Beyond medical care: The case for declaring health a constitutional right in Bangladesh
Medical care involves treating diseases and injuries, while healthcare focuses on preventive measures, public health programmes, and promoting healthy lifestyles
Health is the most critical human right. Without good health, enjoying other fundamental rights becomes nearly impossible. The World Health Organization (WHO) acknowledged this by declaring health a fundamental right for every human being in its 1948 constitution. Because of this, WHO member countries are legally obligated to ensure health for all.
But what about Bangladesh?
Our constitution recognises medical care as a basic necessity of life, alongside food, clothing, shelter, and education. It also asserts that "the raising of the level of nutrition and the improvement of public health" are the state's primary responsibilities.
However, the constitution does not explicitly state that health is a fundamental right of citizens. Fortunately, the Constitution Reform Commission has recommended the recognition of medical care as a fundamental right.
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But medical care and health are not the same. Medical care involves treating diseases and injuries, while healthcare focuses on preventive measures, public health programmes, and promoting healthy lifestyles.
True health extends beyond these services. It requires a comprehensive understanding of the overall quality of life, embracing a holistic approach that includes the physical, emotional, social, and spiritual dimensions contributing to a person's well-being.
We need to shift our focus from just medical care to overall health. Evidence suggests that recognising the right to health leads to better delivery of health services and improved health outcomes. Therefore, it is time to declare health a fundamental right in our constitution.
Many countries have included healthcare rights in their constitutions to ensure that every citizen has access to medical care and public health services. According to a recent report, more than half of today's written constitutions contain provisions that guarantee a 'right to health' in theoretically enforceable terms.
Article 27 of the South African constitution recognises the "right to health care." In Mexico, the constitution declares that "every person has the right to health protection."
Cuba's 2019 constitutional referendum guarantees universal access to healthcare by stating that "health is a right of all people, and it is the state's responsibility to guarantee access to quality medical attention, protection, and recovery services, free of charge".
In Iran, the constitution proclaims the abolishment of all forms of deprivation with respect to food and healthcare. Article 29 of the Iranian constitution establishes that "health services, medical care, and treatment, provided through insurance or other means, are accepted as a universal right for every citizen".
Constitutional recognition of the right to health has led to significant improvements in healthcare access in the aforementioned countries. Therefore, recognising health as a constitutional right is essential when discussing health sector reforms.
Protecting the right to health in the constitution guarantees that everyone, regardless of age, gender, or socio-economic status, can access healthcare services. This declaration could not only shape policies but also help in the development of legal frameworks that make healthcare equitable and accessible to all, regardless of financial capacity.
Recognising health as a fundamental right mandates that all health initiatives, policies, and technical assistance prioritise the realisation of this right. This, in turn, improves health outcomes through investments in public health and nutrition, reduces disparities, and enhances accountability.
One of the most pressing questions in modern healthcare is: Who will cover the costs, and how? In countries like Bangladesh, the state should shoulder the responsibility of providing essential healthcare for all its citizens. Out-of-pocket healthcare expenditures in the country soared to 73% in 2021.
Recent data shows that approximately 25% of the population encountered catastrophic healthcare costs, with many forgoing necessary treatments due to unaffordable expenses. Chronic diseases like diabetes, hypertension, and heart disease are behind these staggering costs.
According to recent reports, 14% of Bangladeshi adults are diabetic, 29% have hypertension, and almost one-third of the population is suffering from non-alcoholic fatty liver disease. Protecting the right to health in the constitution would guarantee free access to essential healthcare for those suffering from these chronic diseases and requiring long-term care.
Free medical care for critical and chronic diseases should be regarded as a component of the constitutional right to health. This protection would ensure access to expensive and essential health services and medicines at no cost.
It could help create a legal framework to nationalise essential healthcare, significantly reducing mortality, limiting disabilities, and improving quality of life. For example, public ownership of treatments for chronic and life-threatening diseases would allow citizens to receive affordable care at government hospitals.
When a constitution explicitly guarantees the right to health, it places an obligation on the government to take reasonable measures to improve health outcomes. This is evident in countries like South Africa and Mexico, which have implemented taxes on sugary drinks in alignment with their constitutional responsibilities and commitments to their citizens' right to health. We also need to impose higher taxes on sugar-sweetened beverages and ultra-processed foods to reduce their consumption.
These products have a direct link to the rise of chronic diseases and adverse cardiometabolic health outcomes in our country. Recognising health as a fundamental right in the constitution will facilitate the implementation of such taxes and protect the health and well-being of our citizens.
Declaring health as a constitutional right would also ensure the state provides necessary care for newborns and pregnant mothers. Healthcare for these groups should be nationalised, with financial support for mothers from pregnancy through six months postpartum. Cash assistance or food voucher programmes can be introduced for these vulnerable sections of the population.
Medical negligence is a barrier to enjoying the right to health. However, there is no legal framework to protect patients' rights in our country. News of medical negligence is common, and we often see media trials for such cases. However, it is not always clear whether negligence actually occurred or whether it was a misunderstanding between the doctor and the patient or their relatives.
In Bangladesh, many people lack basic health knowledge and sometimes insist on incorrect treatments based on their own understanding, which may not be scientifically valid. Newspapers often highlight these cases to attract readers. This does not mean that medical negligence does not exist — it does. But who decides what constitutes negligence, and how can we ensure that patients receive justice?
Recognising health as a constitutional right would obligate the state to form an independent commission to handle cases of medical negligence fairly. There should also be a healthcare protection law to address this issue.
The nation can build a healthier and more resilient society by declaring health as a constitutional right. The points discussed above are just initial thoughts to spark discussion on how constitutional protection of the right to health can lead to better health outcomes nationwide.
Achieving this goal requires a long-term vision and the expertise of relevant stakeholders to develop policy initiatives and create legal frameworks that uphold the constitutional right to health for all citizens.
Shah Mohammad Fahim is a physician and Associate Scientist at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). He is currently pursuing his PhD at Cornell University, NY, USA.
Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the opinions and views of The Business Standard.
