Measuring progress in the realization of the international human right to health: The example of the United States

Key to realizing the international human right to health throughout the world is how progress is measured. Historically, progress has been measured by ratification of treaties, adoption of legal authorities for public health care programs, and comparison of per capita health expenditures as a proxy for resources committed to health care. These measures fall short as accurate indicators of true progress. Health services research has developed indicators, measures, methods and data for measuring and comparing progress in the realization of the international human right to health. The World Health Organization (WHO), United Nations Development Programme (UNDP), Organization for Economic Co-operation and Development (OECD) and World Bank have promoted development of statistical indicators and assisted nations in developing infrastructure for collecting data and reporting indicators. The four key categories of indicators to date are: (1) population health status and outcomes, (2) population access to health care, (3) health sector performance on quality and efficiency, and (4) government competence and commitment to health care. Comparing national performance on realization of the international human right to health with statistical indicators is more informative than comparing legal institutions or per capita health spending. The case of the US is instructive. The US spends more on health care per capita than other countries but performs less well on measures of population-based health status or health sector performance. Also, inequity in American society contributes to disparate health outcomes. In 2000, WHO ranked the US 37th among nations due to disparities in race and income.