On this year’s World AIDS Day, on December 1, we should remember the 35 million people who have died of AIDS-related illnesses, and the 76 million who have been infected with HIV since reporting began. And we can celebrate the fact that nearly 21 million people living with HIV now have access to life-saving treatment.
But we also must not lose sight of the fact that more than 15.8 million people are still awaiting treatment, while an estimated 11 million people do not even know they have the virus. In the time it takes to read this commentary, three more young women will have contracted HIV. These figures represent an indefensible injustice: millions of people are being denied their right to health.
The third United Nations Sustainable Development Goal (SDG3) addresses health. It aims to reduce road accidents; tackle non-communicable diseases; end AIDS, tuberculosis, malaria, and neglected tropical diseases; guarantee universal health coverage and access to sexual and reproductive health-care services; and substantially reduce deaths from environmental pollution – all by 2030.
Although countries around the world have committed to this goal, countless people still inhale dangerous levels of toxic particles, and lack access to safe water and adequate sanitation. Too many governments consistently fail to act on environmental and other regulatory issues, turn a blind eye to companies that profit from selling unhealthy and addictive products, and thus fail those whom they are supposed to protect and serve.
Health is neither a gift nor an act of charity. It is a fundamental human right, encompassing both freedoms and entitlements. Everyone is free to make decisions about their health, regardless of who they are, where they live, what they believe, or how they earn a living.
And everyone is entitled to affordable, quality health services and freedom from discrimination and coercion. Enjoying the right to health means having one’s physical and mental integrity respected, and having the ability to participate and contribute to one’s community.
Today, we call on world leaders to confront health injustices wherever they see them, and to take action to respect, protect, and uphold the right to health for all people. The ambitious SDG agenda for 2030 has afforded all of us the opportunity to shape policies aimed at creating and empowering the “global health citizen.”
Who is this citizen? She is an individual who knows her rights and can voice her concerns, challenge injustices, and hold decision-makers accountable. He is an individual who does not just ask for but demands access to doctors, treatments, or preventive care. The global health citizen is one who becomes a part of the solution.
Empowering global health citizens will require progress in at least three policy areas: popularizing participation, democratizing data, and eliminating discrimination. As to the first, we must open up health programs and policies to meaningful public engagement. In the 1990s, the disability-rights movement coined the phrase, “Nothing about us without us.” All global health citizens, and particularly health-care leaders, should adopt this mantra.
To be sure, public and private corruption remains a significant obstacle to ensuring the right to health for all people. In many countries, health care is one of the most corrupt sectors. To address this, global health citizens will need both institutional support and better tools for demanding that their right to health be respected.
Too many governments consistently fail to act on environmental and other regulatory issues, turn a blind eye to companies that profit from selling unhealthy and addictive products, and thus fail those whom they are supposed to protect and serve.
They should start demanding more measures to ensure good governance and transparency, improve “legal” literacy, fund civil-society organizations, and reinforce legal mechanisms for holding governments accountable.
The second policy area where progress is needed is access to data for every community. At UNAIDS, we follow the adage, “What gets measured gets done.” Data analysis has proven to be one of the most potent tools in the fight against the HIV epidemic, because it enables us to raise awareness, identify people being left behind, guide investment, and coordinate action.
We in the global health field have always been good at estimating mortality and morbidity rates. But it is now time to look beyond epidemiological facts. Guaranteeing the right to health will require us also to monitor the effects of discrimination and stigmatization, as well as laws and environmental factors that threaten people’s health and wellbeing.
Likewise, conducting thorough assessments of the health impact of key policies and investments must become the norm, rather than the exception. The global health sector needs far more independent advocacy and accountability, which the UN and civil-society groups, in particular, are in a strong position to provide.
The third policy area – eliminating discrimination in health-care settings – must become an international priority. The central promise of the SDG agenda is to leave no one behind. Discrimination creates de facto barriers to universal health coverage, and prevents many people from accessing health services of any kind.
For example, one in eight people responding to the HIV Stigma Index say they have been denied health care as a result of prejudice.
It is clear that ending AIDS will require social – not just medical – breakthroughs. Governments must redouble their efforts to protect individuals against discrimination, and create effective mechanisms for people to seek redress when private or state actors violate their right to health. We call on all health-care practitioners and institutions to resist discriminatory laws, policies, or practices.
Safeguarding the right to health provides the foundation needed to enable everyone to realize their potential and their dreams. We should demand nothing less.
Michel Sidibé is Executive Director of UNAIDS. Dainius Puras is United Nations Special Rapporteur on the right to physical and mental health.
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