3 Guide to the rights to healthcare and health protection in Aotearoa New Zealand Who is responsible for delivering human rights? Everyone has a role to play but government has primary responsibility. Government has the responsibility to do everything it reasonably can to make sure everyone enjoys their human rights. Others also have human rights responsibilities, including the private sector in relation to commercial determinants of health. Individuals have human rights responsibilities to each other and our communities. ‘Idealistic’? No, realistic Sometimes people dismiss human rights as ‘idealistic’, but this is based on misunderstandings. The rights to healthcare and health protection do not make the unreasonable demand that a first-class health system be constructed overnight. Instead, for the most part, the rights require that the government takes effective steps to progressively work towards a first-class health system that provides equitable access for all. These rights must always be improving through these steps, never getting worse. Also, the rights to healthcare and health protection recognise that resources are limited. Even a rich country like Aotearoa New Zealand cannot avoid difficult decisions about resource allocation. But human rights place reasonable conditions on policy-making processes, for example, priority should be given to the most disadvantaged individuals and communities. Health professionals and human rights professionals are natural allies Both professions: • Are motivated by similar concerns for the well-being of individuals, populations, and communities • Want effective, integrated, responsive health services that are accessible to all • Recognise the importance of healthcare and the social, environmental, and other determinants of health, including nutrition, housing, and education • Grasp the importance of collective action including public and private actors, civil society, and communities. Good human rights professionals help health professionals do their job. And good health professionals deliver human rights for all. Ethics, law, and accountability Agreed by successive governments of Aotearoa New Zealand, the rights to healthcare and health protection are ethically compelling. They are also binding on Aotearoa New Zealand in international law. These binding human rights require accountability otherwise they become empty promises. But accountability does not necessarily mean going to court. There are other forms of non-judicial – or ‘constructive’ – accountability. Constructive accountability is about finding which health initiatives are working, so they can be repeated, and which are not, so they can be adjusted. It is not about blame and sanctions. It is about checking that all reasonable steps are being taken to ensure human rights obligations are honoured. Constructive accountability requires a degree of independence from those responsible for the health initiatives.