Health Is a Human Right: An Examination of Policy Initiatives in the United Kingdom and Canada and the Need to Take Action

Published on by BPP Human Rights Unit

Julia Goodman reports on policy initiatives and ongoing challenges related to health inequalities in the UK and Canada, suggesting the need for further action.

Introduction
Equitable access to health is a fundamental human right as stated by the World Health Organization (WHO) and the United Nations (UN) in its Sustainable Development and Health Goals.1 The principle of health equality seeks to provide “fair outcomes for everyone” while addressing “avoidable or remedial differences in health between groups of people.”2 ”Health inequalities” are defined as “unfair, avoidable, systematic” and quantifiable differences in direct health outcomes across certain groups in society, as well as differences in indirect health indicators, such as access to care.3 For the UN and the WHO, making health a fundamental human right is a foundational step in encouraging developed nations to work towards achieving health parity for all. This includes addressing the health needs of marginalised groups who suffer from health inequalities and worse health outcomes.4 Although progress has been made in both states, policymakers in both countries are still striving to reduce health inequalities and to comply with international standards of health human rights.

Context of Health Inequalities and Recent Policy Initiatives in the UK and Canada

Health inequalities are measured in the UK and Canada by quantifiable differences in health outcomes. Between 2018-2020, English men and women living in the most deprived areas lived 9.7 and 7.9 years less, respectively, than those in the least deprived areas.5 Beyond life expectancy, there are disparities across other health indicators such as quality and access to care, levels of chronic and preventable disease, and other social determinants of health.6 Deconstructing the causes of differences in health outcomes is not clear-cut and the nature of health disparities is often related to intersectional factors, such as socioeconomic status, race, gender, and geography. As a result, developing specific policies that target disadvantaged or adversely affected groups effectively is challenging. For example, while certain ethnic groups, such as black or Asian, may have a longer life expectancy than white individuals, black women are four times more likely to die in childbirth than white women, demonstrating the complexity related to addressing specific forms of health inequalities.7

While there are also intersectional health disparities across Canada’s diverse population, the health outcomes of Indigenous peoples are disproportionately worse than the rest of the population. Life expectancy for Indigenous men is 9 years shorter than for non-Indigenous men; for women, it is nearly 10 years shorter. Furthermore, Indigenous groups are overrepresented in the addiction treatment systems and have higher rates of suicide per capita than the Canadian average. Long-standing health inequalities like these are, in part, the result of intergenerational trauma related to Canada’s colonial legacy and policies, such as the Indian Act and the residential school system.8 As a result, the urgent focus of policymakers is to redress long-standing injustices endured by Indigenous peoples, which are largely the effect of historical policy.

The UK and Canada – Change Driving Towards Health Equality

While the context of health inequality in both countries differs, there are similarities in the policy initiatives being undertaken by both governments.

1. Enhanced Data Collection, Measurement, and Reporting

Both the UK and Canadian governments are taking steps to implement more robust data collection methodologies and frameworks, which will be used to drive policy development. Recent research in the UK highlights that some former data collection methods have led to gaps in policymaker’s understanding of the true levels of health inequality. For example, certain health data collection methods were based on regional averages, obscuring levels of deprivation and health disparities in rural regions given the close geographic proximity between deprived and affluent areas.9 In 2021, the UK government introduced the Inequalities Dashboard, which captures more granular data at the local level, enabling policymakers to better detect and monitor health inequalities and drive effective policy development.10

In 2017, Canadian policymakers launched the Pan-Canadian Health Inequalities data tool to aid policy analysts and public health practitioners in identifying health inequalities faced by marginalised groups. The tool captures health disparities data from the entire population and collects specific health indicators that are more relevant to Indigenous groups, such as stigma and discrimination experienced in healthcare settings, feelings of social isolation and community belonging, and levels of intergenerational trauma.11 The inclusion of a wider set of factors ranging from well-being to enhanced geographical data will serve as a solid foundation for policy development. The longer-term impact of these new data collection methodologies is in part dependent on how policymakers choose to use the insights delivered by these tools.

2. Engagement of Local Government and the Community

In recent years, the UK and Canada have engaged local governments and the community in policy development.

The UK has focused on empowering local communities to tackle the complex causes of health inequality. In 2022, the UK government passed the Health and Care Act which facilitates cooperation between health services, social care, and local governments. This act established the legislative framework for Integrated Care Systems (ICSs), which are collaboration units between National Health Service (NHS) organisations and local authorities. ICSs cover populations of 500,000 to 3 million people and are responsible for mitigating health inequalities.12 The establishment of ICSs will enable patients with multiple, complex conditions to receive integrated care and health systems to ensure broader social determinants of health are taken into consideration.13 While the Health and Care Act puts ICSs on a statutory footing, newly formed ICSs will need to quickly learn how to partner with each other from a practical perspective, sharing collective responsibility and accountability, for this policy to successfully reduce health inequalities over the long term.14

In Canada, one of the most egregious ways in which policymakers have failed to uphold standards of health-related human rights is in the provision of clean drinking water for Indigenous groups. Longterm drinking water advisories (LDWAs) are health protection notifications about real or potential health risks related to drinking water that have been in place for over a year and result from the lack of clean drinking water and wastewater infrastructure in Indigenous Reserves. In 2013, the Canadian government introduced policy aimed at removing all LDWAs. However, there is wide acknowledgement that this legislation has fallen short since there are still ~30 LDWAs in place today.15 In recent years, the government has conducted consultations with First Nations peoples and community leaders to co-develop federal policy to drive the elimination of LDWAs (consultation is also being conducted for other policy initiatives to reduce inequalities suffered by Indigenous groups, including health inequalities).16 It is promising that, in December 2023, legislation has been tabled to address concerns that surfaced in the consultations, including the provision of adequate and predictable funding, the establishment of minimum standards and the pathway for ongoing engagement regarding new policy initiatives.17 In contrast to the UK, Canada’s LDWA policy approach has focused on consultation with key ethnic groups rather than localised empowerment, reflecting the need for a centralised and coordinated approach at the federal level to tackle the complex long-standing issue of LDWAs.

3. Stamping Out Embedded Bias and Prejudice in the Health System

In the UK and Canada, healthcare-related racism has been identified as a key driver of health disparities, leading to intervention from policymakers. Black mothers in the UK, for example, report significant bias and prejudice, such as nurses assuming they do not know who the father of their baby is, or inappropriate and missed diagnoses since many health practitioners are not versed in the differing health needs of various ethnic groups.18 At present, while NHS clinicians are encouraged to undertake optional Cultural Competency Training (CCT), there is no specific legal mandate for race-specific health training. Following calls for reform, policymakers have partially accepted a recommendation to review maternal health training curricula to include evidence-based learning on “maternal health disparities, its possible causes, and how to deliver culturally competent, personalised and evidence-led care”. These policies are still in development and present a significant opportunity to ameliorate health disparities while leveraging novel data insights and evidence related to race-specific healthcare. Each Local Maternity and Neonatal System will outline further policy measures in March 2024. However, the government is yet to accept recommendations to increase annual budgets for maternity services to £200m-£350m and to set up cross-government targets led by the Department of Health and Social Care to eliminate maternal health disparities, both of which are crucial to achieve the policy objectives.19

In Canada, there has been significant qualitative and quantitative measurement of the health disparities endured by Indigenous groups that are often the result of racial prejudices embedded within the health system. The harrowing stories of Brian Sinclair who waited 34 hours in the emergency room before dying due to a treatable bladder infection, and Joyce Echaquan, who live-streamed her racial mistreatment at the hands of hospital nurses before passing away, underline the absence of equitable, respectable, culturally competent, and dignified care for Indigenous groups.20 Racial biases faced by Indigenous groups have led to persistent unmet healthcare needs, such as lack of monitoring of a chronic condition or screening/diagnosis (shown in the chart below).21 Since Canada’s race-specific data capture methods are more mature relative to the UK, the Canadian government has the appropriate data and evidence to mandate medical and nursing schools to provide race-specific education and training on Indigenous health issues, including the origins and impact of the residential school system, a step that will hopefully provide the foundation for culturally competent care.

Image Source: Statistics Canada, ‘Unmet health care needs during the pandemic and resulting impacts among First Nations people living off reserve, Métis and Inuit’, 30 August 2022

Conclusion
Every human being, irrespective of their background or socioeconomic status, should have access to quality healthcare. Policymakers in both the UK and Canada are focused on understanding the unserved needs of disadvantaged groups and are taking steps to promote trust in health systems to create a fairer, more just society. While there are opportunities to continue to shape and implement healthcare law and policies, both the UK, through recent policy initiatives, and Canada, through legislation addressing Indigenous injustices, are working towards improving the lives and health outcomes of marginalised populations and pushing to close the gaps related to health inequality. To continue making health equality a reality and to entrench the human right to healthcare access for all, we need the continued support of the policies and collaboration between all levels of regional and local government, advocacy partners, health industry groups, and you!

Works Cited

  1. World Health Organization. “Human Rights and Health.” http://www.who.int, 10 Dec. 2022, http://www.who.int/news-room/fact-sheets/detail/humanrights-and-health#:~:text=The%20right%20to%20health%20must; “SDG Indicators — SDG Indicators.” Unstats.un.org,unstats.un.org/sdgs/metadata/?Text=&Goal=3&Target=3.8.
    ↩︎
  2. GOV.UK. “Health Disparities and Health Inequalities: Applying All Our Health.” GOV.UK, 11 Oct. 2022, http://www.gov.uk/government/publications/health-disparities-and-health-inequalities-applying-all-our-health/health-disparities-and-healthinequalities-applying-all-our-health. ↩︎
  3. NHS Outcomes Framework Indicators for Health Inequalities Assessment. 2015; Note: We have used definitions of “Health Equity” and “Health Equality” from WHO, UN, NHS and the King’s Fund. The terms are often used interchangeably in UK policy. ↩︎
  4. World Health Organization. “Human Rights and Health.” http://www.who.int, 10 Dec. 2022, http://www.who.int/news-room/fact-sheets/detail/humanrights-andhealth#:~:text=The%20right%20to%20health%20must. ↩︎
  5. Office for National Statistics. “Health State Life Expectancies by National Deprivation Deciles, England – Office for National Statistics.” http://www.ons.gov.uk, Office for National Statistics, 25 Apr. 2022, http://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthinequalities/bulletins/healthstatelifeexpectanciesbyindexofmultipledeprivationimd/2018to2020. ↩︎
  6. Williams, Ethan, et al. “What Are Health Inequalities?” The King’s Fund, The King’s Fund, 17 June 2022, http://www.kingsfund.org.uk/publications/what-are-health-inequalities. ↩︎
  7. ONS. “Ethnic Differences in Life Expectancy and Mortality from Selected Causes in England and Wales – Office for National Statistics.” http://www.ons.gov.uk, 2021, http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/articles/ethnicdifferencesinlifeexpectancyandmortalityfromselectedcausesinenglandandwales2011to2014; Mundasad, Smitha. “Black Women Four Times More Likely to Die in
    Childbirth.” BBC News, 11 Nov. 2021, http://www.bbc.co.uk/news/health-59248345. ↩︎
  8. The Canadian Press. “Lifespan of Indigenous People 15 Years Shorter than that of Other Canadians, Federal Documents Say | CBC News.” CBC, 23 Jan. 2018, http://www.cbc.ca/news/health/indigenous-people-live-15-years-less-philpott-briefing-1.4500307; Maina, Geoffrey, et al. “A Scoping Review of School-Based Indigenous Substance Use Prevention in Preteens (7–13 Years).” Substance Abuse Treatment, Prevention, and Policy, vol. 15, no. 1, 1 Oct. 2020, https://doi.org/10.1186/s13011-020-00314-1. Accessed 16 Oct. 2020; Wilk, Piotr, et al. “Residential Schools and the Effects on Indigenous Health and Well-Being in Canada—a Scoping Review.” Public Health Reviews, vol. 38, no. 1, 2 Mar. 2017, https://doi.org/10.1186/s40985-017-0055-6; Kim, Paul J. “Social Determinants of Health Inequities in Indigenous Canadians through a Life Course Approach to Colonialism and the Residential School System.” Health Equity, vol. 3, no. 1, 25 July 2019, pp. 378–381, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657289/, https://doi.org/10.1089/heq.2019.0041 ↩︎
  9. APPG. “Inquiry Overview.” APPG Rural Health & Care, Feb. 2022,
    https://rsnonline.org.uk/images/publications/RuralHealthandCareAPPGInquiryOve.pdf. ↩︎
  10. “Inequality Tools – OHID.” Fingertips.phe.org.uk, fingertips.phe.org.uk/profile/inequalitytools#:~:text=The%20Health%20Inequalities%20Dashboard%20provides. Accessed 17 Oct. 2023 ↩︎
  11. “Pan-Canadian Health Inequalities Data Tool, 2017 Edition | National Collaborating Centre for Determinants of Health.” Nccdh.ca, 2017, nccdh.ca/resources/entry/pan-canadian-health-inequalities-data-tool-2017-edition.022, http://www.kingsfund.org.uk/publications/health-and-care-act-key-questions. ↩︎
  12. The King’s Fund. “The Health and Care Act.” The King’s Fund, 17 May 2022, http://www.kingsfund.org.uk/publications/health-and-care-act-key-questions. ↩︎
  13. Charles, Anna. “Integrated Care Systems Explained.” The King’s Fund, 19 Aug. 2022, http://www.kingsfund.org.uk/publications/integrated-care-systems-explained. ↩︎
  14. Naylor, Chris. “Integrated Care Systems Need to Be Different – but How Exactly?” The King’s Fund, 28 Mar. 2022, http://www.kingsfund.org.uk/blog/2022/03/integrated-care-systems-need-to-be-different. ↩︎
  15. Government of Canada, Statistics Canada. “Drinking Water.” Quality of Life Indicator, 1 Dec. 2023, www160.statcan.gc.ca/environment-environnement/drinking-water-eau-potable-eng.htm. ↩︎
  16. Canada, Government of Canada; Crown-Indigenous Relations and Northern Affairs. “Developing Laws and Regulations for First Nations Drinking Water and Wastewater: Engagement 2022 to 2023.” http://www.rcaanc-Cirnac.gc.ca, 29 Feb. 2012, http://www.rcaanc-cirnac.gc.ca/eng/1330528512623/1698157290139. ↩︎
  17. Government of Canada; Indigenous Services Canada. “Drinking Water and Wastewater Legislation.” Government of Canada; Indigenous Services Canada, 11 Dec. 2023, http://www.sac-isc.gc.ca/eng/1697555066364/1697555089256. ↩︎
  18. 8 Peter, Michelle, and Reyss Wheeler. The Black Maternity Experiences Survey, a Nationwide Study of Black Women’s Experiences of Maternity Services in the United Kingdom. 2022. ↩︎
  19. Hughes, Mark. “Women and Equalities Select Committee – Black Maternal Health: Government Response to the Committee’s Third Report.” Patient Safety Learning – the Hub, 30 June 2023, http://www.pslhub.org/learn/patient-safety-in-health-and-care/high-risk-areas/maternity/women-and-equalities-select-committee-%E2%80%93-black-maternal-health-government-response-to-the-committee%E2%80%99s-third-report-30-june-2023-r9679; Women and Equalities Committee. “Black maternal health: Government Response to the Committee’s Third Report.” House of Commons, 28 Jun. 2023. ↩︎
  20. Horton, Jillian. “Opinion: I Was Brian Sinclair’s Doctor. I Understand How Our Health Care System Failed Him.” The Globe and Mail, 8 Oct. 2021, http://www.theglobeandmail.com/opinion/article-i-was-brian-sinclairs-doctor-i-understand-how-our-health-care-system/; “Health Care Staff Mocked, Chastised Joyce Echaquan All Morning, Hospital Roommate Testifies.” The Globe and Mail, 25 May 2021, http://www.theglobeandmail.com/canada/article-health-care-staff-mocked-chastised-echaquan-all-morning-hospital/. ↩︎
  21. Government of Canada, Statistics Canada. Unmet Health Care Needs During the Pandemic and Resulting Impacts Among First Nations People Living off Reserve, Métis and Inuit. 30 Aug. 2022, www150.statcan.gc.ca/n1/pub/45-28-0001/2022001/article/00008-eng.htm. ↩︎

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