Health Is a Human Right, Right?
By Braithwaite, Kisha
The constitution of the World Health Organization states that “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.”1(p1) Although this perspective is notable and has proven to be significant in promoting the quality of life among individuals worldwide, it is unfortunate that this resounding message is often not heard-and too often overlooked- by many parts of American society. Sadly, this basic human right is even more difficult to achieve for the estimated 43.3 million uninsured persons in the United States,2 many of whom are poor, underserved, and underrepresented. Furthermore, the individuals who do have health insurance experience major difficulties navigating a fragmented health care system, accessing culturally responsive and quality health care, and securing associated finances. Every day, working people struggle to make ends meet with health ailments that progressively worsen, in part because of their inability to comfortably connect with a health care provider and establish a medical “base.” In some cases, the fear of receiving bad news about their health from a physician or the stigma associated with seeking mental health treatment may prevent individuals from expeditiously moving forward for health care. Yet, what may be even more daunting is the reality of the medical bills that will most certainly accompany any visit to a health care facility. Sociocultural, economic, political, and environmental tribulations continue to plague our communities and infect our health care systems, resulting in public health crises, disease epidemics, and enduring health disparities, placing vulnerable populations at increased risk of premature mortality and lives filled with suffering.
The distribution of health outcomes is extremely unbalanced across population groups in regard to race and gender.3 African American men have the shortest life expectancy (69.2 years) among the four major race- gender groups in the United States (White women, 80.5 years; White men, 75.4 years; African American women, 76.1 years).4 It is essential to understand that pervasive inequities have a detrimental impact on the physical and mental health status of many individuals, families, and communities. We must adopt the principle that health requires more than just health care. Needed attention to selected social determinants of health has been offered to the general public through provocative documentaries such as Unnatural Causes . . . Is Inequality Making Us Sick? 5 and Sicko.6
Nonetheless, much more remains to be done. In addition to honing in on micro-level connections between exposures and outcomes, there remains an enormous need to examine, at a macro level, the interrelated research, practice, and policy issues that are important for societies that seek to achieve social justice for all and health as a human right.
SOCIAL POLICY IS HEALTH POLICY
Traditional presumptions rooted in the medical model about the causes of diseases and disabilities have hindered multidimensional explanations about determinants of health problems because of overrepresentation of the concepts of individual physiopathological development and familial predisposition. Although these are important considerations and powerful ideologies, they limit critical thinking about additional means for confronting health inequities. A discourse based on social justice supports the notion of a multi-dimensional collective schema for achieving healthy communities while also addressing the social and economic conditions that are at the core of health inequities and health disparities.
The creation of healthy communities depends upon the realization and organization of the vital conditions of everyday life. These conditions include such things as the quality and affordability of housing, level of employment and job security, standard of living, income level, availability and quality of mass transportation, education, social services, crime rates, air and water quality, economic development, racism, sexism, poverty, workplace conditions, and political equality.7 As such, social policy is intertwined with health policy, because they both have similar emerging issues that have consequences for achieving equity and related systemic barriers that may slow progress. Thus, when policy solutions are achieved for one ideology, they can have bidirectional and synergistic effects.
It is imperative that the development of strategies that promote health equity simultaneously address social, economic, and civil inequalities. Eliminating health inequities is a theme of social justice, because health is central to individual productivity and the creation of communities that can thrive. We must continue to make strides that promote urgency in methods for achieving collective actions with systematic, institutional, and political legitimacy, despite conventional public expectations that currently reinforce boundaries.
TOWARD HEALTH JUSTICE
US expenditures on health care exceed those of any other nation, yet the people of the United States experience some of the poorest health outcomes in the industrialized world.8 Health and health care considerations rank among the top priorities for Americans who plan to vote in the November 2008 presidential election. Thus, policymakers should determine the best strategies to address the myriad concerns that contribute to failing health and poor health outcomes, as well as carefully scrutinize the options that will ultimately impact millions of individuals.
The Democratic candidate, Senator Barack Obama, has stated that
We now face an opportunity- and an obligation-to turn the page on the failed politics of yesterday’s health care debates. . . . My plan begins by covering every American.9
According to the Republican candidate, Senator John McCain,
The goal, after all, is to make the best care available to everyone. We want a system of health care in which everyone can afford and acquire the treatment and preventative care they need, and the peace of mind that comes with knowing they are covered. Health care in America should be affordable by all, not just the wealthy.10
If these statements are to live up to their promise, the next US president-whomever that might be-must take a very deliberate approach to restructuring our current system of health care.
It is our responsibility, as public health researchers, clinicians, and policy- and decisionmakers, to become involved in the progression of innovative methods and acts of service that reinforce systematic health care transformation. Accordingly, this legacy issue of the Journal represents a collection of thought- provoking work by some of the most respected intellectuals who are dedicated to improving public health and building healthy communities. Historical, contextual, relevant, and meaningful frameworks about health from multidisciplinary perspectives are presented in a comprehensive manner.
Highlights include an examination of the role that race and racism play in influencing the deleterious individual, institutional, and situational health consequences on health disparities for ethnically, culturally, and racially diverse populations. Health care systems are also explored, and evidence is amassed to build and support the case for health care reform, expansion of health insurance coverage, greater attention on addressing the health care concerns of vulnerable groups, increased access to comprehensive care, and development of health policies to improve the health and health care of disenfranchised individuals and families as a part of a larger social movement for health justice.
A closer look at oral health, a neglected epidemic, is presented. Credence is provided to the burden of oral diseases and influences on social and economic factors for impoverished urban and rural communities. The incidence and prevalence of mental illnesses, substance abuse, and psychosocial and behavioral health problems experienced by children, youth, and adults demand due attention and resources.
Questions about appropriate assessment, diagnoses, and access to viable treatments remain unanswered, despite being repeatedly raised. The delivery of health care services may be further complicated by the disjointed systems that are currently available. Prevention and intervention approaches, research priorities, and advocacy efforts toward improving mental health outcomes and promoting overall health and well-being within families, communities, and societies are discussed.
The historical and complex reasons for men’s poor health outcomes are disentangled and analyzed, and the unique stressors encountered by African American men are illuminated. Social structural discord, exclusionary health policies, poverty, race, and unhealthy behaviors are identified as some of the quandaries that have catapulted the rates of chronic disease and premature death for men of color to the top of the list. Finally, the interface between the criminal justice system and the health care system is inspected. Approximately 650 000 ex-offenders are released annually. Needs of those seeking community reentry and needs of communities absorbing ex-offenders go unmet. Furthermore, there are currently close to 2.2 million men and women who are housed in prisons and jails in the United States,11 and a growing body of evidence points to levels of ill health before, during, and after incarceration, including high rates of infectious diseases, such as HIV/AIDS. The two main goals of Healthy People 201012 are clear: namely, to (1) help individuals of all ages increase life expectancy and improve their quality of life and (2) eliminate health disparities among different segments of the population. To have any hope of achieving these targets, we must seek health justice for all. To the question, “Health is a human right, right?” the collective community voice must be an emphatic “Yes!”
The Flood, by Icky A. This image is part of a series images made for the Advocates for Environmental Human Rights. The images were originally used for a poster/education campaign trying to apply the United Nations’ laws for internally displaced peoples to survivors of Hurricane Katrina. Used with permission of Justseeds.
References
1. World Health Organization. Constitution of the World Health Organization. Available at: http://www.who.int/ governance/eb/ who_constitution_en. pdf. Accessed June 15, 2008.
2. Centers for Disease Control and Prevention. Health insurance coverage. Available at: http://www.cdc.gov/nchs/ fastats/ hinsure.htm. Accessed June 15, 2008.
3. House JS, Williams DR. Understanding and reducing socioeconomic racial/ethnic disparities in health. In: Hofrichter R, ed. Health and Social Justice: Politics, Ideology, and Inequity in the Distribution of Disease. San Francisco, CA: Jossey-Bass; 2003:89- 131.
4. Centers for Disease Control and Prevention. Table 27. Life expectancy at birth, at 65 years of age, and at 75 years of age, by race and sex: United States, selected years 1900-2005. Available at: http://www.cdc.gov/nchs/data/hus/ hus07.pdf#027. Accessed June 15, 2008.
5. Unnatural Causes . . . Is Inequality Making Us Sick? [film]. Available at: http://www.unnaturalcauses.org. Accessed June 15, 2008.
6. Moore M. Sicko. [film]. Available at: http:// www.michaelmoore.com/ sicko/index.html. Accessed June 15, 2008.
7. Hofrichter, R. The politics of health inequities: contested terrain. In: Hofrichter R, ed. Health and Social Justice: Politics, Ideology, and Inequity in the Distribution of Disease. San Francisco, CA: Jossey-Bass; 2003:1-56.
8. Boat TF, Chao SM, O’Neill PH. From waste to value in health care. JAMA. 2008;299:568-571.
9. Quote from Senator Barack Obama, Speech in Iowa City, Iowa, May 29, 2007. Available at: http://www. barackobama.com. Accessed June 15, 2008.
10. Quote from Senator John McCain, Speech in Tampa, Fla, April 29, 2008. Available at: http://www.johnmccain. com. Accessed June 15, 2008.
11. US Department of Justice. Prison statistics. Washington, DC: Office of Justice Programs, Bureau of Justice Statistics; June 2007. Available at: http:// www.ojp.usdoj.gov/bjs/prisons.htm. Accessed June 15, 2008.
12. World Health Organization. Healthy People 2010: Understanding and Improving Health. Available at: http:// www.healthypeople.gov. Accessed June 15, 2008.
Kisha Braithwaite, PhD
About the Author
The author is with the Community Voices: Healthcare for the Underserved and the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta, GA.
Requests for reprints should be sent to Kisha Braithwaite, PhD, 720 Westview Dr, SW, Atlanta, GA 30310 (e-mail: kbraithwaite@msm.edu).
This editorial was accepted June 19, 2008.
doi:10.2105/AJPH.2008.145748
Copyright American Public Health Association Sep 2008
(c) 2008 American Journal of Public Health. Provided by ProQuest LLC. All rights Reserved.