*This article was originally published online by The American Health Planning Association. 

Public health has always waged battle against the dangers that threaten human life. In its beginnings, it was preoccupied with the environmental agents causing disease and threatening human development, but today, in nations fortunate to have sufficient funding for public health those threats have been largely overcome. The greatest threat is no longer environmental or even economic, but social and political, and the vision of public health must be raised to reflect that.

In promoting health today, a consensus of the world’s nations supports the guiding principles laid out in the Universal Declaration of Human Rights, including "the right to a standard of living adequate for the health and well-being of himself and of his family…including medical care," as stated in Article 25. The goal is to improve not only health status but also human development, and embrace social justice as well as human rights.

This approach is reflected even more specifically in the International Covenant on Economic, Social, and Cultural Rights (ICESCR), adopted in 1966 but never ratified by the U.S. Under Article 12, the ICESCR requires governments to recognize "the right of everyone to the highest attainable standard of physical and mental health." In 1978, the World Health Organization’s Declaration of Alma-Ata proclaimed the right to health to be the "most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector." It is the realization of this ideal that should guide public health in the 21st Century.

Public health must now embrace those social and political factors that prevent us from achieving its aims. It must see health as reflective of, and contributing to, the quality of human life, where that quality is largely determined by political and social policies. Sufficient evidence has been collected worldwide to establish the role of social and behavioral factors in health, enough to require that public health adopt this as part of its mission, and nurturing a shared sense of the intrinsic value we all have as members of one community. Where there is evidence that the underlying causes of the morbidity and premature mortality of populations lie outside of the traditional field of public health, it is justified in pursuing those causes to a satisfactory conclusion as an intersectoral advocate.

The improvements sought by public health must be made in politics and education, and though these may still be seen to be "upstream" from it, that is the very reason why public health must adopt their improvement as a priority. Public health officials have a vested professional interest in framing how the public understands public health issues. To do public health in the 21st Century is to engage in a form of political activity driven by a social conscience, and it is always a challenge for public health officials to "speak truth to power" from within government service. Public health is contained within a political compact between people and their government, and when people don’t trust or support their government, the commitment represented by public health cannot be fulfilled. We can no longer claim to be doing public health without promoting public participation in the political process, and through that participation, policies that would better enable public health to achieve its goals.

The practice of public health is so marginalized and parochial in the U.S., policymakers are hardly aware that a body of international law exists that has concrete implications for domestic policymaking regarding health. For a generation, we have evidenced a nearly total disconnect between our global commitments and our domestic politics, never seeing how the two are connected by human rights. A global response is required to address this critical global challenge, and the U.S. must be its leading supporter.

Ensuring the conditions in which people can be healthy should be seen as a human right and a principal responsibility of governments. This means recognizing the human right to public health. This right exists at the intersection of human rights, public health, and international law. Human rights are the underlying determinants of health, and they need to be fulfilled through public health systems.

The concept of the human right to public health answers the threat of global climate change by creating international obligations for realizing health, recognizing the interconnectedness of risk that requires international responses and the need for protection under international law for risks that fall outside of the jurisdiction of individual states. We might all come to see as Kant did that "a transgression of rights in one place in the world is felt everywhere," and that we must practice public health without borders.

"I am not an Athenian or a Greek, but a citizen of the world."

                                                -- Socrates

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