HEALTH AND HUMAN RIGHTS An Over by liaoxiuli1


									Everything You Wanted to Know
  About the Right to Health …
     I know you know this, but every
    boring Powerpoint has to start with
     what are human rights anyway?
 Human Rights are social claims or entitlements
  that apply to all human beings -- they accrue to a
  human being by virtue of being human and are the
  birthright of all human beings
 All human rights are universal, indivisible and
  interdependent and interrelated.
 Human rights protection and promotion is the
  responsibility of Governments. They have
  specific obligations.
     Q: So what does the UDHR
    (1948) have to say about the
           right to health:
             A: A wee bit
   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, …
    OK, forget the UDHR – let’s get to the law What
     does Int’l Covenant on Economic, Social and
         Cultural Rights (1974) Say in Art. 12?

 States recognize the right of everyone to the enjoyment
  of the ―highest attainable standard of physical and
  mental health.‖
 Pedants among us will note difference from WHO
  definition of health, which is ―a state of complete
  physical, mental and social well-being and not merely
  the absence of disease or infirmity."
 So covenant does not aspire to ―complete… well-being‖
  or a right to be healthy but rather ―highest attainable
 So what does highest attainable
        standard mean?
Article 12 lists steps to be taken to achieve the full realization
   of this right shall include those necessary for:
(a) provision for the reduction of the stillbirth-rate and of
   infant mortality and for the healthy development of the
(b) improvement of all aspects of environmental and
   industrial hygiene;
(c) prevention, treatment and control of epidemic, endemic,
   occupational and other diseases;
(d) creation of conditions, which would assure to all medical
   service and medical attention in the event of sickness
   Just those four specific things?
        Seems pretty narrow.
No – these are understood as four examples illustrating the content
(a) Reducing maternal and infant mortality implies a priority for services
      for and protection of women and children
(b) environmental and industrial hygiene implies assuring physical
      conditions for health – clean water, air
(c) control of epidemic and occupational implies public health policies—
      vaccinations, surveillance
(d) medical service an medical attention in the event of sickness implies
      health care services
And we add from other parts of the covenant, non-discrimination, which
      gets to social determinants of health
This interpretation is set out in General Comment 14 (2000) by the
      Committee on Economic, Social and Cultural Rights – our guide to
      the right to health
   Are there other human rights instruments
   that recognize health as a human right?

So glad you asked. One is Convention on Elimination of
  all forms of discrimination Against Women (Article 12)
States must 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.

States shall ensure to women appropriate services in connection
  with pregnancy, confinement and the post-natal period, granting
  free services where necessary, as well as adequate nutrition
  during pregnancy and lactation.
And that is not all, said the Cat in
             the Hat.
Convention on the Rights of the Child, Article
"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
Regional treaties, conference declarations, etc
         OK, enough of the list.
             What’s the gist?
    A: Right to Health encompasses
       Freedom and Entitlements
 Freedoms -- to control one's health and body, including
  sexual and reproductive freedom, and the right to be free
  from interference, such as the right to be free from torture,
  non-consensual medical treatment and experimentation.
 Entitlements
   – the right to a system of health protection that provides
     equality of opportunity for people to enjoy the highest
     attainable level of health.
   – to conditions that promote health access to safe and
     potable water and adequate sanitation, an adequate
     supply of safe food, nutrition and housing, healthy
     occupational and environmental conditions, and access
     to health-related education and information, including
     on sexual and reproductive health.
    Sounds nice. Isn’t this all aspirations –
             just pie in the sky?
     A: Were you paying attention to first
   State have obligations to promote freedom:
     – Obligation to Respect - Refrain from discriminating,
       coercing medical treatment, limiting contraceptives,
       withholding or misrepresenting information, polluting
       water or air
     – Obligation to Protect – prevent violation by third
       parties, e.g., by discriminating, marketing unsafe drugs,
       practicing without qualifications or meeting ethical
       standards, use of harmful traditional practices, violence
       against women
Q: Guess what else states have
      obligations to do.
   State also has obligations to provide entitlements –
    the obligation to fulfill – safe water, primary
    health services, immunizations, disease tracking,
    national policy, etc.
    – The obligation to facilitate : measures to enable
      individuals/communities to fulfill right
    – The obligation to provide: services where otherwise
    – The obligation to promote: measure to advance the
      health of the population
    And obligations get specific:
    Health systems must meet
         certain standards
 Availability – in quantity to meet needs
 Accessibility – Encompasses, non-discrimination,
  physical and geographic access, special population
  (children, elderly), affordable, information
 Acceptability –ethically sound (consent,
  confidentiality), culturally appropriate.
 Quality –Scientifically, medically sound
Yes you in the back, this is how we get to safe health
  care as a human right
      This is all very nice, but human rights
      know it alls scoff because of the deep,
              dark secret of article 2:
             Progressive Realization

States must take steps, individually and through
 international assistance and co-operation, especially
 economic and technical, to the maximum of its
 available resources, with a view to achieving
 progressively the full realization of the rights
 recognized in the present Covenant.
 Progressive means over time, with continuous
 obligation to move expeditiously and effectively
Q: Sounds like all deliberate speed
              to me.
        A: Wrong again
   Committee says there are core obligations of immediate effect
    irrespective of resources.
   That means today, brother.
   Includes taking steps and guaranteeing freedom from
    discrimination, equitable distribution of services. Addressing
    vulnerable populations is key.
   Also includes ―minimum essential levels of each of the rights
    enunciated in the Covenant, including essential primary health
    care.‖ GC para 43.
   Also includes potable water, shelter, WHO essential drugs
   Also include immunizations, maternal/child health services,
    Q: OK I accept all these obligations. But
    how do I know when there’s a violation?
       A: It’s not I know it when I see it.
 Given indefiniteness of ―progressive realization‖ and breadth
  of core obligations need to determine when a state is not in
 Audrey Chapman proposes violations approach. GC adopts.
 Approach distinguishes between inability and unwillingness
 Can be violations of omission (no plan, no regulation, no
  services) or commission (interference with rights).
 GC specifies types of violations regarding obligations to
  respect, protect, fulfill.
Q: OK, so we can identify violations, but
    how to measure and compare?
     A: We’re not quite there yet.

 General Rapporteur on Right to Health,
  Paul Hunt, seeking to development means
  of benchmarks and indicators for measuring
 Current Proposal to focus on three types:
    – Process
    – Structural
    – Outcome
 Q: And now the question you’ve all
          been waiting for:
what’s the difference between right to
health and “health and human rights”
 This is truly scary – I am now in Vince Iacopino
 He says (sometimes) right to health is a
  contradiction, that health is not one of many
  rights. Rather, he says, rights represents the
  conditions for health.
 So maybe I won’t answer at all. Forget it.
              Just kidding
 Right to health does in part depend on other rights,
  e.g., education, protection against torture, but has
  additional dimensions as well, e.g.:
   – Health services, access to meds, etc
   – Environmental determinants of health.
   – Protection against interference by third parties.
 Health also ―is indispensable to exercise of other
 So right to health is a reasonably well–understood
  idea regarding all the human rights requirements
  needed to achieve health.
 The ―health and human rights approach‖ is mostly
  about consequences: looks at how human rights
  violations affect health.
  Health & HR Framework
• Health consequences of human rights violations
• Health policies have human rights
• Also what Vince calls an ―Intrinsic Perspective:
  Human Rights as Essential Conditions for
    - Based on WHO definition and on dignity – so education, non-
  discrimination, freedom from torture are necessary for dignity and
  well-being regardless of impact on health in the narrow sense.
How is PHR using right to
      A: Your turn
 Summary: What to remember
 The right to health encompasses freedoms (respect,
  protect) and entitlements (fulfill)
 Requires others rights to be realized, e.g., education, but
  right to health has additional content
 General Comment contains specific standards for fulfilling
  the right (availability, accessibility etc)
 There exist core obligations that GC seeks to identify
 Similarly, GC seeks to identify what constitutes violations
 Efforts underway to develop benchmarks and indicators
  for measuring compliance
 Right to health contains powerful images and ideas.
And for your reading pleasure
 – General Comment 14, common drive
 –   Reports of UN Special Rapporteur, Paul Hunt
 –   Journal: Health and Human Rights
 –   Amnesty New for Health Professionals, bi-weekly.
     Many links.
 –   Lancet column on human rights
 –   Brigit Toebes, 'Towards an Improved Understanding of
     the International Human Right to Health', Human
     Rights Quarterly, Vol 21, Issue 3, August 1999,

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