Published 15 January 2009, doi:10.1136/bmj.b136
Cite this as: BMJ 2009;338:b136

Editor's Choice

Health is a human right

Alex Jadad and Laura O’Grady’s call for a debate on the definition of health has stimulated fascinating responses to both their editorial (doi:10.1136/bmj.a2900) and their blog (http://blogs.bmj.com/bmj/2008/12/10/alex-jadad-on-defining-health). I particularly like Richard Smith’s response to the blog, in which he suggests that health is "the capacity to do what matters most to you" (http://blogs.bmj.com/bmj/2009/01/05/richard-smith-can-poetry-define-health).

Two other responses appear in this week’s Letters. Peter Mansfield recalls the Peckham experiment in London in the 1930s and 1940s, which aimed to investigate the nature of health (doi:10.1136/bmj.b83). An expanded vision of health is unlikely to come from within medicine, he says. "Economic and climatic constraints will force healthy living on us eventually, or we shall perish." Peter Davies calls on us to embrace the wider context of health beyond the absence of disease (doi:10.1136/bmj.b28). "For too long we as a society have allowed politicians to get away with shunting health off to a ‘medical domain,’ thus avoiding focus on the large scale social and political forces that create health and illness."

There is no doubting the political forces at play in the world’s major conflict zones. Médecins Sans Frontières’ annual list of the most neglected humanitarian disasters, released last month (http://doctorswithoutborders.org/publications/topten), highlights Somalia, the Democratic Republic of Congo, Iraq, Sudan, Pakistan, Zimbabwe, and Burma. That was before this month’s terrible events in Gaza. All these disasters are man made, a point hammered home in an emergency report from the US based charity Physicians for Human Rights on the collapse of Zimbabwe’s healthcare system (doi:10.1136/bmj.b100). The authors say that Zimbabwe’s health crisis is a direct result of violations of human rights, including the right to vote and the right to a standard of living adequate for health.

In the Democratic Republic of Congo, at the hospital made famous last month for the text messages that guided a forequarter amputation by a surgeon working for Médecins Sans Frontières (doi:10.1136/bmj.a2958), there is no elective surgery, only emergency operations, with sometimes nearly 100 casualties a day (doi:10.1136/bmj.b63). Meanwhile in Gaza, medical workers are overwhelmed by the number of casualties, reports John Zaracostas (doi:10.1136/bmj.b87). They are hampered by shortages of critical medical supplies and fuel as Israel’s air and land offensive adds to the already debilitating consequences of a long blockade.

What can the world’s medical profession do in the face of such powerful, longstanding, and complex political forces? Shrink back into the confines of the medical model? Or, as I believe we must, embrace the wider responsibility of championing the right to health in all parts of the world. For this we do need a workable definition of health however hard it is to achieve. And for my part I endorse last week’s call in the Lancet (doi:10.1016/S0140-6736(09)60015-5) for all doctors to see themselves as médecins sans frontièrs—doctors without borders—and to live up to this name "by calling on their national governments and the international community—perhaps through their national medical organisations—to ensure that civilians injured or affected by conflict receive the medical attention they need."

Cite this as: BMJ 2009;338:b136

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