February 26, 2010 Beth Rivin Perspectives and Controversies surrounding human rights

1. The Right to Health: Perspectives and Controversies Beth E. Rivin, M.D., M.P.H.

2. Overview Definitions: Health, Human Rights and the Relationship The Right to Health under International Law Controversies and Challenges in Health and Human Rights

3. WHO Definition of Health 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.

4. Institute of Medicine 2008TheU.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. 4

5. Enabling Environment (determinants of health) Health Enabling Environments Protect Vulnerable Populations from Inequities and Discrimination

6. Foundations of Equity in Health Bioethics Human Rights

7. Human Rights Individual focused Inherent Dignity Inalienable Core principles of nondiscrimination and participation

8. Human Rights Law Government↔ People

9. Health and Human Rights An Approach to Improve Health Using the Human Rights Framework

10. The Right To Health Post WW II International Human Rights Law

11. 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.”

12. The Cold War Split International Covenant on Civil and Political Rights (ICCPR) International Covenant on Economic, Social and Cultural Rights (ICESCR)

13. 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.”

14. 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. 14

15. UN COMMITTEE ON ECONOMIC, SOCIALAND CULTURAL RIGHTSTwenty-second sessionGeneva, 25 April-12 May 2000 Comment 14 on the Highest Attainable Standard of Health ICESCR Article 12(1) 15

16. 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

17. 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 17

18. 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

19. Comment 14Article 12.1 The right to health can be measured: Availability Accessibility Acceptability Quality

20. UN Comment 14Article 12.1 Accessibility (4 dimensions) Nondiscrimination Physical Accessibility Economic Accessibility Information Accessibility 20

21. 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 21

22. 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. 22

23. 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. 23

24. 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…… 24

25. 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………………. 25

26. 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…. 26

27. Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW)

28. 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.

29. 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.

30. Convention on the Rights of the Child (CRC)

31. CRC Article 6 States Parties recognize that everychild has the inherent right to life. States Parties shall ensure to the maximum extent possible the survival and development of the child.

32. 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.

33. 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.

34. 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.

35. Strategy For Equity in Health Development Human Rights Analysis, Planning and Action

36. 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)

37. Human Rights Analysis of Health Systems GunillaBackman et al., Health systems and the right to health: an assessment of 194 countries, 372 The Lancet 2047-85 (2008).

38. 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

39. Human Rights Action: Physicians for Human Rights Documents health rights violations Supports the rights of health workers Advocates for the right to health

40. 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.

41. Controversies and Challenges Universality issue Metrics/indicators Using human rights methodologies for improved population health: is it the right strategy?

42. Are Human Rights Universal? Current Controversy: Universalism v. Cultural Relativism

43. 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

44. Human Rights Indicators Still in evolution

45. 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

46. The End