Council of Europe: the right to health , particularly in relation to vulnerable groups

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Council of Europe the right to health ,
particularly in relation to vulnerable groups

• W. Cezary Wlodarczyk
• Wroclaw, 13 October 2006

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CoE mission

• Vienna Summit (1993) the guardian of democratic
  security - founded on human rights, democracy and
  the rule of law
• Strasbourg Summit (1997) democracy and human
  rights, social cohesion, the security of
  citizens and democratic values and cultural
  diversity
• Summit Warsaw (2005) promoting the common
  fundamental values of human rights, the rule of
  law and democracy strengthening the security of
  European citizens, fostering co-operation with
  other organisations.

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CoE mechanisms

• Fundamentals European Convention on Human Rights
  (guarantees civil and political human rights),
  European Social Charter (guarantees social and
  economic human rights)
• Supervision European Committee of Social
  Rights determines whether or not national law and
  practice in the States Parties are in conformity
  with the Charter
• monitoring procedure based on national reports
  (as a result of the monitoring system, states
  make changes to their legislation and/or practice
  in order to bring the situation into line with
  the Charter)

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SOURCES

• EUROPEAN SOCIAL CHARTER,
• EUROPEAN SOCIAL CHARTER (REVISED)
• DIGEST OF THE CASE LAW OF THE ECSR, EUROPEAN
  SOCIAL CHARTER, March 2005,
• THE HUMAN DIGNITY AND SOCIAL EXCLUSION PROJECT
  (HDSE Project) two thematic reports
  homelessness, health

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Perception of health

• Problems of health always integrated to broader
  context of peoples social position
• Concepts related to values human dignity, social
  integration
• Social determinants of health material status,
  education, occupation, income, family status,
  gender, social support, participation in social
  life
• Health should be protected, but broad set of
  health determinants must be considered
• Concept of health determinants evolved

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Right to health and health care

• Health is an universal right
• In many countries a lot health services is
  principally available to all entitled (insured,
  own citizens or citizens of specified countries)
•  Usually, it is easier to get to preventive
  services
•  Those suffering due to specified diseases can
  have additional entitlement
•  Underprivileged may have additional rights

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Homeless people

• the majority of those who become roofless and end
  up on the street or in an emergency shelter for
  homeless people are poor, have no stable work,
  have weak health and can no longer rely on family
  and friends for help.

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Direct health risks for homeless

• Exposure for physical, biological, chemical,
  social, emotional risks resulted from lack of
  dwellings or poor housing conditions leading to
  ill-health

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Social risks for homeless people

• A number of social rights have traditionally been
  associated with a permanent abode or proof of
  residence. Access to welfare benefits, basic
  health care, personal documents, political
  participation, operates on a territorial basis
  and citizens need to have an address in order to
  claim their rights.
• Homeless people who cannot give proof of
  residence may be denied all other basic human,
  social and political rights.

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First version

• EUROPEAN SOCIAL CHARTER, Turin, 18.X.1961, Entry
  into force Conditions 5 Ratifications.
  Date 26/2/1965
• Right to health
• Rights to social support (no direct reference to
  housing

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Article 11 The right to protection of health

• With a view to ensuring the effective exercise of
  the right to protection of health, the
  Contracting Parties undertake, either directly
  or in co-operation with public or private
  organisations, to take appropriate measures
  designed inter alia

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Article 11

• to remove as far as possible the causes of
  ill-health 
• to provide advisory and educational facilities
  for the promotion of health and the encouragement
  of individual responsibility in matters of
  health
• to prevent as far as possible epidemic, endemic
  and other diseases.

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Health

• State of health of the population
• the state of public health, life expectancy,
  principal causes of death
• the infant and maternal mortality rates as close
  to zero as possible.
• Access to health care
• health care should be funded collectively
• the costs involved should not be too onerous on
  individuals
• access to health care should be provided without
  undue delay (waiting lists)
• health personnel and equipment should be
  sufficient

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Protection and promotion of health

• Encouragement of individual responsibility
• Consultation and screening
• Rights to medical care not emphasized

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Areas of interventions

• Healthy environment air pollution, nuclear
  risks, risks relating to asbestos, food safety
• Tobacco, alcohol and psychotropic substances
• Immunisation and epidemiological monitoring
• Accidents

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Additional provisions

• Article 12 The right to social security
• Article 13 The right to social and medical
  assistance
• Article 14 The right to benefit from social
  welfare services

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Articles 12 13

• Social security, universal, occupational schemes,
  special schemes (sickness, incapacity for work,
  maternity, family charges, unemployment, old age,
  death, widowhood, occupational accidents and
  diseases)
• Social assistance, benefits granted essentially
  on the basis of individual need . Is granted
  where there is no social security benefit
  ensuring that the person concerned has adequate
  resources.

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Social assistance

• Social assistance covers cash benefits and
  benefits in kind payable primarily on the basis
  of need (social allowances, social pensions,
  minimum integration income, etc).
• Medical assistance covers access to free or
  subsidised health care, or payments enabling
  people to afford the care they require.

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Social assistance

• The right to social assistance must be maintained
  for as long as the state of need persists
• Conditions concerning length of residence or
  ordinary residence are contrary to this provision
  (foreigners likely affected)
• Foreigners with their residence or work permits
  valid may not be expelled solely because they
  are in need

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The vulnerable groups

• Social welfare services for everybody lacking
  capabilities to cope, in particular the
  vulnerable groups and individuals who have a
  social problem
• Children, the family, the elderly, people with
  disabilities, young people with problems, young
  offenders, refugees, the homeless, alcohol and
  drug abusers, victims of domestic violence and
  former prisoners

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New version

• EUROPEAN SOCIAL CHARTER (REVISED) Strasbourg,
  3.V.1996, Entry into force Conditions 3
  Ratifications, Date 1/7/1999
• Right to housing
• Protection against poverty and social exclusion

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Article 31 The right to housing

• With a view to ensuring the effective exercise of
  the right to housing, the Parties undertake to
  take measures designed 
• to promote access to housing of an adequate
  standard 
• to prevent and reduce homelessness with a view to
  its gradual elimination 
• to make the price of housing accessible to those
  without adequate resources.

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Adequate housing

• must be defined in law
• structurally secure
• safe from a sanitary and health point of view
• not overcrowded
• with secure tenure supported by the law

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Equal treatment

• Equal treatment with respect to housing must be
  guaranteed, in particular, to the different
  groups of vulnerable persons, particularly
  low-income persons, the unemployed, single parent
  households, young persons, persons with
  disabilities including those with mental health
  problems

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Obligations of the state

• States must gradually reduce homelessness,
  towards its elimination
• States must also take action to prevent
  categories of vulnerable people from becoming
  homeless. To this purpose they must implement a
  housing policy for all disadvantaged groups of
  people to ensure access to social housing
• Forced eviction must be strictly regulated

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Article 30 The right to protection against
poverty and social exclusion

• With a view to ensuring the effective exercise of
  the right to protection against poverty and
  social exclusion, the Parties undertake
• to take measures within the framework of an
  overall and co-ordinated approach to promote the
  effective access of persons who live or risk
  living in a situation of social exclusion or
  poverty, as well as their families, to, in
  particular, employment, housing, training,
  education, culture and social and medical
  assistance 
• to review these measures with a view to their
  adaptation if necessary.

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Article 30

• ...living in a situation of poverty and social
  exclusion violates the dignity of human beings...
  
• access to social rights, in particular
  employment, housing, training, education, culture
  and social and medical assistance.

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CONCLUSION

• A guarantee to all nationals and foreigners
  legally resident and/or working that the right
  to protection of health, set out in the Charter,
  applies regardless of race, sex, age, colour,
  language, religion, opinions, national origin,
  social background, state of health (persons with
  disabilities), scope of family responsibilities
  or association with a national minority.
• It covers the right to social integration and
  participation in the life of the community.