4 Guide to the rights to healthcare and health protection in Aotearoa New Zealand What do the rights to healthcare and health protection contribute? Here we signal ten illustrative features of the rights to healthcare and health protection: Process is as important as outcome – human rights are not only interested in what a health system does (e.g. providing access to essential medicines), but also how it does it (e.g. transparently, in a participatory manner, and without discrimination). Access to health information is key - this enables individuals and communities to be better informed and involved. Equity and non-discrimination - a health system must be accessible to all without discrimination, including those living in poverty, tangata whenua, ethnic minorities, disabled people, women, children, people living in rural and remote areas, rainbow communities, people in mental distress, and other disadvantaged individuals and communities. Outreach programmes must be in place to ensure that disadvantaged individuals and communities enjoy the same access as those who are more advantaged. Participation at all stages - all individuals and communities are entitled to active and informed participation on issues relating to their health: ‘Nothing about us, without us’. Respect for cultural difference – all health initiatives must be sensitive to issues of culture and ethnicity. The health system is required to consider the needs of diverse communities including traditional methods of preventive care, healing practices and medicines. For tangata whenua this includes access to traditional rongoā and kaupapa Māori service models delivered by Māori providers. Effective coordination – a health system depends on effective coordination across a broad range of public and private actions at the national level. This extends to policymaking and the actual delivery of services. Affordable for everyone – there should be no financial barriers to access health services. Any payment for health services should be based on the principle of equity, ensuring that these services, whether public or private, are affordable for all. Equity means that poorer households should not be disproportionately impacted with health expenses as compared to richer households. A holistic approach which includes the underlying determinants of health – human rights encompass timely and appropriate medical care, and the underlying determinants of health, such as adequate water and sanitation and safe and nutritious food. Also, social determinants such as poverty, gender and discrimination impact health outcomes and require careful and close attention. Commercial determinants of health (e.g. alcohol, gambling, tobacco, and fossil fuel) also require careful consideration. Good quality – this includes safe essential medicines, skilled medical professionals, and safe hospital equipment. Quality also extends to the way patients and others are treated – with respect. Prioritisation and striking fair and reasonable balances – few human rights are absolute. This means balances must be struck between competing rights, for example, freedom of information and the right to privacy. Also, there are often legitimate but competing claims in relation to the same human right e.g. the right to healthcare requires a number of different resource intensive components. Managing a health system entails difficult decisions of prioritisation. Human rights assist by requiring this prioritisation to be done in a fair, transparent and participatory process, considering the wellbeing of the most vulnerable and not just the claims of powerful interest groups. Constructive accountability mechanisms ensure that fair and reasonable balances are struck.