Introduction: Rights and the Struggle for Health
Human Rights Dialogue, Spring/Summer 2001, "Rights and the Struggle for Health"
December 2, 2001
More than 880 million people lack access to basic health services. The absence of safe water and basic sanitation contributes to the health problems of hundreds of millions. Of the thirty-four million people world-wide who are infected with HIV/AIDS, 95 percent live in developing countries, many of which are unable to pay market prices for the only life-prolonging treatments currently available.
These facts about global health are disconcerting. But how, if at all, are these health deficits related to human rights? If the purpose of human rights norms is to promote and protect vital human interests, their relevance to health seems difficult to deny.
The relationship between health and human rights is a dynamic one. Poor health and inadequate health care are often related to human rights violations. And violation and underfulfillment of human rights are often due to poor health and lack of access to health care. The link is constitutive in the case of rights to health and health care that have been formulated in documents and treaties such as the Universal Declaration of Human Rights, the World Health Organization's Constitution, and in the national constitutions of several countries. The link is direct in the case of other basic social and economic human rights, such as the right to a standard of living adequate for the health and well-being of oneself and one's family. But poverty and lack of health protection are also indirectly linked to failure to secure civil and political human rights. People who are ill or malnourished and who lack access to medical care must struggle to survive and can often do little to resist oppression.
Why, then, have health issues been so little linked to human rights? Indeed, while both improving public health and securing human rights have long been recognized as important societal aims, they have often been thought to be tenuously connected or even in some tension with one another. This seems puzzling, especially as claims of unjust treatment and demands for institutional reform are increasingly stated in the language of human rights, and many feel that health deprivations are the result of unfair social and economic arrangements. Why do so many remain skeptical about the value of connecting the struggle for improvements in health and access to health care with human rights norms?
This issue of Human Rights Dialogue engages with these questions by exploring whether and how health professionals, policymakers, and activists are linking human rights norms to the evaluation of medical practices, the design of health systems, and popular struggles for improved access to health care. The picture that emerges from these essays is hopeful. As Stephen P. Marks points out in his overview of the new partnership of health and human rights, doctors, health advocates, and human rights organizations are beginning to link health concerns with human rights in ways that are having practical effects in reforming medical practices and challenging institutional barriers to improvements in health. But the articles in this issue also indicate the difficulties that practitioners and activists often have had in drawing on human rights norms to confront practical dilemmas, address difficult policy questions, and mobilize people behind their causes.
Some critics have suggested that the lack of clarity of human rights norms has limited their applicability in the field of health. The right to health (as stated in the International Covenant on Economic and Social Rights) calls on governments to create "the conditions which would assure to all medical service and medical attention in the event of sickness." But what, these critics ask, is the content of the right to health, and what specific obligations does it entail? In his contribution, Rony Brauman criticizes the way that the right to health ahs been conceived, arguing that it gives little guidance to doctors in the field. Should doctors offer direct treatment to those who suffer from tuberculosis or refrain from treating for fear of contributing to significant public health problems resulting from the generation of multi-drug-resistant strains of the disease? For him, human rights might be invoked to support either option - rendering them ineffective for health practitioners in the field. And in his essay Leonard S. Rubenstein suggests that human rights norms are also unclear about how health professionals should balance their loyalties to their patients with their obligations as citizens to their states.
Nevertheless, there is reason to think that human rights concerns can become more helpfully integrated with medical practice. Rubenstein suggests that more specific guidelines that build on existing human rights standards can both improve health practices and create greater awareness of human rights among health professionals. And Neshad Asllani's story of his treatment of Albanians who suffered under Serbian authorities illustrates how many practical dilemmas faced by physicians lead them to learn more about human rights - and even transform them into human rights activists.
Two other essays suggest that statistical indicators can be used to identify how laws and policies are undermining health protection and to empower local groups to press for their reform. Ramona Ortega describes how one group in New York City has used survey data to demonstrate that welfare reform has led to widespread discrimination in allocating health benefits and contributed to health problems of already vulnerable populations. Sarah Zaidi discusses how her organization set out to demonstrate the relevance of human rights to the medical conditions of the people living in the Ecuadorian Amazon by exposing a connection between these conditions and environmental contamination related to oil development. Both of these stories also suggest how attention to international human rights standards can motivate grassroots organizations to carry out creative statistical studies and demand relevant public information to improve the accountability of public institutions and other powerful actors.
Several of these essays indicate the power of human rights norms in people's struggles for improvement in health. First, lack of access to health care is often the result of private conduct that, while prohibited by law, is encouraged or barely deterred by government officials. Timothy Frasca relates how a basic familiarity with human rights can lead people to demand accountability from individual staff members and institutions that deny them the care to which they are legally entitled. Second, social and economic arrangements often avoidably engender obstacles to health care access, sometimes through their contributions to extreme poverty. Richard A. Murphy discusses how local activism in rural North Carolina forced the government to remedy basic social deficits that impinged upon the health of community members. Finally, the difficulty of gaining access to expensive pharmaceuticals remains one of the greatest obstacles to health in the developing world - particularly for those infected with HIV/AIDS. Nathan Geffen's contribution suggests how human fights activists in South Africa have overcome institutional barriers in the form of patent protection by making the government aware of the nature of the epidemic and the need for access to medicine.
The essays in this issue of Human Rights Dialogue add unique, local perspectives to the growing international movement to set the analysis of health concerns in a human rights framework. If the 880 million people worldwide who cannot access basic health care services, the countless poor who need adequate water and sanitation, and the millions in developing nations who are infected with HIV/AIDS are to improve their own health conditions, human rights tools may hold significant promise in helping them do so.