The Universal Right to Health: A Global and Indian Perspective

Health is often treated as a personal matter – something between a patient and a doctor. But in the world of human rights law, health is far more than that. It is a fundamental human right, one that governments are legally and morally obligated to protect. From the corridors of the United Nations to the benches of India’s Supreme Court, the right to health has been progressively recognised, debated, and enforced. Understanding this right – what it covers, where it comes from, and how it applies in India – is essential for anyone studying law, governance, or public policy.

Where does the right to health come from? 🔗

The recognition of health as a human right has its roots in the post-World War II international order. The Constitution of the World Health Organization (1946) was the first formal international instrument to declare health a fundamental right, establishing the principle that governments are obligated to protect and uphold it – not merely aspire to do so.

Two years later, the Universal Declaration of Human Rights (UDHR, 1948) reinforced this in Article 25, which states that everyone has the right to a standard of living adequate for their health and well-being, including food, clothing, housing, medical care, and necessary social services.

The UDHR was aspirational – a statement of intent rather than a binding legal instrument. The binding framework came in 1966, with the adoption of the International Covenant on Economic, Social and Cultural Rights (ICESCR). Article 12 of the ICESCR explicitly sets out a right to health and defines steps that states should take to “realize progressively,” “to the maximum of available resources,” the “highest attainable standard of health.”

The ICESCR obligates states to take concrete steps including reducing infant mortality, improving environmental and industrial hygiene, preventing and treating epidemic and occupational diseases, and ensuring access to medical care for all in times of sickness. Like most other human rights obligations, this right applies to “everyone”, without regard to legal or other status – undocumented migrants, prisoners, and homeless populations are all covered.

General Comment 14: clarifying state obligations 🔗

In May 2000, the UN Committee on Economic, Social and Cultural Rights published General Comment 14 – a landmark interpretive document that has since become the authoritative reference for understanding the content of the right to health. General Comment 14 outlines the content of the international right to health and addresses implementation comprehensively. It introduced the now-standard framework of availability, accessibility, acceptability, and quality (AAAQ) as the four pillars that health services must satisfy.

Violations of state obligations include “state actions, policies or laws that contravene the standards set out in Article 12 of the Covenant and are likely to result in bodily harm, unnecessary morbidity and preventable mortality.” General Comment 14 also establishes that victims of such violations must have access to effective judicial or other remedies at national and international levels.

Health is more than healthcare 🔗

One of the most important – and often misunderstood – aspects of the right to health is its scope. The right to health does not mean the right to be healthy as such, but the obligation on the part of the government to create the conditions necessary for individuals to achieve their optimal health status.

This distinction matters enormously. A government cannot guarantee that its citizens will never fall ill. But it can – and must – ensure that people have access to conditions that make health possible. The right to health as enshrined in international law extends well beyond health care to include basic preconditions for health, such as potable water and adequate sanitation and nutrition.

These are what scholars and policymakers call the underlying determinants of health. The WHO clarifies that it is the state’s legal obligation to ensure uniform access to timely, acceptable, and affordable health care of appropriate quality, as well as to provide for underlying determinants of health such as safe and potable water, sanitation, food, housing, health-related information and education, and gender equality.

The ICESCR is not the only instrument recognising these health rights. Specific treaties highlight health rights for children (Convention on the Rights of the Child, 1989), women (CEDAW, 1979), and persons with disabilities (CRPD, 2006), while the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD, 1965) reinforces non-discrimination in access to services.

The right to health in the Indian Constitution 🔗

India’s Constitution does not explicitly use the phrase “right to health” in its Fundamental Rights chapter (Part III). However, this has not prevented the right from becoming a robust, enforceable legal norm. It has been built through two complementary pillars: Directive Principles of State Policy (DPSPs) and judicial interpretation of Article 21.

Directive Principles: the policy foundation 🔗

Part IV of the Constitution contains several DPSPs that directly concern health. The DPSPs require the state to promote the welfare of its people (Article 38), protect their health and strength from abuse (Article 39(e)), provide public assistance in cases of sickness, disability, or undeserved want (Article 41), and raise nutrition levels, improve the standard of living, and improve public health (Article 47).

While DPSPs are not directly enforceable in court, they carry enormous legal weight. Indian courts have played a vital role in reinforcing the principles of Article 47, particularly by interpreting the right to health and nutrition as an extension of the fundamental right to life under Article 21. In Minerva Mills Ltd. v. Union of India (1980), the Supreme Court affirmed that Directive Principles are essential to achieving social and economic justice.

Article 47 read with Article 21 is an essential aspect of the fundamental rights guaranteed by the Constitution of India. The State has a duty to improve the standard of living, raise the level of nutrition and public health, and ensure that its citizens have access to basic healthcare facilities.

Article 21 and the right to health: the judicial journey 🔗

The transformative work has been done by the Supreme Court through its expansive reading of Article 21 – the right to life and personal liberty. The Court has consistently held that “life” means far more than mere biological survival. The Supreme Court has repeatedly observed that the expression “life” in Article 21 means a life with human dignity and not mere survival or animal existence.

In Bandhua Mukti Morcha v. Union of India (AIR 1984 SC 812), the Supreme Court held that dignity and health fall within the ambit of life and liberty under Article 21. The Court further held in Consumer Education and Research Centre v. Union of India (1995) that the right to health and medical aid to protect a worker’s health – both during service and after retirement – is a fundamental right under Article 21.

The Supreme Court has also held that Article 21 of the Constitution must be interpreted in conformity with international law, and has cited Article 25 of the UDHR and Article 7(b) of the ICESCR while upholding the right to health. This alignment between domestic constitutional law and international human rights norms is a critical feature of India’s legal approach to health rights.

The Paschim Banga case: emergency care as a constitutional right 🔗

No discussion of the right to health in India is complete without the landmark judgment in Paschim Banga Khet Mazdoor Samity v. State of West Bengal [(1996) 4 SCC 37]. This case arose from a tragic set of facts. Hakim Seikh, an agricultural labourer, suffered serious head injuries after falling from a train. Despite being referred to multiple government hospitals for specialised neuro-surgical care, he was repeatedly denied admission due to the unavailability of vacant beds and inadequate facilities. He was turned away from six different hospitals before ultimately receiving treatment at a private hospital at his own cost.

The Supreme Court held that this denial of emergency treatment was a direct violation of Hakim Seikh’s fundamental right to life under Article 21. The Court declared that the right to life enshrined in Article 21 imposes an obligation on the State to safeguard the right to life of every person, and that this obligation stands irrespective of constraints in financial resources.

The Court further held that lack of financial resources could not be claimed as an excuse by states to deny citizens fundamental rights guaranteed to them under the Constitution – the constitutional obligation to provide adequate medical services could not be ignored on account of financial burden. The State of West Bengal was directed to pay compensation and to formulate a blueprint for emergency medical care across the state.

This judgment is significant for several reasons. First, it established emergency medical care as the core minimum of the right to health in India. Second, it imposed a positive obligation on the state – not merely to refrain from harming health, but to actively build and maintain healthcare infrastructure. Third, it confirmed that constitutional courts can award compensation and issue mandatory directions even on matters with budgetary implications.

Clean water, sanitation, and the determinants of health in Indian law 🔗

Consistent with international standards, Indian courts have recognised that the right to health cannot be limited to hospital care. Access to clean water and sanitation are equally central to the right to life. The Supreme Court has determined that Article 21 should be construed to include the fundamental right to the enjoyment of a pollution-free water and air environment.

In Subhash Kumar v. State of Bihar, the Court held that the right to live includes the right to pollution-free water. In Narmada Bachao Andolan v. Union of India (2000), the Court affirmed that water is the basic need for the survival of human beings and is part of the right to life and human rights. Together with M.C. Mehta v. Union of India and related environmental cases, these judgments have woven a comprehensive web of constitutional protection around the underlying determinants of health.

From the constitutional side, Articles 47 and 48A of the Constitution, which respectively direct the State to improve public health and to protect and improve the environment, collectively cast a duty on the State to secure the health of the people. The 73rd and 74th Constitutional Amendments (1992-93) further devolved responsibilities over water supply, sanitation, and primary health to Panchayati Raj Institutions and Urban Local Bodies – a direct recognition that health governance must function at the grassroots level.

What the right to health really demands 🔗

Taking stock of both international and Indian law, the right to health is a multi-layered obligation. At the international level, it requires states to progressively realise the highest attainable standard of physical and mental health, with an immediate core obligation to provide essential healthcare and guarantee non-discrimination. At minimum, states commit to monitoring the progress of their policies and taking steps to improve their service provision.

In India, this translates into a constitutional duty to ensure access to emergency medical care, maintain clean environments, supply safe drinking water and sanitation, and sustain public health infrastructure – all backed by the enforceable provisions of Article 21. The jurisprudence constructs a triple-helix of obligations: availability (infrastructure, drugs, human resources), accessibility and non-discrimination (geographic, economic, informational access), and quality and continuity (standards, referral systems, emergency care).

The right to health, therefore, is not a luxury or a policy aspiration. It is a legally enforceable entitlement – one that connects the individual’s bodily integrity to the state’s structural responsibilities. From the WHO’s 1946 Constitution to the Supreme Court of India’s landmark rulings, the trajectory is clear: health is a right, and governments are accountable for it.

What do you think? Given that the Indian Constitution does not expressly mention the “right to health” in Part III, do you think an explicit constitutional amendment is needed – or is judicial interpretation of Article 21 sufficient to hold the state accountable? And when a government hospital denies emergency care due to lack of beds or funds, as in the Paschim Banga case, should individual hospital administrators also face personal liability, or should accountability rest solely with the state?

References

1. https://www.who.int/about/governance/constitution
2. https://www.un.org/en/about-us/universal-declaration-of-human-rights