perspectives and controversies surrounding human rights

Global Health and Justice Project

The Right to Health: Perspectives and Controversies

Beth E. Rivin, M.D., M.P.H.


Overview

Definitions: Health, Human Rights and the Relationship

The Right to Health under International Law

Controversies and Challenges in Health and Human Rights


Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

The correct bibliographic citation for the definition is:Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

The Definition has not been amended since 1948.

WHO Definition of Health

http://www.who.int/


Institute of Medicine 2008

The U.S. Commitment to Global Health: Recommendations for the New Administration (Obama)

Global health is not just a state but also the goal of improving health

for all people by reducing avoidable disease, disabilities and

deaths.

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Enabling Environments Protect Vulnerable

Populations from Inequities and Discrimination

Health

Enabling Environment (determinants of health)


Foundations of Equity in Health

Bioethics

Human Rights


Human Rights

Individual focused Inherent Dignity Inalienable Core principles of

nondiscrimination and participation


Human Rights Law

Government ↔ People


Health and Human Rights

An Approach to Improve Health Using the Human

Rights Framework


The Right To Health

Post WW II International Human Rights

Law


Universal Declaration of Human Rights, Article 25

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”


The Cold War Split

International Covenant on Civil and Political Rights (ICCPR)

International Covenant on Economic, Social and Cultural Rights (ICESCR)


International Covenant on Economic, Social and Cultural

Rights, Article 12(1)

“The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.”


ICESCR Article 12 (2) The steps to be taken by the States Parties to the present

Covenant to achieve the full realization of this right shall include those necessary for:

(a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child; (b) The improvement of all aspects of environmental and industrial hygiene;

(c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases;

(d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.

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UN COMMITTEE ON ECONOMIC, SOCIAL

AND CULTURAL RIGHTSTwenty-second session

Geneva, 25 April-12 May 2000

Comment 14 on the Highest Attainable Standard of Health

ICESCR Article 12(1)

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UN Comment 14 Article 12.1

Health is a fundamental human right indispensable for the exercise of other human rights

The right to health is not the right to be healthy


UN Comment 14Article 12.1

The highest attainable standard of health takes into account the individual’s biological factors, socio-economic preconditions and a State’s available resources

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Comment 14Article 12.1

A further important aspect is the participation of the population in all health-related decision-making at the community, national and international levels


Comment 14Article 12.1

The right to health can be measured:

• Availability• Accessibility • Acceptability• Quality


UN Comment 14Article 12.1

• Accessibility (4 dimensions) Nondiscrimination Physical Accessibility Economic Accessibility Information Accessibility

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UN Comment 14Article 12.2 (a)

Reduction of stillbirth rate and of infant mortality and for the healthy development of the child may be understood as requiring measures to improve child and maternal health, sexual and reproductive health services, family planning, emergency Ob, and access to information as well as necessary resources

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UN Comment 14Article 12.2 (b)

The improvement of all aspects of environmental and industrial hygiene includes preventive measures with respect to occupational accidents and diseases, ensuring adequate supply of safe and potable water and basic sanitation, prevention and reduction of population exposure to substances such as radiation and harmful chemicals.

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UN Comment 14Article 12.2 (b)

Also includes adequate housing, safe and hygienic working conditions, an adequate supply of food and proper nutrition and discourages the abuse of alcohol and the use of tobacco, drugs and other harmful substances.

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UN Comment 14Article 12.2 (c)

The prevention, treatment and control of epidemic, endemic, occupational and other diseases requires the establishment of prevention and educational programs for behavior related health concerns, such as STIs, the promotion of social determinants of health, education, economic dev and gender equity……

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UN Comment 14Article 12.2 (c)

includes, the right to treatment and the creation of a system of urgent medical care in cases of accidents, epidemics, hazards and disaster relief.

The control of diseases refers to States’ individual and joint efforts to make available technologies for epi surveillance, data collection, immunization control……………….

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UN Comment 14Article 12.2 (d)

The creation of conditions which would assure to all medical service and medical attention in the event of sickness, both physical and mental includes preventive, curative, rehabilitation health services and health education, regular screening programs, treatment of prevalent diseases….

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Convention on the Elimination of All Forms of Discrimination Against

Women (CEDAW)


CEDAW

Article 12 1. States Parties shall take all appropriate measures to eliminate discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access to health care services, including those related to family planning.


CEDAW

Article 14 1. States Parties shall take into account the particular problems faced by

rural women ……….and, in particular, shall ensure to such women the right:

(b) To have access to adequate health care facilities, including information, counselling

and services in family planning; measures to ensure the application of the provisions of the present Convention to women in rural areas.


Convention on the Rights of the Child (CRC)


CRC Article 6

States Parties recognize that every child has the inherent right to life.

States Parties shall ensure to the maximum extent possible the survival and development of the child.


CRC Article 17

States Parties recognize the important function performed by the mass media and shall ensure that the child has access to information and material from a diversity of national and international sources, especially those aimed at the promotion of his or her social, spiritual and moral well-being and physical and mental health.


CRC Article 24

States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.


CRC Article 27

States Parties recognize the right of every child to a standard of living adequate for the child's physical, mental, spiritual, moral and social development.


Strategy For Equity in Health Development

Human Rights Analysis, Planning and Action


Human Rights Analysis in Health Policy and Programs

HeRWAI- Health Rights of Women Assessment Instrument (Aim for Human Rights and Uplift International)

U.S. human rights analysis of health plans (multiple organizations, such as NESRI, NoHLA, Uplift International)


Human Rights Analysis of Health Systems

Gunilla Backman et al., Health systems and the right to health: an assessment of 194 countries, 372 The Lancet 2047-85 (2008).

https://courses.law.washington.edu/rivin/H540a_Sp09/private/Backman_etal_2008.pdf

https://courses.law.washington.edu/rivin/H540a_Sp09/private/Backman_etal_2008.pdf


Human Rights Action: UN Agencies

UNICEF: Works for Children’s Rights, guided by the Convention on the Rights of the Child

UNAIDS: Works to fight discrimination against people living with HIV, advocates for the rights of vulnerable populations and advocates for human rights


Human Rights Action: Physicians for Human Rights

Documents health rights violations Supports the rights of health workers Advocates for the right to health


Human Rights Action: Uplift International

Promotes the right to health through health workforce capacity building

Trains NGOs about human rights analysis and advocacy plans

Supports and trains teachers in madrasah (Islamic day schools) to teach nutrition, health and the rights of the child.


Controversies and Challenges

Universality issue Metrics/indicators Using human rights methodologies

for improved population health: is it the right strategy?


Are Human Rights Universal?

Current Controversy:Universalism v. Cultural Relativism


The Cairo Declaration on Human Rights in Islam

• Adopted and Issued at the Nineteenth Islamic Conference of Foreign Ministers in Cairo on 5 August 1990.

• States that rights must be in accordance with Islamic Syari’ah Law

• Limits fundamental rights and freedoms articulated in int’l hr law, especially for women


Human Rights Indicators

Still in evolution


Using human rights approach for advocacy?

The right strategy for improving health?• Data is still coming in…….relatively new

strategy (late 1980’s)• Context-some countries don’t endorse

certain rights• Donors-some shy away from funding

human rights work


The End

perspectives and controversies surrounding human rights

Health & Medicine

mental health

maternal health

world health organization

reproductive health

healthrelated decisionmaking

human rights framework

international human

healthbioethicshuman