New Evidence that Corruption Threatens the Right to Health Care

By Roy Poses

Article 12 of the ICESCR [International Covenant on Economic, Social and Cultural Rights] established the “right to the highest attainable standard of physical and mental health”, defined as the “right to the enjoyment of a variety of facilities, goods, services and conditions necessary for the realisation of the highest attainable standard of health.” Starting five years ago, a series of authoritative reports suggested that the right to health is seriously threatened by corruption, and health care corruption in particular.

In 2006, Transparency International's Global Corruption Report asserted in its executive summary, " the scale of corruption is vast in both rich and poor countries." As we summarized here, the report discussed the scale and diversity of health care corruption, and the severity of its adverse effects.

The 2009 US Institute of Medicine report on conflicts of interest provided an outline of steps to reduce the conflicts of interest that increase the risk of corruption.

Also in 2009, the ICHRP published its report, "Corruption and Human Rights: Making the Connection." It documented a variety of ways that corruption could violate the right to health, including adversely affecting "the obligation to respect [which] includes the duty of states to refrain from activities that harm health;" "obligation to protect [which] requires states to protect people from health infringements by third parties (e.g. private companies and other organisations that provide healthcare goods and services);" and the "obligation to fulfill [which] requires states to adopt appropriate legislative, administrative, budgetary, judicial, promotional and other measures towards full realisation of the right to health."

In 2010, the article by Julio Frenk et al advocating the better training of "health professionals for a new century" in The Lancet noted increasing health care dysfunction due to commercialism and health care corruption, among other causes, and called for the support of ethical conduct by health professionals and better stewardship of health care organizations. (See this summary on the Health Care Renewal blog.)

Yet despite these strongly stated arguments, health care corruption has received little attention, and there are very few efforts underway to investigate, educate about, and challenge it.

However, two recent events might just increase the realization that to uphold the right to health care, we need to do something about corruption.

The first event was the freezing of new funding by the Global Fund to Fight AIDS, Tuberculosis and Malaria, one of the biggest global sources of funding to combat these devastating infectious diseases in developing countries. One reason for the freeze included increasing losses of money to corruption, estimated to be over $60 million after about one-seventh of the Fund's programs had been examined. Another was that some donors to the fund had suspended donations pending resolution of previous reports of losses due to corruption. Thus the Global Fund was seriously hobbled by concerns about corruption.

The second event was the publication of an article (or see here for a commentary) that estimated the number of childrens' lives that may be lost due to corruption. Authors based in French Guiana assessed the association between countries' perceived levels of corruption as measured by Transparency International's index and their child mortality rates, controlling for most of the known predictors of such mortality. They found that corruption could account for about 1.6% of mortality, or about 144,000 deaths globally.

Up to now, there has been almost no teaching or research on corruption in health care academic institutions (including medical and public health schools, and programs in health care research and policy). There has been almost no mention of corruption by health care professional associations, no high-profile initiative to fight corruption on the part of health care charities and donors, andalmost no interest in corruption among patient advocacy organizations. (See previous discussion here.)

However, I hope that given this new evidence that corruption actually threatens the right to health in concrete ways, building on previous authoritative opinions to that effect, corruption will no longer be considered just a "nuisance."

Further Reading: 

ICHRP (2009).
Corruption and Human Rights: Making the Connection 
Project - Report available in english, spanish, armenian, serbian, thai

ICHRP (2010).
Integrating Human Rights in the Anti-Corruption Agenda : Challenges, Possibilities and Opportunities 
Project - Report - Report available in english, spanish and armenian

About the Author:

Roy M. Poses MD is a physician who is Clinical Associate Professor of Medicine at Alpert Medical School, Brown University, President of the Foundation for Integrity and Responsibility in Medicine, and chief blogger on Health Care Renewal.

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