Debate: Limitations on universality: the "right to health" and the necessity of legal nationality

Abstract

BackgroundThe "right to health," including access to basic healthcare, has been recognized as a universal human right through a number of international agreements. Attempts to protect this ideal, however, have relied on states as the guarantor of rights and have subsequently ignored stateless individuals, or those lacking legal nationality in any nation-state. While a legal nationality alone is not sufficient to guarantee that a right to healthcare is accessible, an absence of any legal nationality is almost certainly an obstacle in most cases. There are millions of so-called stateless individuals around the globe who are, in effect, denied medical citizenship in their countries of residence. A central motivating factor for this essay is the fact that statelessness as a concept is largely absent from the medical literature. The goal for this discussion, therefore, is primarily to illustrate the need for further monitoring of health access issues by the medical community, and for a great deal more research into the effects of statelessness upon access to healthcare. This is important both as a theoretical issue, in light of the recognition by many of healthcare as a universal right, as well as an empirical fact that requires further exploration and amelioration.DiscussionMost discussions of the human right to health assume that every human being has legal nationality, but in reality there are at least 11 to 12 million stateless individuals worldwide who are often unable to access basic healthcare. The examples of the Roma in Europe, the hill tribes of Thailand, and many Palestinians in Israel highlight the negative health impacts associated with statelessness.SummaryStateless individuals often face an inability to access the most basic healthcare, much less the "highest attainable standard of health" outlined by international agreements. Rather than presuming nationality, statelessness must be recognized by the medical community. Additionally, it is imperative that stateless populations be recognized, the health of these populations be tracked, and more research conducted to further elaborate upon the connection between statelessness and access to healthcare services, and hence a universal right to health.

Access to primary healthcare services for the Roma population in Serbia: a secondary data analysis

“…Kingston et al [31] have described in detail the difficulty Roma face in accessing healthcare without the necessary documents. In addition, this research has shown that 18.9% (95% confidence interval = 15.3 - 22.5%) of Roma do not have health insurance cards compared to both the general population, 9.8% (95% confidence interval = 8.8 - 10.8%), and poorest quintile, 5.6% (95% confidence interval = 5.2 - 6.0%).…”

Age trends in prevalence of cardiovascular risk factors in Roma minority population of Croatia

“…This discrepancy arises from the ''statelessness'' of many Roma (Kingston et al, 2010) as well as from the fact that due to social and economic reasons, many Roma do not declare their ethnic origin (Karaman, 2009;Kó sa and Adá ny, 2007).…”

Representações sociais de conselheiros de saúde acerca do direito à saúde e da cidadania

“…Accordingly, health systems and their governments, in order to guarantee the right to health, should work on the social and environmental determinants of health, derived from the form of organization of production in society, and the inequalities that exist in it, emphasizing that the action on these factors should be the responsibility of all State sectors (2) , considering the complexity of this right, as it achieves several spheres, including health, law, financial, educational, technological, housing, sanitation and management pol-icies (17) . Thus, the right to health has been closely related to other human rights such as human dignity, life, nondiscrimination, equity, prohibition against torture, privacy, access to information, and freedom for organizing associations, meetings, and movements (18) .…”

“…In the Brazilian constitution, citizenship is guaranteed in three areas: civil, social and political rights. Hence, the civil rights of individual freedom preservation, such as contract, property, expression, conscience; political rights of representation and participation; and social rights, which are aimed at avoiding the worst effects of capitalism, with the right to health, education, food, labor, housing, leisure, safety, social security, maternity and child protection, and assistance to the disadvantaged were related to the citizen's condition (18) . In short, the term citizenship has contemplated the rights, obligations, as well as respect to the laws that the citizen has in relation to the country where he/she was born or chose to live in.…”