Investigating Opportunities and Threats to the Right to Health in a New Data-driven Economy

A key part of HRBDT’s research is investigation into how data analytics and AI technologies can promote and hinder human rights in the areas of health and social care.

In May, HRBDT consultant Dr Carmel Williams and Prof Paul Hunt published an article in the Journal of Human Rights Practice on ‘Using Big Data to Demonstrate Indivisibility of Rights and Promote Cross-Sectoral Responses to the Sustainable Development Goals’. The article explores the meaning of indivisibility of human rights in the context of the Sustainable Development Goals (‘SDG’). The authors draw on Big Data to explore uptake of a ‘free’ health service for children in New Zealand. With data showing people living with multiple deprivation are less likely to take advantage of health checks for their children than people with fewer deprivations, it suggests action is required across various social domains to address multiple hardships that limit people’s capacity to access health care. These findings are a practical demonstration of the indivisibility of human rights. The right to health cannot be fulfilled when other social rights are unfulfilled. The article argues that the use of Big Data, in well resourced settings, could enhance SDG accountability mechanisms by providing a consistent focus across all SDG targets on specific groups in any country, such as people living with multiple deprivations.

Universal health coverage (UHC) has recently garnered widespread support as a policy objective, being adopted by many nation states. Evaluations of UHC by the World Bank, among others, are largely positive, indicating increased access to affordable health care for many. A recent study by Professor Sonia Bhalotra and Manuel Fernandez Sierra used “big data” from Colombia to investigate unmet demand for healthcare. Details of the research can be found in this blog.

The right to health in Colombia is protected and in 1991 the Constitution was amended to indicate a state commitment to the right to health for all. As a constitutional right, the right to health is enforceable, and there is a widely known route that makes it fairly straightforward for individuals to appeal to the Constitutional Court. These judicial claims (tutelas) are costless, simple, are filed with any judge within the local jurisdiction, and have preferential proceeding such that the judge is mandated to return a decision within 10 days. This is a major `experiment’ in accountability.

The ease of filing tutela claims, together with a judiciary proactive in the protection of social rights, has encouraged their use and between 2010 and 2016, more than 675,000 tutelas were filed against health insurers. On average, 80 percent of these claims have been decided in favour of claimants.

Using administrative data on judicial claims as a measure of the prevalence of unmet demand for health care, Sonia and Manuel analyse impacts on population level health outcomes, leveraging variation over time within insurer and municipality, measuring outcomes as overall and cause and age-specific mortality rates from vital statistics data. The study found large and robust causal effects of health insurer restrictions – revealed through judicial claims- on access to health services and on mortality rates. Using fine-grained data, the study found that restrictions apply to richer and poorer segments of the population and that they impact mortality across the age and cause distribution, with the strongest impact on mortality from ischaemic heart and cerebrovascular diseases.