Table 1 Principles of the right to health used to inform the construction of indicators for breast cancer management and care, adapted from references #5 and #7
Principle | Definition | International human rights law sources |
|---|---|---|
Availability Accessibility Acceptability Quality (AAAQ)a | All health services, goods and facilities shall be available, accessible, acceptable and of good quality (AAAQ). The precise nature of these elements will depend on the conditions prevailing in a particular state Available: functioning public health and health-care facilities, goods and services, as well as programmes, have to be available in sufficient quantity within the state party. The precise nature will vary depending on numerous factors, including the state party’s development level Accessible: health facilities, goods and services have to be accessible to everyone without discrimination, within the jurisdiction of the state party. It includes: non-discrimination; physical accessibility; affordability and information accessibility Acceptable: all health facilities, goods and services must be respectful of medical ethics and culturally appropriate as well as being designed to respect confidentiality and improve the health status of those concerned Good quality: health facilities must be scientifically and medically appropriate and of good quality. This requires skilled medical personnel, scientifically approved and unexpired drugs and hospital equipment, safe and potable, and adequate sanitation | General Comment 14 |
Accountabilityb | [T]he right to health brings with it the crucial requirement of accessible, transparent and effective mechanisms of monitoring and accountability. Those with right-to-health responsibilities must be held to account in relation to the discharge of their duties, with a view to identifying successes and difficulties; so far as necessary, policy and other adjustments can then be made. Examples of accountability mechanisms are: 1.Judicial, e.g. judicial review of executive acts and omissions 2. Quasi-judicial, e.g. (…) human rights treaty-bodies 3. Administrative, e.g. human rights impact assessment 4. Political, e.g. parliamentary committees 5. Social, e.g. civil society movements The accountability mechanism should exist at the national, regional (if available) and international levels. Rightsholders are also entitled to effective remedies when duty-bearers have failed to discharge their right to health obligations. These remedies may take the form of restitution, rehabilitation, compensation, satisfaction or guarantees of non-repetition | General Comment 14 Limburg Principles Maastricht Guidelines |
Core obligationsc | In general comment No. 3, the Committee confirms that States parties have a core obligation to ensure the satisfaction of, at the very least, minimum essential levels of each of the rights enunciated in the Covenant, including essential primary health care. Read in conjunction with more contemporary instruments, such as the Programme of Action of the International Conference on Population and Development, the Alma-Ata Declaration provides compelling guidance on the core obligations arising from article 12. Accordingly, in the Committee’s view, these core obligations include at least the following obligations: a) To ensure the right of access to health facilities, goods and services on a non-discriminatory basis, especially for vulnerable or marginalized groups; b) To ensure access to the minimum essential food which is nutritionally adequate and safe, to ensure freedom from hunger to everyone; c) To ensure access to basic shelter, housing and sanitation, and an adequate supply of safe and potable water; d) To provide essential drugs, as from time to time defined under the WHO Action Programme on Essential Drugs; e) To ensure equitable distribution of all health facilities, goods and services; f) To adopt and implement a national public health strategy and plan of action, on the basis of epidemiological evidence, addressing the health concerns of the whole population; the strategy and plan of action shall be devised, and periodically reviewed, on the basis of a participatory and transparent process; they shall include methods, such as right to health indicators and benchmarks, by which progress can be closely monitored; the process by which the strategy and plan of action are devised, as well as their content, shall give particular attention to all vulnerable or marginalized groups The Committee also confirms that the following are obligations of comparable priority: a) To ensure reproductive, maternal (prenatal as well as post-natal) and child health care; b) To provide immunization against the major infectious diseases occurring in the community; c) To take measures to prevent, treat and control epidemic and endemic diseases; d) To provide education and access to information concerning the main health problems in the community, including methods of preventing and controlling them; e) To provide appropriate training for health personnel, including education on health and human rights | General Comment 14, paras 43 and 44 General Comment 3 |
Legal recognitiond | Legal recognition of the right to health is the first step towards its implementation. Legal recognition means that states must ratify human rights treaties recognising the right to health, such as the ICESCR, and incorporate the right to health into their national constitution | Article 12 ICESCR |
Maximum available resources | States must devote the maximum available resources to the progressive realisation of economic, social and cultural rights. “Resources” are understood to include financial, natural, human, technological, and informational resources.7 States in a position to assist should provide resources to other states in need so that they can realise the right to health of their populations. In turn, states with scarce resources have an obligation to ask the international community for assistance | Article 2.1 ICESCR General Comment 3 General Comment 14 |
Non-discriminatione | The principle of non-discrimination seeks to guarantee that human rights are exercised without discrimination of any kind based on race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status such as disability, age, marital and family status, sexual orientation and gender identity, health status, place of residence, economic and social situation Non-discrimination and equality of men and women before the law are not subject to the principle of progressive realisation; they must be implemented immediately | Article 2.1 ICESCR Article 3 ICESCR Limburg Principles Maastricht Guidelines General Comment 14 General Comment 20 |
Participationf | Active and informed participation of individuals and communities in decision-making that has a bearing on their health | General Comment 14 Limburg Principles General Comment 20 |
Responsibility to respect, protect, fulfilg | States have duties to respect, protect and fulfil the right to the highest attainable standard of health. These duties are equally applicable to medical care and the underlying determinants of health. The obligation to respect requires States to refrain from interfering directly or indirectly with the enjoyment of the right to health. The obligation to protect requires States to take measures that prevent third parties from interfering with the right to health. Finally, the obligation to fulfil requires States to adopt appropriate legislative, administrative, budgetary, judicial, promotional and other measures towards the full realisation of the right to health | General Comment 14 |