orld Health Day is celebrated every year on April 7. The day marks the founding of World Health Organisation in 1948. The constitution of the WHO came into force on April 7, 1948, when 26 of the 61 governments that had signed it ratified it. Pakistan was among these countries. Today, 194 countries are its members – almost the entire world.

Every year, the World Health Day has a theme. This year’s theme is: My health, my right. There is an important reason for selecting this theme. The WHO Council on the Economics of Health for All has found that at least 140 countries recognise health as a human right in their constitutions. Yet, many of the countries are not passing and putting into practice laws to ensure that their populations are entitled to access health services. This underpins the fact that at least 4.5 billion people — more than half of the world’s population — are not fully covered by essential health services.

Let us look at where Pakistan stands in 2024 with reference to this year’s World Health Day theme.

To begin with, Pakistan is not among the countries which explicitly enshrine the right to health in their constitutions. Rights are listed in Articles 9 to 28 in the chapter on Fundamental Rights in Part II of the constitution. Right to health is not one of those.

There is some piecemeal mention of various aspects of healthcare in Chapter 2 of Part II of the constitution, i.e. Principles of Policy. These are principles, not enforceable provisions, but have a guidance value. Article 37 is titled, Promotion of Social Justice and Eradication of Social Evils. Under this article, Section E reads: “The state shall… make provisions for securing just and humane conditions of work… and for maternity benefits for women in employment.” Article 38, Section D reads: “The state shall… provide basic necessities of life, such as food, clothing, housing, education and medical relief, for all such citizens… on account of infirmity, sickness and unemployment.” Article 24(3a) and Article 151(4) on protection of property rights and inter-provincial trade, respectively, also mention “public health” in a very indirect and roundabout away.

These oblique references to medical relief and public health do not constitute a right to health. The concept of healthcare is much broader and multidimensional. It goes far beyond the narrow provision of medical relief to sick citizens. Most importantly, it is vital to understand that a right is enforceable only after it is established as a fundamental right in the constitution. Also, any other law inconsistent with the right conferred has to be made void with a declaration like the following: “The state shall not make any law which takes away or abridges the rights so conferred and any law made in contravention of this clause shall, to the extent of such contravention, be void.”

The concept of healthcare is much broader and multidimensional. It goes far beyond the narrow provision of medical relief to sick citizens.

Pakistan has been a member of the WHO since its inception. Being a member it subscribes to the constitution of the organisation. The WHO defines health in terms of physical, mental and social well-being. It also establishes it as a fundamental human right without any discrimination of race, religion, political belief and economic or social condition.

We have also ratified the International Covenant on Economic, Social and Cultural Rights, which was adopted in 1966. Article 12 of the ICESCR recognises the right of citizens to enjoy the highest attainable standard of physical and mental health. In 2000, the Committee on Economic, Social and Cultural Rights adopted and issued the General Comment 14 on Article 12 of the ICESCR and elaborated its scope in great detail. The comment must be essential reading for those discussing the right to health in any setting. It clearly explains that state parties are obliged to protect, respect and fulfil the right to health.

Being a signatory to international covenants is, however, not sufficient. Pakistan has to translate its international legal obligations into national law; only then do these obligations become enforceable.

Given serious public health crises in the country (as mentioned in the table), chronic state neglect in this regard and not having the right to health in the constitution disfranchises citizens from demanding healthcare from the state. From a jurisprudential perspective, it is understood that the right to health is associated with the right to life (Article 9) and the right to dignity (Article 14), as life and dignity cannot be sustained if health is not protected. However, it is still not equivalent to an explicit right.

The constitution was amended in 2010 to make education a fundamental right. However, the right to health was still not included.

On a positive note, the Pakistan Muslim League-Nawaz and the Pakistan Peoples Party have committed themselves to rectifying this situation. In its election 2024 manifesto, the PML-N explicitly mentioned amending the constitution to include the right to healthcare. The PPP, too, has vowed to introduce this right by legislating a Right to Healthcare Act.

This World Health Day is a strong reminder to realise this election promise through a constitutional amendment with bipartisan support.

The writer is a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University and WHO adviser on UHC. He can be reached at Zedefar@gmail.com