The right to health, though not explicitly mentioned in the Indian Constitution, has been implicitly recognized as a fundamental right under Article 21, which guarantees the right to life and personal liberty to all citizens. Article 21 reads, “No person shall be deprived of his life or personal liberty except according to procedure established by law.” Over the years, the Supreme Court of India has interpreted this right expansively to include the right to health as an essential component of the right to life. This interpretation has become one of the cornerstones of India’s health policy, integrating public health with individual rights.
Historical Context
In the early years following India’s independence, the right to health was not explicitly articulated as part of constitutional jurisprudence. However, the concept gradually gained prominence with the judicial interpretation of Article 21. Initially, health-related provisions were seen through the lens of individual welfare, with the state’s responsibility being somewhat passive. However, with evolving socio-political contexts and public health concerns, the judiciary began recognizing that the right to life under Article 21 not only meant the right to survival but also the right to live with dignity, which encompasses adequate health facilities, access to medical care, and clean living conditions.
The Role of the State and the Right to Health
The state, under Article 21, is mandated to ensure that every citizen has access to healthcare facilities that are both timely and of acceptable quality. It is not just a passive obligation; rather, it is an active duty to create a healthcare infrastructure, ensure affordable and equitable access, and address health disparities. This duty has been made more explicit in recent years with the increase in government initiatives like the Ayushman Bharat Yojana, which seeks to provide health insurance to millions of underprivileged families.
The right to health also involves the prevention of diseases, providing the right to immunization, timely diagnosis, access to medicines, and ensuring that healthcare facilities are available without discrimination based on socio-economic status, caste, or gender. For example, the National Rural Health Mission (NRHM) and its successor, the National Health Mission (NHM), have sought to increase access to health services in rural areas, underscoring the state’s affirmative duty to uphold the right to health.
Challenges to the Right to Health
Despite judicial recognition of the right to health under Article 21, several challenges remain in its effective implementation. These challenges include:
- Inadequate healthcare infrastructure: While the judicial recognition of the right to health imposes a duty on the state, the quality and availability of healthcare services, particularly in rural areas, remain deeply inadequate. There is a scarcity of medical personnel, healthcare facilities, and essential medicines in many parts of the country.
- Inequalities in healthcare access: There is a stark disparity in access to healthcare between urban and rural areas, as well as among different social classes. Marginalized communities, such as Scheduled Castes, Scheduled Tribes, and the economically disadvantaged, often lack access to quality healthcare, which violates their right to health.
- Private sector dominance: While the public health system struggles with underfunding, the private healthcare sector has grown rapidly. However, the privatization of healthcare raises concerns about the affordability and accessibility of medical services, particularly for lower-income groups. The state must ensure that healthcare remains affordable and accessible to all citizens, and not just to the wealthy.
- Pollution and environmental health: The increasing levels of pollution and environmental degradation pose a significant threat to public health. The right to a healthy environment, as part of the right to health, requires a more stringent approach to environmental regulation, particularly in urban areas where air pollution is a major health concern.
Expanding the Right to Health: Key Judicial Pronouncements
The recognition of the right to health under Article 21 began to take concrete shape in the 1980s and 1990s, culminating in significant judicial decisions that shaped the contours of the right.
- State of Punjab v. Mohinder Singh Chawla (1997)
In this case, the Supreme Court held that the right to health is a fundamental right under Article 21. The Court emphasized that health is a basic human need and should be ensured by the state through sufficient medical facilities. The right to health includes the right to medical treatment, adequate health services, and access to preventive care. - Paschim Banga Khet Mazdoor Samity v. State of West Bengal (1996)
In a landmark judgment, the Supreme Court stressed that the state has a constitutional duty to provide adequate medical facilities to its citizens, particularly to those who are economically disadvantaged. The case involved the issue of inadequate medical care and insufficient hospital facilities in rural areas. The Court ruled that the right to health extends to the provision of timely and quality healthcare services and that any delay in providing medical treatment could be a violation of the right to life under Article 21. The Court’s ruling established the principle that the state’s responsibility includes providing access to healthcare in both urban and rural areas, especially in the context of emergencies. - Bandhua Mukti Morcha v. Union of India (1984)
In this case, the Supreme Court expanded the right to life to include the right to live in a healthy environment, free from pollution and other environmental hazards. The Court held that the right to health is not just the right to medical treatment but extends to the right to a clean and healthy environment, as environmental factors play a crucial role in determining an individual’s health. This case set the precedent for linking environmental health with the right to life, implying that the state’s obligation to safeguard public health is not restricted to medical care but also includes addressing environmental concerns. - Consumer Education and Research Centre v. Union of India (1995)
In this case, the Supreme Court acknowledged that the right to life includes the right to live in a pollution-free environment. The Court ordered the closure of polluting industries and emphasized that the state must ensure a safe and healthy environment for its citizens. This decision further reinforced the idea that the right to health extends beyond the traditional realm of healthcare and encompasses environmental factors that directly affect public health. - Kailash Chand Sharma v. Union of India (2010)
The Supreme Court in this case reaffirmed that the state has a duty to ensure the availability of basic medical facilities to the public. It directed the government to provide better healthcare services, especially in rural and underprivileged areas. This judgment is significant in the context of healthcare rights for marginalized sections of society, emphasizing that the state must take affirmative action to address healthcare inequalities.
Recent Developments and Future Directions
The Supreme Court has continued to play a vital role in defining the scope of the right to health under Article 21, and recent decisions continue to expand and solidify this interpretation. In the context of the COVID-19 pandemic, the Court emphasized that the government must take all necessary steps to protect the health of citizens, particularly the poor and vulnerable. The pandemic highlighted the importance of a robust public health system and the need for greater attention to healthcare in policy-making.
Further, as India aims to achieve Universal Health Coverage (UHC), the scope of the right to health will likely continue to evolve. With initiatives like Ayushman Bharat, there is a push for more equitable healthcare systems that cover a larger portion of the population. However, challenges such as inadequate healthcare funding, poor public health infrastructure, and rising healthcare costs need to be addressed to ensure that the right to health is not just a constitutional promise but a reality for all.
Conclusion
The right to health under Article 21 has evolved from a basic right to survival to a broader right to live with dignity, encompassing access to healthcare, a clean environment, and the protection of public health. Through various landmark judgments, the Supreme Court has recognized the state’s duty to ensure that citizens enjoy the right to health as an integral part of the right to life. However, challenges persist in translating these judicial pronouncements into effective policy and practice, especially with regard to accessibility, affordability, and quality of healthcare. The government must take proactive steps to strengthen the healthcare system, reduce inequalities, and ensure that health is accessible to all, thereby fulfilling the promise of the right to health for every Indian citizen.