Do We Need a World Health Insurance to Realise the Right to Health?
Authors: Gorik Ooms, Katharine Derderian, David Melody
Journal: PLoS Medicine (2006)

There has been growing recognition in the international community that health should be considered a human right, a right enshrined by several international treaties. Much less attention has been paid, however, to the ensuing legal obligation to provide international assistance.

Kenneth Roth, director of Human Rights Watch, provided a rare comment endorsing the legal obligation to provide international assistance for health [1]. At the same time, he also underscored two problems associated with fulfilling this obligation: shared responsibility and progressive realisation (i.e., the obligation is not immediate but takes time to fulfil) [1].

The problem of progressive realisation lies in the acknowledgement that all economic, social, and cultural rights cannot be fully realised in a short period of time. This allows states to claim that they are doing or have done everything they can.

This problem has been partially addressed by the Committee on Economic, Social and Cultural Rights (“the Committee”), created to monitor states' achievements on the realisation of the rights recognised in the Covenant on Economic, Social and Cultural Rights (“the Covenant”) [2]. The Committee has stated that “a minimum core obligation to ensure the satisfaction of, at the very least, minimum essential levels of each of the rights is incumbent upon every State party” [3]. The Committee stressed that, in terms of the right to health, “a State party cannot, under any circumstances whatsoever, justify its non-compliance with the core obligations…which are non-derogeable” [4]. The realisation of the minimum essential level is understood to be immediate rather than progressive.

The obligation to provide assistance for health is further circumvented by a second problem: that of shared responsibility. Poor states can blame rich states for not honouring their obligation to provide assistance, thus leaving poor states with insufficient means to meet their core obligations. Rich states can blame poor states—and each other—for not doing enough.

A world health insurance could solve that problem by defining rights and duties for both rich and poor states. Wishful thinking? Maybe not. The basic requirements for a world health insurance have already been developed in theory and even in practice to a certain extent.

A world health insurance would shed different light on the problem of sustainability. Several effective health interventions are branded as “unsustainable” in poor countries, because national health budgets cannot afford them [5]. The option of substantially and permanently increasing national health budgets through international assistance is rarely considered. The creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria (“the Global Fund”) demonstrates the merits of ambitious thinking: the provision of antiretroviral therapy (ART) to people living with AIDS, previously dismissed as unsustainable, became widely accepted as soon as the Global Fund provided a long-term funding perspective. Other health interventions deserve a similar approach.