The assessment of national conduct in realizing the right to heath: using the framework of United Nations

• Date: 01 January 2024
• Pages: 17-35
• DOI: https://doi.org/10.1108/IJHRH-07-2023-0059
• Published date: 01 January 2024
• Subject Matter: Health & social care,Vulnerable groups,Inequalities & diverse/minority groups,Sociology,Race & ethnic studies,Minorities,Multiculturalism,Racial identity,Work,economy & organizations
• Author: Fatemeh Kokabisaghi

The assessment of national conduct in

realizing the right to heath: using the

framework of United Nations

Fatemeh Kokabisaghi

Abstract

Purpose –Health is a human right and a fundamental building block of sustainable development, economic

prosperity and poverty reduction. To realize people’s right to health, evaluating the situationof the right and its

determinants is necessary. Thispaper aims to analyze Iran’s conduct in realizing its population’s right to health.

Design/methodology/approach –A qualitative case study design involving a structured review of

relevant laws, policy documents, reports and academic literature was undertaken. The data were

collected from electronic databases and the official Web pages of the United Nations (UN) and Iran’s

Governmentand analyzed by a framework suggested by the UN.

Findings –Iran’s law and policies intend to combat health inequalities and to provide an adequate

standard of livingfor everyone, particularly disadvantagedgroups and individuals. However, not all laws

and policies protecting disadvantaged groups are adequately implemented. There are disparities in

health status and accessto health care among differentsocio-economic groups. International economic

sanctions and governmentpolicies decreased people’s ability to accessthe necessities of life including

health care. Moreover, social determinants of health, such as culturalbeliefs regarding women’s rights

have notbeen addressed sufficiently in the country’slaws.

Research limitations/implications –This study includes a broad range of subjects and provides an

overview of the health-care systemof Iran. However, more detail is needed to describe every aspect of

the right to health. It was not feasible to address them all in this paper and needs more research. In

addition, as withthe majority of qualitative studies, the design of the currentstudy is subject to limitations.

Firstly,the research quality of narrative reviewsis dependent on the researcher’skills and more easily can

be influenced by his/her personal biases. Second, the rigor is more difficult to maintain, assess and

demonstrate.Nevertheless, narrative studiesoften complement quantitative studiesand are informative.

Originality/value –To fulfill the right to health,Iran should improve affordability and quality of careand

the situation of the determinants of health. The gaps in people’s access to health care need to be

identified,and all necessary means and scarce resources be allocatedto remove access barriers and to

improve the situation of disadvantaged people. The adoption of relatively low-cost targeted programs,

the propermanagement of resources and the preventionof unnecessary costs are suggested.

Keywords Right to health, Compliance assessment, Health system, Access to health care, Iran

Paper type Research paper

Abbreviations

OHCHR = Off‌ice of the United Nations High Commissioner for Human Rights;

WHO = World Health Organization;

MOHME = Ministry of Health and Medical Education;

ICESCR = International Covenant on Economic, Social and Cultural Rights;

AAAQ = Availability, Accessibility, Acceptability and Quality;

ILO = International Labor Organization;

PHC = Primary Health care; and

NCDs = Non-Communicable Diseases.

Fatemeh Kokabisaghi is

based at the Department of

Health Economy and

Management Sciences,

Mashhad University of

Medical Sciences,

Mashhad, Iran.

Received 17 July 2023

Revised 29 October 2023

30 November 2023

Accepted 2 December 2023

The author expresses special

appreciation and thanks to

Prof Martin Buijsen formErasmus

University Rotterdam, The

Netherlands for his valuable

guidance and support throughout

the research process.

Other information

Ethics approval and consent to

participate: not applicable

Consent for publication:not

applicable

Competing interests: not

applicable

Funding: not applicable

Authors’ contributions:not

applicable

DOI 10.1108/IJHRH-07-2023-0059 VOL. 18 NO. 1 2025, pp. 17-35, ©Emerald Publishing Limited, ISSN 2056-4902 jINTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE jPAGE 17

Background

International human rights treaties require the state parties to realize their population’s right

to health by taking particular steps and considering a set of principles. However, states

retain a wide margin of discretion in selecting the measures for realization of the rights.

Obligations arising from the right to health are largely determined by the national context

and domestic conditions such as development level and the political, demographic and

socio-economic situations ofcountries. Moreover, events such as economic crises, war and

international economic sanctions adversely affect the socio-economic situation of people’s

lives and call for new policies to protectthe rights (Kokabisaghi, 2019a,2019b).

The World Health Organization (WHO) has defined health as “a state of complete

physical, mental and social well-being and not merely the absence of disease or

infirmity”(Constitution of the World Health Organization. Sect. Preamble, 1948) and the

definition provided by the International Covenant on Economic, Social and Cultural Rights

(ICESCR) 1966 for the right to health is “the right to the highest attainable standard of

physical and mental health.” (International Covenant on Economic, Social and Cultural

Rights, 1966). These two definitions necessitate a wide range of actions to ensure, protect

and promote this right. Most countries have accepted at least one international or regional

covenant or treaty recognizing the right to health. More than 160 countries ratified the

ICESCR, and 135 countries incorporated the right to health or duties of states concerning

people’s health in their constitutions (Hogerzeil and Mirza, 2011). However, there are

differences in access to healthcare among different socio-economic groups of populations,

even in developed countries.

Australia has no constitutional protection or judicial enforcement for the right to health. The

political and policy environment and subsidized private health facilities and insurance

companies negatively impact the accessibility of health care, particularly for vulnerable

groups (Solomon, 2021). Rural population in Africa experiences significant barriers to

accessing health care including financial barriers, lack of means for transportation, long

distance to health system facilities and limited services available. Poor infrastructure and

shortages of health-care workers entrench the inequalities (Gaede and Versteeg, 2011).

Undocumented immigrantsin Denmark and Sweden have only the right to emergency care.

In the Netherlands, they are entitled to all types of health care; however, their illegal status

might hinder them from seeking health care (Biswas et al.,2012). Alleviating poverty and

improving access of the disadvantaged groups to health care, and recognizing the effects

of social determinants on health are the strategies of Latin American countries for health

system reform (Berwick, 2019). In Pakistan, major causes of poor health root in social and

economic inequalities. In this low-income country, the population’s health is adversely

affected by the lack of access to safe drinking water, nutritious food and appropriate

sanitation. This country does not have a national health insurance policy (Qureshi and

Owusu-Dapaa, 2014).

The right to health has been guaranteed in several national laws and policies in Iran. The

definitions suggested by the WHO and the ICESCR for health and the right to health have

been applied to Iranian laws and policies. The country has several plans to support

vulnerable groups including children and the disabled. However, multiple studies indicated

unequal access of different vulnerablegroups such as rural women (Haghdust et al.,2011),

the elderly (Gholamzadeh et al.,2022), prisoners, people living with HIV (Rahmati-

Najarkolaei et al.,2010

), the disabled (Soltani et al., 2017), the mentally ill (Taghva et al.,

2017) and addicts to health services. Peopleliving in some deprived provinces lack access

to quality health care, medical specialists and rehabilitation care (Abouie et al.,2018).

Moreover, there are differences in the determinants of health including adult literacy and

access to safe water and proper sanitation among developed and less developed areas

(World Health Organization, 2010).

PAGE 18 jINTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE jVOL. 18 NO. 1 2025