In honor of National Public Health Week 2023
Written by Alexis Wing (she/her/hers) and Gracie Rolfe (she/her/hers)
Health is a Human Right
Health as a human right is a concept that was first formally established by the United Nations (UN) Universal Declaration of Human Rights in 1948. Article 25 of this document states that, “[e]veryone has the right to a standard of living adequate for health and well-being of [themselves] and of [their] family, including food, clothing, housing, and medical care…” Although it has been over 70 years since this concept was formalized by the UN, health as a human right is not fully realized in the in the United States health care system. According to 2020 census data, 8.6% of people (28 million) did not have health insurance at any point during the year. Moreover, there were 580,466 people experiencing homelessness in the U.S. in January 2020, and 10.5% of U.S. households experienced food insecurity in 2020.
While access to affordable medical care is an essential component of ensuring that health is a guaranteed human right, access to safe and affordable food and housing are critical to addressing the social determinants of health that too often create inequitable outcomes for marginalized groups – groups that already face barriers due to systems and policies that continue to uphold tenets of white supremacy culture. Not affirming that health is a human right has severe ramifications for everyone, as has been witnessed throughout the COVID-19 pandemic, especially as the U.S. nears 1 million deaths from COVID-19 since March 2020. Asserting that health is a human right is critical to preventing future harms and burdens on communities which already face systemic barriers.
According to Healthy People 2020, “health equity is attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequities, historical and contemporary injustices, and the elimination of health and healthcare disparities.” Health equity also involves meeting people and communities where they are, in order to best serve them and meet their needs in those specific and unique moments. Systems, structures, and policies exist in our society to benefit some and disadvantage many others. These systems, structures, and policies have a direct correlation to health and health outcomes of communities and populations. This is evidenced by disparate health outcomes that burden Black, Indigenous, and People of Color (BIPOC).
We cannot deny life-saving public health measures or interventions to people because we do not agree with the behaviors they are exhibiting. This is also a key component of health equity that is often overlooked or missed in our programs and services. Nowhere is this more evident than analyzing the attitudes and beliefs that surround harm reduction. Harm reduction has long been defined as a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use; it is also a movement for social justice built on the belief in and respect for the rights of people who use drugs.
From a public health perspective, harm reduction advances health equity, addresses racial disparities, and upholds justice and autonomy. However, harm reduction measures and strategies have been consistently stigmatized, under-funded, and often overlooked in public health, with questions around morality and celebrating drug use. The cost of a clean syringe can be as little as 50-90 cents and can prevent someone who injects drugs from contracting infectious diseases (such as HIV or Hepatitis C), which can cost people hundreds of thousands of dollars in treatments alone. Questions of morality and the concept of “enabling people” often get brought up in harm reduction efforts and measures.
In 2015, Scott County, Indiana had one of the worst outbreaks of HIV on record, mostly among rural people who inject drugs (PWID), many of whom regularly shared needles. The Governor of Indiana at the time was Mike Pence, a steadfast conservative who was morally opposed to needle exchange programs, despite evidence that these programs helped to reduce the spread of infectious diseases, particularly HIV. At the time, Indiana law made it illegal to have a syringe without a prescription. Due to the rapid spread of HIV that took place in just two months, Pence was pressured by many county officials and public health experts to put his morals aside and sign an executive order allowing a needle and syringe exchange program. This outbreak occurred at the beginning of 2015, with nearly 72 cases of HIV reported in early March. By October of that same year, not a single person tested positive for HIV, largely thanks to the impact the needle and syringe exchange program had on this small, poverty-stricken county.
2020 marked the single deadliest year for drug-related overdose deaths in the United States. During the same time span in Massachusetts, overdose deaths increased by 5%, including a 69% increase among Black men. Despite this troubling trend, proven harm reduction measures used throughout the world continue to face significant obstacles here in the U.S. In many places across the country, the threat of stiff punishment, community backlash, pervasive stigma, and difficulties of implementation prevent the exploration and establishment of potentially lifesaving initiatives like medication for addiction treatment (MAT), safe consumption sites (SCS), drug clinics, and more.
The current state of the American attitude toward harm reduction, despite tremendous strides that have been made, is still largely influenced by the decades-long War on Drugs, with its draconian drug policies, law and order approach, and abstinence-only mentality. By most accounts, the drug war has done little to curb illicit drug use, hinder the flow of illicit substances across borders, or prevent the overdose crisis we now find ourselves in. Access to culturally responsive, stigma-free care is necessary, especially for people who use drugs, if we hope to affect positive change for people impacted by racialized drug policies and the War on Drugs. Health and healthcare for people who use drugs can look like overdose prevention centers. It can look like decriminalization of drugs, something only the state of Oregon has managed to do in this country, with early results showing the promise of what non-punitive and non-carceral approaches to drug policy can look like.
Inevitably, the health needs of one group will differ from the needs of another group. Humans are complex and multi-faceted beings. So are the systems and structures that exist in our world that oppress and marginalize many. Health equity in its most basic form is meeting people where they are at and providing the resources they need at that moment.
Why don’t we fund health as a human right?
Many other countries such as Sweden, Thailand, and New Zealand fund universal health care, yet the decision of whether to do this in the U.S. remains a contentious issue. Compared to other countries, the U.S. spends significantly more on health care, including those with universal health care, but has worse health outcomes among the general population and vast health inequities that burden low-income groups and BIPOC.
There are many reasons that the U.S. does not embody the principle of health as a human right by funding and implementing universal health care. Health services in the current health system are largely accessed through private insurance companies which consumers and employers can choose and purchase plans from. The critical feature of this system, choice, is a traditional American value that drives the operation and implementation of many of our systems today, including health care, as many Americans believe that transitioning to a universal health care system would force them to sacrifice their ability to make choices about their health care. This is not true, though, and challenging this false narrative is essential to nudging people to reconsider a system that continues to force millions of Americans into severe debt, produce inequitable health outcomes, and benefit only a small portion of those with the most privilege in this country.
The quality of insurance that Americans have access to also dictates the type of care and medications they are able to access. This is especially important to consider for individuals with substance use disorders (SUD), as insurance is required to access any level of care for SUD. Care for SUD, such as residential treatment, counseling, and medications, can be incredibly expensive, and insurances may or may not provide coverage for a treatment option that meets the person’s needs. This forces individuals to seek funds elsewhere, opt for a different form of treatment that may not meet their needs, or simply forgo any treatment within the medical system. The cruel limitations of this system can have deadly consequences, as we’ve seen with the concerning rise in overdose deaths over the last two years.
Medicare, which provides universal health care for individuals over 65 in the U.S., is often cited as a foundation on which to build out universal health care that covers the rest of the country’s population. However, even Medicare has its shortcomings, as it does not cover long term care, such as health, personal, and other support services that help people to live independently. This creates scenarios in which families bear the responsibility of paying for long-term care out of pocket for their loved ones, or providing care themselves to loved ones, both of which can drive financial hardship and stress. Medical advances over the last several decades have allowed people to live and work longer, and ensuring affordable access to care and services that support independent living is a crucial element of universal health care and health as a human right for all.
Saying that health is a human right requires bold action behind it. While the promise of universal healthcare in this country seems far away, there are promising models of universal healthcare on the state level. For example, the Massachusetts health care reform, commonly referred to as Romneycare, was a healthcare reform law passed in 2006 and signed into law by Governor Mitt Romney with the aim of providing health insurance to nearly all of the residents of the Commonwealth of Massachusetts.
The law mandated that nearly every resident of Massachusetts obtain a minimum level of insurance coverage, provided free and subsidized health care insurance for residents earning less than 150% and 300%, respectively, of the federal poverty level (FPL) and mandated employers with more than 10 full-time employees provide healthcare insurance. To date, Massachusetts has one of the lowest uninsured rates anywhere in the country. As has been studied time and time again, states that have high rates of uninsured people also tend to have worse health outcomes; and states with broad and expansive healthcare coverage and low rates of uninsured people have better health outcomes.
Funding healthcare is health equity. Dismantling the systems and structures that hinder health is health equity. Honoring people’s dignity, autonomy, and self-determination is health equity. It is far past time that we realize these truths.