The Right to Health: Part 1

This is part one of a two-part series exploring the right to health, how the right is connected to our mission and to our goals to scale-up, and how your support is vital to our work. You can read part two here.

I don’t know about you, but I think about my health and the health of my daughter, Gillian, on a daily basis. I know that our health is our most basic asset and that ill health will prevent us from participating fully in life – and we love life! So, we work to protect it, through diet and exercise and by making purposeful decisions about where we live – avoiding locations with environmental degradation and obvious signs of pollution. Fortunately, Gillian and I are members of the middle class and live in the United States. The sacrifices we make to ensure our long-term well-being – our health – are usually pretty minor.

That’s not the case for everyone. Our minor sacrifices do not compare to the major sacrifices that lots of people around the world must make. For some people, the sacrifice might be choosing to stay in their home, even though harmful activities pollute their only source of drinking water, because moving somewhere else isn’t a financial option. For others, it might mean choosing to participate in a certain line of work, even though dangerous conditions are present, harmful contaminants and chemicals are used, and the risk of death is shockingly high because safer jobs just aren’t available. These sacrifices might provide shelter and food for the present, but they do not ensure long-term well-being. Can we really call these sacrifices? Doesn’t sacrifice imply choice? These aren’t choices. Or, at least, they shouldn’t be. As members of this global community, we ought to be outraged.


A child patient being seen at the ASRI clinic | Photo: Chelsea Call

The right to health is a fundamental part of our human rights and of our understanding of a life in dignity. It was first articulated in the preamble to the 1946 Constitution of the World Health Organization (WHO), which defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. In 1948, the Universal Declaration of Human Rights mentioned health as part of the right to an adequate standard of living (art. 25). In 1966, the International Covenant on Economic, Social, and Cultural Rights recognized the right to health as a human right. Like many other nations, Indonesia is a signatory to the International Covenant on Economic, Social and Cultural Rights and is, thus, bound to respect, protect and fulfill the right to health for all its citizens.

It is with the right to health in mind that Kari Malen, our International Program Development Director, and I initiated a series of discussions exploring how the right to health is connected to our mission and to our goals in scaling-up. Over the course of a few months, we explored whether and to what extent using an internationally recognized framework – like right to health – might raise the legitimacy of our work, provide a base from which to innovate, maintain focus on the link between human and environmental health, and give both stick and carrot tools for actionable impact on the ground.


Right to Health Challenges

Access to health care – both through services and institutions – is a fundamental human right. We all recognize and understand that. However, the right to health includes more than just the right to see a doctor in a hospital. It extends to the underlying determinants of health – those factors that decide whether it is even possible to be healthy where we live – and contains certain freedoms and entitlements.


A village is flooded, making it difficult for communities to access health care services | Photo: Marisa Thimang

What does this mean on the ground? Well, let’s take a look. Let’s compare right to health in a typical suburban US city to that in a low-income country:

Health Determinants United States Low-Income Country
Safe drinking water City funded water treatment Water obtained from wells & streams
Adequate sanitation City funded waste removal Trash is burned, inadequate or unavailable raw sewage facility, defecation often happens near drinking water supplies
Safe food Federal funded regulation Poor or ineffective regulation, uncertainty about food ingredients and level of toxins
Adequate nutrition & housing Federal funds to support the purchase of food & housing, sufficient availability of nutritional food and safe housing Low or no funds for food & housing, nutritional variety is extremely limited for those with no money, safe housing is often non-existent
Healthy working & environmental conditions Federal & state laws require compliance with minimum safety standards for employees Poor or ineffective worker safety regulation, very often no funds to support enforcement
Health-related education & information Funded education programs in schools and health care facilities, safety information required at job sites Little to no health education or information, often no discussion by health care providers about prevention or maintenance of health
Gender equality Equal opportunity to health services Women must often receive permission from fathers, husbands, or elders before accessing certain health care services


Health Freedoms United States Low-Income Country
Safe from non-censual medical experiments, sterilization, torture, and other cruel or degrading treatment or punishment Federal & state laws require compliance with this freedom, enforcement and public awareness is common Poor or ineffective regulation is often the case, little public awareness among lower-socio-economic populations, mental health and drug addiction facilities commonly violate these freedoms


Health Entitlements United States Low-Income Country
Availability and access to: 1) a health system that provides equal opportunity and enjoyment of the highest attainable level of health; 2) availability and access to prevention, treatment, and control of diseases; 3) availability and access to essential medicines Health care facilities and medicines are regulated to ensure high-quality, safety, and efficacy of all services for all citizens High variability of and unequal access to quality, safety, and efficacy of health care facilities and medicines


Linking Right to Health with Conservation

Seems like the right to health that we, as US citizens experience, is very different from that of citizens living in low-income countries. That’s pretty clear, right? Kari and I thought so too. Then we thought, if our concern – our mission – is to engage in community-led solutions for both human health and the health of the planet, then doesn’t the right to health provide a framework for achieving that? Aren’t there conservation goals embedded within the framework? If we address and remedy human health challenges, don’t environmental health remedies naturally follow? If they do not, is it possible to incorporate them? We noodled on these questions too.


Patients paying for health care with tree seedlings | Photo: Nikki See

We decided, yes. YES. Yes! Addressing human and environmental health challenges can happen concurrently. This is exactly what we have spent the last ten years working toward and we have done it thanks to your support. We all know that improving the health of our planet means improving human health.. which means improving environmental health.. which means improving human health – it is a circle. If we know that, then we also ought to realize that it is not possible for a Nation to respect, protect, and fulfill the right to health while, at the same time, allow environmental degradation.

Bottom-line is this – if the right to health is a fundamental human right, and environmental degradation negatively impacts that right, then we have a foundation from which to argue that the right to health includes the right to environmental health.


Putting it into Action - Our Improved Toolbox

Ok. Big deal, right? We know Indonesia has a weak rule of law. While they are working hard to overcome their history of corruption – both in court and in government office – we know they have a long way to go. What does it matter if we can apply a legal framework to help address and remedy human and environmental health challenges? We aren’t about to start bringing cases in front of the National or International bar, right?

Well, no, of course not. However, we can:

  1. leverage the international recognition of the right to health to describe the work we do and the impact we make – the link between human and environmental health is a matter of fundamental human rights.
  2. use the framework to talk about how right to health challenges are often considered only in terms of state obligations and responsibilities, but we innovate outside that legal box – our projects seek to motivate behavioral change on the individual, community, corporate, and government level.
  3. consider the ways in which conservation value and right to health challenges are connected when choosing our next site for scaling-up.

Kari and I have considered the above-listed ways in which we might apply a right to health framework moving forward. We are just setting off down this path and believe there are many more opportunities that we have neglected to talk about. We also have to guess that you likely have some ideas as well (We are all ears! Feel free to comment or shoot us an email and let us know your thoughts! We welcome your support and expertise.)

Here’s the thing, though – the collective human and environmental health challenges we face are unacceptable. We are all negatively impacted – our global communities and our ecosystems. We must stand up for each other, push for change, offer help, and work toward global solutions.

I clearly remember a dear friend, a professor of environmental law, saying to me once, “Bethany, the rising tide raises all ships. Be the tide.” I think that advice is suited for the challenges we face today.

Let’s be the tide, people.


Next up - Where do we go from here? Your donations helped support the site visit Hotlin and I made to Bangka-Belitung this past July. In the next installment of this two-part series, I’ll introduce Bangka-Belitung and discuss the conservation value of the island region, the right to health challenges, the potential partners, and the community-led solutions. Read part two here.


About Bethany Kois | View all posts by Bethany Kois

Bethany is the Research Director at Health In Harmony, based in Charles City, IA.