Introduction

Health is one of the basic requirements of human being. Nowadays India is facing problem of
degradation of health. The Constitution of India is supreme law to govern the whole Nation. The
condition of health is worsening day by day in spite of various health schemes and policies. The
Supreme Court is performing Nobel function of interpretation of provisions of Constitution. The
framers of Indian Constitution have rightly inserted various provisions regarding health of
public. Further the role of Indian Supreme Court is significant in protecting health of people at
large with the help of various decisions. The effective implementation of Laws enacted based on
Constitutional provisions will control the present problem. The Preamble to the Constitution of
India confers rights on citizens, imposes duties on them and issues directives to State to protect
the rights of its citizens. The Constitution of India is the basic law of India; it aims to secure
social, economic and political justice1. Among the various rights under Indian Constitution,
Right to Health is an important one. Development of the nation depends upon the healthy
population. The basic law of the State safeguards individual rights and promotes national
wellbeing. It is the duty of the State to provide an effective mechanism for the welfare of the
public at large. Health is the most important factor in national development. It is a condition of a
person’s physical and mental state and signifies freedom from any disease or pain. Right to
health is a vital right without which none can exercise one’s basic human rights. The
Government is under obligation to protect the health of the people because there is close nexus
between Health and the quality of life of a person.

1
P.M. Bakshi , The Preamble, The Constitution of India (15th ed.,) Universal Publication (2002).
Historical background and jurisprudence of right to health:

Health has been much regarded as the basic and fundamental human right by the international
community under international human rights law. In contrast to all the other human rights, the
right to health creates an obligation upon the states to ensure that the right to health is respected,
protected and fulfilled, and is duly entitled to all its citizens2. According to Salmond , Every right
has a corresponding duty to be fulfilled and there can be no right without a parallel element of
duty3. Similarly, there are both positive and negative enforceable contents regarding the right to
health; these ranges from adequate protection by the state, providing equal health care facilities
to each individual and imposing the most important obligation upon the state to create such
favourable conditions which render the fulfilment of the right to health4. The origination of the
right to health dates as back as 1946 when the first international organisation, World Health
Organisation (WHO) came into existence to formulate health terms as human right. And even
prior to the coming of World Health Organisation, there were several countries that have been in
the phase of granting of health as a fundamental right5.

Presently, the international organisation working towards the highest attainment of right to health
is the World Health Organisation. Within this, there is a World Health Organisation Indicatory
Metadata Registry (IMR) that acts as a central source of meta-data and lays down certain
indicators for the highest attainment of standards ensuring right to health. These standards are
followed by World Health Organisation as well as other organisations also6. Now, the general
question which arises is as to what does these indicators include. The indicators are actually
inclusive of all the definitions, the methods of estimation, data sources and certain other
information that provide a better understanding of the interests7.

2
Aart Hendriks , The Right to Health in National and International Jurisprudence, European Journal of Health law
5(1998).
3
Deepika Prasad, Jurisprudence – relationship between rights and duties, legal crystal Blog ( accessed on
09/03/2019).
4
Aart hendriks, The Right to health in national and International Jurisprudence ,European Journal of Health law 5
(1998).
5
Aart hendriks, The Right to health in national and International Jurisprudence ,European Journal of Health law 5
(1998).
6
World health organisation, http://www.who.int/gho/indicator-registry/en/ ( accessed on 06/01/ 2019) .
7
World health organisation, http://www.who.int/gho/indicator-registry/en/ ( accessed on 06/01/ 2019).
As many as 100 indicators such as mortality by age,
sex,cause,fertility,morbidity,nutrition,infections,environmental risk factors, non-communicable
diseases, injuries, quality and safety of care, access, health work force, health information,
Health financing, Health security have been prioritized by the global community that provides
crisp information on the existing health situation, trends and rebuttals at the global and national
level.

Recognition of Right to Health under the Indian constitution:

Right to health has not been recognised directly by the constitution of India, but the enjoyment of
the highest attainable standard of health is one of the fundamental rights of every human being
without distinction of race, religion and political belief, economic or social condition. Right to
health is an integral component of right to life enshrined under the Indian constitution. The
constitution of India under Article 19(1)(g), 21, 25 ,26 have an indirect bearing on the health
care thus directing the state the measures to improve the conditions of health care of the people
of India. Apart from the fundamental rights, the constitution provides for certain directive
principles or be followed by the state which have an indirect bearing on the access to healthcare
that include Articles 39,42,47,48-A and 51 -A.

Right to health under fundamental rights:

Part III of the Indian Constitution deals with fundamental rights. The fundamental rights are not
absolute; they are subject to reasonable restrictions. The prime function of the Supreme Court is
to interpret the law. The Constitution of India has not included right to health i. e. right to enjoy
the highest attainable standard of physical and mental health under a specific provision. But it is
the Indian judiciary who treat right to health as an integral part of right to life which is
fundamental for all human beings under Article 21 of the Constitution. The Supreme Court has
given recognition of right to health vide different techniques of interpretation. “The government
is under Constitutional obligation to provide health facilities8.” Right to health is also one of the
rights, which is implied under right to life and personal liberty as guaranteed by the Constitution
of India.

8
State of Punjab v. Mohinder Singh Chawla AIR 1997 SC 1225
1. Article 19 (1) (g) of the Indian Constitution:
According to Article 19 (1) (g) all citizens shall have the right to practice any profession, or carry
on any occupation, trade or business subject to restrictions imposed in the interest of general
public under clause (6) of Article 19. In Municipal Corporation v. Jan Mohammed9, the Court
held that the expression in the interest of the general public in clause (6) of Article 19 is of wide
importance comprehending public order, public health, public security , morals, economic
welfare of the community and the objects mentioned in Part IV of the Constitution. Further, In
Burrabazar Fire Works Dealers Association and Others v. Commissioner of Police, Calcutta10,
the Supreme Court has held that Article 19 (1) (g) does not guarantee the freedom which takes
away that community’s safety, health and peace. It can be said that the reasonable restrictions as
imposed on the freedoms are in wide in sense that Court has the power to interpret the same in
the interest of general public. One must therefore consider Public health as pertinent while
enjoying the freedoms under the Constitution. Also in recent times on many occasions the
Supreme Court has highlighted the significance of public health while delivering many
judgments.
2. Article 21: Protection of Life and Personal Liberty:
The multi dimensional view of Article 21 is an important development in Indian Constitutional
jurisprudence. The Supreme Court has come to impose positive obligations upon the State to
take steps for ensuring for the individual a better enjoyment of his life and dignity under its
comprehensive interpretation of Article 21. The right to health as extended under Article 21
relates with maintenance and improvement of public health, improvement of the environment
etc. The Supreme Court in C.E.R.C. v. Union of India11, held that right to health, medical aid to
protect the health and vigour of a worker while in service or post-retirement is a fundamental
right under Article 21. In Parmanand Katara v. Union of India12, the Supreme Court has
considered a very serious problem existing in medico-legal field such as cases of accident in
which the doctors usually refuse to give immediate medical aid to the victim till, legal formalities
are completed.

9
AIR 1986 SC 1205: (1986) 3 SCC 20
10
AIR 1998 Cal. 121
11
AIR 1995 SC 922
12
AIR 1989 SC 2039
In some cases the injured die for want for medical aid pending the completion of legal
formalities. The Court stated that preservation of health is of paramount importance. Once life is
lost it cannot be restored. Hence, it is the duty of doctors to preserve life without any kind of
discrimination. In Paschim Banga Khet Mazoor Samity v. State of W.B.13, the Court ruled that
under welfare State policy, the primary duty of the government is to provide adequate medical
facilities for its people. The Govt. discharges this application by running hospitals and health
centres to provide medical care to those who need it. In State of Punjab v. Ram Lubhaya
Bagga14, the Supreme Court has recognized that provisions of health facilities cannot be
unlimited. It has to be to the extent to which finance permit. No country has unlimited resources
to spend on any of its projects. The above judgments are the extended view of Article 21
through which Supreme Court held that Right to Health is one of the fundamental rights. It is the
liberal interpretation of the Article 21 that Right to Life “means something more than mere
survival and mere existence.”
3. Article 25 and Article 26 of the Indian Constitution:
Freedom to Profess or Practice Religion and Freedom to manage Religious Affairs: Article 25
guarantees to every person and not to citizen of India the right to profess and practice religion
and Article 26 gives special protection to religious denominations. Both can be enjoyed by any
person subject to public order, morality and health and other provisions of the respective part of
the Constitution. The person has the right to enjoy these freedoms but it should not adversely
affect the right of others including that of not being disturbed in their activities15.

13
1996 (4) SCC 37
14
AIR 1998 SC 1703
15
Church of God in India v. K. K. R. Majestic Colony Welfare Association (2000) 7 SCC 282
Right to Health as understood under Directive Principles of State policies:

Part IV of the Indian Constitution deals with certain principles known as Directive Principles of
State Policy. Although the Directive Principles are asserted to be fundamental in the governance
of the country, they are not legally enforceable. They are guidelines for creating a social order
characterized by social, economic, and political justice, liberty, equality, and fraternity as
enunciated in the Preamble16.These principles are fundamental in the governance of the country
and the State is under the duty to apply these principles while exercising its law making power.
The following directives are of relevance perspective of Right to Health:
1. Article 39: Certain principles of policy to be followed by the State:
This Article secures health and strength of the workers, men and women. It also mandates that
children be given the opportunities and facilities to develop in a healthy manner and in condition
of freedom and dignity and that childhood and youth are protected against exploitation and
against moral and material abandonment. It is true to say that Article 39 (e) and (f) indicates
that the Constitution makers were rather anxious to protect and safeguard the interests and
welfare of workers and children. It enunciates that the working class is important in nation
building and therefore state government shall provide protection to their health.
In Lakshami Kant Pandey v. Union of India17, BHAGAWATI, J. while delivering the opinion
of the court observed that: “It is obvious that in civilised society the importance of child welfare
cannot be overemphasised because the welfare of the entire community, its growth and
development depends upon the health and well being of its children. Children are a supremely
important national asset and the future well being of the nation depends on how its children grow
and develop.” Further, In Sheela Barse v. Union of India18, Supreme Court has held that “A
child is a national asset and therefore, it is the duty of the State to look after the child with a view
to ensuring full development of its Personality.” Clause (f) was modified by the Constitution
42nd Amendment Act, 1976 with a view to emphasizing the constructive role of the State with
regard to children19.

16
Article 21 of the constitution of India “No person shall be deprived of his life and personal liberty except
procedure established by law”
17
AIR 1984 SC 469
18
AIR 1986 SC 1786: (1986) 3 SCC 596
19
Pandey, Dr. J. N., “Constitutional law of India”, 44th ed., 380, Central Law Agency, Allahabad, 2007.
2. Article 42: Provision for just and humane conditions of work and maternity relief:
This Article necessitates that the State shall make provision for securing just and humane
conditions of work and maternity relief20.In U.P.S.C. Board v. Harishankar21,Supreme Court
has held that Article 42 provides the basis of the larger body of labour law in India. Further
referring to Article 42 and 43, the Supreme Court has emphasized that the Constitution expresses
a deep concern for the welfare of the workers. The Court may not enforce the Directive
Principles as such, but they must interpret law so as to further and not hinder the goal set out in
the Directive Principles. In Bandhua Mukti Morcha v. Union of India22, BHAGWATI, J.
observed: „This right to live with human dignity enshrined in Article 21 derives its life breath
from the Directive Principles of State Policy and Particularly clauses (e) and (f) of Article 39 and
Article 41 and 42.‟ Since the Directive Principles of State Policy are not enforceable in a Court
of law, it may not be possible to compel the State through judicial process to make provision by
statutory enactment or executive fiat for ensuring these basic essentials which go on to ensure a
life of human dignity.
In P Sivaswamy v. State of Andhra Pradesh23, the Supreme Court has held that Article 42 of the
Constitution makes it the obligation of the State to make provisions for securing just and humane
conditions of work. There are several Articles in Part IV of the Constitution which indicate that it
is the State’s obligation to create a social atmosphere befitting human dignity for citizens to live
in. The gist of Article 42 is that it stands as the basis of the body of labour law and welfare of
the workers. The Court must interpret law to achieve the goals set out in the DPSP.
3. Article 47: Duty of the State to raise the level of nutrition and the standard of living and to
improve public health:

Article 47 enumerates that the State shall regard the raising of the level of nutrition and the
standard of living of its people and the improvement of public health as among its primary duties
and, in particular, the State shall endeavour to bring about prohibition of the consumption except
for medical purposes of intoxicating drinks and of drugs which are injurious to health24.

20
Prof M.P .Jain “Indian Constitutional law”, 8th ed., (1383) ,Lexis Nexis Butterworths Wadhwa, Nagpur,2018.
21
AIR 1979 SC 65: (1978) 4 SC 16
22
AIR 1984 SC 802
23
AIR 1988 SC 1863
24
P.M.Bakshi , “The Constitution of India- Bare Act ”, 15th ed., 90 Universal Law Publishing Co. Pvt. Ltd.,
New Delhi, 2015.
Art 47 is helpful for imposing stringent conditions on liquor trade with reference to Article 19(6).
In Vincent Panikurlangara v. Union of India25 the Court stated that “maintenance and
improvement of public health have to rank high as these are indispensable to the very physical
existence of the community and on the betterment of these depends, the building of the society of
which the Constitution makers envisaged. Attending to public health, in our opinion, therefore is
of high priority perhaps the one at the top”. The Supreme Court while interpreting Article 47 has
rightly stated that public health is to be protected for the betterment of the society. Further it has
been held that, in this welfare era raising the level of nutrition and improvement in standard of
living of the people are primary duties of the State.

4. Article 48-A: Protection and improvement of environment and safeguarding of forests and
wildlife: Article 48-A requires that, the State shall endeavour to protect and improve the
environment and to safeguard the forests and wildlife of the country26. This article was inserted
by the 42nd amendment Act 1976. It obligates the State to endeavour to protect and improve the
environment and to safeguard the forest and wildlife of the country. In M.C. Mehta V. Union of
India27, it was held that, “Art 39 (a), 47 and 48-A by themselves and collectively cast a duty on
the State to secure the health of the people, improve public health and protect and improve the
environment.

Right to Health & fundamental duties:

PART- IV-A of Indian Constitution deals with fundamental duties of citizens.

Article 51- A: Fundamental duties:
It shall be the duty of every citizen of India-
(g) To protect and improve the natural environment including forests, lakes, rivers and wild life,
and to have compassion for living creatures. It shows that every citizen is under the fundamental
duty to protect and improve natural environment since it is closely related to public health. The
Supreme Court observed that Article 51 -A does not expressly cast any fundamental duty on the
state, the duty of every citizen of India is the collective duty of the state28.

25
AIR 1987 SC 990: (1987) 2 SCC 165
26
Seervai, H. M., “Constitutional Law of India”, 4th ed., Universal Law Publication, New Delhi, 2006
27
JT 2002 (3) SC 527
28
AIIMS student’s Union v AIIMS, AIR 2001 SC 3262 ; AIR SCW 3143.
Responsibilities of institutions of Local self Government:

The Indian Constitution observes a federal political structure. There is a division of legislative
powers between the union and the states who assigns certain matters that are related to
concurrent competence. In this scheme, the subject of Health has been left to the States to a large
extent. Article 243-W of the Constitution provides that the legislature of the State may by law,
endow the municipalities with such powers and authorities as may be necessary to enable them
to function as institutions of local self government29. This power is connected with matters
included in the Twelfth Schedule, item 6 i.e. Public health, sanitation conservancy and solid
waste management.
“There is, however, a significant difference between local government authorities and the State
health authorities, the latter having enormous powers to make available financial resources and
make key appointments. Healthy alliances between the two types of authorities are crucial, if
health is to be effectively promoted30.” Similar provision is made for the Panchayats under
Article 243-G in matters connected with Eleventh Schedule under item 23 i.e. health and
sanitation, including hospitals, including primary health Centres and dispensaries.
Various Municipal laws prescribe duties of such local authorities in the sphere of public health
and sanitation which include establishment and maintenance of dispensaries, public vaccination,
providing special medical aid and accommodation for the sick in the time of dangerous diseases,
taking measures to prevent the outbreak of diseases etc. The State may endow the Municipalities
with such powers and authorities which may be necessary to enable them to function as
institutions of self government (Article 242 of the Constitution).
State has provided with respect to the performance of functions and implementation of schemes
as may be entrusted to them including those in relation to the matters listed in the Twelfth
Schedule to the Constitution which is included at Item 6, ‘Public Health sanitation conservancy
and solid waste management’. Similar provision is made for the Panchayats under Article 243-G
read with the Eleventh Schedule (Item 23), of the Constitution. There is, however, a significant
difference between local government authorities and the State health authorities, the latter having
enormous powers to make available financial resources and make key appointments.

29
Jain, Prof. M. P., “Indian Constitutional law, 8th ed., (lexis Nexis Butterworths Wadhwa ) 2018.
30
Abhichantani Justice, R. K. , “Health as a Human Right- Role of Courts in Realisation of the Right”, accessed at
http://gujarathighcourt.nic.in/Articles/articles.htm/
Healthy alliances between the two types of authorities are crucial, if health is to be effectively
promoted. The citizens can approach the High Court under Article 226 of the Constitution for
seeking a Mandamus to get the duties enforced whenever there is failure of these statutory
obligations of the local authorities. A wide dimension of the Right to Life and the right to a
healthy environment entails the consequent wider characterization of attempts or threats against
those rights, what in turn calls for a higher degree of their protection. The importance of health
promotion at the work place is increasingly recognized particularly in large organizations. Health
promotion of workmen reduces absenteeism thereby leading to gain in the productivity.
In Consumer Education and Resource Centre vs Union of India31 it was held that the Right
to Health is essential for human existence and is, therefore an integral part of the Right to Life.
Fundamental Right under Article 21 read with Articles 39(c), 41 and 43 of the Constitution and
makes the life of the workman meaningful and purposeful with dignity of person. Right to life
includes protection of the health and strength of the worker and is a minimum requirement to
enable a person to live with human dignity. Similarly in Bandhua Mukti Morcha v Union of
India32, the Supreme Court has held that the Right to Life includes the right to live with dignity.
The Supreme Court held that the right to health includes the health care and right to determinants
of health such as food security, water supply, housing and sanitation etc. It reflected the
importance of health as a prerequisite for Right to Life whereby it can be inferred that Right to
Health is an important human right and its denial can be detrimental to the existence of human
life.
The Apex court held in Paschim Baga Khet Mazoor Samiti v State of West Bengal33 that that
Article 21 imposes an obligation on the State to safeguard the right to life of every person
therefore failure on the part of a government hospital to provide timely medical treatment to a
person in need of such treatment results in violation of his Right to Life guaranteed under Article
21. Further, the Court ordered that Primary health care Centres be equipped to deal with medical
emergencies. It has also been held in this judgment that the lack of financial resources cannot be
a reason for the State to shy away from its constitutional obligation. Medical practitioners do not
enjoy any immunity from an action in tort, and they can be sued on the ground that they have
failed to exercise reasonable skill and care.

31
AIR 1955 SC 636
32
AIR 1984 SC 802
33
AIR 1996 SC 426
The Supreme Court has held that medical practitioners are governed by the Indian Medical
Council Act and are subject to the disciplinary control of the Medical Councils. Service rendered
to a patient by a medical practitioner (except where the doctor renders service free of charge to
every patient or under a Contract of personal service), by way of consultation, diagnosis and
treatment, both medical and surgical, was held to fall in the case of within the ambit of ‘Service’
as defined in Section 2(1) (O) of the Consumer Protection Act, 1986.
In Parmanand Katara v. Union of India34, the Supreme Court said that whether the patient was
innocent or a criminal, it is an obligation of those in charge of community health to preserve the
life of the patient. Every doctor has a professional obligation to extend his services with due
expertise and care for protecting life. The Right to Health is integral to Right to Life as held in
State of Punjab and Others v Mohinder Singh35. The Government has a constitutional
obligation to provide health facilities. In Mahendra Pratap Singh v State of Orissa36, a case
pertaining to the failure of the government in opening a primary health care centre in a village,
the court had held that the government is required to assist people get treatment and lead a
healthy life. Primary concern should be the primary health centre and technical fetters cannot be
introduced as subterfuges to cause hindrances in the establishment of health centre. It also stated
that, great achievements and accomplishments in life are possible if one is permitted to lead an
acceptably healthy life. Thereby, there is an implication that the enforcing of the right to life is a
duty of the state and that this duty covers the providing of right to primary health care implying
that the right to life includes the right to primary health care.
The Right to Life has been given a wider perceptive to include environment pollution affecting
health of the citizens in the land mark case of M.C Mehta v Union of India37 the Supreme
Court has held that environmental pollution causes several health hazards, and therefore violates
Right to Life. Specifically, the case dealt with the pollution discharged by industries into the
Ganges. It was held that victims, affected by the pollution caused, were liable to be compensated.
Similarly, in Subhash Kumar v State of Bihar38, the Court observed that ‘right to life
guaranteed by Article 21 includes the right of enjoyment of pollution-free water and air for full
enjoyment of life.’

34
1989(4) SCC 286
35
AIR 1997 SC 1225
36
AIR 1997 ORI 37
37
AIR 1987 SC 1086
38
AIR 1991 SC 420
The first health related Public Interest Litigation was filed in the Supreme Court in the
Workmen of State Pencil Manufacturing Industries of Madhya Pradesh Case39concerning
the death of workers at young age in the slate pencil manufacturing industries, due to the
accumulation of soot in their lungs. The Supreme court in M.C. Mehta vs Union Of India40
held that there are dicta that life, public health and ecology have priority over unemployment and
loss of revenue. The “precautionary principle” requires the State to anticipate, prevent and attack
the causes of environment degradation . Right to pollution free air falls within Article 21, thereby
there is no reason to compel a non-smokers to be helpless victims of air pollution. Right to
enjoyment of pollution free water.

International Instruments pertaining to the Development of Right to Health :

Our parliament, the highest political institution in the country, has always been energetic to meet
the needs of the changing society. Due to urbanization and industrialization the social patterns of
the people are rapidly changing. The most important part is that, with the changing society, the
law needs to be changed protecting the interests of the disadvantageous groups and the weaker
sections. The Indian Parliament has done much to improve the social patterns41 of citizens by
enacting social welfare legislations. These legislations are framed in order to achieve the goals
set in our Constitution. The different legislations have been made in order to protect different
groups of people like women, children, workers etc. Apart from the goals laid down in our
Constitution, it also provides for a variety of fundamental rights. Health being one of the most
important fundamental right needs extra protection by specific legislations. Our Constitution also
requires the State to ensure health and nutritional well-being of all people. Before independence
the health care sector was in dismal condition as the number of mortality rate owing to diseases
was high. But since independence, the main emphasis has been the health care sector. This has
been made possible by enacting various legislations. The Researcher has discussed in this
chapter as to how the different legislations in India protect health as a human right of the
citizens.

39
CWP No. 5143 of 1980
40
AIR 1987 SC 1086
41
https://www.un.org/en/events/instruments/health/ ( accessed on 03/03/2019)
The rudiments of international health law can be traced to the International Sanitary Conference
held in 1851. The Conference was necessitated by cholera epidemics in Europe which forced
European States to realize that protecting their boundaries from disease importation, and to case
trade burdens imposed by strict quarantine restrictions. The major activity of this era, which
lasted from 1851-1940, was focused on control of human infectious disease control. The concern
with public health also led States to negotiate international treaties on the alcohol trade to Africa,
and on psychotropic drugs. By the mid -1920’s four international health organizations had been
established.
Further, scientifically based measures for the protection of public health resulted in fewer and
less onerous restrictions on international trade42.The right to health is enshrined in numerous
national constitutions, as well as binding international human rights law. Right to Health is
necessarily implied in the following International Documents, as can be seen from the provisions
given below.

Charter of the United Nations:

The Charter of the United Nations was signed on 26 June 1945, in San Francisco, at the
conclusion of the United Nations Conference on International Organization, and came into force
on 24 October 1945.
The Preamble of the UN Charter43 states, “WE THE PEOPLES OF THE UNITED NATIONS
DETERMINED to save succeeding generations from the scourge of war, which twice in our
lifetime-has brought untold sorrow to mankind, and to reaffirm faith in fundamental human
rights, in the dignity and worth of the human person, in the equal rights of men and women and
of nations large and small, and to establish conditions under which justice and respect for the
obligations arising from treaties and other sources of international law can be maintained, and to
promote social progress and better standards of life in larger freedom”

42
Pramod nair, Global Health Jurisprudence: the role of the who and international law, (331-334).
43
Article 1(3)and (4) ,Charter of the United nations and Statute of the International court of justice.
http://treaties.un.org/doc/publication/ctc/uncharter.pdf/ (accessed on 02/03/2019)
Article 1 States,
The Purposes of the United Nations are (3) “...To achieve international cooperation in solving
international problems of an economic, social, cultural, or humanitarian character, and in
promoting and encouraging respect for human rights and for fundamental freedoms for all
without distinction as to race, sex, language, or religion; and (4) To be a center for harmonizing
the actions of nations in the attainment of these common ends.”
Agenda 2144 .Chapter 6. paras. 1 and 12

6.1 of Chapter 6 -“Health and development are intimately interconnected. Both insufficient
development leading to poverty and inappropriate development... can result in severe
environmental health problems.... The primary health needs of the world’s population... are
integral to the achievement of the goals of sustainable development and primary environmental
care.... Major goals... By the year 2000... eliminate guinea worm disease...; eradicate polio;..”.
6.12 of chapter 6 - “By 1995 ... reduce measles deaths by 95 per cent...; ensure universal access
to safe drinking water and ... sanitary measures of excreta disposal...; By the year 2000 [reduce]
the number of deaths from childhood diarrhoea ... by 50 to 70 per cent...”
Habitat Agenda45 :

It confirms “Human health and quality of life are at the centre of the effort to develop sustainable
human settlements. We... commit ourselves to... the goals of universal and equal access to... the
highest attainable standard of physical, mental and environmental health, and the equal access of
all to primary health care, making particular efforts to rectify inequalities relating to social and
economic conditions..., without distinction as to race, national origin, gender, age, or disability.
Good health throughout the life-span of every man and woman, good health for every child... are
fundamental to ensuring that people of all ages are able to ... participate fully in the social,
economic and political processes of human settlements....

44
Chapter 6- 6.1 & 6.12 paras of the Agenda 21,Protecting and promoting Human health
http://www.un.org/en/events/pastevents/pdfs/agenda21.pdf/ (accessed on 12/03/2019)

45
Chapter -1, IX -36 Of Habitat Agenda goals and Principles ,Commitments and the global plan of action
https://www.un.org/en/events/pastevents/pdfs/habitatagenda.pdf/ (accessed on 12/03/2019)
Sustainable human settlements depend on ... policies ... to provide access to food and nutrition,
safe drinking water, sanitation, and universal access to the widest range of primary health-care
services...; to eradicate major diseases that take a heavy toll of human lives, particularly
childhood diseases; to create safe places to work and live; and to protect the environment....
Measures to prevent ill health and disease are as important as the availability of appropriate
medical treatment and care. It is therefore essential to take a holistic approach to health, whereby
both prevention and care are placed within the context of environmental policy....
World summit for social Development in Copenhagen,1995:
46
It undertakes the task in following words in Commitment 6, "We commit ourselves to
promoting and attaining the goals of universal and equitable access to ... the highest attainable
standard of physical and mental health, and the access of all to primary health care, making
particular efforts to rectify inequalities relating to social conditions and without distinction as to
race, national origin, gender, age or disability....”
Ottawa charter for health promotion 1986:

As per this Charter47, Health is a positive concept emphasizing social and personal resources, as
well as physical capacities. Therefore, health promotion is not just the responsibility of the health
sector, but goes beyond healthy lifestyles to well being.
Prerequisites for Health:
The fundamental conditions and resources for health are peace, shelter, education, food, income,
a stable ecosystem, sustainable resources, social justice and equity. Improvement in health
requires a secure foundation in these basic prerequisites.
Declaration Of Ottawa On The Rights Of The Child To Health Care 1998
1) The health care of a child, whether at home or in hospital, includes medical, emotional,
social and financial aspects which interact in the healing process and which require
attention to the rights of the child as a patient.

46
http://www.un.org/development/world-summit-for-social-development.html/ (accessed on 12/03/2019)

47
The Ottawa Charter for Health Promotion, First international conference on Health Promotion, Ottawa
21,November,1986 https://www.who.int/healthpromotion/conferences/previous/ottawa/en/index1.html/ (accessed on
12/03/2019)
2) Article 24 of the 1989 United Nations Convention on the Rights of the Child recognizes the
right of the child to the enjoyment of the highest attainable standard of health and to facilities for
the treatment of illness and rehabilitation of health, and states that nations shall strive to ensure
that no child is deprived of his or her right of access to such health care services.
In the context of this Declaration a child signifies a human being between the time of birth and
the end of her/his seventeenth year, unless the law applicable in the country concerned children
are legally recognized as adults at some other age.

The Jakarta Declaration on Health Promotion into the 21st Century:

The Jakarta Declaration48 on health promotion offers a vision and focus for health promotion into
the next century. It reflects the firm commitment of participants at the 4th International
Conference on Health Promotion to draw upon the widest range of resources to tackle health
determinants in the 21st century.
The five Ottawa Charter strategies are essential for success:
• Build health public policy
• Create supportive environments
• Strengthen community action
• Develop personal skills
• Re-orient health services.
The Budapest Declaration on Health Promoting Hospitals

Content and Aims for Hospitals Participating in Health Promoting Hospitals - An

international Network.
The Declaration49 requires that, “Beyond the assurance of good quality medical services and
health care, a Health Promoting Hospital should:
1. Develop a common corporate identity within the hospital which embraces the aims of the
Health Promoting Hospital.

48
http://www.wma.net/what-we-do/medical-ethics/declaration-of-helsinki/ (accessed on 14/03/2019).
49
Part 1 of (2),(13),(14),(9) , Part 2 (10) of specific recommendations & Criteria fro hospitals participating as pilot
hospitals in health promoting hospitals of Budapest Declaration http://www.un.org/development/ (accessed on
14/03/2019).
2. Create supportive, humane and stimulating living environments within the hospital especially
for long-term and chronic patients.
3. Improve the health promoting quality and the variety of food services in hospitals for patients
and personnel.
4. Public discussion of health promotion issues and possible health promoting activities within
the hospital by:
• Internal Newsletter
• Public presentations within the hospital.
5. Provision of evaluation information at least annually to:
• the Joint Project Committee
• the Management
• the Staff
• the public and to those who provide funding
• other organizations, both local, national and international including WHO and the coordinating
Centre for the Network.
Declaration of Helsinki50 1989:
Because it is essential that the results of laboratory experiments be applied to human beings to
further scientific knowledge and to help suffering humanity, the World Medical Association has
prepared the following recommendations as a guide to every physician in biomedical research
involving human subjects. They should be kept under review in the future. It must be stressed
that the standards as drafted are only a guide to physicians all over the world. Physicians are not
relieved from criminal, civil and ethical responsibilities under the laws of their own countries.
Biomedical research involving human subjects must conform to generally accepted scientific
principles and should be based on adequately performed laboratory and animal experimentation
and on a thorough knowledge of the scientific literature.

50
https://www.wma.net/waht-we-do/medical-ethics/delcaration-of-helsinki/ (accessed on 14/03/2019).
The Declaration of Alma-Ata 1978:

The Declaration of Alma-Ata51 identifies some vital components of an effective health system.
The declaration is especially instructive because of its public-health, medicine, and human-rights
aspects and it provides compelling guidance on the core obligations of the right to health.
Principal themes considered in Alma Ata are

• The importance of equity

The need for community participation
• The need for a multisectoral approach to health problems
• The need for effective planning
• The importance of integrated referral systems
An emphasis on health-promotional activities
• The crucial role of suitably trained human resources
• The importance of international cooperation
Essential health interventions

Education concerning prevailing health problems

• Promotion of food supply and proper nutrition
• Adequate supply of safe water and basic sanitation
• Maternal and child health care, including family planning
• Immunization against major infectious diseases
• Prevention and control of locally endemic diseases
• Appropriate treatment of common diseases and injuries
• Provision of essential drugs.

51
https://www.who.int/publications/almaata declarationen.pdf/ (accessed on 15/03/2019)
Global Health Watch 2008

Global Health Watch is a collaboration of leading popular movements and nongovernmental

organizations52 comprising civil society activists, community groups, health workers and
academics. It was initiated by the People’s Health Movement, Global Equity Gauge Alliance and
Medact (Marion Birch, director of the London-based charity). It has compiled the second edition
of its alternative world health report - a hard-hitting, evidence-based analysis of the political
economy of health and health care - as a challenge to major global bodies that influence health.
Its monitoring of institutions including the World Bank, the World Health Organization and
UNICEF reveals that while some important initiatives are being taken, much more needs to be
done to have any hope of meeting the UN’s health related Millennium Development Goals, Civil
society organizations and scientists from around the world are calling for ‘a new development
paradigm’ to address the toxic combination of climate change, growing poverty and inequality
and poor health53.
Health Rights in International Human Rights Instruments
The human right to health is recognized in numerous international instruments.
Provisions within such instruments regarding a right to health are pointed out below.
Universal Declaration of Human Rights
The Universal Declaration of Human Rights affirms that everyone has the right to a standard of
living adequate for the health of himself and of his family, including food, clothing, housing and
medical care and necessary social services54.
International Covenant on Economic, Social and Cultural Rights 1966
The International Covenant on Economic, Social and Cultural Rights 1966 provides the most
comprehensive article on the right to health in international human rights law. It insists 55 that the
state parties to the Covenant recognize the right of everyone to the enjoyment of the highest
attainable standard of physical and mental health.

52
http://www.idrc.ca/en/project/global-health-watch-2006-2008/ ( accessed on 15/03/2019).
53
Archana Parashar, Human rights: Imperatives of theoretical change 6-37 40, No - ¼,Human Rights Special Issue,
published By Indian law Institute 1998 http://www.jstor.org/
54
Art.25(1) of Universal Declaration of Human Rights, 1949
55
Art.12 of International Covenant on Economic, Social and Cultural Rights,1966.
The steps to be taken by the state parties to the Covenant to achieve the full realization of this
right shall include those necessary for:
* The provision for the reduction of the stillbirth rate and of infant mortality and for the healthy
development of the child;
* The improvement of all aspects of environmental and industrial hygiene; The prevention,
treatment and control of epidemic, endemic, occupational and other diseases;
* The creation of conditions which would assure access to all medical service and medical
attention in the event of sickness.
International Convention on the Elimination of All Forms of Racial Discrimination 1965
The right to health is recognized in the International Convention on the Elimination of All Forms
56
of Racial Discrimination of 1965. This Convention categorically mentions that state parties
undertake to prohibit and to eliminate racial discrimination in all its forms and to guarantee the
rights of everyone, without distinction as to race, color, or national and ethnic origin, to equality
before the law, notably in the enjoyment of the right to public health and medical care.
Convention on the Elimination of All Forms of Discrimination against Women 1979
This Convention also contains some provisions regarding right to health. The Convention57
points out the responsibility of state parties to take all appropriate measures to eliminate
discrimination against women in the field of health care in order to ensure, on a basis of equality
of men and women, access to health-care services, including those related to family planning.
Similarly, it states that notwithstanding the provisions of the above mention, state parties shall
ensure to women appropriate services in connection with pregnancy, confinement and the post-
natal period, granting free services where necessary, as well as adequate nutrition during
pregnancy and lactation.

56
Art. 5(e)(iv) of International Convention on the Elimination of All forms of Racial Discrimination 1965
57
Art. 12 of Convention on the Elimination of All forms of Discrimination against Women 1979
Convention on the Rights of the Child 1989
The right to health is also addressed in the Convention on the Rights of the Child. It provides that
58
state parties should recognize the right of the child to the enjoyment of the highest attainable
standard of health and to facilities for the treatment of illness and rehabilitation of health. State
parties should strive to ensure that no child is deprived of his or her right of access to such
health-care services. State parties should pursue full implementation of this right and, in
particular, should take appropriate measures:
* To diminish infant and child mortality;
* To ensure the provision of necessary medical assistance and health care to all children with
emphasis on the development of primary health care;
To combat disease and malnutrition, including within the framework of primary health care,
through, inter alia, the application of readily available technology and through the provision of
adequate nutritious foods and clean drinking water, taking into consideration the dangers and
risks of environmental pollution;
* To ensure appropriate prenatal and post-natal health care for mothers;
* To ensure that all segments of society, in particular parents and children, are informed, have
access to education and are supported in the use of basic knowledge of child health and nutrition,
the advantages of breastfeeding, hygiene and environmental sanitation and the prevention of
accidents;
* To develop preventive health care, guidance for parents and family planning education and
services. Similarly the Convention mentions that state parties shall take all effective and
appropriate measures with a view to abolishing traditional practices prejudicial to the health of
children. Moreover, state parties should promote and encourage international cooperation with a
view to achieving progressively the full realization of the right recognized in the present article.
In this regard, particular account shall be taken of the needs of developing countries.

58
Art. 24 of Convention on the Rights of the child 1989
Convention on the Rights of Persons with Disabilities 2006
The Convention on the Rights of Persons with Disabilities requires states to
promote, protect and ensure the full and equal enjoyment of all human rights and fundamental
freedoms by persons with disabilities, including their right to health, and to promote respect for
their inherent dignity59. The Convention further recognizes the right to the enjoyment of the
highest attainable standard of health without discrimination for persons with disabilities and
elaborates upon measures states should take to ensure this right60.
The International Convention on the Protection of the Rights of All Migrant Workers and
Members of Their Families 1990
This Convention stipulates that all migrant workers and their families have the right to
emergency medical care for the preservation of their life or the avoidance of irreparable harm to
their health. Such care should be provided regardless of any irregularity in their stay or
employment61." The Convention further protects migrant workers in the workplace and stipulates
that they shall enjoy treatment not less favorable than that which applies to nationals of the state
of employment with respect to conditions of work, including safety and health62.

Right to Health under Regional standards

The right to health is also stipulated in regional human rights instruments. Such regional
instruments are discussing below.
The Inter-American System
The American Declaration on the Rights and Duties of Man establishes the right to the
preservation of health through sanitary and social measures (food, clothing, housing, and medical
care), while it conditions its implementation on the availability of public and community
resources63." Similarly the Organization of American States' Charter stipulates, as among the
goals for contributing to the integral development of the person, access to knowledge of modern
medical science and to adequate urban conditions64.

59
A rt. 1 of Convention on the Rights of the Persons with Disabilities 2006.
60
Art.25 of Convention on the Rights of the Persons with Disabilities 2006.
61
Art.28 of International Convention on the Protection of the rights of all migrant workers and members of their
families 1990.
62
Art.25 of International Convention on the Protection of the rights of all migrant workers and members of their
families 1990
63
Art. XI of the American Declaration on the Rights and Duties of Man,1948.
64
Art.34 of the Organization of American States' Charter,1948
Moreover, the American Convention on Human Rights alludes indirectly to the right to health
when it refers to the commitment of state parties to take measures to guarantee the full
realization of the rights implicit in the economic, social, educational, scientific, and cultural
standards set forth in the Charter65." The Additional Protocol of San Salvador explicitly sets forth
the right to health for all individuals. It lists six measures that should be taken by state parties to
guarantee this right, including the development of universal primary care networks66. In
addition, the Protocol guarantees the right to a healthy environment. Nonetheless, the Protocol
rules out the possibility of submitting individual petitions before the supervisory organs of the
Inter-American system with respect to the right to health67.
European System
The European Social Charter refers to the right to protection of health, for the attainment of
which it stipulates health promotion, education and disease
prevention activities68." It guarantees access to social and medical assistance to those without
adequate resources69. Similarly, the Convention on Human Rights and Biomedicine enshrines
equal access to health care70.
African System
The African Charter on Human and Peoples' Rights enshrines the right to the highest possible
level of health, to which end necessary measures will be taken, while also guaranteeing medical
services in case of illness. The African Charter on the Rights and Welfare of the Child also
includes recognition of the right to health71.

65
Art.26 of the Organization of American States' Charter,1948
66
Art. 10 of the Organization of American States' Charter,1948
67
Art.11 of the Additional Protocol of the Organization of American States’ Charter,1948
68
Art.11 of the European Social Charter,1961.
69
Paragraph 13 of the first Part of the European Social Charter,1961.
70
Art.3 of the Convention on Human Rights and Biomedicine,1999
71
Art. 16 of the African Charter on the Rights and Welfare of the Child,2001.
World Health Organization:
Health Organization of the League of Nations:
After the First World War (1914-1918), when the League of Nations and its Health Organization
were formed, there was a proposal to establish a single international health organization.
However, negotiations broke down and two international health organizations remained. The
72
League of Nations Health Organization carried out activities covering a wide field of health
issues.
Second World War and health in the Region
Before Second World War, most of the countries in the South-East Asia Region were under
colonial rule. India, Burma (now Myanmar) and Ceylon (now Sri Lanka) were British colonies.
Bangladesh was then a part of British India. By a treaty, Bhutan had agreed to accept British
guidance in its external affairs. Nepal managed to avoid becoming a colony. So did Thailand.
Maldives became a British Protectorate in 1887. The whole of the Indonesian archipelago was
part of the Dutch empire. Korea had been annexed by Japan in 1910 and remained a colony till
after the Second World War. Mongolia was a state of Manchu China till the early twentieth
century. In 1921, after a revolution, it became an independent state known as the Mongolian
People’s Republic.
The general level of health in the colonies, protectorates, as well as independent countries in the
Region was poor. The hot and humid climate of the tropics in which most of the countries are
situated, created a favorable environment for most of the infectious organisms of various
diseases to survive and thrive. Coupled with this was the widespread poverty, leading to
illiteracy, poor housing conditions, overcrowding and under nutrition or malnutrition.
Epidemics of smallpox, cholera, plague and malaria sporadically swept through the populations
whose resistance to disease was already low. Mortality from these epidemics was naturally high.
Medical care was limited to a small section of the population. The health of the people in a
number of countries73, which was already not satisfactory, had considerably deteriorated by the
end of the war.

72
http://www.wto.org/ (accessed on 05/03/2019).
73
http://www.searo.who.int/india/about/en/ (accessed on 05/03/2019).
Food shortages resulting in under nutrition and malnutrition, lack of health and medical services
and acute shortage of medicines adversely contributed to this situation. Malaria was widespread
in all countries. So were tuberculosis, venereal diseases. Infant mortality was also very high in
most countries.

The word ‘Health’ in the UN Charter

Dr. De Paula Souza and the Brazilian delegation to the United Nations conference must be given
the credit for having insisted that the concept of ‘health’ be included in the Charter of the United
Nations74.The Constitution of the World Health Organization has been called the ‘Magna Carta’
of health. In its final form, it constitutes one of the most powerful instruments for international
collaboration to enable man to improve his condition of life. The United Nations Commission on
Human Rights, which met in Geneva in December 1947, incorporated in the Charter of Human
Rights75 the following article:
"Everyone, without distinction as to economic and social conditions, has the right to the
preservation of his health through the highest standards of food, clothing, housing and medical
care which the resources of the State and community can provide. The responsibility of the State
and community for the health and safety of its people can be fulfilled only by provision of
adequate health and social measures." The World Health Assembly, therefore, chose 7 April as
World Health Day , the day the WHO Constitution came into force, as a suitable alternative. The
Assembly resolved that, beginning 1950 and each year thereafter, World Health Day should
appropriately be celebrated on 7 April by all Member states.

74
See United Nations Charter, Articles 57 and 62.
75
Charter of Human Rights ,United Nations Commission on Human Rights.
Constitution of the World Health Organization

The States Parties to this Constitution declare, in conformity with the Charter of the United
Nations, that the following principles are basic to the happiness, harmonious relations and
security of all peoples76:
• Health is a state of complete physical, mental and social well-being and not merely the absence
of disease or infirmity.
• The enjoyment of the highest attainable standard of health is one of the fundamental rights of
every human being without distinction of race, religion, political belief, economic or social
condition.
• The health of all peoples is fundamental to the attainment of peace and security and is
dependent upon the fullest cooperation of individuals and States.
• The achievement of any State in the promotion and protection of health is of value to all.
• Unequal development in different countries in the promotion of health and control of disease,
especially communicable disease, is a common danger.
• Healthy development of the child is of basic importance; the ability to live harmoniously in a
changing total environment is essential to such development.
• The extension to all peoples of the benefits of medical, psychological and related knowledge is
essential to the fullest attainment of health.
• Informed opinion and active co-operation on the part of the public are of the utmost importance
in the improvement of the health of the people.
• Governments have a responsibility for the health of their peoples, which can be fulfilled only
by the provision of adequate health and social measures.
Accepting these Principles, and for the purpose of co-operation among themselves and with
others to promote and protect the health of all peoples, the Contracting Parties agreed to the
present Constitution and established the World Health Organization77 as a specialized agency
within the terms of Article 57 of the Charter of the United Nations on 12 January 1948.

76
https://www.theguardian.com/world/world-health-organization/ ( accessed on 06/03/2019).
77
Promod nair, Global Health Jurisprudence: the role of the WHO and International Law (331-334).
Consumer law applicable to health services:
The consumer Protection Act,1986:
The Preamble of the Act states “an act to provide for better protection of interests of consumers
and for that purpose to make provision for the establishment of consumer councils and other
authorities for the settlement of consumers’ disputes and matters connected therewith.” There
are a number of legislations for the protection of consumers like the Drugs (control) Act, 1950,
Prevention of Food Adulteration act, 1954, Essential Commodities Act, 1955 and so on. But the
Act mainly focuses for the better protection of consumers and consumer justice. The Act applies
to all goods and services in private, public or cooperative sector.
The term services are made to include services provided by doctor. This is now very well settled
by the Supreme Court in the case of Indian Medical Association v V.P. Santha78. Hence
doctors rendering services are all covered under the Act. Only those services which are provided
free of charge are exempted from the act.
Consumer79 is defined under the Act “as any person who buys goods against consideration
includes any user of such goods and any person who hires services against consideration
including a beneficiary of such services.” Deficiency80 means any fault, imperfection,
shortcoming or inadequacy in the quality, nature and manner of performance which is required to
be maintained by or under any law for the time being in force or has been undertaken to be
performed by a person in pursuance of a contract of otherwise in relation to any service.
The term service81 is defined as service of any description which is made available to potential
users and includes services like banking, insurance, transport, processing etc. and by the
aforesaid decision of Supreme Court now medical services are also included in the term service.
But any service which is provided free of charge or which is under a contract of personal service
is not included under the Act.

78
(1995) SCC 651
79
Section 2(d) of the Consumer Protection Act,1986
80
Section 2(g) of the Consumer Protection Act, 1986
81
Section 2 (o) of the Consumer Protection Act, 1986
Any patient who is provided with deficient medical services can take action before the District
Forum, State Commission and the National Commission taking into consideration the
jurisdiction as provided under the Act82. Relief83 which may be directed to the patients against a
doctor as envisaged under the Act are as follows:
1. To pay such amount as may be awarded by it as compensation to the consumer for any loss or
injury suffered by the consumer due to the negligence of the opposite party;
2. To remove the defects or deficiencies in the services in question;
3. To discontinue the unfair trade practice or the restrictive trade practice or not to repeat it;
4. To provide for adequate costs to the parties.
The Courts considering patients to be under the purview of the Consumer Protection Act, has
decided a number of cases against doctors on medical negligence.

Environment and Health ;

Environment and health intricately linked. Environmental factors contribute significantly to
health burden. In India, 60 per cent of malaria, almost all gastro-intestinal and respiratory
diseases, and significant proportion of organ specific, skin diseases, are caused because of poor
environmental conditions.
Environmental regulation is largely enacted and enforced with human well being and public
health as its focus. Though we have a number of environment laws to protect the health and well
being of the people, but we find that these laws are not implemented in letter and spirit84.
In 1986 ,The Environment (Protection) Act was passed which authorizes the Central
Government to protect and improve environmental quality, control and reduce pollution from all
sources, and prohibit or restrict the setting and /or operation of any industrial facility on
environmental grounds85.
The Environment Protection Act (1986) is the umbrella Act of all environmental legislation. It
was brought to prominence after the Bhopal gas tragedy as legal redress to people affected by
environmental problems.

82
Section 11,17 and 21 respectively of the Consumer Protection Act, 1986
83
Section 14 of the Consumer Protection Act,1986
84
https://www.legalserviceindia.com/laws/comsumer-laws.htm/ (accessed on 04/04/2019).

85
McMichael .AJ et al., eds. Climate change and Human health , Geneva, World Health Organisation,2003
The Environment Protection Act focuses on the populations’ general treatment of the
environment in India, whereas the National Conservation Strategy and Policy Statement on
Environment and Development (NCSPSED), a policy proposed in 1992 following the Rio
Summit, tries to describe how the environment should be considered in the context of growth
oriented policies and programmers.
In pursuance of Section 6, 8 and 25 of the Environment (Protection) Act, 1986 the Central
Government has made the following rules for the protection of health and environment:
• Hazardous wastes (management and handling) rules, 1989 for the management and handling of
the hazardous wastes which would affect the health of the people
• The Hazardous Micro-organisms Rules, 1989 for the manufacture, use, import, export and
storage of hazardous Micro-organisms/Genetically engineered organisms and cells.
• The Biomedical waste (Management and Handling) Rules, 1998 which is a legal binding on the
health care institutions are framed to streamline the process of proper handling of hospital waste
such as segregation, disposal, collection, and treatment.
• Recycled Plastics Manufacture and "Usage Rules, 1999 for the manufacture and use of recycled
plastics carry bags and containers86.
• Municipal solid wastes (management and handling) rules, 2000 have been framed to regulate
the management and handling of municipal solid wastes.
• Noise pollution (regulation and control) rules 2000 have been framed because the increasing
ambient nose levels in public places from various sources like industrial activity, construction
activity, generator sets, and loudspeakers. Public address system, music system etc have
deleterious effects of human health and the psychological well being of the people. So in order to
regulate and control noise producing and generating source with the objective of maintain the
ambient air quality standards in respect of noise the rules are being framed87.
• The Ozone Depleting Substances (Regulation and Control) Rules, 2000 have been framed to
regulate ozone depleting substances.
• The batteries (management and handling) rules 2001 have also been made.

86
Physical Activity, Environmental issues , World Health Organization,
https://www.who.int/hpr/physactiv/environment.shtml/ (accessed on 04/03/2019).
87
Dora C, Phillips M., eds. Transport, Environment and health, WHO Regional Publications, European Series , No
.89 , Copenhagen, World Health Organization,2000.
Medical laws:
In India we have a large number of legislations in the field of medicine and health. The
legislations are made keeping in view of the needs of the society and protecting the health of the
people. The drug industry did basically not exist in India in the beginning of the 20th century.
Most of the drugs were imported from foreign countries. The change was brought from the end
of the First World War when the demand of the indigenous products increased; this led to the
establishment of the pharmaceutical manufacturing concerns. In order to earn more profits some
of the products produced were of inferior quality and harmful for public health. As a
consequence the Government was, called upon to take notice of the situation and consider the
matter of introducing legislation to control the manufacture, distribution and sale of drugs and
medicines88.
Two of the laws, The Poisons Act and the Dangerous Drugs Act were passed in 1919 and 1930
respectively. The Opium Act was quite old having being adopted as early as 1878. But to have a
comprehensive legislation, with the rapid expansion of the pharmaceutical production and drug
market required by the end of the second decade for its control, the Indian Government
appointed, in 1931, a Drugs Enquiry Committee under the Chairmanship Lt. Col. R. N. Chopra
which was asked to make shifting enquiries into the whole matter of drug production,
distribution and sale by inviting opinions and meeting concerned people. The Committee was
asked to make recommendations about the ways and means of controlling the production and
sale of drugs and pharmaceuticals in the interest of public health89. The Chopra Committee
toured all over the country and after carefully examining the data placed before it, submitted a
voluminous report to government suggesting creation of drug control machinery at the centre
with branches in all provinces. For an efficient and speedy working of the controlling
department, the committee also recommended the establishment of a well-equipped Central
Drugs Laboratory with competent staff and experts in various branches for data standardization
work.

88
Thomson Reuters,2015 , Web of Science ( Science ed., ) Journal of Health Politics, Policy and law, Duke
University Press
89
https://www.who.int/health-laws/en/
At present the following Acts are in force in order to govern the manufacture, sale, import,
export and clinical research of drugs and cosmetics in India.
• The Drugs and Cosmetics Act, 1940
• The Drugs and Magic Remedies (Objectionable Advertisement) Act, 1954
• The Narcotic Drugs and Psychotropic Substances Act, 1985
• The Epidemic Diseases Act, 1897
• The Transplantation of Human Organs Act, 1994
• The Mental Health Act, 1987.
Occupational Health laws:
Labour and Industrial Law legislations in India dates back to nearly 150 years. Well, it can be
classified into pre-independence and post independence eras90. The Fatal Accidents Act, 1855,
Indian Boilers Act, 1923; Workman’s Compensation Act, 1923; Trade Unions Act, 1923, The
Children (Pledging of Labour) Act, 1933; The Employees Liability Act, 1938, The Industrial
Employment (Standing orders) Act, 1946; The Industrial Disputes Act, 1947 etc., are the
beneficial as well as protective legislations. After independence, more than 100 enactments were
made by Central and various State Governments to regulate working conditions, obligations,
rights of employers and workmen.
These are the following legislations and their provisions relating to health.
• Employees’ State Insurance Act, 1948
• The Factories Act, 1948
• The Maternity Benefit Act, 1961
• The Mines Act, 1952
• The Plantation Labour Act, 1951
• Workmen’s Compensation Act, 1923

90
G.K. Kulkarni, Implementation of Occupational Health Legislation at Work Place, Issues and Concerns ,12(2):51-
52 , Indian Journal of Occupational and Environmental Medicine Aug.,2008. https://www.health.ny.gov/
Women and Health Laws:
Women have always obtained an inferior status in our society. They are often ignored and are
considered to be as child producing machines91. In such situation there is no one to take care of
women who besides homely duties do a much more to help the economic condition of the
family. The legislators have done a great task by enforcing laws protecting health of women.
These are the following laws relating to the health of women:
• Pre-conception and Pre-Natal Diagnostic Techniques (Regulation and Prevention of
misuse)Act, 1994
• The Medical Termination of Pregnancy Act, 1971

Children and health:

Today’s children are tomorrow’s asset. The future of our country is dependant on our today’s
children. But we find majority of children are not able to develop themselves due to economic
constraints. And because of which their health is not taken care of. The researcher has discussed
the following laws relating to children92. We also find that the children are not properly taken
care of just because of lack of knowledge of their parents.
The laws have done much in this field too.
 The Child Labour (Prohibition and Regulation) Act, 1986 .
 The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production,
Supply and Distribution) Act, 1992
 The Juvenile Justice (Care and Protection) Act, 2000.

91
https://www.journals.elsevier.com/womens-health-issues/recent-articles/ (accessed on 04/04/2019).
92
https://www.healthychilden.org/ (accessed on 04/04/2019).
Food laws and health measures:

Food plays a very important role in protecting the health of a human being. Henry Shue talks of
the Right to ‘Subsistence’ , which will include right to food among other things as a means of
leading a healthy and satisfactory life93.The National Food Security Act,2013 (also Right to food
Act) is an Act of the Parliament of India which aims to provide subsidized food grains to
approximately two thirds of India's 1.2 billion people94.

It was signed into law on 12 September 2013, retroactive to 5 July 2013.The Noble Laureate
Amartya Sen endorsed that India had more endemic hunger and regular undernourishment than
any part of the World95.The National Food Security Act, 2013 (NFSA 2013) converts into legal
entitlements for existing food security programmes of the Government of India. It includes
the Midday Meal Scheme, Integrated Child Development Services scheme and the Public
Distribution System. Further, the NFSA 2013 recognizes maternity entitlements.

The Midday Meal Scheme and the Integrated Child Development Services Scheme are universal
in nature whereas the PDS will reach about two-thirds of the population (75% in rural areas and
50% in urban areas).Later, the National Food Security (Amendment ) Bill, 2018 was introduced
to amend the National food Security Act of 2013.

The following legislations have been discussed relating health and food laws:
• The Food Safety and Standards Act, 2006
• The Prevention of Food Adulteration Act, 1954
The Indian Parliament has addressed a number of issues and has made laws in respect of various
aspects of health. The legislature has been prompt enough to address newer and upcoming issues
in the health sector. Since independence, health has been given a pivotal place by the Indian
Parliament and the same continues to be so as on date. More importantly the Government’s
capacity to develop national health policy and legislation that conforms to human rights
obligations is strengthened with the implementation of progressive legislations.

93
Quoted by Atul Vishvvanathan and ketan Makhijia, Arrest Hunger : The Right to Food. The Lawyers
Collective,19 (13) February 2004.
94
Govt defers Promulgation of ordinance on Food security bill, “ Times of India , 13th June,2013.
95
B.N. Arora, Human Rights: Right to Food Eluding millions in India, Mainstream (8-9) 6th Dec., 2003.
The only uncovered area till now has been the recognition of health as a human right through
specific legislation. The same has been attempted to be fulfilled by the parliament with the
introduction of National health bill. Health has to be promoted from the human rights perspective
and the same has to be borne in the minds of each and every individual involved in the health
care sector. This is only possible when the legislations are made with a view to promote and
protect health from a human right perspective. we find that the legislations in India fail to focus
and promote health from human rights approach. Step towards the full realization of rights must
be deliberate, concrete and targeted as clearly as possible towards meeting a government’s
human rights obligations96.
All appropriate means, including the adoption of legislative measures and the provision of
judicial remedies, as well as administrative ,financial. educational and social measures ,must be
used in this regard. India being a signatory to various international instruments has implemented
the same into its legislations and policies positively. The principle of progressive realization of
rights imposes an obligation upon the state parties to move as expeditiously and effectively as
possible towards the goal set97. Any deliberately retrogressive measures require the most careful
consideration and need to be fully justified by reference to the treaty concerned and in the
context of the full use of the maximum available resources.

To conclude, it can be said that health legislation can be an important vehicle towards ensuring
he promotion and protection of the right to health. In the design and review of health legislation,
human rights provide a useful tool to determine its effectiveness and appropriateness in line with
both human rights and public health goals.

96
https://www.publichealthlawcenter.org/ (accessed on 04/04/2019)
97
https://www.who.int/water-Sanitation /health/hygiene/emergencies/ (accessed on 04/04/2019)
Implementation of right to Health : Role of Government:

A policy is typically described as a deliberate plan of action to guide decisions and achieve
rational outcome (s)98. It is a guide to do an action to change what would otherwise occur, a
decision about amounts and allocations of resources: the overall amount is a statement of
commitment to certain areas of concern99. In a welfare state like ours it is the duty of the
Government not only to make legislations but to take effective steps so as to put into action, the
basic human right of health.

These actions are the obligations of the government and should be more focused on the
following aspects.

(i) Providing adequate health care, including health facilities, and those goods and
services that are necessary for the treatment of illness and rehabilitation. Hence it also
includes timely and appropriate health care together with essential elements such as
hospitals; clinics and other health-related facilities; and essential medicines.
(ii) Providing basic amenities which determines the health of the population that include
safe and portable water; adequate sanitation; an adequate supply of safe food;
adequate nutrition ;adequate housing; health occupational and environmental
conditions ,education and information about health, including sexual and reproductive
health100.
(iii) Ensuring people’s participation in decision making that includes the design and
implementation of policies that affect their health ,at community, national and
international levels.
(iv) Providing adequate facilities concerning to maternal, child and reproductive health.
Effective steps to be taken for the Prevention, treatment and control of diseases; and
(v) Ensuring all these obligations on the basis of non-discrimination in access to health
care.

98
www.cehat.org/humanrights/hrcampaign.html/ ( accessed on 04/04/2019).
99
http://www.lawyerscollective.org/un/ (accessed on 04/04/2019).
100
Selvaraj S, Karan A. Deepening Health Insecurity in India: Evidence from National Sample Surveys since
1980s.,Economic and political weekly ,44:55 -60; 2009
Reports of various Committees formed for Public Health:
After Independence, India adopted the welfare state approach, which was dominant worldwide at
that time. As with most post-colonial nations, India too attempted to restructure its patterns of
investment. During that time, India's leaders envisaged a national health system in which the
State would play a leading role in determining priorities, financing and provide services to the
population. Hence the government has from time to time set up number of committees to ensure
public health. The recommendations given by the committees made to improve the public health
system in India. The following are the major committees formed and established to look into the
public health matter.

Bhore Committee101:

The emphasis of the first health report, i.e. the Health Planning and Development Committee's
Report, 1946 (popularly known as the Committee Report) on the role of the State was explicit.
The committee submitted its report in the post war period. The committee recommended on
several aspects for the improvement in the public health sphere. It was a plan equivalent to
Britain's National Health Service. The Report was based on a countrywide survey in British
India. It is the first organized set of health care data for India. The poor health status was
attributed to the prevalence.

It considered that the health programme in India should be developed on a foundation of

preventive health work and proceed in the closest association with the administration of medical
relief. The Committee strongly recommended that health services system should be based on the
needs of the people, the majority of whom were deprived and poor. It felt that the need for
developing a strong basic health services structure at the primary level with referral linkages.

It was decided that medical benefits would have to be supplied free to all at the point of delivery
and those who could afford to pay should channel contributions through the mechanism of
taxation.One of the noteworthy recommendations of the Committee was to enact Public Health
Act that aimed for the codification of all health laws, incorporate new provisions and make
amendments under the legislations to meet the needs of the society, formulation of health care
plans and the most important was to legalise the self-regulatory medical councils.

101
See Bhore Committee 1946, Report of the Health Survey and Development Committee(1), Survey (ii),
Recommendations, (iii), GOI ,Manager Of publication, New Delhi.
Sokhey Committee 102;

The National Planning Committee (NPC) set up by the Indian National Congress in 1938 under
the chairmanship of Colonel S. Sokhey stated that the State, and the integration of preventive and
curative functions in a single state agency was emphasized. The Sokhey Committee Report was
not as detailed as the Bhore Committee Report but endorsed the recommendations of the Bhore
Committee Report. It stressed on the need of better public health facilities.

Mudaliar Committee:

The concern of the Health Survey and Planning Committee (Mudaliar Committee 1962) was
limited to the development of the health services infrastructure and the health cadre at the
primary level. It felt the growth of infrastructure needed radical transformation and further
investment. The committee also brought a detailed report on the status of health care in India. It
also had a major task to follow up the recommendations of the Bhore Committee and make
recommendations for further progress. It strongly recommended to implement a comprehensive
Public Health Act and in furtherance to it drafted a Model Public Health Act. The
recommendations of this committee were taken into consideration by the government in
formulation of various public health policies103.

Ajit Prasad Jain Committee104:

It undertook an in depth study on the conditions of hospitals in the public sector but failed to
focus on the private hospitals. It laid down certain standards to improve the conditions only at
the public sector. Meanwhile the Chaddha Committee Report (1963), the Kartar Singh
Committee Report on Multipurpose Workers (1974) and the Srivastava Committee Report on
Medical Education and Support Manpower (1975)remained focused on giving recommendations
on how the health cadres at the primary level should be distributed.

102
Sokhey Committee Report,1948, National Health : Report of the Sub-committee of the National Planning
Committee.
103
Mudaliar Committee Report 1961, Report of the Health Survey and Planning Committee, (I –II) Ministry of
Health, Government of India, New Delhi.
104
The legacy of 1953 , Frontline https://www.ohchr.org/Documents/Issues/Children/Study/ (accessed on
06/04/2019).
ICMR/ICSSR Committee105:

The ICMR/ICSSR Report (1980) was in fact a move towards articulating a national health policy
that was thought of as an important step to realize the Alma Ata Declaration. It was realized that
one had rearticulate and get back into track an integrated and health system that policy-makers
had wavered from. It reiterated the need to integrate the development of the health system with
the overall plans of socioeconomic and political change. It recommended that the Government
formulate a comprehensive national health policy dealing with all dimensions-environmental,
nutritional, educational ,socioeconomic, preventive and curative. The National Health Policy,
1983 attempted to incorporate all these. Provision of universal, comprehensive primary health
services was its goal. A large number of private and voluntary organizations who were active
across the country in the health field were to support the Government in its efforts to integrate
health services. Evolving a decentralized system of health care and nation wide chain of
epidemiological stations were some of the main recommendations.

Varadappan Committee106:

The main concern of the committee was the nursing profession. It pointed out a major lacunae
and that was the ineffectiveness of Nursing Council to stop unqualified non-registered nurses in
private nursing homes from practicing or to deregister nurses who violate its code of guidelines.

105
Indian Council of Social Science Research (ICSSR) and Indian council of Medical research (ICMR).Health for
all :An Alternative strategy. Report of a study Group. New Delhi :ICSSR ;1980.
106
Varadappan Committee 1989, Report of the High Power Committee on Nursing and Nursing profession, Ministry
of Health and family Welfare, New Delhi.
Brief Overview of five Years Plan: (First Five Year plan (1951-1956)-Twelfth Five year
plan (2012-2017) :

A very brief overview of first five year plan (1951-56) to Twelfth five year plan (2012-2017)107
in the public health sector is given herewith to know the gradual progress in the sphere of
providing public health care. The objectives of the First (1951-56) and Second Five-Year (1956-
61) Plans were to develop the basic infrastructure and manpower visualized by the Bhore
Committee108. Though health was seen as fundamental to national progress, less than 5% of the
total revenue was invested in health.

The following priorities formed the basis of the First Five-Year Plan: provision of water supply
and sanitation; control of malaria; preventive health care of the rural population through health
units and mobile units; health services for mothers and children; education, training and health
education; self-sufficiency in drugs and equipment; family planning and population control.
Starting from the first plan, vertical programmes started, which became the centre of focus. The
Malaria Control Programme, which was made one of the principal programmes, apart from other
programmes for the control of TB, filariasis, leprosy and venereal diseases, was launched. Health
personnel were to take part in vertical programmes. However, the first plan itself failed to create
an integrated system by introducing verticality. Another major shift came in the Third Plan
(1961-1966) when family planning received priority for the first time109.

Increase in the population became a major worry and was seen as a hurdle to the development
process. Although the broad objective was to bring about progressive improvement in the health
of the people by ensuring a certain minimum level of physical well being and to create
conditions favourable for greater efficiency, there was a shift in focus from preventive health
services to family planning. During the Fourth Plan (1969-1974), efforts were made to provide
an effective base for health services in rural areas by strengthening the PHCs. The vertical
campaigns against communicable diseases were further intensified. During the Fifth Plan (1974-
1979), policy-makers suddenly realized that health had to be addressed alongside other
development programmes.

107
Planning commission of India, Government of India: Five Year Plans : Planning Commission
https://planningcommission.nic.in/ (accessed on 19/01/2019)
108
Ibid
109
Ibid
The Minimum Needs Programme (MNP) promised to address all this but became an instrument
through which only health infrastructure in the rural areas was to be expanded and further
strengthened. It called for integration of peripheral staff of vertical programmes but the
population control programme got further impetus during the Emergency (1975-1977)and most
of the basic health workers got sucked into the family planning programme. The Sixth Plan
(1980-84) was influenced by two policy documents: the Alma Ata Declaration and the
ICMR/ICSSR report on ‘Health for All by 2000'.The Seventh Plan (1985-90) restated that the
rural health programme and the three-tier health services system need to be strengthened and that
the government had to make up for the deficiencies in personnel, equipment and facilities110. The
Eighth Plan(1992-97) distinctly encouraged private initiatives, private hospitals, clinics and
suitable returns from tax incentives. With the beginning of structural adjustment programmes
and cuts in social sectors, excessive importance was given to vertical programmes such as those
for the control of tuberculosis, polio and malaria funded by multilateral agencies with specified
objectives and conditions attached. Both the Ninth (1997-2002) and the Tenth Five-Year Plans
(2002-2007) start with a dismal picture of the health services infrastructure and go on to say that
it is important to invest more on building good primary-level care and referral services. Both the
plans highlight the importance of the role of decentralization but do not state how this will be
achieved. The main objectives of the Eleventh plan (2007-2012) is mainly aimed to increase the
enrolment in higher education of 18-23 years of age group by 2011-2012.It mainly aims at
environmental sustainability.

It mainly reduces total fertility rate to 2 %. It mainly focuses towards empowerment through
education & skill development111. The Twelfth Five – Year Plan(2012-2017) of the government
of India has been decided to achieve a growth rate of 8.2% but the National Development
Council ( NDC) on 27th December , 2012 approved a growth rate of 8% for the 12th five year
plan. With the planning commission dissolved, no more formal plans are made for the economy,
but five –year defence plans continue to be made. The latest is 2017-2022.

110
Ibid
111
Sony Pellissery and Sam Geall “ Five Year Plans’ in Encyclopedia of Sustainability 7 (156-160).
AYUSH ( Ayurveda, Yoga and Naturopathy, Unani , Siddha and Homeopathy):

The eleventh plan recognizes that there is a resurgence of interest in holistic systems of health
care, especially, in the prevention and management of chronic lifestyle related non-
communicable diseases and systemic diseases. Health sector trends suggest that no single system
of health care has the capacity112 to solve all of society’s health needs. India can be a world
leader in the era of integrative medicine because it has strong foundations in Western biomedical
sciences and an immensely rich and mature indigenous medical heritage of its own. The vision
for AYUSH provides to mainstream AYUSH by designing strategic interventions for wider
utilization of AYUSH both domestically and globally, the thrust areas in the Eleventh Five Year
Plan are Strengthening professional education, Strategic research programmes, Promotion of best
clinical practices, Technology up gradation in industry, Setting internationally acceptable
pharmacopoeial standards, Conserving medicinal flora, fauna, metals, and minerals, utilizing
human resources of AYUSH in the national health programmes, with the ultimate aim of
enhancing the outreach of AYUSH health care in an accessible, acceptable, affordable, and
qualitative manner.

National Health Mission:

In May 2013,the UPA government had launched National Urban Health Mission113, which was
later integrated into National Rural Health Mission and a new National Health Mission was
Created from 2014-2015.

Both NUHM and NRHM are now two of the six components of NHM .The Six components of
National Health Mission as follows:

1.National Rural Health Mission (NRHM –RCH Flexipool).

2.National Urban Health Mission Flexipool for Population above 50000.

3.Flexible pool for communicable disease.

4.Flexible pool for Non-Communicable disease including Injury and Trauma.

112
Role of AYUSH workforce ,therapeutics and principles in health care delivery with special reference to National
Rural health Mission 36(1)5-8 (2015) https://www.ayush.gov.in/( accessed on 09/03/2019).

113
Department of ISM and H-2002,NEW Delhi : Ministry of Health and family welfare, Government of India,2002
5. Infrastructure Maintenance.

6.Family Welfare Central Sector Component.

National Rural Health Mission114:

The major functions under this sub-mission is to provide reproductive, maternal, newborn ,child
health and adolescent (RMNCH+A ) Services to the rural deprived people through its network of
ASHA, ANMS and AWWS.NRHM also called NRHM-RCH Flexipool is one of the components
of NHM and is for all towns and villages below population of 50,000.Under this mission,
115
government seeks to provide accessible, affordable and quality healthcare to rural population.
Thrust of this mission is to provide a fully functional , community owned, decentralized health
delivery system in rural areas.

National Urban Health Mission116:

National Urban Health Mission (NUHM) seeks to improve the health status of the Urban
population particularly urban poor and other vulnerable sections by facilitating their access to
quality primary healthcare. NUHM covers all state capitals ,district headquarters and other cities,
towns with a population of 50,000 and above (as per census 2011) in a phased manner.

Various Initiatives under National Health Mission:

Accredited Social Health Activists (ASHA).

Rogi Kalyan Samiti.

Janani Suraksha Yojana.

Janani Shishu Suraksha Karyakram (JSSK) 2011

National Ambulance Services

India Newborn Action plan.

114
National Rural Health Mission – Framework of Implementation 2005-2012 .New Delhi : Ministry of Health and
Family welfare, Government of India 2005
115
Government of India. (2005). National Rural Health Mission (2005–2012) Mission Document. Ministry of
Health and Social Welfare, Government of India.
116
Ministry of Health and Family welfare ,Indian Public Health standards ,Revised Guidelines for Community
health canter, Directorate general of health Services ,New Delhi : Government of India : 2012
Rashtriya Bal Swasthya Karyakram (RBSK)

Rashtriya Kishore Swasthya Karyakram

Child death Review

National Health Policy 2017 :

The union cabinet approved the national health policy117 2017.It will replace teh previous policy
which was framed 15 years ago in 2002. It aims at providing healthcare in an “assured manner”
to all by addressing current and emerging challenges arising from the ever changing socio-
economic, epidemiological and technological scenarios.

The Highlights of National Health Policy118, 2017 are as follows:

(i) It aims to raise Public healthcare expenditure to 2.5 % of GDP from Current 1.4%
with more than two-thirds of those resources going towards primary healthcare.
(ii) It envisages providing a larger package of assured comprehensive primary healthcare
through the health and wellness centres.
(iii) It is a comprehensive package that will include care for major non-communicable
diseases(NCDS)119 , geriatric health care, mental health ,palliative care and
rehabilitative care services.
(iv) It proposes free diagnostics, free drugs and free emergency and essential healthcare
services in all public hospitals in order to provide healthcare access and financial
protection.
(v) It seeks to establish regular tracking of disability adjusted life years (DALY) index as
a measure of burden of disease and its major categories trends by 2022.
(vi) It aims to improve and strengthen the regulatory environment by putting in place
systems for setting standards and ensuring quality of healthcare.

117
Srinivasan P . National health Policy for Traditional Medicine in India . World Health Forum, 1995 16: 190-193.
118
Ministry of Health and Family Welfare , Indian Public health Standards ,Revised Guidelines for primary health
center, Directorate General of Health Services, New Delhi: Government of India , 2012.
119
. Government of India. National Health Policy 2002, New Delhi, Ministry of Health and Family Welfare,
2002.
 (vii) It also looks at reforms in the existing regulatory systems both for easing drugs and
devices manufacturing to promote make in India and also reforming medical
education.
(viii) It advocates development of mid-level service providers, Public health cadre,nurse
practitioners to improve availability of appropriate health human resource.
(ix) It aims to ensure availability of 2 beds per 1000 population to enable access within
golden hour.
(x) It purposes to increase life expectancy from 65 to 70 years by 2025.
(xi) It aims to reduce total fertility rate (TFR) to 2.1 at sub-national and national level by
2025.
(xii) It also aims to reduce mortality rate (MR) of children under 5 years of age to 25 per
1000 by 2025 and maternal mortality rate (MMR) to 100 by 2020.
(xiii) It also aims to reduce infant mortality rate to 28 by 2019 and reduce neo-natal
mortality to 16 and still birth rate to ‘ Single digit’ by 2025.

National Population Policy 2000:

Since the middle of the 20th century ,developing countries like India have been facing the
problem of unsustainable population growth that had placed a lot of pressure on their
development pattern and prosperity. In 1976, the government of India came up with its first
National Population Policy. The Policy came up with a number of measures to arrest the
population growth. National Population Policy120, 2000 (NPP-2000) where in February 2000, the
government of India came up with the Second National Policy on Population. For the first time,
since independence, this document comprehensively addressed the problem of population growth
121
in integration with issues such as child survival ,maternal health, women empowerment and
contraception. The immediate objective of the policy is to offer service delivery in integrated
approach to improve reproductive health and child care.

120
https://www.ncbi.nlm.nih.gov/pubmed/ ( accessed on 09/03/2019)
121
Government of India. (1946). Health Survey and Development Committee, ( i, ii, iv) Recommendations. New
Delhi: Government of India Press
The mid –term objective of the policy was to maintain a total fertility rate (TFR) as 2.1 children
per women as it was considered as the replacement level. The long term objective of the policy
is to achieve population stabilization by the year 2045.

Benefits :

The expected benefits of the policy are as follows:

(i) Make in India Programme

(ii) Identifying a major loophole
(iii) Issues and Problems:

The Key issues related with this policy are as follows:

(a) Excessive interference

(b) NPPA underestimated

(c) Eliminating loan licenses

(d) Price Control Policies

(e) Addressing Quality Concerns.

While the draft pharmaceutical policy 2017 appears to be a promising policy, the Pharmaceutical
industry has not been very happy about the developments. So, some form of comprehensive
mechanism can be developed. But the need for a more comprehensive reform is necessary which
is not clearly envisaged in this draft policy.

National Policy on Indian Systems of Medicine & Homoeopathy, 2002

In many places, the Indian Systems of Medicine & Homoeopathy continue to be widely used due
to their accessibility, and sometimes, because they offer the only kind of medicine within the
physical and financial reach of the patient. The Indian medicine system is also embedded in the
beliefs of a wide section of the public and continues to be an integral and important part of their
lives and for some, it is also away of life. Complementary and Alternative Medicine or
Traditional Medicine is rapidly growing worldwide. In India also, there is resurgence of interest
in Indian Systems of Medicine. People are becoming concerned about the adverse effects of
chemical based drugs and the escalating costs of conventional health care.
Longer life expectancy and life style related problems have brought with them an increased risk
of developing chronic, debilitating diseases such as heart disease, cancer, diabetes and mental
122
disorders. Although new treatments and technologies for dealing with them are plentiful
nonetheless more and more patients are now looking for simpler, gentle therapies for improving
the quality of life and avoiding iatrogenic problems.

India possesses an unmatched heritage represented by its ancient systems of medicine which are
a treasure house of knowledge for both preventive and curative healthcare. The positive features
of the Indian Systems of Medicine, namely, their diversity and flexibility; accessibility;
affordability; a broad acceptance by a section of the general public; comparatively low cost; a
low level of technological input and growing economic value have great potentials to make them
providers of healthcare that the larger sections of our people need a huge infrastructure already
exists comprising thousands of hospitals and dispensaries, registered practitioners and twice the
number of Indian Systems of Medicine & Homoeopathy colleges as available for allopathy.
Many Post-Graduate institutions offer doctoral courses. Four researches councils and several
apex scientific institutions and universities have also contributed to clinical research, ethno-
botanical surveys, pharmacological and pharmacognostical studies on plants and drug
standardization of simple and compound ISM formulations.

Clinical research studies covering the use of ISM drugs for a range of diseases and public health
problems conducted over the last thirty years have led to many useful conclusions about the use
of single and compound ISM drugs to treat numerous intractable problems. Although Govt, set
up an independent Department in 1995 to give focus to these issues, ISM has not been able to
play a significant role in health care delivery services for want of their legitimate involvement in
public health programmes. Hence a policy is drawn to gain the significance of Indian systems of
medicine and homeopathy.

122
Indian Public Health Standards (IPHS) for Community Health Centers, Draft Guidelines, Directorate General of
Health Services, MOHFW, GOI, April 2005
Pharmaceutical Policy, 2017:
123
The draft Pharmaceutical policy 2017 has been introduced by the Department of
Pharmaceuticals with the objective of regulating the production and marketing of pharmaceutical
products in India.

The Key features of this Policy are as follows:

(i) Price Control to Monitoring

(ii) Powers of National pharmaceutical pricing Authority;

Which has been functioning as an autonomous body will experience a massive dilution of its
powers. The government exercises control over the functioning of NPPA.

(iii) Certain Eliminations:

The New policy will see elimination in third party manufacturing of the medicines and loan
licensing.

(iv) Quality Concerns:

The policy asserts that while the drugs to be exported go through a process of stringent
quality assurance as per the internal requirements of the importing countries, the same is not
done for the indigenously manufactured drugs produced for Indian markets.

National Water policy (2012):

In pursuance of the Strategies identified in National Water Mission Document as well as
deliberations in National Water board, Ministry of water Resources had initiated the process of
reviewing the National Water Policy,2002. Accordingly , the Drafting Committee on National
Water Policy 124has evolved the draft Policy after taking into consideration recommendations of
various stakeholders.

123
https://www.pharmaceuticalpolicy.nl/ and https://www.pharmaceuticals.gov.in/ (accessed on 09/04/2019).

124
National Water Policy 2012(pdf), Ministry of Water resources (GOI).Draft National Water Policy (2012) as
recommended by National Water Board (pdf) ,Ministry of Water Resources.
The Salient features of Draft National Water Policy (NWP, 2012) are :
(1) Emphasis on the need for an National water framework law, Comprehensive legislation
for optimum development of inter-state rivers and river valleys, amendment of Irrigation
Acts, Indian Easements Acts,1882 etc.
(2) Water, after meeting the pre-emptive needs for safe drinking water and sanitation,
achieving food security, supporting poor people dependent on agriculture for their
livelihood and high priority allocation for minimum eco-system needs , be treated as
economic good so as to promote its conservation and efficient use.
(3) Ecological needs of the river should be determined recognizing that river flows are
characterized by low or no flows , small floods (freshets),large floods and flow variability
and should accommodate development needs. A portion of river flows should be kept
aside to meet ecological needs ensuring that the proportional low and high low releases
correspond in time closely to the natural flow regime.
(4) Adaptation strategies in view of climate change for designing and management of water
resources structures, review of acceptability criteria and increasing water storage have
been emphasized.
(5) A system to evolve benchmarks for water uses for different purposes, i.e: water, foot
prints and water auditing be developed to ensure efficient use of water .Project financing
has been suggested as a tool to incentivize efficient and economic use of water.
(6) Adequate grants to the states to update technology, design practices, planning and
management practices, preparation of annual water balances and accounts for the site and
basin, preparation of hydrologic balances for water systems and benchmarking and
performance evaluation.
(7) Setting up of the Water Regulatory Authority has been recommended. Incentivization of
recycle and re-use has been recommended. The central government has brought final
draft of the national Water Framework bill,2016 to provide uniform National Legal
framework to manage water in a better and efficient way.
 The comprehensive draft bill proposes model law for all states. However, water being a
state subject under VII schedule of Constitution, the law will be not binding on Stated for
adoption. Therefore, the draft National Water Framework Bill, 2016 suggests basin –level
management.

Summary:

The term Right to Health is nowhere mentioned in the Indian Constitution yet the Supreme Court
has interpreted it as a fundamental right under Right to Life enshrined in Article 21. It is a
significant view of the Supreme Court that first it interpreted Right to Health under Part IV i.e.
Directive Principles of State Policy and noted that it is the duty of the State to look after the
health of the people at large. In its wider interpretation of Article 21, it was held by the Supreme
Court that, the Right to Health is a part and parcel of Right to Life and therefore one of
fundamental rights provided under Indian Constitution. In the real sense, the court has played a
pivotal role in imposing positive obligations on authorities to maintain and improve public
health.

An effective system of people’s monitoring of public health services if organized at the village,
block and district levels with powers conferred in Panchayati Raj system would involve
community in health services whereby significantly increasing the accountability of these
services. The citizens have a right to quality health care, treatment and medication regardless of
race, religion, social status and ability to pay. The duties of the State and Municipal authorities
can be enforced through the Courts whenever a breach occurs. It is in the enforcement of these
obligations of the State and local authorities that the Courts can play an effective role in
safeguarding the right to health of the citizens. The overview of the plans and policy reports not
only throws light on the gap between the rhetoric and reality but also the framework within
which the policies have been formulated. The health reports and plans mostly concentrated on
building the health services infrastructure and even this lacked a sense of integration. Most of the
policy reports miss out on the importance of a strong referral system. Instead, there has been
more emphasis on building the primary level care and even that has lacked proper
implementation.
The multisectoral approach that is much needed and the inter sectoral linkages that are essential
for a vibrant health system have not been well thought out, and there has been no plan drawn out
for it later. The outline of plan documents and their implementation have been incremental rather
than being holistic.

It is important to question whether it is only the low investment in health that is the main reason
for the present status of the health system or is it also to do with the framework, design and
approach within which the policies have been planned. At the same time it can also be concluded
that it is not only the obligation of the State to take steps in promoting the health care to the
people but certain groups like the health professional associations such as medical associations;
those providing health care like medical professionals; those involved in service delivery like
medical representatives; health authorities both governmental and non governmental; health
promotion groups like NGOs providing health related education, working in sexual and
reproductive health and mental health; community health care groups, advocates for patients’
rights and anti-smoking organizations. Trade unions, consumer protection agencies and religious
groups may also contribute towards providing health issues.

All these groups should mainly focus health in concurrence with human rights, humanitarian
assistance, sustainable development, domestic violence, education and the environment in which
they live. The healthcare services provided by all of the above groups should mainly focus on the
poor, vulnerable or otherwise disadvantaged group like women ,children, adolescents, aged
persons, refugees, asylum seekers, minority groups suffering from discrimination, indigenous
peoples, persons with disabilities, victims of communal violence and victims of natural
calamities.