COVID-19: The UK’s failure to provide a right to health.
The right to health is the widely agreed upon in definition and widely contested in practice. The term ‘health rights’ was first defined by the World Health Organisation in their 1946 constitution as “a state of complete physical, mental and social wellbeing”. Therefore, encompassing both the provision of goods such as medicine, food and shelter as well as the prevention from grievous harm to the body through practices such as torture or mutilation. The UN codified the right to health for all in article 25.1 of the Universal Declaration of Human Rights 1948 which states a standard of living must include access to “medical care and necessary social services”. The International Covenant on Economic, Social and cultural rights which recognised “the highest attainable standard of physical and mental health”, further reiterating the right, assigning the responsibility of such provisions to the state. Yet the existing structure of the NHS is undermining the right to health in the UK and has become one which inflicts structural violence against minorities.
Britain is one of the few countries in which public money sourced from tax revenues is a fundamental element of its healthcare system. At its conception in 1948 the NHS was founded by the popular liberalism movement in the UK as a collective system of healthcare intended to be “universal, equitable, comprehensive, high quality, and free at the point of delivery”. It was part of a wider liberalisation in post war Britain which saw the promotion of a social contract and the channelling of access from the rich to the poor. However, the rise of market capitalism under successive conservative governments in the 1980s paired with the increased focus on legal interpretations of human rights saw a consumerist framework imposed upon the NHS. Since the 1980s, successive governments have pushed market forces in the NHS as a leveller to improve value for money. This frames patients as consumers and adds an element of competitiveness to healthcare. In its increased individuality the NHS’s structure has allowed for the silences of cultural and social aspects of health. The perpetuating of the structure as being focused on a prescribed individual means the continuation of discrimination.
This commoditisation of the NHS directly undermines several groups’ access to adequate healthcare, in particular, Black, Asian and minority ethnicity (BAME) groups. It is often used as a generalisation to refer to non-white UK citizens. There is no one prevailing reason why BAME groups in the UK are more susceptible to COVID-19. However, there are certain practices and elements of the healthcare structure in the UK which can be correlated to the increased incident of BAME group members deaths as a result of the virus.
The pre-existing structural inequalities that COVID-19 pandemic has highlighted are twofold: first there are socioeconomic inequalities and second employment inequalities. Underlying both of these is race. The UK government has recognised this by releasing a report attributing urbanisation, socioeconomic inequalities and type of work as three main reasons why per 100,000 people in the UK BAME groups had between 10-50% a higher risk of dying of COVID-19 than white groups.
Patrick Hayden, an expert on health rights, argues that the struggle for access to appropriate medical care in the face of inequalities signals not only distribution reform but structural violence. Structural violence is harm to the individual which is not caused by a clearly distinguishable actor . Instead, it is caused by the overarching framework which dictates norms, discourse and definition within society. In this perspective the realisation of a right to health would assume the absence of structural violence. Furthermore, structural violence is heavily linked with the process of silencing. Silencing is a way in which groups are omitted from definitions and majority discourses in a way which fails to recognise their status in qualifying for human rights. Soon, the structure of inequalities allows for the non-recognition of minority groups as human beings worthy of the right to health. Therefore, rights can only be exercised within relationships of mutual recognition. In this way groups who have struggled for political representation struggle to realise equal rights to their counterparts.
The reasoning for so many BAME deaths is often that so many workers in the NHS are BAME. A report in May 2020 highlighted that six in 10 of the health workers killed by COVID-19 in the UK were of BAME and a further report in June showed that the vast majority of hospital doctors who had died after testing positive for coronavirus (33) were also ethnic minorties. In a survey conducted by Leicester Asian Doctors and Nurse societies 31.5% of respondents said they felt they weren’t provided with appropriate PPE in the workplace. Furthermore, 58% of the respondents attributed the increased incident of BAME coronavirus deaths to lack of PPE. The survey concluded that almost 3/4s of Asian doctors and nurses surveyed experienced increased anxiety at work due to the handling of the pandemic. Clearly, frontline BAME staff members of the NHS feel both their physical and mental health is compromised as a part of their work within the COVID-19 pandemic. PHE recommended making it law for health risk assessments to be done for BAME workers and give them clearer representation in leading NHS roles. However, these recommendations were omitted from initial reports and widespread news reports that BAME doctors feel let down over the NHS’ failure to conduct the called for risk assessments and engage in methods of redeployment for doctors at risk. Moreover, there are no institutional structures in place to protect BAME worker rights that are directly created by the NHS.
The NHS continues to operate within major groups being silenced and excluded. It is clear that there are fundamental differences in the way BAME group members are able to access the right to health during the pandemic versus their white counterparts. The existing structure of the NHS is undermining the right to health in the UK. It is one that causes structural violence against minorities. Furthermore, the UK’s focus on liberal market policy has led to its inability to ensure the right to health for all of its NHS workforce.
