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, USAlancegable@wayne.edulancegable@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,lancegable@wayne.edu