It is agreed that social determinants or socio-economic factors impact the health of individuals and communities. This is why the realization of the right to health cannot be limited to access to health care offered by a doctor or in a hospital context. From this perspective, we must grant, within our health network, an even more important role to social services, public health and mental health services, in particular.
The right to health also involves state interventions in housing, work, a healthy environment, education, etc. This, in accordance with the approach of the interdependence of rights, advocated internationally by the World Health Organization and the UN Committee on Economic, Social and Cultural Rights, and to which the League of Nations subscribes. rights and freedoms (LDL). In this regard, you will find on the LDL website a definition of the right to health, which underlines the importance of the participation of the population in the definition of health and social services strategies.
The State is responsible for the protection and fulfillment of all human rights, including the right to health. This does not mean that it is the only one providing the services necessary for the realization of this right, but rather that it is responsible for this realization as well as for violations of the right to health. The recent adoption of the Act aimed at making the health and social services system more efficient – the famous PL 15 – raises questions in this regard.
On the one hand, it entrusts the new Santé Québec agency, a state corporation similar to Loto-Québec or the Société des alcools du Québec, with responsibility for the operations of the health network, while entrusting the Minister of Health that of orientations and policies. On the other hand, it promotes the increase in the number of private actors engaged in the delivery of health care and services, which are not subject to human rights requirements if they are not establishments within the meaning of the Law. We recently noted, for example, that the Minister of Health did not know how many patient hours a family medicine group devoted to them, which he says he is trying to remedy. It is therefore not so easy to keep an eye on private matters.
The question therefore arises as to how the government will henceforth respond to its responsibility with regard to the right to health given the new distinction between health care orientations and operations. It arises all the more as Santé Québec will evolve in a managerial environment, seeking efficiency at all costs, marked by figures, targets and measurement. Furthermore, this environment will be largely limited to the delivery of curative health services. What will happen, under the governance of Santé Québec, to already unloved services in the health network, such as public health, mental health and social services?
Quebec parliamentarianism has demonstrated the effectiveness of mechanisms ensuring that public actors report annually directly to the National Assembly. This is the case of the Public Protector and the Commission on Human Rights and Youth Rights. Such mechanisms allow parliamentarians to highlight dysfunctions at the source of the violation of several human rights. However, Santé Québec, as a state corporation and operating agent of the health system, will not be subject to such a democratic exercise. However, it will serve as a screen for the Minister of Health, who will be tempted to avoid his responsibility towards the right to health.
Quebec therefore needs, in this new context, a mechanism to evaluate the implementation of the right to health in all its dimensions. Why not entrust this task to the National Assembly, also providing a path of participation open to the population? Especially since this proposal has the merit of promoting the participatory dimension of the monitoring and deployment of human rights.
Certainly, the Law is riddled with various complaint and other mechanisms intended to control service disruptions, errors and various faults recorded in the network. However, this cannot replace the need to globally evaluate the realization of the right to health in Quebec. In addition, the increase in the number of private actors outside the network, linked to Santé Québec by contract, creates entities which will escape these administrative control mechanisms.
Human rights, including the right to health, impose obligations on the State and therefore on the ministers responsible for different files, including the Minister of Health. This implies an explicit ministerial commitment to its compliance. No offense to the minister and his government, their responsibility remains complete for the realization of the right to health.