK $ 3,867 8.4 % 25th 28th
Sources: CMS, OECD, WHO
Country RankingsCountry Rankings
Infant MortalityInfant Mortality
1960 and 20041960 and 2004
U.S. Insurance Coverage U.S. Insurance Coverage 20072007
Source: US Department of Health and Human Services
U.S. Uninsured Rate 1996-U.S. Uninsured Rate 1996-20062006
Source: US Department of Health and Human Services
U.S. Uninsured Rate U.S. Uninsured Rate PredictionsPredictions
Source: Commonwealth Fund
U.S. Health Expenditures U.S. Health Expenditures 20072007
Major themesMajor themes Part I. Health as a Human Right: an Part I. Health as a Human Right: an
evolution of substance and processevolution of substance and process
Part II. Health Reform in the United Part II. Health Reform in the United States: a perennial struggle for common States: a perennial struggle for common groundground
Part III. Health reform proposal and Part III. Health reform proposal and human rightshuman rights
Part IV. RecommendationsPart IV. Recommendations
Part I. Health as a Human Right: an Part I. Health as a Human Right: an evolution of substance and processevolution of substance and process
What is health?What is health?
Constitution of the WHO (1948): “health Constitution of the WHO (1948): “health is a state of complete physical, mental, is a state of complete physical, mental, and social well-being and not merely the and social well-being and not merely the absence of disease or infirmity.”absence of disease or infirmity.”
What are human rights?What are human rights? What is the right to health? What is the right to health?
Framing Health and Human Framing Health and Human RightsRights
Human rights are universal and immutableHuman rights are universal and immutable
Human rights transcend state sovereigntyHuman rights transcend state sovereignty
The human rights movement has had The human rights movement has had great successes, but human rights great successes, but human rights violations continue to occur with great violations continue to occur with great frequency around the worldfrequency around the world
Human rights have proliferatedHuman rights have proliferated
Sources of the Human Right to Sources of the Human Right to HealthHealth
International and regional legal International and regional legal frameworksframeworks
International organizationsInternational organizations National governments and other National governments and other
domestic jurisdictionsdomestic jurisdictions International NGOs, funders, and International NGOs, funders, and
other political actorsother political actors
Framing Health and Human Framing Health and Human RightsRights
Three relationships:Three relationships:
Health affects Human RightsHealth affects Human Rights Human Rights affect HealthHuman Rights affect Health Health and Human Rights are Health and Human Rights are
inextricably linked and mutually inextricably linked and mutually reinforcingreinforcing
Mann, Gostin et al. (1994) Health and Human RightsMann, Gostin et al. (1994) Health and Human Rights
Source: WHO
The International Human The International Human Rights SystemRights System
Sources of the Human Right Sources of the Human Right to Healthto Health
Universal Declaration of Human Universal Declaration of Human Rights, article 25 (1948): the right to Rights, article 25 (1948): the right to heath is “a standard of living heath is “a standard of living adequate for the health and well-adequate for the health and well-being of [a person and that person’s] being of [a person and that person’s] family, including food, clothing, family, including food, clothing, housing, and medical care and housing, and medical care and necessary social services…”necessary social services…”
Sources of the Human Right Sources of the Human Right to Healthto Health
ICESCR, article 12 (1966): “the right ICESCR, article 12 (1966): “the right of everyone to the…highest of everyone to the…highest attainable standard of physical and attainable standard of physical and mental health.”mental health.”
Includes: “conditions which would Includes: “conditions which would assure to all medical service and assure to all medical service and medical attention in the event of medical attention in the event of sickness.”sickness.”
Sources of the Human Right Sources of the Human Right to Healthto Health
General comment 14: focus on the General comment 14: focus on the underlying determinants of health underlying determinants of health
Four factors: availability, Four factors: availability, accessibility, acceptability, and accessibility, acceptability, and qualityquality
Three responsibilities: respect, Three responsibilities: respect, protect, and fulfillprotect, and fulfill
Sources of the Human Right Sources of the Human Right to Healthto Health
Special Rapporteur reports: Special Rapporteur reports: Right to health includes the protection Right to health includes the protection
of other human rightsof other human rights ““a strong health system is an essential a strong health system is an essential
element of a health and equitable element of a health and equitable society.”society.”
Part II. Health Reform in the United Part II. Health Reform in the United States: a perennial struggle for States: a perennial struggle for
common groundcommon ground
Health Care Reform has always been Health Care Reform has always been politically divisivepolitically divisive
Part II. Health Reform in the United Part II. Health Reform in the United States: a perennial struggle for States: a perennial struggle for
common groundcommon ground
Part II. Health Reform in the United Part II. Health Reform in the United States: a perennial struggle for States: a perennial struggle for
common groundcommon ground
Health Care Reform has been Health Care Reform has been politically divisivepolitically divisive
Part II. Health Reform in the U.S.: a Part II. Health Reform in the U.S.: a perennial struggle for common perennial struggle for common
groundground
Part II. Health Reform in the United Part II. Health Reform in the United States: a perennial struggle for States: a perennial struggle for
common groundcommon ground
Part III. Health reform proposals and Part III. Health reform proposals and human rightshuman rights
1) Expanding access to health insurance1) Expanding access to health insurance Limit pre-existing condition exclusions and Limit pre-existing condition exclusions and
expenditure capsexpenditure caps Individual mandateIndividual mandate Subsidies for qualifying individuals and Subsidies for qualifying individuals and
small businessessmall businesses Health insurance exchangesHealth insurance exchanges Essential health benefit packagesEssential health benefit packages AbortionAbortion Other access expansionsOther access expansions
Part III. Health reform proposals and Part III. Health reform proposals and human rightshuman rights
2) Cost containment across the 2) Cost containment across the health systemhealth system
3) Quality improvement3) Quality improvement
4) Other issues4) Other issues Medical malpractice reformMedical malpractice reform Single payer and human rightsSingle payer and human rights
Part IV. RecommendationsPart IV. Recommendations Pass health reform because it Pass health reform because it
advances health and human rightsadvances health and human rights Develop rights-based approaches to Develop rights-based approaches to
health policyhealth policy Recognize the right to health in the Recognize the right to health in the
United StatesUnited States Support health through other human Support health through other human
rightsrights
U.S. Health Reform and the U.S. Health Reform and the Elusive Target of Human Elusive Target of Human
RightsRights
Thank You!
For more information, please contact:Lance Gable, Wayne State University Law School,[email protected]