Ara's Blog #1 (For March 23): Health & Human Rights

The following discussion presents the relation of health and human rights within the contexts of ethics, policy development and international community participation toward its [respective] sustainability. Following each set of points, I propose an open-ended question to initiate further discussion.

Two principles of public health practice that coincide with the interrelations of health and human rights, are (PHLS): achieving community health by respecting the rights of individuals and, advocate for the empowerment vulnerable groups to ensure the necessary conditions for equitable health access.

Within the international health doctrines, the right to health includes the right to: basic health services, affordable quality care, some level of health education, and equal access. It excludes the right to: be healthy (understood due to its subjectivity) and unlimited access to services (understood due to costs). According to the Universal Declaration of Human Rights, which is a “common standard for all people and nations”, everyone has the “right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing, and medical care and necessary social services.” And the International Covenant on Economic, Social and Cultural Rights (ICESCR) states the right of everyone to “the enjoyment of the highest attainable standard of physical and mental health”. If we are to establish health as a human right, how do we describe that provision? “Right to health”: this seems that it’s guaranteeing too much—that is, perfect health which is too subjective; “Right to health care” and “right to health protection” is more feasible. Is this a justifiable argument?

Public health’s three core functions—assess community needs, develop policies to prioritize the prevention of major public health problems, and assure program implementation—are vulnerable to potential human rights violations within the confines of health policy development (Gostin 2000) . When selecting the health issue without societal consent/input, you are discriminating and marginalizing a specific group of people. Once you are to assess the selected health issue, the means in doing so will be ethically challenged: informed consents, privacy, equal inclusion of all societal subgroups, etc. When developing the policy without societal participation, you are thereby likely to discriminate against a specific subgroup of people in the population (by age, race, gender, etc). Lastly, when implementing the provision of health services, you may discriminate if the socioeconomic dynamics regarding the affordability, accessibility, and quality of the services provided to societal subgroups isn’t taken into account. The trend of not incorporating socioeconomic components and determinants of health within other parallel systems impacting health outcomes further exacerbates the progress toward health policy development incorporated within a human rights framework (London, 2008).

However, can we begin to make health policies all-inclusive on the grounds of preserving the social values of every subgroup being targeted? Can such a proposal avoid over-inclusive and under-inclusive policies, whereby beneficial provisions may be too costly for the former and too discriminatory with the latter? Can social value be trumped?

The interdependency of health and human rights toward its [respective] sustainability is interpreted within the framework of civil liberties (Gostin, 2000). Here, Gostin states that if there is a coercive governmental regulation, people will shy away from public health programs, interventions, or measures toward a healthy lifestyle. The unintended purpose of the act will be that it’s better to not know what you have and thereby, it prevents public health participation. If safeguards against discrimination and loss of privacy aren’t enforced, social burdens may arise upon the individual. Thereby, to promote a more comfortable and less stressful motivation to seek testing, or treatments for potentially serious risks is essential for adherence toward public health campaigns. Furthermore, the denial of social, political, and economic rights will impede a person’s action toward healthier living. To illustrate his viewpoint, human rights violations related to risk-taking behaviors (resulting in increased risk) may include the criminalization of high-risk sexual behaviors, also resulting in lower access to care and lack of equal protection of the law (Essex 2008). In addition, human rights violations related to vulnerability (resulting in increased vulnerability) may include Gender-based discrimination or conflicts resulting in population displacement.

The lack of proper and adequate human and economic resources in developing countries impedes the government’s ability to effectively implement and sustain human rights and health-related programs and policies within an immediate time frame. Thereby, international governments play an ever increasing role in attaining these goals and objectives. I would propose that the debate should be not only whether or not the international bodies have a prolonged commitment to participation (if any), but also the extent of involvement (monetary means) without imposing further socio-economic disparities and reduced provision of essential health services within the donor’s host country as a result of significant contributions. Are we indirectly invoking a new harm principle while directly trying to eliminate or mitigate another?

Within the U.S., the role and interrelations between health and human rights remains vague—when considering the lack of “affirmative obligation” (Gostin, 2000) within the US Constitution for the procurement and provision of services. Judicial refusal to examine government’s failure to act, irrespective of circumstances, leaves the state free to abuse its power and cause harm to citizens. In other words, a constitutional rule that punishes government misfeasance (when the state intentionally or negligently causes harm) but not nonfeasance (when the state simply does not act) provides an incentive to withhold services and interventions. How is inactive negligence of causing harm (direct or indirect) not the same as active negligence of causing harm (direct/indirect)? Why isn’t the former held just as accountable as the latter?

In conclusion, when discussing the interdependency of health and human rights, in the context of public health conditions, there should be a two-tier framework within developing the justifications/feasibility for health intervention implementation: Public Health & Ethics. Within the public health component, the availability of treatment, public acceptance, and costs of diagnosis/prognosis should be taken into account. Within the ethical framework, the essential factor to consider is the strength of upholding civil liberties. Within these confines, I believe the underlying principle that persons should be treated as an end and never as a means only will be safeguarded within the framework of preserving the rights to health care and the right for livelihood sustainability.

Thank You.


References:


Essex M, Mboup S, Kanki P, Marlink R and Tlou S, second edition. AIDS in Africa. Kluwer Academic/Plenum Publishers, New York, (2002): 641-653. [Ch. 27: Gruskin S., Tarantola D. HIV Prevention and Care in Resource-Poor Settings]

Gostin, LO. Public health law: power, duty, restraint. Berkeley: University of California Press, 2000

London, L. “What is a human rights-based approach to health and does it matter?” Health and Human Rights 2008 vol. 10 (1); 65-80.

Public Health Leadership Society (PHLS). Principles of the Ethics in Public Health Practice. 2002.