Health Reform and Human Rights: Does the U.S. Measure Up?


This article is part of a series published by RH Reality Check in partnership with the Center for Reproductive Rights. It is also published in recognition of International Human Rights Day, December 10th, 2010. Read more International Human Rights Day 2010 posts here.

CRR participated in the Universal Periodic Review, (UPR) a unique process which involves a review of the human rights records of all 192 UN Member States once every four years. 

The UPR is a State-driven process, under the auspices of the Human Rights Council, which provides the opportunity for each State to declare what actions they have taken to improve the human rights situations in their countries and to fulfil their human rights obligations. The UPR was created through the UN General Assembly on 15 March 2006 by resolution 60/251, which established the Human Rights Council itself. It is a cooperative process which, by 2011, will have reviewed the human rights records of every country. Currently, no other universal mechanism of this kind exists. The UPR is one of the key elements of the new Council which reminds States of their responsibility to fully respect and implement all human rights and fundamental freedoms. The ultimate aim of this new mechanism is to improve the human rights situation in all countries and address human rights violations wherever they occur.

After the midterm elections, Republican leaders are claiming a mandate to undo healthcare reform.   Last month, there was an opportunity to look at healthcare in the U.S. through a different lens – one less focused on the “evils of Obamacare” and more focused on whether the U.S. healthcare system is actually set up to ensure that people can get the medical services that they need. 

Three days after the midterm election, the U.S. engaged in a three-hour dialogue with the United Nations Human Rights Council to discuss its human rights record as part of a process called the Universal Periodic Review (UPR).  The Council set up the UPR in 2006.  As part of the process, countries submit self-assessments every four years and then respond to questions from the Council and other U.N. member nations.

Although there wasn’t sufficient to time to question the U.S. delegation in-depth, one way in which the U.S. departs from the international community is its failure to recognize healthcare as a human right. During its review, the U.S. did express a commitment to democratic solutions to enable American to live healthy lives and cited the new health reform law as a means to address the affordability of medical services.  But it neglected to go further and commit to addressing persistent barriers to sexual and reproductive health. Too often in the United States, your ability to get healthcare depends on where you live, your race or gender.  Whether you’re eligible for health coverage.  Or the kind of health services you need.   For many groups and types of healthcare service, stigma and marginalization result in significant barriers to accessing healthcare.  Access to sexual and reproductive healthcare is a prime example.

The combination of attitudes toward sexual and reproductive health and consistent disparities to health access for disadvantaged groups in the U.S. often results in the “perfect storm” in preventing access to healthcare services.  It’s no secret that many groups in the United States face significant barriers to accessing quality health services, including lack of health care coverage, shortage of health care providers in many communities, institutional bias etc.  These existing health disparities are exacerbated when medical services involve sexual and reproductive health where health care policy and practice is often driven by stigma, marginalization and just plain politics.  

A human rights approach to healthcare requires that the government work to identify barriers in healthcare access and take affirmative steps to remove obstacles to care and develop and implement policies to improve access.  Where groups are facing more barriers than majority populations, governments need to do more.

On November 2, the Center for Reproductive Rights, Renee Chelian, an abortion provider in Michigan and client of the Center, Amnesty International and the Woodhull Freedom Foundation provided testimony at the U.N., highlighting the barriers marginalized groups in the U.S. encounter in trying to obtain sexual and reproductive health services, specifically low-income and rural women, men who have sex with men, sex workers and women of color. Over the next few days, Renee Chelian of Northland Family Planning and Cristina Finch of Amnesty International will share with you what we told the Council.

When you read their blogs, keep in mind that the U.N. has recognized four components in determining whether healthcare is accessible and has emphasized that governments have an obligation to adopt policies to ensure access to eliminate barriers to healthcare services.     

Non-discrimination: Healthcare must be accessible to all especially the most vulnerable or marginalized sections of the population.   Discrimination based on race, color, sex, language, religion, political or other opinion, national or social origin, property, birth, physical or mental disability, health status (including HIV/AIDS), sexual orientation and civil, political, social or other status is prohibited.  In addition to refraining from adopting discriminatory policies, countries have an obligation to take steps to address disparities in health care access and outcomes.  For instance, U.N. human rights bodies have consistently expressed concern about racial disparities in healthcare.  They’ve also recognized that realization of women’s right to health requires health policies that provide a full range of high quality healthcare, including sexual and reproductive services and the removal of barriers interfering with access to health services.

Economic accessibility: Whether privately or publicly funded, healthcare facilities, goods and services must be affordable to all.  Health coverage that fails to cover sexual and reproductive health services raise discrimination and economic accessibility issues.

Physical accessibility: Health facilities must be within safe physical reach for all segments of the population, especially vulnerable or marginalized group, such as minorities, indigenous populations, women, children, adolescents, older persons, persons with disabilities and persons with HIV/AIDS.   Individuals living in rural communities should have access to adequate health facilities, including information, counseling and family planning services. 

Informational accessibility: Everyone has the right to receive information concerning health issues.  U.N. human rights bodies have repeatedly stressed the importance of sexual education and information as a means of ensuring the right to health because it contributes to reduction of the rates of maternal mortality, abortion, adolescent pregnancies, and HIV/AIDS.                   

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