The human right to health, Universal Health Coverage (UHC) and the social determinants of health.

A number of key concepts underpin contemporary global health concerns. These include the human right to health, Universal Health Coverage and the social determinants of health.

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The human right to health appears in several post World War 2 international instruments. These include the 1948 preamble to the Constitution of the World Health Organization; Article 25 of the 1948 Universal Declaration of Human Rights; and Article 12 of the 1976 International Covenant on Economic, Social and Cultural Rights. For instance, Article 12 affirms “the enjoyment of the highest attainable state of health as a human right under international law”.

A key current instrument supporting this human right is Universal Health Coverage (UHC). This states that all people should have equal access to quality health services covering health promotion, disease prevention, treatment and rehabilitation, and people should have coverage with financial risk protection.

UHC is a main policy objective within the United Nations Sustainable Development Goals and the commitment to “leaving no-one behind”. Most high-income countries, with the striking exception of the United States, offer UHC. Increasingly middle and low-income countries are moving towards this policy objective. At the moment, however, many countries fall significantly short of this objective. Often out-of-pocket payments remain a significant impediment to access to services.

Across the global population, health is improving, yet very unequally. For example, life expectancy differs between over 80 years for both sexes in some high-income countries to around 50 years in a low-income state such as Somalia1. Many Somalis live long lives; the difference comes from very high levels of infant mortality, with the infant mortality rate in Somalia reported by WHO to be 132/1000 live births. Such differences in life expectancy and other measures of health and well-being occur both between states, but also strikingly within states. Such differences reflect differences in human experience and the conditions in which people grow, live, work and age. These differences reflect differences in the distribution of power, influence and resources within society and societies. These factors are referred to as the social determinants of health, which have been increasingly studied and reported upon. The social determinants are active across the whole of the life-course.

There is an increasing understanding of a range of policy interventions which can reduce the impact of the social determinants of health. Most of these policy interventions lie outside the direct remit of health ministries and health services. Instead, these are the responsibilities of other ministries and sectors within government and society. To intervene, the WHO promotes intersectoral policies, referred to as the whole of government, the whole of society and health in all policy approaches.

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