By Sophie Lange, News Editor
On Wednesday, Boston University Chair and Professor of Health Law, Policy and Management Michael Stein, M.D., gave a lecture titled “The Pursuit of Healthiness.” Assistant Professor of Public Policy Christopher Rick introduced Stein and thanked the audience for attending.
Stein opened his lecture by discussing how the COVID-19 Pandemic changed the individualistic perspective on health to a more collective view.
“We quickly came to understand that individuals’ health did not exist in isolation. We cared for ourselves, but we also cared about affecting housemates and neighbors and older people who rose buses with us,” Stein said.
In 2023, Stein began attending medical conferences again as the Pandemic waned and saw buttons that read “health is a human right.”
“As a scientist, I was intrigued and confounded. What did that even mean? As a primary care doctor, I certainly knew of and supported the movement of universal health insurance that will provide everyone with access to doctors for primary preventive care… I wondered why the button didn’t instead read ‘healthcare is a human right,’” Stein explained.
He discussed how the right to health is more complex than the right to free speech because health is controlled by a variety of factors, many of which are beyond personal control. Additionally, he questioned if health could be a right when no laws existed to protect it.
To further illustrate the meaning of the right to health, Stein spoke about a 21-year-old college student who was one of his patients. This patient had an asthma attack and had been referred to Stein after a visit to the Emergency Room. During his appointment with Stein, the patient admitted to vaping despite having issues with his asthma and agreed that it could be causing some of his breathing problems. Stein asked the audience if this patient had the obligation to change his lifestyle in some ways to improve his health and observed that less than half of those present said yes.
In his book “Me vs. Us,” Stein argued that health is both definable and measurable. However, he explains that health is not a measure of life expectancy.
“The World Health Organization’s charter proclaimed enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being. The authors of the charter defined health as, ‘The state of the complete physical, mental and social well-being and not merely the absence of disease,’” Stein said.
Then, Stein explained that the definition of health has further evolved in the 21st century and how the World Health Organization (WHO) “recognizes health as a dynamic developmental and adaptive state, encompassing physical, mental, social, and also emotional and spiritual aspects of people’s current and future lives. Health is reported by individuals in terms of well-being, daily functioning, resilience, and capability for a meaningful and flourishing life.”
Stein expressed that health is ever-evolving in a social context and that the list of fundamental human rights gets longer as the world grows wealthier. In the public health world, Stein said, the language of “rights” is often avoided and instead replaced with discussion about “social determinants of health.”
“Do we really need all of those rights to satisfy and fulfill the right to health that we’ve described?” Stein asked. “If a right to health requires a right to, and perhaps we see them, all of these broad and intractable social rights, it seems impossible that health as a human race can ever be taken seriously… Certainly not in the United States.”
He continued on the topic of the United States’ failure to address issues such as poverty, homelessness, illiteracy, racism, low wages, unsafe working conditions or incarceration and how that makes the goal of health as a human right seem nearly impossible.
“When something is seemingly impossible, we call it aspirational. Health is a human right, it seems to me, as that button says, as an aspiration, an idea, a marvelous idea. The right to health is pure, a goal regardless of the budget of a country, its GDP, its population, its government office holders, [and] how it’s spending its funds,” Stein said.
He expressed again that no laws govern health: “There’s no law banning poverty, illiteracy or homelessness in this country, so the promise of health as a human right seems a little vigorous. It means that those interested in health as a right will need to work tirelessly toward policies and legislation that move us to the end of these social barriers.”
This led to a discussion about health equity, which Stein explained is connected to human rights. In relation to this, he spoke about how the government’s ability to provide health equity is directly connected to the pursuit of happiness, a right upon which the United States was founded.
“If we were to accept that there is a right to health in the United States,… then its pursuit is reasonably understood as obligating the government to address and improve that full array of social determinants of health that we talked about,” Stein commented.
He continued to explain that access to healthcare is perceived as being the social determinant with the highest controllability.
Stein explained that “medical care has been split off in our thinking from the other social determinants because it feels narrow and controllable and simply a matter of money and organization. And therefore it seems more achievable than getting everybody clean air.”
However, Stein argued that the government has failed to provide adequate access to medical care and protection from the disparities that arise from the social determinants of health. Stein circled back to his 21-year-old patient with asthma and explained that he was on Medicaid, meaning his healthcare is completely subsidized by the government.
“Just as the government is obligated to provide health, or at least healthcare to citizens, does the patient have an offsetting obligation in return?” Stein asked.
Beyond the idea that taxpayers are funding this patient’s care only for him to ignore the recommendations of a medical professional, Stein also expressed the idea that “the vulnerability of other patients is precisely what obliges any individual patient to behave responsibly.”
Despite the fact that this patient believes he has a right to health, as evidenced by the “health is a human right” button on his jacket, Stein said that this patient does not believe he has a responsibility to protect his individual health as a citizen.
Stein discussed the limitations that the Supreme Court (SCOTUS) imposed upon the federal government in terms of its ability to implement protective health measures during the Pandemic such as eviction moratoriums and vaccine mandates, all in the name of personal freedom and what Stein called the perils of limiting others’ actions.
“They [SCOTUS] struck down the CDCs eviction moratorium, [and] they struck down the Labor Department’s requirements that companies require vaccination or do weekly testing, believing it’s impossible for one person to really know how another person should live. We Americans have decided that the potential benefits to be derived by curtailing others activities are outweighed by the inherent perils. It seems preferable to lead people to work out their own salvation in their own ways, rather than run the risk of causing a catastrophe by interfering,” Stein said.
Stein concluded his lecture by discussing the interconnection between health and human dignity and the importance of rights language in the conversation about health.
“Health enables joy and pleasure. Health is not focused solely on death and disease. Rights language broadens our imagination of what health is for, and what is health for? Health is to maximize happiness and help fulfill our human potential. Health is a right balance is our preventing sickness with an emphasis on enabling joy. Health is a relative to another aspirational piece of humanity that may waive a human right called dignity… Dignity is not only a human right itself, but it constitutes a basis for other rights. And the same could be said about health as a means to human potential. Health as a human right is a moral and ethical claim,” Stein said.
