community health

1. United Nations Human Rights
Geneva
January 15-16 2009
Arturo C. Cunanan, Jr. MD, MPH, PhD
Culion Philippines

2. “It should be recognized that the
tremendous physical and social burden
caused by leprosy can not be fully
expressed just in terms of statistics.”
Dr.S.K.. Noordeen

3. SOCIAL ASPECTS OF LEPROSY
FACTS / REALITIES
• Despite medical advances, people affected by
leprosy are still stigmatized.
– The use of the word ‘leper’ as a metaphor for whoever
is feared and ostracized
– Even other stigmatized groups – such as people with
AIDS /HIV or ex-prisoners – will complain of being
‘treated like lepers’.
– That a person with or had leprosy still experience
exclusion or difficulty access to education,
employment, housing, public transport and other
activities like marriage.

4.  that people affected by leprosy even those cured continue
to hide their condition from their employers, their
colleagues and even their family
 even people affected by the disease will believe many of
the myths about leprosy and re-enforce by society and as a
result suffer from low self-esteem and morale

5. Why is there stigma in leprosy
• Physical Outward Appearance
• Progressive Characteristics over time
• Communicability and Disabling
• Religious Links
• Poverty Related
• Isolation and Segregation
• Myths and Mysteries
STIGMA LEADS TO DISCRIMINATION

6. The Philippines Experience

7. Highlights
A. Compulsory segregation and isolation of leprosy patients
Culion Leper Colony 1906
- Separation of Children of “leprous” parentage
 From birth
 Sent to Welfare Institution – for adoption
 Lost opportunity for parents and children for bonding
 Children rivalry
 Favouritism of parents
 Disenfranchisement of family members
 Low self esteem , low morale,
 Feeling of inferiority

8. B) Equity and Access to Health Care
- “Cured” Patients Suffering from other
Medical and Surgical
Ailment
>Place on Separate Wards/Isolated
>Refer to Sanitaria/Leprosaria
>Stigmatization coming from general health
staff
C) Double Standard in Wage/Salary Level
- Context of Gratuity Pay / Rehabilitation Objective
D) Accessibility to Public Transportation
- Particularly those with Visible Disabilities and tale tale
signs of leprosy

9. D) Unequal Employment Opportunities
- Particularly for cure persons affected with leprosy
-With Disabilities Secondary to Leprosy
- Children or Descendants to Leprosy from “Leper”
colony
E) Refusal / Conditional School Admission
- Required Medical Clearance and other test
- Must Undergo a More Rigid Process

10. Human Rights and Leprosy
• Human rights Approach in Eliminating
discrimination against persons affected by leprosy
– that policies and institutions should be based explicitly
on the norms and values set out in the international law
of human rights.
– offers an explicit normative framework, that of
international human rights.
• reinforced by legal obligations
• Guide in formulation of national and international policies
including reduction of stigma and discrimination against
people affected by leprosy

11. Human Rights
• Policy Context : Elimination of discrimination
against persons affected by leprosy base on
Human Rights.
• the rationale of reducing stigma and discrimination
no longer derives merely from the fact that the
People Affected by Leprosy have needs but also
from the fact that People Affected by Leprosy have
rights.
• An entitlement that give rise to more than charity,
more than a moral or social obligation it becomes a
legal obligation

12. Recommendations
• Inclusion of People Affected by Leprosy representative in
the National Leprosy Advisory Boards.
• Development of advocacy materials and strategies
addressing social and human rights issues to be included in
the leprosy awareness campaign activities
• Conduct consultations or survey (Regional / provincial/
sanitaria) to determine status of people affected by leprosy
• For local and international NGOs and funders to continue
assisting genuine social re-integration through
empowerment of people affected by leprosy
• For collaboration of leprosy activities with non-medical or
non health programs of different government agencies like
labor, education, social services, agriculture etc.

13. Continuation
• To review the status, roles, relevance of leprosy sanitaria
under low endemic situation , its expanded role, custodial
care of disabled, old, segregated people affected by leprosy
and its contribution to attainment of leprosy free zone.
• To include social / human rights issues in Leprosy Summit
or other leprosy forum.

14. THANK YOU