Readers' Responses: Rights and the Struggle for Health

A Past, Present, and Future Challenge for the Health and Human Rights Movement

March 25, 2002

The Spring/Summer 2001 issue of Human Rights Dialogue, “Rights and the Struggle for Health,” illustrates how a human rights perspective might be applied to issues ranging from the delivery of medical care to ensuring a safe environment, from local advocacy to global campaigns to tackle the pandemic of HIV/AIDS. Although there is certainly no single “human rights approach” to health, there are identifiable themes and principles that have emerged, as noted in both the Marks and the Rubenstein pieces.

Our work on these issues has led us to a concern with how to spread human rights principles and applications to the vast majority of health professionals and other health workers. In general, there are few health practitioners who actually put a health and human rights discourse into practice in their daily work, and there are few human rights groups working on health rights. Indeed, it seems that the enthusiasm for the discourse of human rights in health—as measured by some international journals and other academic forums—has not spread beyond a relatively insular group.

A goal of the health and human rights movement must be to foster a culture of human rights among the larger community of health care practitioners, and, in this regard, we feel there has been a lack of attention in the field as a whole to the education of health-related professionals. A few pioneering organizations have created health and human rights curricula and offered workshops and courses oriented to medical and other health-sciences students. We applaud these initiatives, and we believe these efforts should be carried out much more widely in order to reach a preponderance of future clinicians and health-policy makers. Until providers in countries such as Peru are educated in human rights—both as to the rights of their patients and their own roles in greater struggles for democracy and social justice—the discourse of human rights in health will remain just that: a discourse.

We have learned from our experiences with students from Peru and across Latin America through the Peruvian civil association EDHUCASalud (Educación en Derechos Humanos con Aplicación en Salud, “Civil Association for Health and Human Rights Education”). We have seen that one-shot workshops cannot suffice to educate providers in health and human rights; in the long-term, the educational training that future professionals receive must be reformulated. However, we have also seen how some medical and health-sciences students who have been exposed to human rights concepts and training have assimilated these concepts and transformed them in their daily work and will forever be guided by certain core principles and aspirations of human rights. In short, we consider that strategies to create a new profile of future health professionals deserve more attention within the health and human rights movement in order to expand the impact of this nascent field.

J. Jaime Miranda, M.D.
Peruvian Programme, Health Unlimited; and Founding Member, EDHUCASalud

Alicia Ely Yamin, J.D., MPH
Law and Policy Project, Mailman School of Public Health, Columbia University; and Advisor to EDHUCASalud.

A Broad Focus on Health

To receive the best available health care should be the right of every human being on the planet. That seems obvious, yet often other factors decide just who receives what kind of care. I was pleased to see that the issue of Human Rights Dialogue dedicated to human rights and the struggle for health did not concentrate on just some of those factors, present mostly in the so-called countries of concern, but rather showed that a wide array of factors can influence diminished rights to proper health care and that some of them are present even in the highly industrialized, developed nations.

Two articles about the AIDS crisis showed the stark discrepancy in life expectancy between patients in developed countries and those in poor countries. The polluted lands of indigenous people in Ecuador and their inadequate access to health care obviously cry out for action. The same goes for assuring that no medical professional abuses his profession in “dual loyalty” matters by assisting in the torture or mistreatment of people. Rather, it is important to encourage them to serve as witnesses to such abuses, as Neshad Asllani did in Kosovo. But in those areas, as Stephen Marks wrote, there has already been significant thinking and action using the health and human rights approach.

It is disturbing to see that the circumstances described in Sarah Zaidi’s article on Ecuador can also be found in South Carolina and that certain economic measures, like welfare reform, may diminish the chances for people to receive proper health care, even in one of the world’s richest nations—the United States. I commend the authors who took the bold step of recognizing such measures as an attack on the human rights framework. I found the problem described by Rony Brauman the most intriguing because it presents us with a lose-lose dilemma. However, he did conclude that with less profit-oriented selfishness on the part of the rich world, MDR-TB would be treatable.

The I would like to read an article on health and human rights in Afghanistan— a country where just 10 percent of the population has access to clean water, where 70 percent of the population over the age of fifteen is illiterate, where 90 percent of the roads are unpaved and most of the villages are inaccessible during the Winter months, and where until recently the Taliban both did not allow for women to be treated by a male physician and actively discouraged women from obtaining any education. Perhaps a human rights approach could serve to address some of these grave inequities.

Ivo Skoric
Balkans Net
New York, New York

Health and Human Rights in the Philippines

As a resident of a developing country, I read the essays featured in the Spring/Summer 2001 issue of Human Rights Dialogue, “Rights and the Struggle for Health” with particular interest. The Philippines has faced a multitude of problems over the last thirty years. Slow but real development was cut short by fourteen years of martial law under the Marcos dictatorship, which not only placed power play at the forefront but also involved numerous human rights violations.

People's right to health was recognized but was attended to by only a few professionals and agencies. Health care, personnel, and programs seemed a low priority in the face of torture and displacement. The Department of Health struggled to make generic drugs available to the majority of the population who live below the poverty line, to run information campaigns about reproductive and sexual rights, and to cope with such basic problems as tuberculosis and children's diarrhea, which is widespread and simple to solve yet has gone unchecked. And today, especially among former sex workers at the American bases, there is HIV/AIDS. All of this is in addition to the need for safe water and basic sanitation and for health workers to attend to the urban and rural poor in the slums, villages, and squatter areas.

Hardly any public or official dialogue about health and human rights is heard. The understanding and concern, although present, have not been deepened, disseminated, or confronted.

The Philippines must profit from the dialogues, operational experience, and solutions developed within the global village. We welcome the opportunity to listen and to learn.

Doreen G. Fernandez
Professor of Communication
University Ateneo de Manila
Quezon City, Philippines