Even in a region characterized by a number of countries with robust constitutions and judicial enforcement of social rights, Colombia stands out as a striking example of judicial activism regarding health rights. Better known outside the region for its brutal fifty-year-old civil conflict, it seems startling if not paradoxical that the Colombian Constitutional Court (the Court) has developed some of the most progressive jurisprudence in the world with respect to economic, social and cultural rights. The Colombian context indeed presents many contrasts: a long tradition of creating democratic institutions coexists with authoritarianism and alarming levels of political and social violence, and entrenched poverty persists despite years of strong economic growth. 1 The extreme social inequality in Colombia is reflected in its health statistics, where national averages mask deep disparities that run along urban versus rural divides, as well as racial, ethnic and class lines. 2
Nowhere has Colombia's judicialization of social demands been more striking than in the health domain. According to a report by the Human Rights Ombudsman's Office of Colombia, between 1999 and 2008, a stunning 674,612 actions for protection of constitutional rights were filed before the courts in relation to health issues; the Court itself has taken more than a thousand health cases since its formation. 3 By 2008, it was clear that recourse to the courts had become an essential "escape valve" in a health system that was incapable of regulating itself; but the routinization of judicial intervention had created additional problems.
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