Is there a right to health for the people of Scotland?

Dr Tony Robertson reflects on how we make the right to health a reality for everyone.

It is fundamentally unjust that systematic inequalities in Scotland today mean that some people live healthier, longer lives than many others. And this is not just a concern for those most unfairly impacted. Whilst public health improvements, via declining deaths from alcohol, heart disease, most cancers and respiratory disease, were evident in the first decade of the 21^st century, these improvements have stalled and got worse in some cases. And any health benefits we do see are not being realised equally across social groups. The ‘social gradient in health’ is alive and well, sadly.

Scotland’s relatively poor health compared to the rest of Europe, and our shocking health inequalities, can only change if there is a paradigm shift in how we view health and understand its underlying causes. This is not about individual lifestyle choices; this is about structural change. We need our government to commit to establishing a right to health for all peoples, that accounts for, and seeks to address, historical inequities. It is of course encouraging that health, and the myriad of health determinants, are included in Scotland’s second National Human Rights Action Plan (SNAP2) (2023-2030) and that the Scottish Government has stated a commitment to introduce a Human Rights Bill. However, we have already had a SNAP1, launched in 2013. In that time, health inequalities across a multitude of metrics have stalled or gotten worse.

Too complex?

The ALLIANCE’s recent report on people’s understandings of the right to health highlights key issues we face in promoting and realising the right to health. The evidence from the report states that the right to health is too complicated and not seen as something on the political agenda in Scotland. Respondents felt that “framing health information from a human rights perspective can make it less accessible for individuals…and that until the right to health is better understood and defined in practical terms both at policy level and at street level, any information provision would be at risk of being inaccessible and redundant”.

How do we make the right to health a reality?

As a first step we need to foster a debate about exactly what a ‘right to health’ entails and then work together to address underlying social, economic, political and commercial determinants of health to address real change in the nation’s health. A peoples’ movement that centres health within the wider social, economic, environmental and political components of our societies and pushes for more radical, systematic change is one way to push the needle towards a healthier, safer, ecologically-viable country. There is a need to reimagine the possibilities of our societies and promote the measures which, if properly implemented, would make an impact on poor physical, mental, social and environmental wellbeing.

There are no ‘quick fixes’ to Scotland’s ills, but we must not ignore the upstream determinants and the broader definitions of a right to health. Alongside tackling these wider determinants and encouraging a less superficial narrative on health, we need to focus our attention on how policies, manifestos and ideologies are developed, promoted, implemented and evaluated, including removing unfair power dynamics that prevent the real engagement and participation of communities. Yes, it is challenging to work with somewhat abstract concepts like a right to health. The scale of the issues we face are complex and require system change, but we must empower all citizens to have the voice, receptive audience and power to express and realise their individual needs and human rights, as well as fight for the systemic change that is needed.

This opinion forms part of a specially commissioned series by the Health and Social Care Academy which reflects on learning and insights from the report ‘Investigating knowledge and understanding of the right to health’.

End of page.