Scandinuviun Studies in LuwVolume 62

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SCANDINAVIAN STUDIES IN LAWVOLUME 62

LAV/ V/ITHOUT STATE

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Health, Rights and the State

Maria Green & Titti Mattsson

178

1

a

Introduction t'79180181r82186187

The2.12.22.32.42.5

Rieht to l{eatth as Part of International and National Law

International Law "'', "'ïffiil*t ï".^' Tjt|:'"Hïoc"i*ï"i n sil . . . . . . :... :.

lnþmational Economrc' ùuur.r s¡rs -"-'in" night to Healthil;".",i" H"althLaw in sweden

3 The Right to Ilealth and the Health of a Foster Child in

lT"u"ä;; ;,à'nà"ìit'' ðå"åiir""' r"' r";*; äìù';; i; iläï "

":\ iii**in**1**t*n**ru1*'' f:;3.2'2 Legal or Oiher nemedies " " " " "

188189191

191193

196

4 Conclusion

lTSMariaGreen&TittiMattsson:Health'RightsandtheState

1 Introductionr

A child living with a foster family in Skåne' Sweden' turns down 'an offer of

ice cream. lce cream' J;;"pi;ñ-' *uk"* her teeth hurt' At the dentist' it is

àlr"ou"t"¿ that her teeth are filled with cavities'Likely she does t"t il;;l;, ;ut her health.is a matter of international law'

and in particular " .""ãt oi international human rights law' which both

guaranteestoheran"*bt'oftightsandcreates'forhergovernment'anumberof corresponding Ooti"r.ïotg Uãf"* :h" Ylt born' a series of legal agreements

among states establi,nåJãtii"t"*ational human right to health' and in the

years since then activisis, scholars' government officials' and a range of United

Nations instftutions, "mo;;;ñihuu" *o.k"d to flesh out what that right

means more ,p""ifi"uúî' i"**tt can speak in some detail of her various

substantive rights, of nå'r ";;t ;t";" iight'' of 'cross-cutting human rights

principles," or "right'-ãa';^"fftã""n"1" tõ health systems or health services'

and more. At the core "oî;ll

;.f',h$ is the basic nature of international human

rishts law, in which i"d;å;;it ;;d communities have rights and states have

ffi;;;,i]On; ,ä .n.u." that those rights are properlv enjove{'

This essay foof, uiïut ""nitã"

righi to healttr in Sweden as a way of

interrogating, gently, whar it means to ise international human rights law' with

its focus on the state, as a normative reference point for domestic health policy

and practice. In part f,'ï. ì"""t" ifre right to health in its place in human rights

and in intemational law in g"rr".ã1, exploring the contradictions and

complexities inherent i' o'itg" i"tylionaf rights standards to address

domestic economic and social policy. In part_ II, wã explore_the rleh! to health

specifically *itt ,"guä tï',frïp.uá"uf weil-being of the hypothetical foster

child. Looking at issris-trr; range from her access to health care to her

procedural protections within the h-ealth system' we examine what questions a

"righttohealth"upp,outn*ould'uit"'und*hutbenefitsmightormightnotaccrue to her if her health experience were closely grounded in international

human rights law.

l

ti

Ë&,tqi1

.t:

t'

l1

itltjr

This essav draws on writings, teaching and discussions during the years by 'Mattsson

and

åT:ï:ïi* å;å,r*, ä,J,írirriffi;t¡r..pe;t"e ¡ads.or health care and human rights.

ifu;öubff;*;'î".rt¿Tä'""",^rt¡"t''l' ""¿ Randolph' stsan' Bringing Theory Infto

Proctice:OperationalCriter-iaforAssessinglmplementalionofthe[nternationalRighttoDevetopment, unired Nario;Jáä".',iåì"offin.útitwc.z^ptöRp.s zoto; creen' Maria,",,;;;:í;;î;;;;;;,'w;;;'w'; ratk About Indicators: current Approaches 1o Human

Rights Measure."nt, Hurrrun Rigittt q""nt¡V 23 (2001) pp tO62-iOgl; Mattsson' Titti

and Vinnerljun g, Bo, Barn ¡ i"'^¡i"ni^ ÅEarder J¿ir ¿i'^"t ¡;rsa¡la' Studieförbundet

Näringsliv och samhälle, sr"*rräií1 ãõià; Niut rron, ritti, Barnet som subjekt och aktör'

En räilslig studie om mrìi'"1"*¡i,'t¡li"r.' lustus förlag, uppsala 20061 Mattsson, Titti''Participation'fo, ottz cnoti'iîî'"in'i tàor ¡o' realiziing ùe goat for vulnerable'p'eople

with focus on health ,"rr,rlri,'in"rt. u..r"t.un and B' Toebes (eds') Human Rights tn

Essential Public Service r"*itron, H'Áan Rights Law Series' Routledge Press' Oxford

2016.

Maria Green & Titti Mattsson: Health' Rights and the State 179

2 The Right to Health as Part of International and National

Law

Home from the dentist, and writing downher foster address in an imaginative

mood, our child mighi 'ìutt *iä her house' street and town' and then'

stretching her mind t" 'it"îtl ft"tt"ff fully in the world' expand to include

Sweden, Europe, the E;;h, the Solar System' the Milþ Way' the Universe'

Her lawyer, charged *ïrr'i;iñ;ï:."ñ:"1: her legal iigt'tt to health'' would

benefit from similarly tir"";-t"g;ñ right in the geogäphv:f 1u*.'1taflp wittt

local and national,t"ti;ä;il'Ã;;:'i"idñ tJinitu¿e the internationallv

recognized right to tt'" : nign"* attainable standãrd of health"' which is part of

international economrc, :;:ffin;;;itt*r tigt"t' which is part of international

human rights law, *hidì;;; otint"*utioãal law. Each õf these spheres has

implications for how tnå n'íå"iî'gîiiã r'"¡'r' plays out in at the level of an

individual,s everyday lif".-Ëu"n aiso raises p.o'Ut"tnt of implementation that

international law, in uuiio", ways, has attempted to addreis. Almost all of

these problemr, u, *"tius th" 'oL'úot" centeiin some way on the role of the

state.Starting with the outer edge of this legal space' we will explore the

oroblems and solutioris ã"t"iãi"¿ with each onè' But it may help to first

i#rrÅffi;ì;;h"å;î;;ä; international right to health might ofrer'

and therefore to ,rtO""tu'i¿ tt'" nuto'" of the problems raised (meaning aspects

of law that might dili"ñ th! practicat lmpu"t of the existence of the right)

and solutions offered (meaning analyses, secondary standards, etc, that might

;;ît*,úp;actical impact of t-he existence o{the ticlÐ' .' -'-:-^views differ on wirät the existence of an internationally recognized human

righr to health adds ,"'it "îii:t"ing of individuals and communities' we take

the position in tfti' ""ayit'ui ttt"

"o'"" of the value of the international right lies

in four .o-pon"ntr,'i.iffiitt,'i.gi,i.u"V, conceptual clarity regarding

arrUrrun"" uná p'o""", and internationalization'Universality *;;"th"tï;ttcht applies to every human being' At the

geographic/political #ì' ;ililitt "uår- human being in every location in

the world, ,"gurat"rrîîii,å'"ä*r" "r ni, oï tt"r sovernmint. At the individual

level, this ."un' "u"'rî iñãual human beirt' õsardless of his or her gender'

age, ethnicitv, nutio'iui'itö:";;i'g;;' -p'"õn"ã or absence of disabilities'

*lártft or any other characteristic'Legitimacy,"r"" ïJì'" nutut" of an intemationally recognized right' which

is that each ,igt't "'t"tri'tt*;;ti* of legitimate clåims with regard to one's

societyasawhole'2¿,,indiuidoulorcommunitywishingtoenjoytherighthasa well-establirr,"¿ "^i*äiit*". -,¡e adontion of the right by governments

using formal l"gd p;;;;d - on which to j'ustifl' the claims that he' she or it

2

180 Maria Green & Titti Mqttsson: Health' Rights and the State

wishes to make. In certain, but not all contexts, the language of human rights

also has a powerful emotiånal or moral force separate from any formal legal

status.Conceptual clarity refers to the growing international jurisprudence.that has

built up äround the various rights that are established in international human

.tgn" f"* This jurisprudence iright come from formal processes,(for instance'

UN treaty bodies pro"ed.tt"s; Jr adoption of clarifuing soft law'..or from

*i¿"iv-u"""pted wòrk by scúolars, ÚN specialized agencies' civil society

or-gunirutionr, and so foittt. Wlttr regard to the right to health' this means a

grã"rrv e*puíded undersianding of wÍat the text of the relevant human rights

ñur¿ tu* pìovisions mean withiegard both to substance (for instance' access to

health services, freedom from ãedical experimentation) and process (for

ìnr*", non-díscrimination or access to means of accountability)'Internationalizationreferstothefactthatinternationalrecognizedrights

u.ing*itt'them,bytheirnature,boththeexistenceofinternationalfora(UNpiã"Zrr., for UN-ievel rights, regional. processes for regional rights laws)

where issues can be *ir"ã, u.rd a'legitimated interest of other states in the

""¡áV-"n, of the rights ; túe nationailevel' By adopting rights. as a matter of

international law, states are explicitly stating that enjoyment of the.rights is not

p"."rv a domestic matter. In tiis "ssuy,

*" fo"ur exclusively on international

iÑ-í"""f; human right, la* for reásons for time and space' but regional

ùu-un rights standarãs u,d fora are in some contexts the richest space for

effective ise ofthe internationalization aspect oflegal rights regimes'

With these understandings in mind, *è tutn now to each of the spheres oflaw within which our child's right to health is located'

2.1 Internøtional Løw

International law is based on notions of sovereignty and consent of nation-

stãtes. fnat is, formally speaking' international law' whether in the form of

"ura-uw law or of -treäty lÑ- - thery

. gwo being primary sources of

international legal duties - binds each individual state only to the extent that

it uirtut" has ag"reed to be bound by it. This raises two major issues with regard

to the universality aspect of international human rights law' The first is that

what .,universal rights'' the individual legally enjoys are detetmined by which

state he or she happens to be under thelurisdiction of at any given time' As

fr"-un rights treatieì become more widely adopted, and as the number of rights

considered to have be.ome customary law slowly expands (meaning. in broad

terms that states are generally bound unless they actively object) this

distinction may become iess important, but it remains relevant. The second is

inu,, u, Hanna'h Arendt noted aithe start of the human rights legal era. not all

human beings have an aff,rliation with a nation-state.3 To the extent that rights

g"t tt"l. legãl existence in the form ofinternational legal obligations that vary

3 Se¿ note 5, below. Berkowitz locates this point at p.293 in Arendt's The origins ofTotalitarianism, Harvest Books 1 973

Maria Green & Titti Mattsson: Health' Rights and the State l8l

ftom sþte to lt'Tfi1lTlîå;j!"å:å*t international law allows statelessness'

it " gout of universalttY t

2.2 Internationøl Human Rights Law

rnrheuniverseorinternatiiÏ,f "tih,l,#::'"*J:ïî'rï,1i:,^,iË,'i.iiuî*uto" area of to,îä"';J;r" tr,"v¡uu" un ¡nt"t"*t in how other states

in't"*utionul legal regulatt":::'^Ïi';;];;;;J;;;;, the apportioning of use

;;;"" on rhat *r" liî"ÍåïJ'"Jìilr;Jiiiä;il;;:üås w'r have been

äl*u*t ft".* ? ti::l^t

*ith the idea that eacn iiìi guin in s3me.,1a1^from the

reached bY both states

asreement, and thar Jn';ïii i"r" ir tr.,. ott"t tiãe violates the agreement'

lîö'*ïilr"itl-:#,"å:,T'ili:".;j;,;:f ""1".Ï""::""¡¡.i$:l*:";the same Premlse' ar

enForcemenr U""uor"ìil"V'îåï"'Uã""n, to tt"t"-U"ing a penalty when they or

fn;j¿ffi ,îüî5Xl ;lli ffi:!i!î äu il,ìo, "" "r I v a d d res s e s dut i es or

u"äï,'"äii",qtltLi,li*pçîïIJL""',";:$iü,ji,îå1'ï"îîH:i;ï"á"i*'"i' separate. jurisdi"lllil:, iÏ:ï:ru;']*il"tr'o for reasons of a

interest in seeing nghts protected bv :lT: :i'låJJiiÏffi; iwiether bv

;ä;;i ù år i

" r i *,."'llf:f yä""f ru;*:ru:f: i. :lii:*" "uu,"

orãovernmental officiaãhared ethnic or ""r*ìi'"iii"ii",

*lrrr ,t*";h;t" rights are being violated

( ror i nstan ce, ¡"* * î i' å" "' î r' o' " l' " î1t;' J¿1¡;: ¿Ut:l':':lt::J ;i"'*i;

Hi";äüause the violations -ut: huu1:.c^,'o;'l'"*;;;"ts of retugees from

iliå*tr-"t:lJ;f :îi"'?'ff î'.lliåiTiffi ;;iî;""rightsrawJreatesrar

lsss of a self-interesîJ in""ãti"" ro' '"'pon'äîììoru'iontittun do most other

aieas of international law'

l"iniltll:"f .ïLï"ffiÍå,1:"i::iî#:'"i,:åî:iåif iiît;,"Xil ;ï,îi :il:11îå::?:Ëü,Ïi; ;;,,"" or swereignrv, have a

tundamental po*"'ïo-ãË"ide whom t" ''11*

iiT^ãitiÃt of citizénship to and

whom to exc I ude' unã iï g"n"u I h uman t¡e'l¡,"'Jtr'ïn#'ii tîît"11;: Ïn:irìi, fo*"'' A standard in intematio¡"t t"Ïå;ä;"; ;;;* "ãn't'uint

on this

;"#ä îif;l:x',mrmai'iåä' TT ;å;;'nation mav limit the

4

ri

il

5

Maria Green & Titti Mattsson: Health' Rights and the State 183

health"), the right to food' the right to housing' the right to education' and

mrun****ru'ffileeally binding âs â trvarro"tJu" riít"ry lllt-",¡" rnternational covenant on

e*rri[tîx**iiglül'.",.i.i"*"l T,i.:,;. fr äilEconomic, s:"i,ul,-11'und political rights were'i":T1l:"::*11"t:¿i" ro take

ï'ïiÏ:iiåiilHi':"1,ä"ä'ï"t*i""t'"'l1ïi:åiïîï"illïl?iJno*"'"ii :þäî ilrü :1

.:^o*lï', ål$ li ï,",i,i"J ï'":ffi

' ö;i"ì. 19 ^:111'

to t ak e

correspondinglY coml

he I p tuI a ction rath er'äï"r';i; í';' "ry li nïlråiî' "üii;''iï'åii;ïiËäîT ïh1W[ eì:',ï:i'ïJT:::*i,.Ëi¡þ *.**,;i{those under their ¡urisdiction' while'ìn rt

ïä;ü*erelY to "take stePs '":T^,7... with a view to achieving progresstvely

recognized in the present Covena'nt 'l' ^-'^.ilable resour.es' this means that'"ïi;;;-t;'tes have widelv differing ""i:tï;";;;"u'á nu' ratified both

formally speaking, although eveu hu1a1i uui", ro fulfiu those rrghts diverge

;;;;iì;,"h ; the sam eri ehts ;:i:3åi :i:';ff ","r :ü¿.-îJy l, î1,j" v ote does

il; t, "or"l.fåories, f,ormally ro"u*, n ri'in'"^r"nälou I iu:- T .lJmbabw e or

not create varylng c

Sweden. Ho*"u",',]ïiì',,gúï.",r,'*r.r-' ",å"ä, *iiaiy uu.ying obtigations in

Zimbabwç, u "ottfi-*itñ t*it"o '"'"t;;;:u"Js*"détt'

a country with

qîï"r""ir"Ë'öandothsrs.-"":i:i:d"ff ì:r*ffi *:ï"'.,tåtlilî*1"*i"ïtf o"nial solutions' work-arounds''

human rights theoT'"äd;ä;;' we give a limited account now

these solutions'Thatrightsmoreorlesstracktorelationshipsbetween.theindividualand

,p""in""r,:r-:tîït"g::ii j*ïxi;:li,åii"q]å':ïlllFî''liii:included looKngb i nd i n g uN ¿ecr arïiåïr'* i2'9' t?: ïi'ii"*"* î ï: îï'îi :T,':åiåü ì

iltiiïï-ilïilhiîårîï:ff i¡3;ilfrïf +;11*u'*,rt'**äiË#;i' and efforts to clarifo anv^r;,ffi;ì;;

Right to Development or

individual srates either through th.: D":t:'#;;iäi-i¡ ãuties lETos) arising

il*;;n ;" enhanced understanding f^t ;niì î;,;;;tional cooperation' in core

undei scartered language, mostly ': :"^#:'ui"in",î" "ont"*t of human rights

ilrul'li**ruïåJ:i:i#ïJï;îå';";;'humanrightsandtrade'

particularly with regard to intellectual property rights) and in integrating'hu*un rigLts into glõbal development standards including the recently adopted2030 Agenda for Sustainable Development.

Thaistates often do not have as large a stake in enforcing other states'compliance with human rights law as with other international legal standards isp"thupt inherent in the nature of the law; all the same, the very existence ofirn-un rights law as binding law can be understood as an attempt by states tomitigate ìhis expected indifference by embedding the obligaiions into an

inteirational legãl framework that would, perhaps, invoke the underlyinginterest of otheritates in seeing the rule of international law upheld generally.

with regard to economic, social and cultural rights, the issues of.,progressivã realizalion, and "maximum available resources," have beenimpùtant objects of secondary jurisprudence. Another has been the deeperiszue of econ-omic, social and cultural rights being assumed to be too complexand expensive to be treated as actual rights rather than objects of unfetteredpoliticál give-and-take. The solutions to these sets of issues have included an

äffirmation, by the UN Committee on Economic, Social and Cultural Rights, ofa duty to actively move forward on the rightsT and, perhaps more,important, a

now well-established analysis that divides govemmental duties for all of theelements of the rights into three types: a "respect" duty to do no harm, a,,protecf' duty to ensure that third parties do not cause harm, and a'fulfill "duty to actively ensure that the systems are in place through which everyoneenjoys the right.s"t-he protect duty also addresses directly the fact that many critical actors inhuman ìights contexts (whether the rights are civil and political rights oreconomic] social and cultural rights) are not the state itself. "Protect" bringsthose actors into the human rights legal regime by setting out states' duties,grounded in intemational human rights law, to regulate those actors. At theiame time, recognizing that governmental power to affect behavior may be

limited, particularly in developing countries, measures to address non-stateactors directly have been adopted, most notably the non-binding RuggieGuiding frinóiples on Business and Human Rights, which arose through theUN sy-stem und huu" been widely endorsed both by governments and

businesses themselves.Another development has been a strong emphasis on non-discrimination,

which is understood to always apply - that is, to not be dependent onresources or subject to progressive rcalizaTion. If a government isimplementing a health system, even a limited one, it must ensure that it does so

wiihout disciimination, and that it protects against discrimination by anyprivate actors involved. Jurisprudence on specific economic, social and cultural

184 Maria Green & Titti Mattsson: Health, Ríghts and the State

7 See IJ¡ited Nations Committee on Economic, Social and Cultural Rights, GeneralComment 3, The Nature of States Parties' Obligations, 1990, paragraph2'

8 Søe, among others, United Nations Committee on Economic, Social and Cultural RightsGeneral Cãmment 14, the Right to the Highest Attainable Standard of Health,2000' UNDocument No. Elc.l2l2000/4, paragraph 33. See also, Shue, note 2, above'

Maria Green &Titti Mattsson: Health' Rights and the State 185

rights has also stressed other process-related rights such as participation and

ä*::lT' iy;s have seen a grow itc 1"ïp.'i:î:åt fr;f'jii,..}.i'Iii"nili

"ri:iï;lå'åîffi :iî,ùi'""ä:ffi :triilf, ,it$*i::ul*;:

progressive realtzatton'

followmg:

oNon-discriminationandattentio'n''i';i#:;:lß:;:;i;t;"#:i'';'^members of groups that might'0"'ïi;""äi""ättii li"Ufe to beieftpolicy or p'ogiut' or that might be dts¡r;iv""åä;'- 'out ofthe benLfrts unless special actto

o Participation' which in human rights contexts refers to having a voice

in deciiions that affect one'

o A c c e s s t o i nþ r m a t i oz¡' w h i ch' ": lY'1î lî l;;:ä""1åï ïJ'J:i:: :åother core governmental informatlo-t

rules in ti*"iåîåîå""t" around them' and so forth'

o Means of accountabiliry' including fundamentally means of complaint

and remedv' i¡Åî'lití;right is ti"l"ä';;;*t' it utot"n' there is a

means to '"i':ffi ì':;;"";ã to have tiã sit"ation ue conected'

rhe notion of a "human rights-based Ti:î:".$y"iÌ¿"''."\;T;liåifHf 'ffÏhx'*¡:'n:ïi,;[:il*tþ{tt"¿iil¡,*rt*lg*=äi;i:î;o* to adõPt it' regardless "l TYilffiiî:älr*''n":"':"lupi*åtrifçfi,;,i;t: i::i"i'i'#l ''iitiï;";;"-'"r'"9 "*¿"ø''

*r'i"r' in practical1-" io* or

means rhe "rorr-"1,1ìrlät"ä"t-tigrttt principles listed above' or so

them. ,-hts-based approach means reflecting.,h." hïT* rights.inAdoPting a ng

soals and o'o""t'åï'uîîì"Ji' '"r tr'i"1"'iîif-at trana' i'e' when assessrng

ñeeds and *r,"n "prännin g. impreme".'lä.iJ;;fil::,"ïffii:ïiïi"Ji:

i:ï::l*' mf lï;rl;f 'n "it"*l'* ;J;;i ",

i " r i gh i t o, s'co graphi c ar I v

accessible n"u,,n "Ïi""Ïnîil, un .1"*"n, .'r",rt" titltitá ñealth (see below) and

wouldensure*"iî.äïiîå"-ispaid..nJj"in""mightbemostvulnerabletoä;;"*lt*g from consolidation'

186 Maria Green & Titti Mattsson: Health' Ríghts and the State

The major development agencies in the UN human rights system' among

otnã, ir,teåational and natioãal governmental and non-governmental actors'

have explicitly adopted;h;;"" rights-based approach to their work'e

2.4 The Right to Health

Therighttothe..highestattainablestandardofhealth''appearsintheInternational eilf of niähl, io rt " Universal Declaration of Human Rights and

in the International corienant on Economic, Social and Cultural Rights' It also

appears in the convention on the Rights of the child, where it establishes

rightsanddutiesregardingttt"health-ofeveryoneundertheageoflS;andthers are health-relatei ,årr¿ur¿r in the Disábility convention (CRPD), the

ConventionontheEliminationofallFormsofDiscriminationAgainst.Women(CEDAW), tfre Conuention on the Elimination of all Forms of Racial

bi*ti*itíi"n (CERD) and the Migrants convention (CMW)'Since the 1990s, in plrti,"olu',th-e substantive and procedural content of the

,igtt, un¿ duties estab'iished by the uN treaties'right to health provisions --,trï ir, what the provisions actually mean, in practical t""T:' Iilh regard to

what states should and should not do - has received considerable attention'

Among the major sources of analysis are a General Comment by the UN

Committee on Economic, Social anä Cultural Right; reportt -by t-Y:":ttive UN

Special Rapporteurs oì'rft" Right to Hea-lth; work by the World Health

ó'rgu"øuti"n ttre t]N Ofn"" oith" High Commissioner for Human Rights,

tlNlCEFandotherspecializedUNagencies;jurisprudenceofnationalcourtswhose constitutions reflect internatio-nal rights provisions; work bJ scholars

and work by civil ,o"i"ty organizations-toiheró is a journal, the Health and

Human Rights Journoi puutãtre¿ out of the Harvard school of Public Health,

devoted to the topic. onã "un

read entire books centered on the right to health

as a whole or on specific topics within it'-" irr" ¡grr, to health as set out in uN-level human rights treaties can be

undersboã to include, among other things, rights to access.to health services'

-"ài"in", and other health goods; to measures against epidemics;.to freedom

from medical experiÁentiion; to patient privacy; ,an{ to "underlyingdeterminants of healthli such as clean ãrinking water and adequate sanitation'

"ã"qr"t" and safe rood, and so forth.,It includes a substantive right to health

information (for instanä, u"""rr to information about reproductive health), and

can now be understood (or at least strongly argued) to encompass the core

cross-cutting human ,igtrà prin"iples desciibed above: non-discrimination and

9S¿e..TheHumanRightsBasedApproachtoDevelopmentCooperationTowardsaCommonUnderstanding Among UN Agencies"' 2003'

10 For a quick entrée into the world of intemational human rights law and the right to health,

see the OHCHR right to health homepage at "www.ohchr.orgÆN/IssuesÆscR/Pages/Health.aspx#key". For health systems'-*d hurnun rights specifically'. see especially

Backman, Gunilla, Hunt, paul et ât., Health systems and the right to health: an assessment

of 194 countries,TheLancet3'12 (2008) pp' 2047-8'

Maria Green & Titti Mattsson: Health' Rights and the State 187

attention to who might be being teft out or. disproportionately harmed (this one

i" hevond doubt), pu*'"iiutiåi access to informJtion generally' and means of

ä"oíntuuirity. rn" ,u#l#i;";ffi;å "i rr'" right-ought ro be avaitabte

Ithere are enough gooor"uîã'r"rvices in tt,e countrfto *"ãt them), accessible

ìin t"rt, of non-discriåï"ttøt' æographic ot iltvti"ut accessibility' and

àffordabilitv) and of ^;;;;;;" ..i";tiry- leg' noi out¿ut"¿ if medicines' well-

i;;ä;f#tors, and so Forth)'rl

The right is subject å ;;;;;tt*e realization' and its elemenls are generallv

discussed in rerms "f .h: #tï;-"/p*""JÁrffrl ¿"ries described above' A rights-

based approa"h t" h"Jh iä;ii"ã'l;;; ,hi different stages of health policies,

programs and projects;;fl;;;il;"bstantive elÀents oithe right when setting

Ë""i, ""¿ impiementinfî'":*t' tr"' t'"1i':fi:::ii:JJg:itilå ;Ïäïl:

figsl;l'LT;l*i:l;#Jüff""':"1,i";;;;';'(inctuding'again-'rorinstance, in how ¡n¿¡"uå"'* å"te'mined. and in decisions about what data to

äectäJ;t,h what forms of disaggregation)'

2.5 Domestic Health Løw in Sweden

sweden is a country with g.7 million people, of whom about 2 million are

under the age of f S. S*äà"r'lrur-ifr.""i"uåls of domestic govemment' Apart

from the national ,or"-ää,'ñ; il " regional level consisting of 20 County

Councils, including S¿;;î itt" 'oott" u:n¿ ui the local level there ate 290

municipalities, each *ith;;b"tJ council or assembly' Sweden has a long

iï"ái'*,ï " i ¿

"r i u eri n g ;';h' ;; ;i nt'

"con om i

:artv åïi :î i',":i î::i åi,i; iti""tt'l*á¿"n's health care system has regulat

most compa,utiu" unil'ã' 'oi- uu'ious- international health care systems'

Children under the "r"ïi;,; räiuã fr"" ft"utttr"ur", including regular medical

examinations un¿ uu"Ji""J;;''"; well as À"" á"ntur care' The Swedish

childcarc centers ofrei ffiorr to parents and organize gatherings for new

oarents living within " gi;; u'"u' Th" p'og'ut incfudes support in parenting'

information un¿ "¿u"utiilä:å*;"iììã 1,,1år,r' care, h.álih promolion and

health check-ups and ä"ï"iãp-*tuf '"t""ni"n'' tt'*' Sweden's health and

medical care for "hild;';;î also for trre reiorthe population' generally is

expected to meet " hig;-;äJ;Jand isîrlly subsidized bv the state'

No explicit ""t"t*'iåî"ìîtgñ n"uttnjut" services exists in Sweden'

although the section ;î';î;^î;til^"nt- of ihe Government (part of the

Constitution) that sets;';;t-;;f"rceable aims of government includes the

following statement:

The oersonal, economic and cultural *tlf*-" of the individual shall be

fundamentar aims of p"uri.'riti"itï. in purticutur,.the public institutions shall

secure the right to "-pl"v;;;;'håititä ät¿ education' ånd shall promote social

II

l

11 UN Committee on Economic' Social and Cultural Rights' General Comment

above.

14, note 8,