Case 2009-69-03

The claimants, two prisoners, alleged a violation of their constitutional rights under Article 111 of the Constitution of the Republic of Latvia (the “Constitution”) based on the failure of the Government to provide adequate diet and nutrition to protect their right to health.

In 2006, the Cabinet of Ministers of the Republic of Latvia (the “Cabinet”) adopted new regulations on the standard diet for prisoners. The regulations differentiated between employed and unemployed persons, minors, and ill prisoners. In 2009, the regulations were modified to only contain three classifications: basic level, minors, and ill persons. The modifications decreased the amount of nutrition provided to prisoners who fell in the basic level.

The claimants alleged that the new standards in Appendix 1 violated their rights under Article 111 of the Constitution, which guarantees a right to health, as they were not provided with sufficient nutrition to maintain their health. The claimants also alleged that in order to be compliant with the Constitution, the Regulations needed to differentiate between employed and unemployed prisoners and also needed to consider the prisoner’s age, height, weight, and state of health.

The Court held that there was a violation of Article 111 of the Constitution to the extent that the regulations did not provide sufficient calcium, Vitamin A, and Vitamin C. The Court declared that the government must rectify these deficiencies by June 1, 2010 in order to prevent that regulations from becoming null and void.

Article 111 of the Constitution requires that “[t]he state protects the health of people and guarantees to everyone a minimum level of medical assistance.” While there is no right to be healthy, there are certain obligations on the state to provide services that impact the opportunity a person has to attain the highest state of health. When interpreting the right to health, the Court noted that international human rights must serve as an interpretive guide. In looking at Article 12 of the International Covenant on Economic, Social and Cultural Rights, the Court acknowledged that the right to health includes an “adequate supply of safe food.” While the right to health is a social right generally subject to limitations by available resources, the Court noted that prisoners are fully dependent on the state and that international norms do not allow the state to claim inadequate resources as a defence to a claim of failure to fulfil its obligation to ensure a right to health. The state therefore had a non-derogable obligation to provide convicts with a proper nutritious diet.

As Latvia had not established state minimum nutrition requirements, the Court compared the provisions of the regulations with the Recommendable Energy and Nutrient Intakes. The Court found that generally the nutrition requirements under the regulations met the recommendations. However, there were some specific deficiencies. The plan did not provide adequate calcium, a problem that could be rectified by increasing dairy intake. The plan also did not provide sufficient Vitamin A and Vitamin C. This problem could be rectified by providing vegetables that are rich in these vitamins. The Court held that the specific deficiencies must be rectified if the regulations are to be considered compatible with Article 111 of the Constitution. The Court noted that invalidating the regulations immediately would have a detrimental impact on prisoners and therefore declared that the regulations would only become null and void if the problems were not rectified by June 1, 2010.

With regards to the claimants’ allegations that the regulations must differentiate between employed and unemployed prisoners and also needed to consider the prisoner’s age, height, weight, and state of health, the Court held that this was not required.

“8.1. Satversmes tiesa ir norādījusi, ka no šīs Satversmes normas neizriet personas tiesības būt veselai vai valsts pienākums nodrošināt ikvienam iespējami augstāko veselības līmeni. Tomēr tiesības uz veselību ietver gan konkrētas brīvības, gan konkrētas tiesības. Brīvības nozīmē, piemēram, to, ka ikviens cilvēks var brīvi kontrolēt savu veselību un ķermeni. Satversmes tiesa norādījusi arī uz personas brīvību veikt pasākumus, ko tā uzskata par nepieciešamiem savas veselības nodrošināšanai. Savukārt tiesības ir saistāmas ar valsts pienākumu izveidot atbilstošu veselības aizsardzības sistēmu. Tādējādi tiesībām uz veselību atbilst valsts pienākums gādāt par veselības aprūpes iestāţu, pakalpojumu, aprīkojuma un zāļu esamību un pieejamību, kā arī citiem apstākļiem, kas ietekmē personu iespēju sasniegt visaugstāko veselības līmeni.”

“8.1. The Constitutional Court has already stated that this norm does not implicate a person’s right to be healthy and the State’s responsibility to attain the highest state of health for everyone. Right to health, however, contains particular freedoms and rights. Freedom means one’s control of his/her body and health. The Constitutional Court has also indicated the action one can carry out for maintaining a healthy state. Rights, however, mean the State’s responsibilities of providing for such services and other circumstances, which affect one’s chances to attain the highest state of health.”

“8.2. … ANO Starptautiskā pakta par ekonomiskajām, sociālajām un kultūras tiesībām 12. pants noteic, ka šā pakta dalībvalstis atzīst katra cilvēka tiesības sasniegt visaugstāko fiziskās un psihiskās veselības līmeni. ANO Ekonomisko, sociālo un kultūras tiesību komitejas vispārējā komentārā Nr. 14 “Tiesības uz visaugstāko sasniedzamo veselības līmeni” (turpmāk – Vispārējais komentārs Nr. 14) norādīts, ka tiesības uz veselību ietver ne vien tiesības uz veselības aprūpi, bet arī tiesības uz veselību veicinošiem faktoriem, tādiem kā droša dzeramā ūdens pieejamība, adekvāti sanitārie apstākļi, pienācīgs nodrošinājums ar ēdienu un uzturvielām u.c. Tā, piemēram, viens no valsts pienākumiem, tai īstenojot tiesības uz veselību, ir nodrošināt visiem vienlīdzīgu pieeju veselību veicinošiem faktoriem, tostarp ēdienam ar pietiekamu uzturvērtību. Savukārt viens no pamatpienākumiem, kurš valstij, īstenojot tiesības uz veselību, ir jāpilda un no kura valsts nevar atkāpties, lai arī kāda būtu tās ekonomiskā situācija, ir pienākums nodrošināt ikvienam tāda minimāli nepieciešamā ēdiena pieejamību, kura enerģētiskā vērtība būtu pietiekama, lai pasargātu cilvēku no bada.”

“8.2. … Article 12 of the International Covenant on Economic, Social and Cultural Rights declares that member countries of this Covenant acknowledge a person’s right to attain the highest possible level of physical and mental health. In UN Committee on Economic, Social and Cultural Rights General Comment No. 14: The right to the highest attainable standard of health (hereinafter – General Comment No. 14) it is stated that the right to health is not only a right to appropriate health care but also to the underlying determinants of health, such as access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions. Thus, one of the State’s responsibilities is to provide equal access to underlying determinants of health, including nutritionally adequate nourishment. Regardless of its economic situation, the State’s duty is to ensure access to minimum essential food, which is nutritionally adequate and safe, to ensure freedom from hunger to everyone.”

“8.3 … Nodrošinot ieslodzītos ar uzturu, jāņem vērā, ka viņi atrodas pilnā valsts apgādībā, kā arī valsts iestāţu pakļautībā. Ne visiem ieslodzītajiem tiek nodrošināts darbs, tāpat viņiem ir liegta iespēja saņemt pārtikas pienesumus. Līdz ar to lielākā daļa ieslodzīto ir atkarīgi no uztura, ko tiem nodrošina valsts. Tādēļ valstij ir pienākums nodrošināt ieslodzītos ar pietiekamu uzturu – tādā daudzumā un kvalitātē, kas nevarētu nodarīt kaitējumu veselībai arī ilgstošā laika posmā.”

“8.3. … It should be taken into account that convicts are fully provided for by the State. Not all convicts are provided with work and they do not have an opportunity to receive additional food. Majority of prisoners, therefore are dependent on the nutrition provided by the State. For that reason, the State is obligated to provide convicts with a proper nutritious diet which would not harm their state of health in the long-term.”