ri Lanka, though recently categorized as a middle income country, has achieved very good health statistics for several decades at a relatively low cost (i.e. low rates of investment in health). These remarkable achievements have been described, studied and highlighted at international conferences, research publications by renowned economists and in influential reports. Economists consider Sri Lanka as an outlier in achieving good health status despite being relatively poor in terms of per-capita income and investments in health.
There are several factors contributing to this success story. A key reason is that the government provides a range of preventive and curative services at zero-cost to the user (i.e. a‘free’ health service). These services are provided through state sector hospitals, and by an extensive network of preventive care services based on the Medical Officers of Health model. The latter is where teams of health personnel (e.g. Public Health Midwives, Public Health Inspectors, Public Health Nursing Sisters, led by community-based Medical Officer of Health or Consultant Community Physicians) silently provide grass-root level services to all parts of the country. It is likely that they collectively save more lives than all the high-tech hospitals together. They are, indeed, the unsung heroes in our success in health. It is essential that Sri Lanka takes steps to strengthen this unique model. We are now in a very good position to do so by including health as a fundamental human right. This step is also a prerequisite to protect health in a period of rapid changes we face, both globally and locally. It will ensure adequate levels of health to all, including the poorest segments of the population who may be left behind at times of rapid economic growth. It will reflect values dear to most Sri Lankans, as health is recognized as a basic humane characteristic expounded by all major religions and imbibed in our collective consciousness. Finally, it reiterates a basic goal or value of being humans: i.e. to live a reasonable length of time, free of suffering from illness or injury.
"We are in effect behind an increasing number of countries that recognize health as a fundamental right."
The current Constitution of the Democratic Socialist Republic of Sri Lanka does not explicitly state that health is a fundamental right. There is, however, an indirect statement in Article 27 2 (c): “the realization by all citizens of an adequate standard of living for themselves and their families, including adequate food, clothing and housing, the continual improvement of living conditions and the full enjoyment of leisure and social and cultural opportunities”.
We are in effect behind an increasing number of countries that recognize health as a fundamental right. A study done on 191 countries in 2011 showed that almost 70 countries guaranteed the rights to overall health or medical care. There were a few who even protected the right to free medical care. The lack of a clear statement on health is a sad reflection to a country where health is considered national priority.
The core proposal is for the new Constitution to include a clear statement on the right to health. This should include a right to reasonable healthcare, but extended to other determinants of health as stated in several UN documents (see section below).
A draft is given below for consideration by the readers.
“The Constitution guarantees the right of everyone to the enjoyment of the highest attainable standard of physical, mental and social dimensions of health.”
“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including the access to medical care, preventive services and social services”.
Directive Principles of State Policy and Fundamental Duties
The State takes affirmative steps necessary to improve underlying determinants of health, such as access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions, and access to health-related education and information in a culturally sensitive manner
The State ensures that it will take necessary action to
(a) prevent, treat, and control epidemic, endemic, occupational and other diseases;
(b) create conditions which would ensure equitable access to all health and social services in the event of sickness or injury, and in the provision of essential drugs
(c) create conditions that promote health of the individual and populations, and protect from harm that could affect the health of society
(d) continue and strengthen a public sector health service that is free to the user at the point of delivery
(e) ensure that no one is unfairly denied emergency care
INT’L DIMENSION OF HEALTH AS A FUNDAMENTAL HUMAN RIGHT
We are at a juncture when the government is engaging with the UN and international community. Therefore, we should consider our obligations with the UN in the arena of health as a human right. There are several documents made that are relevant and some are outlined below.
Health as defined in the Constitution of the WHO, recognizes three dimensions: physical, mental and social: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The WHO recognizes health as a fundamental human right:
“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. The health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest co-operation of individuals and States. The achievement of any State in the promotion and protection of health is of value to all”. and appropriate health care but also to the underlying determinants of health, such as access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions, and access to health-related education and information, including on sexual and reproductive health”.
A similar set of rights to health is also reiterated by the Human Rights Council of the UN. They all reflect the growing need to protect health of individuals as well as populations. For example, with increasing global trade, it is necessary for States to ensure that society as a whole is protected from events such as dumping of toxic waste in a country, which may not impinge on the individual rights of its citizens immediately.
The country is at a crucial juncture of developing a new constitution. The article argues for including health as a fundamental human right. This is a great opportunity not to be missed, which will ensure that we strengthen the unique health system of our country. This will be a lasting legacy to the current and future generations of Sri Lankans.
Prof. Saroj Jayasinghe
MBBS, MD (Col), MD (Bristol), FRCP (Lond), FCCP
Professor in the Department of Clinical Medicine
Faculty of Medicine
University of Colombo
and Consultant Physician
National Hospital of Sri Lanka
(PS: The document does not reflect the views of institutions I work in)