Since 1977, WHO-Europe has promoted a strategy for health policy based on ethical values and human rights, a movement known as Health for All. It is a call for equity, solidarity, and participation, with a broad intersectoral vision of health designed as a blueprint to guide its 52 member states in developing their national health policies. This is combined with a legal framework comprising international human rights treaties, instruments, norms and standards. Together it constitutes an approach considered to be ethical, values-based governance. The Health for All Policy Framework was first produced in 1980 and last updated in 2005. Its 1998 iteration describes three core values reflecting moral values already current in its member states: “health as a fundamental human right; equity in health and solidarity in action; and participation and accountability.”

The Health for All approach promotes a vision of health that extends far beyond patient care to include prevention activities, promotion of healthy lifestyles, and those health determinants found in the physical, social and economic environment that affect health, most notably poverty. On page 16, the report declares,

“Since poverty is a major source of health inequity, a Health for All policy should address poverty reduction, ensuring that the health system is responsive to poor, marginal and vulnerable population groups. From a Health for All perspective, action on poverty and other health determinants is considered properly intersectoral, with the health sector playing a leading role.”

It advocates activism in public health:

“Social parameters such as income, housing or education have a great effect on health status, and health equity depends substantially on the implementation of appropriate policies in all public sectors. As a consequence, health sector policies and programmes that seek to improve the health of all citizens should consider collaborating with any relevant actor, whether inside or outside the government, and whether concerned primarily with social, educational, environmental or legislative issues.” (p.45)

There is a growing consensus among the [American] electorate that we need to “reform health care,” but no consensus has yet developed about how to do that. Let that not be seen as precluding a major advance. Medicare was passed in 1965 without ever having achieved the support of a majority of the American people. What is required is courageous, visionary political leadership. We must see that the individual freedoms we cherish need the protection of a collective approach on a societal level, that we all have a right to share in that protection, and that public health has a value for us far greater than the sum of its parts. Benjamin Mason Meier and Larisa M. Mori articulate these ideas well in their article, “The Highest Attainable Standard: Advancing a Collective Human Right to Public Health”:

“…If individuals are bearers of a human right to health, societies then become the only possible bearers of a collective right to public health, with the collective right necessary to fulfill the individual right. That is, the individual and public components of health rights are not mutually exclusive but rather are interdependent. In a globalized world, the collective enjoyment of public health is a precondition for an individual human right to health, with public health programs addressing the collective determinants of health outside of the control of the individual. The discourse of collective rights can be used to supplement individual rights in affirming the inherent equality and solidarity of all people.

“Without public health and the lives it protects and promotes, no other rights would be possible. Whether caused by an individual lack of curative care or a collective lack of public health, the resulting morbidity and mortality suffered represents a gross violation of human rights. Public health is a vital component of health rights, without which states could not assure the health of individuals.”

By John Steen, Consultant in Health Planning, Health Policy, and Public Health, jwsteen@zoominternet.net

NOTE: This article is a follow-up to The Vision of Health in the 21st Century , which appeared in the CHPPD Fall 2008 Newsletter.