insurance

Human Rights Day, December 10: Access to Medical Care as a Human Right

I was shocked that I had never read the Universal Declaration of Human Rights (UDHR). Surely I must have learned about it at some point? As I scanned my memory back at world history, US history, and government classes, I couldn’t remember studying it in high school or during my years in university. Certainly it was mentioned at some point. But compared to my familiarity with the Declaration of Independence, the U.S. Constitution, and other historic U.S. documents, somehow the UDHR wasn’t on my radar. I believe that we as pediatricians can help change our culture by familiarizing ourselves with the UDHR and referencing it in our conversations with our family members, friends and those with whom we work.

When I discovered and read the UDHR recently, Article 25 in particular stood out to me. “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.” (emphasis added) 

If achieving these rights outlined in the UDHR, namely access to affordable and accessible medical care as a human right, were part of our culture in the United States, how would conversations about child health, public health insurance, and our culture of health in general, change? Where could our actions as a nation collectively, driven by our legislation and system, go with this sort of culture? More can and ought to be done to use this important declaration as a tool to foster a culture and, ultimately, a society that values equal access to healthcare and public health insurance, especially for the most vulnerable children our country. 

The UDHR was drafted by the United Nations Human Rights Commission in 1948 as an important part of an effort to promote peace and prevent further catastrophe that occurred during World War II. In the preamble of the UDHR, it states “Whereas disregard and contempt for human rights have resulted in barbarous acts which have outraged the conscience of mankind, and the advent of a world in which human beings shall enjoy freedom of speech and belief and freedom from fear and want has been proclaimed as the highest aspiration of the common people,… Now, therefore, The General Assembly, Proclaims this Universal Declaration of Human Rights as a common standard of achievement for all peoples and all nations…” 

Following its preamble, the Declaration outlines thirty articles that outline what are deemed as universal human rights. In studying these rights, I realized that many of the articles align with concepts familiar to most Americans. To the casual American reader, statements such as “Everyone has the right to life, liberty, and the security of person”, “No one shall be subjected to torture or to cruel, inhuman or degrading treatment of punishment” sound familiar.  Rights such as “the right to freedom of thought, conscience and religion” or “the right to freedom of peaceful assembly and association” have their correlates in the U.S. Constitution. Other rights, such as “the right to marry and found a family” may not be canonized in writing, but are indeed part of our common values as Americans. In short, adopting the principles of the UDHR into our identity, culture and belief system does not require the sacrifice of existing values that we all hold dear. Rather, the UDHR adds to those beliefs some concrete and objective ways by which humans can live life to their fullest potential. Because the Declaration was new to me, I spent some time searching through the medical literature for references to this document. On the AAP website, the UDHR was referenced explicitly in only two articles within its database. On PubMed, searching for “Universal Declaration of Human Rights” yielded 229 results. Common topics of articles that cited the UDHR were articles regarding the rights of underserved, migrant or refugee populations, the rights of persons with speech and communication disorders, and, unsurprisingly, the overlap of  medical ethics and human rights. From this brief search, I concluded that while connections between human rights and access to medical care were being made, it has not been prominent within the culture of medicine or even medical humanities. It reaffirmed to me the need for pediatricians and physicians in general to champion the document and reference it more readily.

One article I found in my search, A Culture of Health and Human Rights, elaborated on the importance of human rights as a framework whereon a national culture of focus towards universal health and well-being could be built. Written in 2016 by two Boston University law professors, the article offers the following model:

 “Human rights offers a sustainable conceptual framework that supports the imperative of improving the social determinants; empowers the public to demand positive change; and offers common ground for initiatives, both public and private, that improve population health. Policies that protect and fulfill basic human rights are policies that address the social determinants of health, well-being, and equity. A culture of health can be most effectively deployed to improve population health when linked to a human rights agenda.” 

In tackling the current culture of health that exists in our country, authors Wendy Mariner and George Annas suggest:

“If a culture of health is intended to mean that Americans should prize health as a national social norm, it will be challenging to realize. In our pluralistic, multicultural country, attitudes about health and its causes vary, especially among different socioeconomic groups. While everyone might agree in principle that health, well-being, and equity are desirable, there is less consensus on where health ranks among life goals and values. Empirical observations of what people actually do—actual norms—suggest that there is no universally accepted—or practiced—culture of health in the United States. Many people might view health not as a primary good or an end in itself but as a means to attain other life goals, such as financial security, personal safety, respect in one’s community, and fulfilling relationships with family and friends. Those who are struggling to raise a family on minimum wages or in a violent neighborhood might be too preoccupied with survival to make health a high priority.”

Mariner and Annas go on to argue that given the plurality of opinions towards health, the best way to improve health culture in our country is to change policy. They astutely note that this endeavor will require decades-long efforts of focused coalitions with unified commitment towards human rights and improving the social determinants of health. 

If culture changes about children’s health can and should start with us as pediatricians, what can we do? More so than ever before, we can amplify our voice on online platforms. Arguably more effective and important are the day-to-day conversations we have with those in our immediate circles. If we individually internalize and embrace those rights that have been declared as universal, we can offer our voice from a place that is grounded in international support and consensus when divisive language about topics like healthcare and immigration arise, or during election seasons. 

Since 1950, December 10th has been dedicated as Human Rights Day and is recognized in many countries. We can use this day, and frankly any other day, to promote access to medical care as a basic human right. Nestled between Thanksgiving and the winter holidays, acknowledging Human Rights Day in our own personal way would lead to conversations about the UDHR.  That will give us opportunities to inform and discuss these principles and how they apply to the children in our communities.

Discussions, especially during the COVID-19 pandemic, have reflected a constant politicization of medical and healthcare issues which need not be political. By addressing the needs of children from a universal human rights framework, we can cast a wider, more inclusive net that catches the attention of those with whom we come in contact. Our efforts can slowly help others, including family, friends and neighbors, embrace health as a part of our culture, and more important, as a human right. As a generation of pediatricians more globally minded than perhaps any generation before, I hope we can help the world embrace the challenge of promoting a “standard of living adequate to the health and well-being” of all children.

David Oleson, MD

References:

Mariner WK, Annas GJ. A Culture Of Health And Human Rights. Health Aff (Millwood). 2016 Nov 1;35(11):1999-2004. doi: 10.1377/hlthaff.2016.0700. PMID: 27834239.

https://www.un.org/en/about-us/universal-declaration-of-human-rights

Increasing Enrollment in Medicaid and CHIP

Medicaid and the Children’s Health Insurance Program (CHIP) are the two largest public health insurance programs for working and low-income children families in the United States. With the implementation of the Affordable Care Act (ACA), both of these programs have seen an increase in enrollment across the country during the past year even in states, such as Texas, that have decided not to expand Medicaid eligibility to poor adults. As of May 2014, Texas had 80,435 new enrollees in Medicaid– a 1.8% increase over pre-ACA figures. However, roughly 874,000 Texans eligible for Medicaid and CHIP have still not enrolled, including over 700,000 children. (more…)

AAP supports increased funding for pediatric mental health services

The AAP responds to a request from the Senate Finance Committee regarding our nation’s mental health system.

In the wake of the tragic shootings at Sandy Hook Elementary School in Newtown, CT, the Administration and Congress are looking for ways to improve our nation’s mental health system. Exposure to violence causes toxic stress in childhood, which can have long-term negative effects on children. Managing adult mental health disorders begins with ensuring that children have access to quality mental health services. (more…)

The AAP Praises CHIP & Asks for Continued Support

The American Academy of Pediatrics is voicing its continued support of the Children’s Health Insurance Program (CHIP) and hoping to garner future support in the process. CHIP was signed into law in 1997 as part of the Balanced Budget Act, it was reauthorized in 2009 under the CHIP Reauthorization Act, and extended through 2019 with funding through 2015 in 2010 under the Patient Protection and Affordable Care Act. (more…)

Assistance for Health Insurance Enrollment

The Affordable Care Act’s (ACA’s) requirement that all individuals have health insurance coverage by the end of March 2014 prompts the current widespread search for health insurance coverage. Recent changes in Medicaid eligibility requirements, state-to-state variation in Medicaid coverage, and new health insurance marketplaces create a daunting environment as parents embark on their search to find the appropriate health insurance for themselves and their children. In anticipation of this challenge, the ACA and some states are funding a variety of consumer assistance programs to help families navigate the plethora of health insurance changes. (more…)

Why So Many Insurance Cancellations?

There’s been a lot in the news about the Affordable Care Act and healthcare.gov rollout, but why so many people are receiving insurance cancellation letters may not be entirely clear.  Watch this 2 minute video by Sarah Cliff from the Washington Post about what it all means.

 by Dolly Lucio Sevier, MD