The richest country in the world refuses to provide adequate healthcare to its own citizens.

Infringement of the right to health in the United States (US) is endemic—perhaps even a basic part of the social fabric. The failure to provide the right to health in a country as wealthy as the US reflects misplaced social priorities and a bizarre acceptance of a parasitic, exploitative healthcare system that pulls people into financial ruin and cuts lives short.

THE RIGHT TO HEALTH IS A HUMAN RIGHT

Article 25 of the Universal Declaration of Human Rights (UDHR) expressly declares health as a human right:

(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The UDHR’s guarantee of a right to health was later expressly codified in the International Covenant on Economic, Social and Cultural Rights (ICESCR). Article 12 of the ICESCR provides that states party to the treaty shall affirm the right of everyone to the “highest attainable standard of physical and mental health.” It goes on to affirm the importance of reducing infant mortality, promoting child development, improving “environmental and industrial hygiene,” and preventing and treating disease.

As of 2019, 169 states have ratified the ICESCR. The US has only signed the treaty, not ratified it, but a signature suggests the intent to be bound by the Covenant’s principles at a later date.

Several other international treaties reference and affirm the right to health. These include:

• The 1965 International Convention on the Elimination of All Forms of Racial Discrimination: art. 5(e)(iv);

• The 1979 Convention on the Elimination of All Forms of Discrimination against Women: arts. 11(1)(f), 12, and 14(2)(b);

• The 1989 Convention on the Rights of the Child: art. 24;

• The 1990 International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families: arts. 28, 43(e), and 45(c); and

• The 2006 Convention on the Rights of Persons with Disabilities: art. 25

The International Covenant on Civil Political Rights (ICCPR) also guarantees the right to life, directly implicating the right to health. Specifically, ICCPR article 6(1) provides: “Every human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily deprived of his life.” The Human Rights Committee—the treaty body that oversees the implementation of the ICCPR—notes in its General Comment No. 36 that the right to life should not be interpreted narrowly, and that the right to life includes the right to “enjoy a life with dignity” (¶ 3) and access to health care (¶ 26).

In contrast to the ICESCR, the United States has ratified the ICCPR and is bound to it.

THE UNITED STATES HEALTHCARE SYSTEM VIOLATES THE RIGHT TO HEALTH

The healthcare system in the United States (US) gravely violates the right to health, because it denies access to healthcare—and thus restricts the right to health—on the basis of monetary resources. The rich are increasingly the only people with adequate access to healthcare, while those without money forego healthcare or are led to financial ruin in pursuing it. 

A 2017 study by the Commonwealth Fund found that while 44 percent of lower-income people in the US reported financial barriers to care, only 26 percent of those with higher incomes reported the same. But, and rather shockingly, even a high-income person in the US was more likely to report financial barriers than a low-income person in the United Kingdom (only 7 percent of people with lower incomes and 4 percent with higher incomes reported that costs prevented them from getting needed healthcare in the UK). The US ranked last in a comparison of 10 industrialized countries on measures of health system equity, access, administrative efficiency, care delivery, and healthcare outcomes.

Foregoing healthcare because of cost is common. An outrageous 58 percent of Americans report that they have delayed or forgone medical or dental care because of prohibitively high costs with 31 percent of all respondents saying they did this “often”. Two-thirds of Americans who file for bankruptcy report that they have done so because of medical issues—either because of high costs for care or the need to take time out of work.

Much of this data can be tied to the prohibitively-high costs of healthcare in the US. According to the Organisation for Economic Co-operation and Development (OECD), National Health Spending is 17.1 percent of GDP in the United States, compared to the 8.8 percent OECD average. In fact, the average US person spends double the OECD average on healthcare—$10,586 per person on healthcare compared to the average of $3,994. None of this spending appears to lead to longer lives: US life expectancy is 78.6 years, compared to an OECD average of 80.7 years.

RACIAL INEQUALITIES PERSIST IN PROVIDING HEALTHCARE

High costs alone are not the only thing restricting access to healthcare. Racial inequalities are intrinsic in the United States healthcare system as well—a serious infringement of the human rights of those oppressed by such discrimination. African-Americans live 3.8 years fewer than white Americans, and African-Americans face higher death rates at younger ages from heart disease, diabetes, and cancer, as well as higher risks for HIV infection, homicide, and infant mortality. According to a study released by The Century Foundation in December 2019, African-American women are three times as likely to die of pregnancy-related causes than white women. The African-American infant mortality rate is two times that of white infants. Skin colour remains a determining factor in shaping one’s destiny in the United States.

Discrimination of any social good is a grave human rights violation. The ICCPR carries several provisions that prohibit discrimination. Article 2 requires states party, including the US, to enable the protection of human rights affirmed by the Covenant “without distinction of any kind, such as race...”. Article 26 of the Covenant notes that “All persons are equal before the law and are entitled without any discrimination to the equal protection of the law,” expressly prohibiting discrimination for any reason, including race.

THE UNITED STATES MUST PROVIDE FOR THE RIGHT TO HEALTH

There is no excuse for the continued deprivation of the right to health in the United States. Health is a human right, and access to healthcare that supports the right to health, and the right to life, should be the priority of the state and federal governments. Healthcare must be provided in a manner that guarantees access on the basis of non-discrimination.

Perhaps most importantly, US citizens must demand for themselves a different healthcare system that is more in line with OECD spending and which provides better results. They must reject the powerful interests that have made billions of dollars in monetizing and exploiting illness and suffering—and claim their right to health.

Dave Inder Comar is the co-founder of Human Rights Pulse and a practising attorney.

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