Lance Gable, JD, MPH Assistant Professor of Law Wayne State University Law School

1. U.S. Health Reform and the Elusive Target of Human RightsJohn F. Roatch Global Lecture in Social Policy and Practice, Arizona State University, March 5, 2010 Lance Gable, JD, MPH Assistant Professor of Law Wayne State University Law School Detroit, Michigan, USA lancegable@wayne.edu

2. U.S. Health Expenditures, 2007 Sources: CMS, OECD, WHO

3. Country Rankings Infant Mortality 1960 and 2004

4. U.S. Insurance Coverage 2007 Source: US Department of Health and Human Services

5. U.S. Uninsured Rate 1996-2006 Source: US Department of Health and Human Services

6. U.S. Uninsured Rate Predictions Source: Commonwealth Fund

7. U.S. Health Expenditures 2007

8. Major themes • Part I. Health as a Human Right: an evolution of substance and process • Part II. Health Reform in the United States: a perennial struggle for common ground • Part III. Health reform proposal and human rights • Part IV. Recommendations

9. Part I. Health as a Human Right: an evolution of substance and process • What is health? • Constitution of the WHO (1948): “health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” • What are human rights? • What is the right to health?

10. Framing Health and Human Rights • Human rights are universal and immutable • Human rights transcend state sovereignty • The human rights movement has had great successes, but human rights violations continue to occur with great frequency around the world • Human rights have proliferated

11. Sources of the Human Right to Health • International and regional legal frameworks • International organizations • National governments and other domestic jurisdictions • International NGOs, funders, and other political actors

12. Framing Health and Human Rights • Three relationships: • Health affects Human Rights • Human Rights affect Health • Health and Human Rights are inextricably linked and mutually reinforcing Mann, Gostin et al. (1994) Health and Human Rights

13. Source: WHO

14. The International Human Rights System

15. Sources of the Human Right to Health • Universal Declaration of Human Rights, article 25 (1948): the right to heath is “a standard of living adequate for the health and well-being of [a person and that person’s] family, including food, clothing, housing, and medical care and necessary social services…”

16. Sources of the Human Right to Health • ICESCR, article 12 (1966): “the right of everyone to the…highest attainable standard of physical and mental health.” • Includes: “conditions which would assure to all medical service and medical attention in the event of sickness.”

17. Sources of the Human Right to Health • General comment 14: focus on the underlying determinants of health • Four factors: availability, accessibility, acceptability, and quality • Three responsibilities: respect, protect, and fulfill

18. Sources of the Human Right to Health • Special Rapporteur reports: • Right to health includes the protection of other human rights • “a strong health system is an essential element of a health and equitable society.”

19. Part II. Health Reform in the United States: a perennial struggle for common ground • Health Care Reform has always been politically divisive

20. Part II. Health Reform in the United States: a perennial struggle for common ground

21. Part II. Health Reform in the United States: a perennial struggle for common ground • Health Care Reform has been politically divisive

22. Part II. Health Reform in the U.S.: a perennial struggle for common ground

23. Part II. Health Reform in the United States: a perennial struggle for common ground

24. Part III. Health reform proposals and human rights • 1) Expanding access to health insurance • Limit pre-existing condition exclusions and expenditure caps • Individual mandate • Subsidies for qualifying individuals and small businesses • Health insurance exchanges • Essential health benefit packages • Abortion • Other access expansions

25. Part III. Health reform proposals and human rights • 2) Cost containment across the health system • 3) Quality improvement • 4) Other issues • Medical malpractice reform • Single payer and human rights

26. Part IV. Recommendations • Pass health reform because it advances health and human rights • Develop rights-based approaches to health policy • Recognize the right to health in the United States • Support health through other human rights

27. U.S. Health Reform and the Elusive Target of Human Rights Thank You! For more information, please contact: Lance Gable, Wayne State University Law School, lancegable@wayne.edu