health and human rights 101 timothy h. holtz, md, mph institute of human rights emory university

Health and Human Health and Human Rights 101Rights 101

Timothy H. Holtz, MD, MPHTimothy H. Holtz, MD, MPH

Institute of Human RightsInstitute of Human Rights

Emory UniversityEmory University

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

being..."being..."

-Preamble to the WHO -Preamble to the WHO ConstitutionConstitution

What is Health?What is Health? ““Health is a state of complete physical, mental, Health is a state of complete physical, mental,

and social well-being and not merely the absence and social well-being and not merely the absence of disease or infirmity.”of disease or infirmity.” WHO Definition of HealthWHO Definition of Health WHO as a UN related international body links health and WHO as a UN related international body links health and

human rightshuman rights Declaration of Alma Ata, 1978Declaration of Alma Ata, 1978

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

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

Public Health lacks:Public Health lacks:

Conceptual framework based on historyConceptual framework based on history How many lay people know what public health How many lay people know what public health

is or does?is or does?

Vocabulary that is understandableVocabulary that is understandable

Clarity of direction that is insightfulClarity of direction that is insightful

System of ethicsSystem of ethics Biomedical ethics Biomedical ethics Public health ethics Public health ethics

Human Rights has:Human Rights has:

Distinct values agreed upon around Distinct values agreed upon around the worldthe world

Codified in internationally recognized Codified in internationally recognized treatiestreaties

Adopted by most countries, unlike few Adopted by most countries, unlike few other rules of international other rules of international engagementengagement

An Alternative DefinitionAn Alternative Definition

Health is the condition in Health is the condition in which which

human rights are fulfilledhuman rights are fulfilled

Combining Health and Human Combining Health and Human Rights provides:Rights provides:

Common language and framework to Common language and framework to referencereference

A junction on which to collaborateA junction on which to collaborate

Opportunity for cross-disciplinary Opportunity for cross-disciplinary educationeducation

A system of public health ethicsA system of public health ethics

Right to HealthRight to Health

What does it mean?What does it mean? health health medical care medical care health care health care ““Right to Health” = Right to Health” =

right to health protection = right to health protection = medical care + healthy conditionsmedical care + healthy conditions

Where does it come from?Where does it come from?

Right to Health ComponentsRight to Health Components

Declaration of the right to healthDeclaration of the right to health Prescription of standards aimed at Prescription of standards aimed at

meeting the health needs of specific meeting the health needs of specific groupsgroups

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

Universal Declaration of Universal Declaration of Human Rights, Article 25.1Human Rights, Article 25.1

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

Non-binding declaration

International Covenant on International Covenant on Economic, Social, and Cultural Economic, Social, and Cultural Rights, (ICESCR) Article 12.1*Rights, (ICESCR) Article 12.1*

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

*Adopted 16 Dec 1966, entered into force 3 Jan 1976, butnever ratified by the US

Right to Health in other Right to Health in other International DocumentsInternational Documents

Constitution of the World Health Constitution of the World Health Organization (WHO)Organization (WHO)

Convention on the Rights of the ChildConvention on the Rights of the Child African Charter on Human and People’s African Charter on Human and People’s

RightsRights Convention on the Elimination of all Forms Convention on the Elimination of all Forms

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

of Racial Discrimination (CERD)of Racial Discrimination (CERD)

Right to Health in National LawRight to Health in National Law

20 Constitutions in Western 20 Constitutions in Western Hemisphere include language invoking Hemisphere include language invoking a right to healtha right to health ““Right to Health” in 5 ConstitutionsRight to Health” in 5 Constitutions ““Right to Health Protection” in 8 othersRight to Health Protection” in 8 others

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

Argentina, Colombia, and Costa Rica do Argentina, Colombia, and Costa Rica do notnot

ICESCR, Article 12.2ICESCR, Article 12.2 The steps to be taken by the states parties The steps to be taken by the states parties

to the present Covenant to achieve the full to the present Covenant to achieve the full realization of this right shall include those realization of this right shall include those necessary for:necessary for: The provision for the reduction of the still-birth The provision for the reduction of the still-birth

rate and of infant mortality and for the healthy rate and of infant mortality and for the healthy development of the child;development of the child;

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

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

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

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

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

Promotion of food supply and proper nutritionPromotion of food supply and proper nutrition Basic sanitation and safe water supplyBasic sanitation and safe water supply Emphasis on maternal and child healthEmphasis on maternal and child health Prevention and control of local endemic diseasesPrevention and control of local endemic diseases Treatment of common diseases and injuriesTreatment of common diseases and injuries Provision of essential drugsProvision of essential drugs Importance of health educationImportance of health education High priority given to vulnerable groupsHigh priority given to vulnerable groups Equal access to all at an affordable costEqual access to all at an affordable cost Importance of participation in planning and Importance of participation in planning and

implementationimplementation

Contemporary expansion of Contemporary expansion of Human RightsHuman Rights

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

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

Contemporary expansion of Contemporary expansion of Human RightsHuman Rights

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

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

Old Conceptual ModelOld Conceptual Model

HumanRights

Well-BeingHealth

New Conceptual ModelNew Conceptual ModelFramework for UnderstandingFramework for Understanding

Human Rights

Health

Human Rights

Human Rights

Health

Health

Framework of UnderstandingFramework of Understanding

RELATIONSHIP #1RELATIONSHIP #1Understand the impact, positive or Understand the impact, positive or negative, of health policies, programs, negative, of health policies, programs, and practices on human rights.and practices on human rights.

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

Health Health Human Rights Human Rights

Three core functions of public health each Three core functions of public health each can have human rights components:can have human rights components: Assess health needs and problems, Assess health needs and problems,

using both investigation, surveillance, using both investigation, surveillance, and researchand research

Develop policies designed to address Develop policies designed to address priority health issuespriority health issues

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

Restriction of rights Restriction of rights

Article 29, UDHRArticle 29, UDHRIn the exercise of (his) rights and freedoms, In the exercise of (his) rights and freedoms, everyone shall be subject only to such everyone shall be subject only to such limitations as are determined by law solely for limitations as are determined by law solely for the purpose of securing due recognition and the purpose of securing due recognition and respect for the rights and freedoms of others respect for the rights and freedoms of others and of meeting the just requirements of and of meeting the just requirements of morality, public order and the general welfare morality, public order and the general welfare in a democratic society.in a democratic society.

Derogation of RightsDerogation of Rights

The public good* can take precedence to:The public good* can take precedence to:

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

-ICCPR, Article 4-ICCPR, Article 4*Public health qualifies as one such public good.

The Siracusa PrinciplesThe Siracusa Principles

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

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

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

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

The restriction is not imposed arbitrarilyThe restriction is not imposed arbitrarilyUNECOSOC,1985


RELATIONSHIP #2RELATIONSHIP #2

Understand the impact of human Understand the impact of human rights violations on human health.rights violations on human health.

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

Human Rights Human Rights Health Health

Obvious and inherent health impact of Obvious and inherent health impact of severe human rights violationssevere human rights violations TortureTorture Imprisonment under inhumane conditionsImprisonment under inhumane conditions Summary execution without trialSummary execution without trial Disappearances (“dirty wars” of Central and Disappearances (“dirty wars” of Central and

South America in 1980s)South America in 1980s) Other – Unethical research practicesOther – Unethical research practices

Nazi medicine & US Tuskegee study (CDC)Nazi medicine & US Tuskegee study (CDC)

Human Rights Human Rights Health Health Direct and indirect health consequences of Direct and indirect health consequences of

many other human rights violationsmany other human rights violations UDHR Article 23-Violation of the right to work UDHR Article 23-Violation of the right to work

under just and favorable work conditions, and under just and favorable work conditions, and right to join trade unions. right to join trade unions.

UDHR Article 26-Violation of right to education.UDHR Article 26-Violation of right to education. UDHR Article 1-Violation of right to collective UDHR Article 1-Violation of right to collective

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

Human Rights Human Rights Health Health DiscriminationDiscrimination Health policiesHealth policies Compromise of medical independenceCompromise of medical independence Lack of access to medical careLack of access to medical care Violent conflict affecting civilian Violent conflict affecting civilian

populationspopulations Indiscriminate harm from weaponsIndiscriminate harm from weapons Unethical research practicesUnethical research practices Dangerous environmental exposuresDangerous environmental exposures


RELATIONSHIP #3RELATIONSHIP #3

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

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


What are the underlying conditions What are the underlying conditions needed for health?needed for health?

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

Dignity and healthDignity and health


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

One final concept…One final concept…

Rights (provided by States) Rights (provided by States) are often accompanied by are often accompanied by

duties (of individuals)duties (of individuals)

So, now that you know So, now that you know what your rights are…what your rights are…

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

protected and fulfilled.protected and fulfilled.

What you can do?What you can do?

Join ISAHHR and Human Rights WeekJoin ISAHHR and Human Rights Week Contact Tarun Gulrajani at Contact Tarun Gulrajani at

[email protected]@sph.emory.edu Join HRI-L listservJoin HRI-L listserv

Send a message to Send a message to [email protected]@listserv.emory.edu

Subscribe hri-l firstname lastnameSubscribe hri-l firstname lastname Take “IH 508;Health and Human Rights”Take “IH 508;Health and Human Rights” Volunteer for conference April 14-16 Volunteer for conference April 14-16

20052005

Where can you learn more?Where can you learn more? UDHR and other HR documentsUDHR and other HR documents

http://www.un.org/rightshttp://www.un.org/rights Twenty-five Human Rights DocumentsTwenty-five Human Rights Documents

Center for the Study of Human RightsCenter for the Study of Human Rights 25 Questions and Answers on Health and 25 Questions and Answers on Health and

Human RightsHuman Rights http://www.who.int/hhr/information/25_questiohttp://www.who.int/hhr/information/25_questio

ns_hhr.pdfns_hhr.pdf Health and Human Rights; A ReaderHealth and Human Rights; A Reader

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

““Human rights are our common Human rights are our common heritage and their realization heritage and their realization

depends on the contributions that depends on the contributions that each and every one of us is willing to each and every one of us is willing to

make, individually and collectively, make, individually and collectively,

now and in the future."now and in the future." -Louise Arbour, -Louise Arbour,

United Nations High United Nations High Commissioner for Human Commissioner for Human

Rights Rights