Council of Europe: the right to health ,

particularly in relation to vulnerable groups

W. Cezary Wlodarczyk

Wroclaw, 13 October 2006

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.

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);

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;

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;

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;

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.

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;

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.

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;

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 under take, either directly or in co‑operation with public or private organisations, to take appropriate measures designed inter alia:

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.

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;

Protection and promotion of health

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

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;

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;

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.

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.

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;

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;

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;

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.

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;

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;

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;

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.

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.

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.