University of Essex, UK.
Health Hum Rights. 2008;10(1):81-92.
The right to the highest attainable standard of health should be the cornerstone of any consideration of health and human rights. The content of this fundamental human right is now sufficiently well understood to be applied in an operational, systematic, and sustained manner. At the heart of the right to the highest attainable standard of health lies an effective and integrated health system, encompassing medical care and the underlying determinants of health, which is responsive to national and local priorities and accessible to all. Yet in many countries, health systems are failing and collapsing, giving rise to an extremely grave human rights problem. This article outlines the general approach of the right to the highest attainable standard of health toward the strengthening of health systems. It identifies some of the key right-to-health features of a health system, such as transparency, participation, equity and equality, a comprehensive national health plan, a minimum "basket" of health-related services and facilities, disaggregated data, monitoring and accountability, and so on. This general approach has to be consistently and systematically applied across the "building blocks" that together constitute a functioning health system. By way of illustration, the article applies this approach to one of these "building blocks:" leadership, governance, and stewardship. There are numerous health movements and approaches, including health equity, primary health care, social determinants, and so on. All are very important. But it is misconceived to regard human rights as yet another approach with the same status as the others. Like ethics, the right to the highest attainable standard of health is not optional--and, like ethics, it recurs throughout all other approaches. The right to the highest attainable standard of health is the only perspective that is both underpinned by universally recognized moral values and reinforced by legal obligations.
健康权是任何健康和人权审议的基石。这一基本人权的内容现在已经得到了充分的理解，可以以一种可操作、系统和持续的方式来应用。在享有能达到的最高健康标准的权利的核心，是一个有效的、综合的卫生系统，涵盖医疗保健和健康的基本决定因素，该系统要对国家和地方的优先事项作出反应，并能为所有人提供服务。然而，在许多国家，卫生系统正在崩溃，这引发了一个极其严重的人权问题。本文概述了享有能达到的最高健康标准的权利对加强卫生系统的总体方法。它确定了卫生系统的一些关键的健康权特征，如透明度、参与、公平和平等、全面的国家卫生计划、一套最低限度的“篮子”卫生相关服务和设施、分类数据、监测和问责制等。这种总体方法必须在构成一个运作良好的卫生系统的“组成部分”中始终如一地、系统地应用。作为说明，本文将这种方法应用于这些“组成部分”之一：领导、治理和管理。有许多健康运动和方法，包括健康公平、初级卫生保健、社会决定因素等等。所有这些都非常重要。但是，将人权视为与其他方法具有同等地位的另一种方法是错误的。与道德一样，享有能达到的最高健康标准的权利不是可选的——而且，与道德一样，它贯穿于所有其他方法。享有能达到的最高健康标准的权利是唯一一种既基于普遍公认的道德价值观，又有法律义务支持的观点。
