ACP declares: Health is a human right

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Health is a human right that is both aspirational and something that can be implemented, according to the American College of Physicians (ACP).

The College published a new position paper with the declaration and an accompanying editorial about it.

“The relationship of health to rights or human rights is complex,” authors Matthew DeCamp, MD, PhD, and Lois Snyder Sulmasy, JD, said in the paper.

Some people find no right of any kind to health or health care. But individual physicians and society both have responsibilities to patients, the ACP paper said.

“By recognizing health as a human right based in the intrinsic dignity and equality of all patients and supporting the patient-physician relationship and health systems that promote equitable access to appropriate health care, the United States can move closer to respecting, protecting, and fulfilling for all the opportunity for health,” the position paper said.

“Why did it take ACP so long to articulate this position?” said an accompanying editorial by P. Preston Reynolds, MD, PhD. “The answer perhaps stems from the U.S. definition of health, physicians’ general lack of understanding of global human rights, and the delivery of health and human services that reflect long-standing structural inequities.”

Key positions

The position paper outlined four core stances for ACP:

• ACP views health as a human right based on the intrinsic dignity and equality of all patients.
• Recognizing and implementing health as a human right requires ethical and evidence-based medical care but also the optimization of social and structural determinants of health.
• Understanding health as a human right can inform the ethical design, implementation, and evaluation of health care delivery.
• Health as a human right aligns with – but does not fully encompass – the ethical obligations of physicians, the medical profession, and a just society.

Social determinants of health

The authors note physicians “play a key part in but are not primarily responsible for achieving all of health.” That responsibility is shared with patients, health care institutions, governments, and others.

“Of note, health as a human right acknowledges the reality of progressive realization; in the real world, not all aspects of health can be achieved immediately, but progress toward that goal is essential,” the position paper said.

The authors said health as a human right has “implications for the social and structural determinants of health,” such as food, clean air and water, and eduction.

In the United States, social determinants of health account for an estimated 60% of health outcomes. Recognizing those connections, physicians and health care institutions should develop partnerships with others to promote health and welfare, not necessarily “to medicalize social issues, which could have unintended consequences,” the position paper said.

How does it really work?

Reynolds also asked, “In practical terms, how does this idea of health as a human right really work?”

He cited work in South Africa, where Dr. Solomon Benatar, the personal physician of Nelson Mandela, and Physicians for Human Rights successfully sued the government for failing to fulfill a constitutional right to health of citizens. PHR then could compel international pharmaceutical companies to lower prices, allowing the government to buy medicines and deliver them to people who need them.

“Yet, health is more than access to medical treatment,” Reynolds wrote. “Physicians in the United States must recognized that failure to address poverty, illiteracy, homelessness, low wages, unsafe working conditions, and mass incarceration erodes our ability to deliver on the promise of health to all persons living here.”

“Health as a Human Right: A Position Paper from the American College of Physicians,” and the editorial, “ACP and the Human Right to Health,” were published Oct. 31, 2023 in Annals of Internal Medicine.