Conclusions 2021 of the European Committee of Social Rights on Health, Social Security and Social Protection

The Committee has examined both the country reports on the thematic group of provisions related to health, social security and social protection and the information on follow-up to collective complaints. The reference period for the reporting system is 01/01/2016- 31/12/2019 so the period immediately before the Covid 2019 pandemic, a period of the greatest importance for the shaping of responses during the COVID-19 crisis.

In relation to the right to protection of health, the Committee issued a statement in April 2020 ^[1] with recommendations : “healthcare in a pandemic must be effective and affordable to everyone, and that groups at particularly high risk, such as homeless persons, persons living in poverty, older persons, persons with disabilities, persons living in institutions, persons detained in prisons, and persons with an irregular migration status must be adequately protected by the healthcare measures put in place”.

In relation to safeguarding the social rights during the COVID-19 crisis, the committee sent a targeted questionnaire[2] based on their March 2021 statement.[3] In this, the committee reminds the states that “in designing and implementing new additional measures, States Parties must take due account of all social rights-holders, giving special attention and appropriate priority to the most socially vulnerable groups and individuals. (…).”

In this questionnaire, the Committee recalled that States Parties were required to provide non-resident foreigners, without resources, with emergency social and medical assistance. Such assistance must cover accommodation, food, clothing and emergency medical assistance, to cope with an urgent and serious state of need. No condition of length of presence can be set on the right to emergency assistance (Complaint No 86/2012, European Federation of national organisations working with the Homeless (FEANSA) v. the Netherlands, decision on the merits of 2 July 2014, §171). The Committee has asked the states to answer this in the next thematic report to confirm that these requirements are met.

The Committee took note of the reply to the questions related to Covid-19 for information purposes only, as they related to developments outside the reference period. In other words, the information referred to in the Covid-19 section has not been assessed for the purposes of Charter compliance in the current reporting cycle.

The European Committee concluded that several problems relating to health and social protection still persist in Europe in the period 2016-2019. The individual assessment country by country can be found here.

Among the different conclusions, we would like to highlight primarily the conclusions in relation to the rights that have special implications for homeless people.

Article 11 - The right to protection of health.

In their conclusions, the Committee found that many States failed to take adequate steps to address the high levels of infant and maternal mortality, which when examined together with other basic health indicators, pointed to weaknesses in the health systems. Public healthcare expenditure remains too low in certain countries and the right to access to health care is not guaranteed sufficiently.

With respect to the obligation by States to prevent as far as possible epidemic, endemic and other diseases, the Committee noted the absence of efficient immunisation and epidemiological monitoring programmes, the lack of legislation prohibiting the sale and use of asbestos or the lack of lack of sufficient measures to ensure access to safe drinking water in rural areas.

Article 13 - The right to social and medical assistance

22 nonconformities and several deferrals, only Netherlands was in conformity

The assessment under Article 13§1 and the conclusions of non-conformity concern inter alia the following grounds:

• the level of social assistance paid to a single person without resources is not adequate (below the poverty threshold): Armenia, Bosnia and Herzegovina, Croatia, Czech Republic, Denmark, Estonia, Hungary, Latvia, Lithuania, Malta, the Republic of Moldova, Montenegro, North Macedonia, Norway, Romania, Serbia, the Slovak Republic, Spain, Turkey, the United Kingdom.
• the right to social and/or medical assistance is not guaranteed to any person in need (the Republic of Moldova, Montenegro, Romania, Spain, the United Kingdom)
• excessive conditions of residence to access social and medical assistance for foreigners lawfully resident (Andorra, Austria, Croatia, Latvia, Lithuania, North Macedonia, Romania and Serbia)

Article 14 - The right to benefit from social welfare services

The right to benefit from social welfare services requires States Parties to set up a network of social services to help people to reach or maintain well-being and to overcome any problems of social adjustment.

A problematic issue was the access to social services by nationals of other States Parties. The problem of restrictive access to such services to foreigners remained in Azerbaijan, the Czech Republic, Hungary, Latvia, Poland, Serbia and Turkey.

The Committee found little progress in many States Parties as regards social security. Inadequate minimum level of income-replacement benefits is still the main ground of non-conformity. The minimum levels of unemployment benefit, sickness benefit and disability benefit in many countries fall below 40% of median equivalised income. The Committee did note that in some States Parties the levels have risen at a higher rate than the median income. However, they remain low or sometimes fall between 40 and 50% of the median income.

Article 30 - The right to be protected against poverty and social exclusion

The Committee concluded that in many countries the poverty level is far too high, and the measures taken to remedy this fundamental problem have been insufficient and the situation has been exacerbated by the Covid-19 pandemic.

In respect of five States (Estonia, Latvia, Serbia, Turkey and Ukraine), the ECSR found that the situation was not in conformity with Article 30 on the ground that there is no adequate overall and coordinated approach in place to combat poverty and social exclusion.

On the Positive Developments, the committee pointed out that in the Czech Republic since 2019, the Ministry of Health has been implementing the project “Expanding Access and Creating Healthcare Opportunities for the Homeless” (abbreviated as “Doctor’s Office for the Homeless”) aimed at people living on the streets who are at risk of losing their refuge or living in socially excluded communities. Its main purpose is to provide medical assistance to target groups who do not seek medical and social care and who do not participate in preventive check-ups and programmes.

The Committee also made public its Findings 2021 in respect of eight States bound by the collective complaints procedure concerning the follow-up given to decisions on the merits of collective complaints in which the Committee found a violation. An analysis on this can be found in a separate piece of news here.