HUMAN RIGHTS AND THE SOCIAL DETERMINANTS OF HEALTH

Sofía Charvel

Programa de Salud Pública psaludpublica@itam.mx

@sofiacharvel

The case of Mexico

• Human Rights and International Treaties containing

human rights have Constitutional rank recognized

in Article 1 of the Mexican Constitution that explicitly

states such recognition and protection.

But which human rights are protected?

• not discrimination, health, education, right to

nutritious food, housing, potable water, freedom

of speech, between others.

Mexican Constitution: Chapter I “Human Rights and

their Guarantee (2011)

How human rights are “protected” in our

constitutional system?

• rights are not only recognized but are fully

protected and guaranteed judicially and by

every other authority level: federal, local and

municipal.

• then inequality among individuals should be

minimal and health outcomes should be

positive...

Mexican Constitution: Chapter I “Human Rights and

their Guarantee (2011)

Dissociation between the Constitutional norm and

our human development level in health.

CONEVAL

National

Evaluation

Committee for

Public Policies

on Social

Development. (among other

responsabilities

evaluates and

provides

measurements

of poverty in

Mexico).

19.4% of Mexican population does not

have enough income to cover basic food

necessities.

which means that 19.4 percent suffers

malnutrition or hunger.

Maternal mortality was at 50.7 per

100,000 births in 2011.

Infant mortality 16.7 deaths/1000 births

percent.

Reforms, public health policies and changes have

been made with a positive outcome in health.

The Mexcian health reform implemented in 2003 with Seguro Popular that intends to intends to establish universal health coverage.

The overall goal was to provide access to an explicit and comprehensive package of essential health services and specialized interventions associated with specific diseases and health conditions to 50 million Mexicans who had previously been excluded from public, social insurance.

Public policy to address the obesity epidemic. GOALS:

1.- Revert the obesity and overweight prevalence in 2006 among children aged 2 to 5.

2.- Stop the growth in prevalence of obesity and overweight population aged 5 to 19.

3.- In adult population deaccelerate the obesity and overweight growth.

Seguro Popular

National Alimentary

Health Agreement

Programa de Salud Pública

SEGURO POPULAR

Universal Coverage has three components: 1) all people have access

to health services funded by publicly organized insurance;

2) regular access to a defined package of health services; and

3) system that guarantees, to all on an equal basis, the maximum attainable health results.

2011, 52.6 million people were incorporated to the Seguro Popular.

Improvement in maternal mortality and mortality in children younger than 5 years have been larger

for the previously uninsured than for social security beneficiaries. Mortality in children

younger than 5 years fell by 11% for the population without social security compared with 5% for those

with access.

Programa de Salud Pública

Maternal mortality fell by 27% for those without social security

compared with 3% for those with social security access.

However women without social security, covered by seguro popular experience a 66% higher mortality.

PC: Universal Coverage in México • UNIVERSAL COVERAGE IN MEXICO

• Data suggest that Mexico still needs to expand coverage:

– Many expensive services are excluded from SP coverage.

– Out-of-pocket payments accounted for an estimated 48% of total spending on personal health care services.

• Despite having achieved “universal coverage” Mexican citizens do not have equal access neither to health care or to financial protection against the potentially high costs of severe illness or injury.

• Citizen perception vs Official data, population survey: – ~20% report no health coverage (young: unemployed & and School

Dropouts) – ~40% report access to a limited health package and protection for some

conditions considered catastrophic – ~40 report access to unlimited coverage

NATIONAL ALIMENTARY HEALTH AGREEMENT

strategy against obesity

• Promote physical activity at school, work and

communities with the collaboration of public and private sectors.

• Increase availability and consumption of safe drinkable water.

• Less sugar and fat in beverages.

• Increase daily consumption of fruits, vegetables, cereals, fiber, leguminoses, increasing their availability, acces and promoting its consumption.

• Empower people to make healthy diet decisions through a friendly product labelling system and with useful nutritional education.

• Promote and protect breastfeeding as the exclusive diet for newborns until 6 months and after 6 months promote complementary nutrition.

• Diminish use of sugars and sweeteners.

• Diminish consumption of saturated fat and trans fat.

• Provide education on portion control.

• Promote a low sodium diet.

National Alimentary Health Agreement: the objectives

Programa de Salud Pública

intended to generate healthy lifestyles and environment for individuals.

Thus it affects some of the social and environmental determinants of obesity,

and should be considered a very important public policy for the prevention of obesity and overweight.

However, 4 years after the signature of the agreement what has been the outcome?

Can we say it has produced effective public policies and programs?

RESOLUTIONS OF THE SUPREME COURT

As lawyers analyzing the human right and health outcomes we cannot leave aside the resolutions that the Mexican Supreme Court generates. We are moving to a new and a little bit more active Court, but we are far away to have the interpretations we need to improve Mexicans right to health, mainly for those who cannot access to justice. It is risky that now that this kind of problems are arriving to the Court, people start to receive money instead of health attention as a compensation of the deficiencies in the social health system. That can help to have a population not so unhappy, but sick. And this kind of resolutions will take us far away from a culture of prevention and promotion of health in our society and that can make the way to be longer and harder to achieve the right to health protection we have in the constitution.

RIGHT TO HEALTH PROTECTION

Fuente : Public Health Law O. Gostin

For human rights to be effectively observed and protected and to have an impact on health outcomes, constitutional recognition is not enough in our country. Firm and effective public policies are needed; and further more all these public policies must be put in place by legal instruments that have the possibility of being enforced effectively, by a competent authority to generate a high standard in the development of our human right to health and then we will start having better health outcomes results.

THANK YOU