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Health and Human Rights 101. Timothy H. Holtz, MD, MPH Institute of Human Rights Emory University. “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being...". -Preamble to the WHO Constitution. What is Health?.

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Health and Human Rights 101

Timothy H. Holtz, MD, MPH

Institute of Human Rights

Emory University


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“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being..."

-Preamble to the WHO Constitution


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What is Health? health is one of the fundamental rights of every human being..."

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

    • WHO Definition of Health

    • WHO as a UN related international body links health and human rights

  • Declaration of Alma Ata, 1978

    “Health…is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.”

  • Commitment by WHO for “Health for All by the Year 2000”


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Public Health lacks: health is one of the fundamental rights of every human being..."

  • Conceptual framework based on history

    • How many lay people know what public health is or does?

  • Vocabulary that is understandable

  • Clarity of direction that is insightful

  • System of ethics

    • Biomedical ethics  Public health ethics


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Human Rights has: health is one of the fundamental rights of every human being..."

  • Distinct values agreed upon around the world

  • Codified in internationally recognized treaties

  • Adopted by most countries, unlike few other rules of international engagement


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An Alternative Definition health is one of the fundamental rights of every human being..."

Health is the condition in which

human rights are fulfilled


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Combining Health and Human Rights provides: health is one of the fundamental rights of every human being..."

  • Common language and framework to reference

  • A junction on which to collaborate

  • Opportunity for cross-disciplinary education

  • A system of public health ethics


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Right to Health health is one of the fundamental rights of every human being..."

  • What does it mean?

    • health  medical care  health care

    • “Right to Health” =

      • right to health protection =

      • medical care + healthy conditions

  • Where does it come from?


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Right to Health Components health is one of the fundamental rights of every human being..."

  • Declaration of the right to health

  • Prescription of standards aimed at meeting the health needs of specific groups

  • Prescription of ways and means for implementing the right to health


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Universal Declaration of health is one of the fundamental rights of every human being..."Human Rights, Article 25.1

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.

Non-binding declaration


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

*Adopted 16 Dec 1966, entered into force 3 Jan 1976, but

never ratified by the US


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Right to Health in other International Documents Rights, (ICESCR) Article 12.1*

  • Constitution of the World Health Organization (WHO)

  • Convention on the Rights of the Child

  • African Charter on Human and People’s Rights

  • Convention on the Elimination of all Forms of Discrimination against Women (CEDAW)

  • Convention on the Elimination of All Forms of Racial Discrimination (CERD)


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Right to Health in National Law Rights, (ICESCR) Article 12.1*

  • 20 Constitutions in Western Hemisphere include language invoking a right to health

    • “Right to Health” in 5 Constitutions

    • “Right to Health Protection” in 8 others

  • US Constitution/Bill of Rights does NOT include any mention of a right to health

  • Argentina, Colombia, and Costa Rica do not


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ICESCR, Article 12.2 Rights, (ICESCR) Article 12.1*

  • 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:

    • The provision for the reduction of the still-birth rate and of infant mortality and for the healthy development of the child;

    • The improvement of all aspects of environmental and industrial hygiene;

    • The prevention, treatment, and control of epidemic, endemic, occupational and other diseases;

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


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Essential aspects of primary health care approach (Alma Ata):

  • Emphasis on preventive health (immunization/family planning) more than curative medicine

  • Promotion of food supply and proper nutrition

  • Basic sanitation and safe water supply

  • Emphasis on maternal and child health

  • Prevention and control of local endemic diseases

  • Treatment of common diseases and injuries

  • Provision of essential drugs

  • Importance of health education

  • High priority given to vulnerable groups

  • Equal access to all at an affordable cost

  • Importance of participation in planning and implementation


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Contemporary expansion of Human Rights Ata):

  • Initial focus on civil and political rights has expanded to include advocacy for the realization of economic and social rights, as well as concerns about the environment and consequences of global economic development on health.

  • Wider societal involvement and participation in human rights struggles and discourse is broadening the language and uses of human rights concepts, based always on core fundamentals.


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Contemporary expansion of Human Rights Ata):

  • Increasing realization that non-state actors, such as societal institutions and transnational corporations, may strongly affect health status and influence the capacity for realization of rights, yet elude state control.

  • Melding of approach-using human rights protection and promotion concurrently.


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Old Conceptual Model Ata):

Well-

Being

Human

Rights

Health


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New Conceptual Model Ata):Framework for Understanding

Human Rights

Health

Human Rights

Health

Human Rights

Health


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Framework of Understanding Ata):

RELATIONSHIP #1

Understand the impact, positive or negative, of health policies, programs, and practices on human rights.

Maxim/challenge: All public health interventions and programs are potentially burdensome to human rights.


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Health Ata): Human Rights

  • Three core functions of public health each can have human rights components:

    • Assess health needs and problems, using both investigation, surveillance, and research

    • Develop policies designed to address priority health issues

    • Implement programs to achieve specific health goals, and monitor one’s progress


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Restriction of rights Ata):

Article 29, UDHR

In the exercise of (his) rights and freedoms, everyone shall be subject only to such limitations as are determined by law solely for the purpose of securing due recognition and respect for the rights and freedoms of others and of meeting the just requirements of morality, public order and the general welfare in a democratic society.


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Derogation of Rights Ata):

The public good* can take precedence to:

“secure due recognition and respect for the rights and freedoms of others; meet the just requirements of morality, public order and the general welfare, and in times of emergency when there are threats to the vital interests of the nation.”

-ICCPR, Article 4

*Public health qualifies as one such public good.


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The Siracusa Principles Ata):

  • Provided for and carried out in accordance with the law;

  • In the interest of a legitimate objective of general interest;

  • Strictly necessary in a democratic society to achieve the objective;

  • There are no less intrusive and restrictive means available to reach the same goal; and

  • The restriction is not imposed arbitrarily

UNECOSOC,1985


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Framework of Understanding Ata):

RELATIONSHIP #2

Understand the impact of human rights violations on human health.

Maxim: Violations of all human rights, not just those explicitly describing health, have indirect and direct health impacts.


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Human Rights Ata): Health

  • Obvious and inherent health impact of severe human rights violations

    • Torture

    • Imprisonment under inhumane conditions

    • Summary execution without trial

    • Disappearances (“dirty wars” of Central and South America in 1980s)

    • Other – Unethical research practices

      • Nazi medicine & US Tuskegee study (CDC)


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Human Rights Ata): Health

  • Direct and indirect health consequences of many other human rights violations

    • UDHR Article 23-Violation of the right to work under just and favorable work conditions, and right to join trade unions.

    • UDHR Article 26-Violation of right to education.

    • UDHR Article 1-Violation of right to collective dignity.

    • UDHR Article 25.2-Violation of women’s rights.


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Human Rights Ata): Health

  • Discrimination

  • Health policies

  • Compromise of medical independence

  • Lack of access to medical care

  • Violent conflict affecting civilian populations

  • Indiscriminate harm from weapons

  • Unethical research practices

  • Dangerous environmental exposures


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Framework of Understanding Ata):

RELATIONSHIP #3

Understand that the promotion and protection of human rights and the promotion and protection of health are fundamentally linked.

Maxim: This inextricable connection is at the core of human health. It has strategic implications and practical consequences.


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Health Ata): Human Rights

  • What are the underlying conditions needed for health?

  • Complementary approach and interdependence of all rights in advancing human well-being

  • Dignity and health


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Health Ata):  Human Rights

Individual and population vulnerability to disease, disability, and the ultimate outcome once ill (death) is inextricably linked, and in fact dependent upon, respect for human rights and dignity.


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One final concept… Ata):

Rights (provided by States) are often accompanied by duties (of individuals)


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So, now that you know what your rights are… Ata):

You have a duty to participate as a civil actor to guarantee that your (and others) rights are respected, protected and fulfilled.


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What you can do? Ata):

  • Join ISAHHR and Human Rights Week

  • Join HRI-L listserv

  • Take “IH 508;Health and Human Rights”

  • Volunteer for conference April 14-16 2005


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Where can you learn more? Ata):

  • UDHR and other HR documents

    • http://www.un.org/rights

  • Twenty-five Human Rights Documents

    • Center for the Study of Human Rights

  • 25 Questions and Answers on Health and Human Rights

    • http://www.who.int/hhr/information/25_questions_hhr.pdf

  • Health and Human Rights; A Reader

    • Edited by Jonathan Mann, Sofia Gruskin, Michael Grodin, George Annas


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“Human rights are our common heritage and their realization depends on the contributions that each and every one of us is willing to make, individually and collectively, now and in the future."

-Louise Arbour,

United Nations High Commissioner for Human Rights


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