Over the past 70 years, the international legal community has created a legal obligation for states to provide access to health care and medicines to its citizens through three legally binding treaties and conventions. This obligation is called a right to health and is primarily created through the 1946 Constitution of the World Health Organization, the 1948 Universal Declaration of Human Rights, and the 1966 International Covenant on Economic, Social and Cultural Rights.[1] Despite this legal obligation, a majority of states are failing to meet the obligations placed before them, especially in the context of providing health care and access to insulin and other necessary medical devices to Type One Diabetics.
The right to health is an expansive right that covers many distinct aspects of what health is. For example, the right to health is an inclusive right that includes “underlying determinants of health” that include safe drinking water and food; adequate sanitation, nutrition, and housing; health-related education and information; and gender equality.[2] It also includes several freedoms such as the right to be free from non-consensual medical treatment like forced sterilization and medical experiments.[3] Most importantly for access to insulin, it also contains entitlements, such as the right to prevention, treatment and control of diseases, as well as access to essential medications.[4]
The right to health places three main obligations on to states – the obligation to respect, protect, and to fulfill.[5] The obligation to respect “requires States to refrain from interfering directly or indirectly with the right to health.”[6] This includes refraining from marketing unsafe medication.[7] The obligation to protect “requires States to prevent third parties from interfering with the right to health.”[8]
States should adopt legislation or other measures to ensure that private actors conform with human rights standards when providing health care or other services (such as regulating the composition of food products); control the marketing of medical equipment and medicines by private actors; ensure that privatization does not constitute a threat to the availability, accessibility, acceptability and quality of health-care facilities, goods and services.[9]
The obligation to fulfill requires States to adopt “appropriate legislative, administrative, budgetary, judicial, promotional and other measures to fully realize the right to health.”[10] This includes adopting a national health policy or plan that covers the public and private sectors.[11]
Type One Diabetes is caused by an autoimmune reaction where the body attacks the cells in the pancreas that produce insulin.[12] It is genetic, incurable, and unpreventable. Most Type Ones are diagnosed at a young age, leading to the misnomer “juvenile diabetes.”[13] Since the pancreas of a Type One diabetic does not produce insulin, type ones are entirely insulin-dependent and rely on injections of insulin to control blood sugar levels.[14] It is estimated that 10% of the 463 million adults that are diabetics have Type One.[15]
Despite being nearly 100 years old, insulin is extremely expensive and hard to come by in some states. For example, in Mali, a year’s supply of insulin for one person costs around 39% of a family’s yearly income, without taking into account the cost of and access to syringes for insulin injections and other equipment that is necessary for blood glucose testing.[16] In the United States, people who are diagnosed with diabetes have an average medical cost of $16,752 which is approximately 2.3 times higher than the estimated expenditure without diabetes.[17]
Since insulin is mandatory for people with diabetes to live, let alone live with a certain quality of life, access to insulin is a right that all people are entitled to. Therefore, under the right to health, governments have a duty to make sure that their citizens can afford insulin and are not dying in an attempt to stretch a life-saving drug out because they simply cannot afford to buy it and are not resorting to using unsafe alternatives. This is an obligation that most states are failing to meet either through failing to make insulin accessible to its citizen or failing to implement legislation that would help protect Type One diabetics.
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OHCHR, The Right to Health, 1, https://www.ohchr.org/documents/publications/factsheet31.pdf. ↑
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Id. at 3. ↑
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Id. ↑
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Id. ↑
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Id. ↑
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Id. ↑
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Id. at 26. ↑
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Id. ↑
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Id. at 27. ↑
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Id. ↑
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CDC, Type 1 Diabetes, Centers for Disease Control and Prevention 1 (2021), https://www.cdc.gov/diabetes/basics/type1.html (last visited Feb 13, 2021). ↑
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Id. ↑
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Id. ↑
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Diabetes Facts and Figures, Int’l Diabetes Fed’n, https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html; Type One Diabetes, Int’l Diabetes Fed’n (Mar.20, 2020), https://www.idf.org/aboutdiabetes/type-1-diabetes.html. ↑
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Diabetes and insulin access worldwide, Diabetes.co.uk (Nov. 26, 2018), https://www.diabetes.co.uk/in-depth/diabetes-and-insulin-access-worldwide-2/. ↑
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The Cost of Diabetes, Am. Diabetes Ass’n, https://www.diabetes.org/resources/statistics/cost-diabetes#:~:text=People%20with%20diagnosed%20diabetes%20incur,in%20the%20absence%20of%20diabetes. ↑
