What does the right to health mean for governments?
Health professionals working with the right to health also need to be familiar with the obligations that it imposes on Governments. The right to health, like all human rights, imposes three levels of obligations on governments. These are the obligations to respect, to protect, and to fulfil.
The obligation to respect implies a duty of the state not to violate the right to health by its actions.
- The state must refrain from denying or limiting equal access for all persons, including prisoners, detainees, minorities, asylum seekers and illegal immigrants;
- The state must refrain from censoring, withholding or intentionally misrepresenting accurate health-related information, including sexual health education and information.
The obligation to protect implies a duty of the state to prevent violations of the right to health by others. It must take measures which prevent third parties from interfering with or violating the right to health.
- The government must introduce and enforce appropriate controls for the marketing of medical equipment and medicines by third parties;
- The government must ensure that medical practitioners and other health professionals meet appropriate recognised standards of education, skills and ethical codes of conduct.
The obligation to fulfil means that governments must act in order to ensure that rights can be enjoyed.
- The government must focus on rectifying existing imbalances in the provision of health facilities, goods and services. For example, it should allocate sufficient public resources to the most deprived regions in the country, in particular to the poor and otherwise vulnerable and disadvantaged groups.
- The government must promote activities that benefit good health and ensure the dissemination of appropriate information.
What are the immediate and progressive obligations of States?
Given the differences between countries fully realising the right to health will need variable amounts of time and resources. The most appropriate measures to implement the right to health will also vary from one country to another. While international law sets out the various state obligations, each government must determine for itself which measures are the most suitable for complying with these obligations. However, beyond a certain point the same basic minimum standards must apply everywhere. These are the immediate obligations. Government’s are also under an obligation to put in place policies to progressively realise the right to health. As more resources are made available, so governments have to fulfil more of their responsibilities.
What are core obligations?
Core obligations are intended to ensure that people everywhere are provided with, at the very least, the minimum conditions under which they can live in dignity; enjoy the basic living conditions needed to support their health; and be free from avoidable mortality. Core obligations require immediate and effective measures and are not subject to progressive implementation.
In the case of healthcare, governments must provide:
- immunisation against major infectious diseases;
- measures to prevent, treat and control epidemic and endemic diseases;
- essential medicines, as defined by WHO’s Action Programme on Essential Medicines;
- reproductive, maternal (pre-natal and post-natal) and child health care;
- essential primary health care as described in the Alma-Ata Declaration;
- access to health facilities without discrimination;
- equitable distribution of all health facilities, goods and services.
In the case of underlying determinants of health, governments must provide:
- access to the minimum amount of food that is sufficient, nutritionally adequate and safe, to ensure their freedom from starvation and malnutrition; and
- access to basic shelter, housing and sanitation, together with an adequate supply of safe and potable water.
In the case of health education and information, governments must provide:
- education and access to information about the main health problems in the community, including methods of prevention and control; and
- appropriate training for medical and other health professionals, including education in health and human rights.
Governments must also adopt and implement a national public health strategy and action plan, based on epidemiological evidence, which takes into account the health concerns of the whole population.
What are the international obligations arising from the right to health?
International human rights law makes it clear that the responsibility of states includes international assistance and co-operation. This is required where the fulfilment of government obligations is beyond the scope of available resources, and the international community must assume some responsibility, for example by contributing to development aid.
Depending on the availability of resources, developed countries should promote access to essential health facilities, goods and services in resource-poor countries and provide the necessary aid when required. In all cases of international assistance and co-operation, priority must be given to the fulfilment of core obligations arising from the right to health.
 In exceptional circumstances of urgent public health concerns such as the need to contain outbreaks or epidemics of serious infectious diseases, the state’s obligation to respect can be superseded. An example would be the necessity to quarantine an individual with open pulmonary tuberculosis who refuses treatment, so as to prevent the spread of infection and secure public health. However such measures by government must be temporary and fully justifiable. All such exceptions must conform to the Siracusa principles. See: United Nations, Economic and Social Council, U.N. Sub-Commission on Prevention of Discrimination and Protection of Minorities. Siracusa Principles on the Limitation and Derogation of Provisions in the International Covenant on Civil and Political Rights. E/CN.4/1985/4. 1985.
 International assistance and co-operation can be seen as reflecting and affirming principles of global equity and shared responsibility which underpin contemporary models of development assistance, the Millennium Declaration being a case in point.