Digitalization and the right to health in remote regions
The ongoing COVID-19 pandemic has led to advances in digitalization. Trade, education, work, access to locations, and much more, are facilitated through technology. In this text, it will be shown how digitalization can be utilized to improve health services in remote regions This practical need will persist after the pandemic will have been overcome. In this text, it will be shown that the human right to health, which is protected by international human rights treaties, can be implemented more effectively in rural and remote regions by facilitating digitalization strategies, like the one seen already in Finland. The discussion will be conducted in the framework of the International Covenant on Economic, Social and Cultural Rights (ICESCR), which is ratified by most countries around the world. As technological progress continues, such technical-legal developments based on increased accessibility will become relevant globally.
In the last two years, COVID-19 has killed millions of people around the world, and many of us have lost friends or family members. COVID-19 has affected many of us in different ways, and governments have found different manners to respond to the crisis. In the summer of 2020, a couple of colleagues from around the world got together to write a book on governance responses to COVID-19, “Governing the Crisis: Law, Human Rights and COVID-19”, which I had the pleasure to edit. It was a collaborative project that brought together diverse opinions and different perspectives. What was hard to imagine back then was that we would still be in the pandemic crisis two years later, despite the fast development of vaccines. One of the governance shortcomings that was difficult to imagine was that states would not do enough to combat the pandemic and that governments would practically surrender in the face of new mutations and higher transmission risks.
Thanks for reading International Law! Subscribe for free to receive new posts and support my work.
Today, we know much more about COVID-19 than two years ago. It is now clear that the disease is not limited to the lungs but that it affects many organs and in particular blood vessels. Long-Covid has emerged as a major health challenge and the impacts of the virus on the brain should be reason enough to eradicate SARS-CoV-2, rather than allowing it to spread, in particular among children who cannot yet be vaccinated.
It is important to remember that human rights not only consist of the state not taking specific actions that violate human rights. Human rights violations can also take the form of ommissions, when there is an active duty of the state to protect legal goods that are protected through human rights law, such as human life, health, and physical integrity. It is not enough for the state to refrain from actively killing or injuring people, the state also has a duty to protect life, health, and physical integrity. The realization of such rights requires specific action to be taken, for example by ensuring that the health care infrastructure is sufficient to provide essential health care services. The duty to protect human rights actively, does not oblige the state to guarantee perfect protection against all potential risks. The law, including human rights law, does not require the impossible. What international human rights law does require, however, is for the protection of human rights, including the protection of human life, health, and physical integrity, to be effective.
As we learn more about COVID-19 and Long Covid, we see the long-term consequences of the infection. Even those who had few symptoms when initially infected run the risk of long-term damage to blood vessels and organs, such as the brain. The infection itself is already harmful to human health. It is therefore not compatible with the human right to health and physical integrity, nor the human right to life, nor with human dignity as such, to expect people to get infected in order to create a kind of herd immunity. This is even more so as it now is becoming clearer and clearer that re-infections with SARS-CoV-2 are possible and that an earlier infection does not provide the same kind of protection that the vaccination can give. There is a very real risk that governments sacrifice the health of their citizens and residents in pursuit of an illusion. In light of the emergence of the Omicron variant, it seems more and more likely that more restrictions will become necessary in the near future to limit infections.
Taking effective protective measures against the further spread of SARS-CoV-2 is particularly important for remote and rural communities, for example in the Arctic. If the next hospital is hours away by road, if there are just a few dozen intensive care beds in a province, if winter weather makes health services less accessible, health care services must reach the patients where they are. In thinly populated areas in the Arctic, this can mean an increasing reliance on telemedicine, as is already the case in rural communities in Finland, where municipalities provide rooms with telemedicine equipment that allow local residents to have a meeting with a physician remotely via video, instead of having to travel for hundreds of kilometres to the regional hospital. A few days ago, the use of a nearly completely autonomous drone to transport a defibrillator to a patient in Sweden made global news. The defibrillator arrived within minutes. Today, defibrillators are designed to be easy to use by persons without any prior instructions as the user interface will walk the user through the necessary steps. In many cities, at least in richer countries, defibrillators have become common in shared and public spaces, such as subway stations or malls, similar to the availability of fire alarms or fire extinguishers. Combining ease of use with accessibility and advanced technology is one way to utilize medical technology also in places where medical staff is not present immediately. In Norway, COVID-19 patients have been provided technical equipment to monitor themselves at home while recuperating, thereby easing the burden of hospitals while ensuring that vital functions are being monitored at all times. The latter approach requires the ability to intervene quickly and to provide the patient with the required health care immediately and will therefore in practice not always be suitable for remote regions. Long-term monitoring of patients who are very unlikely to require immediate medical assistance anytime soon, however, could also happen in rural home communities.
Essential for many of these digital health services is connectivity. In the European High North, mobile internet connectivity is provided on the basis of equality, thereby guaranteeing that also residents in remote regions have access to fast mobile internet, even hundreds of kilometres north of the Arctic Circle (Kirchner, 2020). The pandemic has shown that there is an increasing need for secure (see Salminen & Pälas, 2021) connections, not just in many workplaces but in particular for the interaction between patients and medical staff. In particular patient data has to be protected adequately (Cristani, 2021). Although electronic communication cannot completely replace all in-person interaction, in particular in medical settings, the transmission of information can go a long way towards improving the provision of medical services in remote communities. That requires investments in technology and infrastructure and there is a real risk that remote regions in economically disadvantaged countries fall further behind and that a lack of funding can continue to mean a lack of access to medical services. Digitalization of medical services can go a long way towards realizing the right to health care in an equitable manner, but the costs must not be underestimated.
Health is a human right and states have a positive duty to protect human health as much as possible. This already follows from Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), which refers to “the highest attainable standard of physical and mental health” (Article 12 (1) ICESCR). This does not require the state to provide perfect protection against all possible risks but positive measures need to be taken towards the continuous improvement of the realization of the human right to health. Classically, that has been understood as providing health care infrastructure by operating hospitals, emergency rescue services etc. Today, this requirement to provide effective infrastructure and the necessary human resources deserves a holistic approach and it will also have to include electronic means of communication and telemedicine. Most importantly, it requires good working conditions for health care staff. In particular, during the pandemic, the burden on staff members in hospitals and other medical institutions in many countries has become unbearable. Improving their situation is not only a matter of decency and labour laws but also an aspect of the effective realization of the right to health.
For remote communities in the Arctic, these issues are particularly important. This is not only the case due to the limited availability of health care services as a result of low population density but also because of the need for mental health care (see Kirchner, 2017). This need is particularly pronounced in the Arctic, not least due to the high risk of suicide in some Arctic regions (Lehti et al., 2009; Trout & Wexler, 2020) which has been associated with cultural disconnects (see Haggarty et al., 2009) as an ongoing result of colonialism (Silviken & Kvernmo, 2007; Barrett, 2019). Suicide prevention (see Collins et al., 2017) will remain a key concern in the Arctic for the future as well. Here, too, digitalization can enhance access to medical and psychological services.
Protecting human health in all its forms is a task for society as a whole. This also includes mental health, as is now recognized for example by the Arctic Council (Arctic Council, 2020). Everybody who lives in the Arctic (and the same applies to other rural and remote regions) depends on the natural environment in one way or another, be it through food security or exposure to extreme climate, weather events, or other risks. Here it becomes evident that the effective protection of human health requires a holistic methodology, such as the “One Health” approach. It is not a coincidence that the University of Alaska in Fairbanks is home to a research center on One Health (University of Alaska Fairbanks, 2021) and that Finland’s Prime Minister Sanna Marin emphasized One Health in her 2020 speech to the General Assembly of the United Nations during a special session on COVID-19 (Marin, 2020). That speech is still well worth watching as it includes ideas that transcend politics but reflect values that are shared across the Arctic and that put people before profits. The protection of human life and health requires all hands on deck and the activation of all technological tools at our disposal, for everybody, everywhere, and without discrimination.
While the Arctic was used as an example of how the human right to health can be developed over time, the digitalization of health services is relevant for rural and remote regions around the world. As technological progress continues, the increasing inclusion of technical solutions will more and more become part of the legally valid expectations for the realization of the human right to health. The continuous realization of social rights is not limited to merely increasing more of the traditional infrastructures, such as hospitals, but also includes the adoption of new technologies, such as the vaccines against the SARS-CoV-2 virus, drones delivering pharmaceuticals, or telemedicine solutions that reach everybody who needs them.
Arctic Council (2020). “The Coronavirus in the Arctic: Spotlight on Mental Health”, 22 April 2020, https://arctic-council.org/news/the-coronavirus-in-the-arctic-spotlight-on-mental-health/.
Barrett, Olivia (2019). “Suicide rates and patterns among Indigenous Peoples of the Artic”, 27 June 2019, https://jsis.washington.edu/news/suicide-rates-and-patterns-among-indigenous-peoples-of-the-artic/.
Collins, Pamela Y. et al. (2017). “Suicide prevention in Arctic Indigenous Communities”, in: 4 The Lancet Psychiatry, pp. 92-94.
Cristani, Federica (2021). “Right to Privacy and Data Protection During the Coronavirus Crisis: the Debate Over the Use of Tracking Apps in Italy”, in: Kirchner, Stefan (ed.), Governing the Crisis: Law, Human Rights and COVID-19. Vienna: Lit Verlag, pp. 77-99.
Haggarty, John M. et al. (2009). “Suicidality in a Sample of Arctic Households”, in: 38 Suicide and Life-Threatening Behavior, pp. 699-707.
International Covenant on Economic, Social and Cultural Rights (1966). Adopted 16 December 1966, entered into force 3 January 1976, 993 United Nations Treaty Series 3.
Kirchner, Stefan (2017). “Access to Mental Health Care in the Arctic”, in: 4 Russian Journal of Comparative Law, pp. 78-87.
Kirchner, Stefan (2020). “Mobile Internet Access as a Human Right: A View from the European High North”. in Salminen, Mirva; Zojer, Gerald & Hossain, Kamrul (eds.), Digitalisation and Human Security: A Multi-Disciplinary Approach to Cybersecurity in the European High North, pp. 141-173.
Lehti, Venla et al. (2009). “Mental health, substance use and suicidal behaviour among young indigenous people in the Arctic: A systematic review”, in: 69 Social Science & Medicine, pp. 1194-1203.
Marin, Sanna (2020). Prime Minister Marin at Special Session of the UN General Assembly 3-4 December 2020.
Salminen, Mirva & Päläs, Jenni (2021). “The COVID-19 Induced Societal Digital Leap: Incorporating a Legal View in the Responsibilisation of Individuals for Cybersecurity”, in: Kirchner, Stefan (ed.), Governing the Crisis: Law, Human Rights and COVID-19. Vienna: Lit Verlag, pp. 36-64.
Silvike, Anne & Kvernmo, Siv (2007). “Suicide attempts among indigenous Sami adolescents and majority peers in Arctic Norway: Prevalence and associated risk factor”, in: 30 Journal of Adolescence, pp. 613-626.
Trout, Lucas & Wexler, Lisa (2020). “Arctic Suicide, Social Medicine, and the Purview of Care in Global Mental Health”, in: 22 Health and Human Rights Journal, pp. 77-89.
University of Alaska Fairbanks (2021). “Center for One Health Research”, https://www.uaf.edu/onehealth/.
About the author
Prof. Dr. Stefan Kirchner is working at the intersection of international environmental law, human rights, and the law of the sea. In addition to practising law, he has taught international law at universities in Germany, Finland, Italy, Lithuania, Ukraine, and Greenland. His most recent books include “Security and Technology in Arctic Governance” (ed., 2022), “Governing the Crisis: Law, Human Rights and COVID-19” (ed., 2021), “El Ártico y su gente - Ensayos de derecho internacional” (2020), and “The Baltic Sea and the Law of the Sea - Finnish Perspectives” (with T. Koivurova, H. Ringbom and P. Kleemola-Juntunen, 2019). This text only reflects his personal opinion.
Thanks for reading International Law! Subscribe for free to receive new posts and support my work.