When we idealistically discuss the prospect of universal health care, we rarely extend our reach beyond the borders of our own nation. We look internationally only to scrutinize the healthcare systems of foreign countries that claim to do it better than we do. Opposition claims that foreign systems are socialist and that we are beyond that, while champions of the cause continue to point at the inverse relationship of money spent and quality of health care in our country. It is difficult to blame the policy makers for focusing on such immediate concerns. After all, we are ushering in a Bush-less era and have big plans for our healthcare system with Obama at the forefront. If we take a step back however, we realize that our very constitution doesn’t even address the health of our country’s citizens. Life, liberty and the pursuit of happiness seem to sidestep the prospect of health for all. Now let’s take another look internationally. There exist countries that have enshrined the right to health in their very constitution and have owed it to an approach emphasizing the “Human Right to Health”. There exist international treaties that “recognize access to health services and health information, among other health areas, as human rights.” (Skolnik, 60) This blog will discuss the powerful combination of health and human rights and the approach that has given entire nations the ability to call health a right.
The idea to include health among enforceable human rights can be most fundamentally assigned to the notion of instable compassion. “Compassion is undoubtedly a great virtue. But it is also notoriously unstable and historically, reliance on it has ill-served the interests of the oppressed. Particularly in times of great economic crisis — like the present — the needs of the poorest and most marginalized tend to get short shrift regardless of such sentiments.” (Yamin, 1) Though a noble aspiration, reliance on the compassion of the benevolent can not guarantee results for populations that require assistance. Yamin incorporates the much more serious idea of accountability as the method by which states and governments can be held responsible for human rights violations. Yamin states that “failures of beneficence and “compassion fatigue” do not trigger accountability; human rights violations do.” (Yamin, 1) The very preamble of the constitution of the World Health Organization states that “The enjoyment of the highest attainable standarad of health is one of the fundamental rights of every human being.” (Skolnik, 62) The problem lies in the lack of a mechanism to hold countries accountable. By placing responsibilities on those that are signatories of international human rights treaties, accountability is established and subsequent consequences can be enacted on those that fail to address these rights for their citizens. As Yamin stated, human rights violations are easier to punish than absent compassion. The Universal Declaration of Health, signed by most countries in 1948, is what forces its signatories to “see health and human rights as inextricably linked and bring this notion to consideration of the determinants of health and ways in which health issues may be addressed.” (Skolnik, 61) This combination of health and human rights involves bringing together the realms of public health and human rights and adopting a view previously untapped in public health approaches.
Such a paradigm shift is evident when we see what new avenues the human rights angle generates for public health professionals. Whereas traditionally, public health sought “to identify risk factors associated with disease, disability and premature death,” at an individual level and “to stimulate individual behavior change through information, education, and clinic-based services,” (Mann, 1940) this new human rights angle forced health professionals to examine rights violations and “consider a whole human being made vulnerable to a wide variety of pathogens and unhealthy conditions as a result of how the person is treated by society—expressed and articulated in the language of human rights and dignity.” (Mann, 1941) This new syntax was the launching point from which laws could be enacted to defend citizens’ right to health and take action against diseases like HIV/AIDS. We have been mostly aware of the idea that the highest attainable standard of health is dependent on sufficient working conditions and access to healthy resources, but we need to acknowledge the impact of “the dignity of the individual and the rights to education, free speech, and participation in the political process. Conversely, the ability to fully exercise other fundamental human rights depends on the right to health. Violation of any human right, including the right to health, contributes to the infringement of other rights.” (Easley, 1922) This understanding is what a significant portion of the ‘health as a human right’ proposal rests upon and has made it possible to discuss pandemics at a different, more approachable level.
With the HIV/AIDS pandemic polarizing the world population and stigmatizing the diseased individuals, the human rights angle became all-important in guaranteeing that government care for the ill was based on science rather than stereotypes. (Stone, 2) Unfortunately, a stigmatized and marginalized population is much less inclined to seek testing and proper treatment, especially if some doctors and dentists refuse to see patients due to their inaccurate fear of possible disease transmission. The HIV/AIDS pandemic is difficult enough to quell without stereotypes disenfranchising members of population that could potentially get treatment and become active members of society. As seen in the documentaries presented in class, a motivated individual, especially one who is personally affected by the disease, is a valuable asset to spreading information, increasing awareness and affecting change among their target populations. The advantage of providing legal protection to this population existed in their mindset, as “people will feel secure in their rights and dignity—and be more willing to seek testing and treatment. Enshrining human rights principles at the national level therefore may serve to change the culture of stigmatization that can surround the disease.” (Stone, 2) Beyond the much more tangible issue of providing drugs and treatment to infected populations, removing the social stigma attached to the disease has benefits that are just as important. In the case study of mother-to-child-transmission of HIV, we saw yet another example of how health as a human right could be used to attain and distribute the proper drugs to help prevent premature infant death.
With a number of public health problems growing in magnitude, public health professionals are forced to include the contributions of other groups, especially human rights professionals, if they are to achieve the goals that the groups share. This understanding can significantly tip the balance in our favor in the struggle against disease.
References:
Mann, JM, Voice from the Past, Health and Human Rights: If Not Now, When? American Journal of Public Health, Vol 96, No.11. 2006
Skolnik, R., Essential of Global Health: Ethical and Human Rights Concerns in Global Health., PG 59-71., Massachusetts., Jones and Bartlett Publishers. 2008
Easley, Cheryl E., Marks, Stephen P., Morgan, Russell E. The Challenge and Place of Human Rights in Public Health. December 2001, Vol 91, No. 12 | American Journal of Public Health 1922-1925
Stone, Lesley, Ostin, Lawrence O. Using Human Rights to Combat the HIV/AIDS Pandemic. Human Rights Magazine Volume 31, Number 4 Fall 2004
Yamin, Alicia. "Beyond compassion: The central role of accountability in applying a human rights framework to health" Health and Human Rights: An International Journal [Online], 10 19 Feb 2009
Thursday, March 26, 2009
Wednesday, March 25, 2009
The Human Right to Health and Health Care Systems
Yahaira Plata
PM 565
Blog
3/25/09
There are various documents in history that state the right to health and well-being. The Universal Declaration of Human Rights (1948) states in 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” (http://www.unhchr.ch/udhr/lang/eng.htm).
The first line clearly dictates the right to medical care and a standard of living adequate enough to be healthy. Similarly, the International Covenant on Economic, Social, and Cultural Rights (1966) states,
“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.
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” (http://www.unhchr.ch/html/menu3/b/a_cescr.htm)
Furthermore, the Convention of Elimination of All Forms of Discrimination against Women, the Convention on the Elimination of All Forms of Racial Discrimination, and the Convention on the Rights of the Child each also contain articles that explicitly state the right of humans to health and medical care. However, very few current health systems worldwide can say they truly offer their people this right. This paper will examine the successes and failures of systems to provide this right.
Some of the most prominent universal health care systems talked about in the world today are those of Britain and Cuba. The British National Health Service dates back to 1948 and “was the product of one of the most successful transitions from a private to a national public system” (Susser, 1993). In principle, the population had access to medical services, the inequities in the distribution of hospitals were addressed, and patients and doctors were still allowed freedom in choice. Susser points out, “We see the results in lower rates of surgery in the UK as compared with rates in the United States” (1993). However, early data showed that, despite a truly national health service, the UK was still not successful in diminishing the disadvantage in health. “A 10-year follow-up of a total population found an accelerating gradient in the risk of death, with the least risk in the highest grades and the most risk in the lowest grades” (Susser, 1993). There has been a widening differential in mortality between the most and least deprived of the UK and show a clear socioeconomic gradient (Whitehead, 1997). Therefore in the case of Britain, a universal system still did not guarantee equality in health across the board.
Cuba, on the other hand, has been able to implement a system that has truly improved the health of an entire country. “In the words of Dr. Paul Farmer, Cuba is showing that ‘you can introduce the notion of a right to health care and wipe out the diseases of poverty’” (Van Gelder, 2007). Each neighborhood in Cuba has their doctor and nurse team, and if a patient is not satisfied, they can choose to visit a different neighborhood team.
“House calls are routine, in part because it's the responsibility of the doctor and nurse team to understand you and your health issues in the context of your family, home, and neighborhood. This is key to the system. By catching diseases and health hazards before they get big, the Cuban medical system can spend a little on prevention rather than a lot later on to cure diseases, stop outbreaks, or cope with long-term disabilities” (Van Gelder, 2007)
When a health issue is beyond the neighborhood doctor, polyclinics provide specialists and outpatient surgeries; hospitals provide inpatient treatment and neighborhood doctors take over care when patients return home. Cuba is able to maintain the health status of their population because “ its economic system prioritizes the needs of the population instead of the profits of the corporations. It is only because Cuba has chosen to build its society according to different principles, based on equality and social justice, that it has been able to make the right to health a reality for its citizens” (Da Fonseca, 2007). This prioritization is one that many nations need to follow.
While these two nations show success in providing their population access to health, the United States is far behind in providing the right to health. In 2007, President Bush praised the US efforts to fight hunger, AIDS, and malaria in Africa and emphasized Article 25 of the Universal Declaration of Human Rights. However, when later asked about the child’s health bill, he said he vetoed it because it was too expensive. As Alan Jenkins points out,
“that fundamentally misunderstands what a human right is. Recognizing a human right to health care, as the Universal Declaration of Human Rights does, means prioritizing fulfillment of that right over other objectives. And paying for it. To be sure, a country's financial resources are relevant to the calculus; poor countries are expected to move incrementally towards satisfaction of the right when they cannot fulfill it immediately”
Today the US has nearly 46 million uninsured Americans and about 18,000 Americans die every year of preventable or treatable diseases. The Institute of Medicine points out, 69 % of children come from families with one or two full-time workers. These families depict the lack of Article 25 in the US.
Though the United States has the most expensive health care system in the world, it does not take care of its population nearly as well as Cuba or Britain. The US is ranked 37th on the WHO ranking of overall health system performance. And while, as a country, its policies point to health as a commodity, a 2006 study by the Commonwealth Fund found that three-quarters of all adults believe the U.S. healthcare system needs either fundamental change or complete rebuilding. The number one reason Americans today declare bankruptcy is due to medical bills and financing their health care. One of the richest nations in the world does not provide their citizens the ability to even afford health care and denies them the right to health.
Cuba and Britain was able to transition their nations to provide their citizens the right to health. The US, however, has allowed their citizens to suffer this inequity. Alan Jenking points out,
“Acknowledging the human right to health care does not resolve whether the government should be the chief provider of health insurance for Americans. But it does make government responsible for ensuring that all Americans have access to health care."
The United States needs to stand behind their claim to equality and human rights by providing access to care. A need for reform has arisen and the US needs to act and provide its citizens what it promises.
References
Da Fonseca, Joaquim. “Our International Experience in the Struggle for the Right to
Health” International Conference on the Right to Health. Dec 11, 2007.
Insuring America’s Health: Principles and Recommendations, January, 14, 2004, Institute of Medicine of the National Academies, http://www.iom.edu/?id=19175,
Jenkins, Alan. “ A Human Right to Health” Retrieved from http://www.tompaine.com/articles/2007/10/09/a_human_right_to_health.php
Shoen, Cathy, et al. Public Views on Shaping the Future of the U.S. Health System, August 2006, The Commonwealth Fund, http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=394606
Susser, Mervyn. “ Health as a Human Right: An Epidemiologist Perspective on the
Public Health” American Journal of Public Health. Vol 83:3. March 1993.
The People’s Movement to Human Rights Education: The Human Right to
Health.http://www.pdhre.org/rights/health.html.
Van Gelder, Sarah. “Health Care For All: Love, Cuba” Yes! Magazine. Issue 42, Summer
2007.
Whitehead, M., Evandrou, M., Haglund, B., and F. Diderichson. “As the Health
Dividends Widen in Sweden and Britain, what’s Happening to Access to Care?” British Medical Journal. 315: 1006- 1009. 1997.
Human Rights to HIV/AIDS
The number of people living with HIV/AIDS has been risen from 29.5 million in 2001 to 33 million in 2007 globally and annual deaths has increased from 1.7 million to 2 million in 2007 (9). When AIDS was first identified in early 80s, only little was known about ways of transmission of diseases and treatments which can contribute to fear and discrimination among people with HIV/AIDS. However, so far we have discovered various preventions, treatments and testing and we are continuing to fight against HIV/AIDS epidemics as well as fear, discrimination in certain countries in the world. Unfortunately in some developing countries while HIV prevention and treatment are available, people with HIV/AIDS still have to face stigma and discrimination due to lack of appropriate governmental policies of human rights and even if they established policies, they did not carried out as real actions (5). The spreading and the consequences of HIV/AIDS are resulted from the lack of effective enjoyment of human rights. Therefore human rights of people with HIV/AIDS can be both political and medical further more it is social concern that need to be involved simultaneously from three different aspects (1). In this sense, HIV/AIDS is not just simply a nasty disease but we need to view this epidemic as medical, social and economic contexts that closely linked to the human rights. Social exclusion of HIV positive people which causes discrimination and economic degeneration such as poverty can make people more vulnerable to HIV infection. Social justice and access to HIV prevention education and drugs play a vital role to help to protect people from being exposed to the HIV virus since they can hinder enjoyment of all human rights and furthermore it leaves the HIV affected people without protection from health hazards like AIDS. Poverty implies less access to health care and prevention privileges and often the surrounding factors such as housing, food and lifestyle renders the poor vulnerable to HIV infection. HIV infected people are often discriminated against in almost of basic human rights from their access to employment, housing, health and social services and legal rights. If government fails to provide or protect these social basic human rights, it will continue to increase prevalence of HIV/AIDS. In 2001, 189 nations from United Nations Special Session on HIV/AIDS signed the Declaration of Commitment on HIV/AIDS which perceived as a milestone to establish specific goals in preventions and cares from people with stigmatization and risk groups of HIV/AIDS (7).
Human rights to health are extremely important in both nationally and internationally, especially for those countries where still remain discrimination against women and marginalized groups such as poor and uneducated people (7). We have seen these examples from the sister of Suraiya, 21 years old women in Afghanistan died in childbirth at early age due the neglect of government and their discrimination against women and John William who was mistreated in the hospital due to his condition of HIV positive in Africa (5). There still several countries which have governmental policies that interfere with the accessibility and effectiveness of HIV-related measures for prevention and care (5). For example, laws that discriminate men who have sex with men, people who inject drugs and sex workers are not respected, protected and fulfilled their rights. The protection of human rights of people with HIV and vulnerable to HIV is extremely crucial to prevent more victims and decrease mortality. More importantly, the relationship between HIV and human rights are not only involved with people with HIV, but also involves with the policies of prevention, testing and nondiscriminatory distribution of HIV drugs. As the number of people living with HIV continues to grow in worldwide, HIV related human rights issues are not only apparent but also diverse from each country (3). In some developed countries like United States and Europe, people with HIV or AIDS can be benefited from widely available antiretroviral treatment, however in some of developing countries there are still high rates of mortality and spread of HIV now due to lack or unequal distribution of the drugs (3).
Human rights violation cause increase on vulnerability of especially horrible communicable disease like HIV globally since they have profound impacts on the health of individuals, communities and the population (7). And people living with HIV, including women, young people and other most-at-risk populations, such as sex workers, men who have sex with men, drug users and prisoners should play a major focus when establishing human rights of HIV infected people. Although the vulnerability may applies to all people, relatively women, children, minorities and poor people, sex workers and men who have sex with men are more vulnerable to infection of HIV and they tend to be highly discriminated or even harmed by legal or governmental policies of human rights.
The initial approaches to HIV were mainly focused on the reduction of risk of acquiring HIV infection through using condoms in sexual relationship and early diagnosis and treatment of infection (8). These projects can be successful at the educated community while it may have faced challenges on some countries where the social and economic stresses remain. However these risk reduction strategies confronted some obstacles such as the balance of international and national project level and applying same projects at different social and cultural settings (2). They may have confronted with problems from limitations of human rights as they relate to HIV, inadequate accountability for human rights by pharmaceuticals and lack of consensus in HIV programming efforts For example, in sub-Saharan African countries these projects were confronted with denial and rejection of prevention models which were seen by many culturally insensitive (2) . Often gender-related issues, stigma and discriminations toward people with HIV (sex workers, men who have sex with men and injecting drug users) may have made difficulty of reaching these people and eventually they do not receive proper prevention and treatments. The first Global Strategy of AIDS prevention was managed by the WHO and it was intended to prevent HIV transmission, to care for HIV-infected persons and reduce morbidity and mortality and ultimately to unite national AIDS programs (6). According to Mann, the key elements of a national AIDS program are political openness, creation of a national AIDS committee, initial epidemiologic and resource assessment, and development of a medium-term AIDS plan. The plan should specifically diverse areas including epidemiological surveillance, laboratory capability, education programs for health workers, prevention of sexual transmission, prevention of blood transmission, prevention of intravenous drug abuse, and prevention of infection of women of childbearing age altogether (4).
As HIV/AIDS epidemic increases, we must understand the fundamental linkages between HIV/AIDS and human rights and acknowledge the importance of international and national HIV/AIDS policies and programs to prevent higher mortality due to HIV/AIDS. However unfortunately, very little is carried out in reality. It can only be brought under control through the global cooperation of international, national governmental and non-governmental organizations (6). The human rights movement, which has been spearheaded by agencies of the United Nations, has helped protect victims of HIV/AIDS from discrimination, stigmatization and other affronts to human dignity, resisted irrational reactions by nations produced by panic, fear and ignorance and has spread knowledge concerning the realities of HIV/AIDS throughout the world. Different approach to human rights in HIV can be its advocacy, the use of the law, including both international and national legal norms and standards. The critical components of rights of HIV need to pay attention to the legal and policy context, participation, non-discrimination, the right to health (availability, accessibility, acceptability, and quality of services) (3). As World Health Organization offered a Corporate Strategy, public health action should promote the recognition of health dimension of social, economic, environmental and developmental policies to ensure that such policies and consequent programs contribute to the advancement of health (6).
As I have mentioned above, HIV/AIDS is not just medical problem but social and economic concerns we need to pay attention to. Although various organizations like UN, UNAIDS and Amnesty raised a awareness of human rights to HIV/AIDS, both inadequacy and incapability to human rights to HIV/AIDS hinder to protect people with HIV/AIDS. Human rights are inalienable, indivisible and interdependent according to World Conference in Human Rights in Austria (3). Therefore individual cannot lose human rights anymore than they cease being human being and he or she cannot be denied a right because it is regarded as less important. Lastly, human rights are part of complementary framework that one right impacts on all others. Human rights of HIV/AIDS showed us that all aspects of human rights are interconnected and human rights can be most crucial and powerful things to fight against HIV/AIDS epidemics in the world (6). We need to keep in mind that we need to pay more attention to the social and economic factors that might render people vulnerable to HIV infection and also discrimination against HIV positive people when we develop human rights of HIV/AIDS
Reference
1. Byrnes, A, Gruskin, S, Kemp, L, Tarantola, D & Zwi, A., (2008) Human Rights, Health and Development: Technical Series Paper., University of South Wales., Retrieved on March 19, 2009 from http://www.theglobaljusticenetwork.org/wp-content/uploads/2_tarantola.pdf
2. HIV/AIDS and Human Rights (Resource Guide) (2007)., Open Society Institute and Equitas-International Centre for Human Rights Education, New York., Equitas
3. Gruskin, S & Tarantola, D., April 2002 ., HIV InSite Knowledge Base Chapter, Human Rights and HIV/AIDS., Retrieved on March 19, 2009 from University of California, San Francisco,
4. Mann, JM, (2006) Voice from the Past, Health and Human Rights: If Not Now, When? American Journal of Public Health, Vol 96, No.11
5. Skolnik, R., (2008) Essential of Global Health: Ethical and Human Rights Concerns in Global Health., PG 59-71., Massachusetts., Jones and Bartlett Publishers.
6. Tarantola, D., Global Justice and Human Rights: Health and Human Rights in Practice., Retrieved on March 19, 2009 from http://www.theglobaljusticenetwork.org/wp-content/uploads/2_tarantola.pdf
7. United Nation AIDS, Human Rights and HIV., Retrieved on March 19, 2009 from http://www.unaids.org/en/PolicyAndPractice/HumanRights/
8. World Health Organization, Health & Human Rights., Retrieved on March 19, 2009 from http://www.who.int/hhr/HHRETH_activities.pdf
9. Worldwide AIDS/HIV Statistics End of 2007., Retrieved on March 19, 2009 from http://www.avert.org/worldstats.html
Human rights to health are extremely important in both nationally and internationally, especially for those countries where still remain discrimination against women and marginalized groups such as poor and uneducated people (7). We have seen these examples from the sister of Suraiya, 21 years old women in Afghanistan died in childbirth at early age due the neglect of government and their discrimination against women and John William who was mistreated in the hospital due to his condition of HIV positive in Africa (5). There still several countries which have governmental policies that interfere with the accessibility and effectiveness of HIV-related measures for prevention and care (5). For example, laws that discriminate men who have sex with men, people who inject drugs and sex workers are not respected, protected and fulfilled their rights. The protection of human rights of people with HIV and vulnerable to HIV is extremely crucial to prevent more victims and decrease mortality. More importantly, the relationship between HIV and human rights are not only involved with people with HIV, but also involves with the policies of prevention, testing and nondiscriminatory distribution of HIV drugs. As the number of people living with HIV continues to grow in worldwide, HIV related human rights issues are not only apparent but also diverse from each country (3). In some developed countries like United States and Europe, people with HIV or AIDS can be benefited from widely available antiretroviral treatment, however in some of developing countries there are still high rates of mortality and spread of HIV now due to lack or unequal distribution of the drugs (3).
Human rights violation cause increase on vulnerability of especially horrible communicable disease like HIV globally since they have profound impacts on the health of individuals, communities and the population (7). And people living with HIV, including women, young people and other most-at-risk populations, such as sex workers, men who have sex with men, drug users and prisoners should play a major focus when establishing human rights of HIV infected people. Although the vulnerability may applies to all people, relatively women, children, minorities and poor people, sex workers and men who have sex with men are more vulnerable to infection of HIV and they tend to be highly discriminated or even harmed by legal or governmental policies of human rights.
The initial approaches to HIV were mainly focused on the reduction of risk of acquiring HIV infection through using condoms in sexual relationship and early diagnosis and treatment of infection (8). These projects can be successful at the educated community while it may have faced challenges on some countries where the social and economic stresses remain. However these risk reduction strategies confronted some obstacles such as the balance of international and national project level and applying same projects at different social and cultural settings (2). They may have confronted with problems from limitations of human rights as they relate to HIV, inadequate accountability for human rights by pharmaceuticals and lack of consensus in HIV programming efforts For example, in sub-Saharan African countries these projects were confronted with denial and rejection of prevention models which were seen by many culturally insensitive (2) . Often gender-related issues, stigma and discriminations toward people with HIV (sex workers, men who have sex with men and injecting drug users) may have made difficulty of reaching these people and eventually they do not receive proper prevention and treatments. The first Global Strategy of AIDS prevention was managed by the WHO and it was intended to prevent HIV transmission, to care for HIV-infected persons and reduce morbidity and mortality and ultimately to unite national AIDS programs (6). According to Mann, the key elements of a national AIDS program are political openness, creation of a national AIDS committee, initial epidemiologic and resource assessment, and development of a medium-term AIDS plan. The plan should specifically diverse areas including epidemiological surveillance, laboratory capability, education programs for health workers, prevention of sexual transmission, prevention of blood transmission, prevention of intravenous drug abuse, and prevention of infection of women of childbearing age altogether (4).
As HIV/AIDS epidemic increases, we must understand the fundamental linkages between HIV/AIDS and human rights and acknowledge the importance of international and national HIV/AIDS policies and programs to prevent higher mortality due to HIV/AIDS. However unfortunately, very little is carried out in reality. It can only be brought under control through the global cooperation of international, national governmental and non-governmental organizations (6). The human rights movement, which has been spearheaded by agencies of the United Nations, has helped protect victims of HIV/AIDS from discrimination, stigmatization and other affronts to human dignity, resisted irrational reactions by nations produced by panic, fear and ignorance and has spread knowledge concerning the realities of HIV/AIDS throughout the world. Different approach to human rights in HIV can be its advocacy, the use of the law, including both international and national legal norms and standards. The critical components of rights of HIV need to pay attention to the legal and policy context, participation, non-discrimination, the right to health (availability, accessibility, acceptability, and quality of services) (3). As World Health Organization offered a Corporate Strategy, public health action should promote the recognition of health dimension of social, economic, environmental and developmental policies to ensure that such policies and consequent programs contribute to the advancement of health (6).
As I have mentioned above, HIV/AIDS is not just medical problem but social and economic concerns we need to pay attention to. Although various organizations like UN, UNAIDS and Amnesty raised a awareness of human rights to HIV/AIDS, both inadequacy and incapability to human rights to HIV/AIDS hinder to protect people with HIV/AIDS. Human rights are inalienable, indivisible and interdependent according to World Conference in Human Rights in Austria (3). Therefore individual cannot lose human rights anymore than they cease being human being and he or she cannot be denied a right because it is regarded as less important. Lastly, human rights are part of complementary framework that one right impacts on all others. Human rights of HIV/AIDS showed us that all aspects of human rights are interconnected and human rights can be most crucial and powerful things to fight against HIV/AIDS epidemics in the world (6). We need to keep in mind that we need to pay more attention to the social and economic factors that might render people vulnerable to HIV infection and also discrimination against HIV positive people when we develop human rights of HIV/AIDS
Reference
1. Byrnes, A, Gruskin, S, Kemp, L, Tarantola, D & Zwi, A., (2008) Human Rights, Health and Development: Technical Series Paper., University of South Wales., Retrieved on March 19, 2009 from http://www.theglobaljusticenetwork.org/wp-content/uploads/2_tarantola.pdf
2. HIV/AIDS and Human Rights (Resource Guide) (2007)., Open Society Institute and Equitas-International Centre for Human Rights Education, New York., Equitas
3. Gruskin, S & Tarantola, D., April 2002 ., HIV InSite Knowledge Base Chapter, Human Rights and HIV/AIDS., Retrieved on March 19, 2009 from University of California, San Francisco,
4. Mann, JM, (2006) Voice from the Past, Health and Human Rights: If Not Now, When? American Journal of Public Health, Vol 96, No.11
5. Skolnik, R., (2008) Essential of Global Health: Ethical and Human Rights Concerns in Global Health., PG 59-71., Massachusetts., Jones and Bartlett Publishers.
6. Tarantola, D., Global Justice and Human Rights: Health and Human Rights in Practice., Retrieved on March 19, 2009 from http://www.theglobaljusticenetwork.org/wp-content/uploads/2_tarantola.pdf
7. United Nation AIDS, Human Rights and HIV., Retrieved on March 19, 2009 from http://www.unaids.org/en/PolicyAndPractice/HumanRights/
8. World Health Organization, Health & Human Rights., Retrieved on March 19, 2009 from http://www.who.int/hhr/HHRETH_activities.pdf
9. Worldwide AIDS/HIV Statistics End of 2007., Retrieved on March 19, 2009 from http://www.avert.org/worldstats.html
Friday, March 20, 2009
Non-Communicable Diseases in China
China is currently experiencing a rapid epidemiological transition. The incidence of chronic diseases—cancer, cardiovascular disease, diabetes, arthritis, cerebrovascular disease, mental illness, and others—has increased dramatically as a result of societal changes, especially those related to diet, physical activity, and tobacco use. China’s growing rates of chronic diseases have been attributed to the aging of the Chinese population, in addition to increases in high-risk behaviors.[1] Our class reading regarding this topic (Yang et al., 2008) points to the importance of prevention in curbing the rise of chronic diseases in China. This blog focuses further on a particularly susceptible group: rural-to-urban migrant workers.
China’s accelerated epidemiological transition parallels the tremendous economic growth and development China has seen in recent decades. As is expected, such growth has brought with it rapid urbanization. From 1978 to 2004, the percentage of the population living in cities increased from 17.9% to 41.8%.[2] Internal migration of rural residents to urban areas has certainly contributed to this rapid urbanization. It is estimated that the number of rural-urban migrant workers in China was 11 million in 1982, and presently the number of rural-urban migrant workers stands at 120 million.2 This number is expected to increase by about 10 million every year.[3]
There are a number of reasons for the massive influx of rural residents into urban areas. First, there is a great disparity in the income that can be earned in the countryside versus the city. Second, China’s transition to a modernized market economy has in many ways favored migration from rural to urban areas. With a market economy has come the collapse of state-owned farms. Furthermore, the Chinese government introduced the Household Responsibility System in agricultural reform, under which government-owned farmland is entrusted to individual households, which pay taxes, keeping all other proceeds. Together, the collapse of state-owned farms and the contracting of individual households to manage government farmland have led to the disintegration of collective farms and a surplus of rural labor.[3]
There are many driving forces for rural-urban migration in China, yet there are also other forces aiming to contain such migration. Most notable is the hukou system, or the Household Registration System. The Chinese register as residents of their birthplace under the hukou system, and only residents are eligible for social services such as low-income housing, education, and health care benefits.[3] Thus, rural-urban migrants and their families are ineligible for such social services upon migration to the city. For example, a migrant worker’s children would not be able to enjoy the same public education available to their urban-resident counterparts. But although the hukou system acts as a deterrent of sorts, it certainly has not hindered the 120 million Chinese rural residents who have chosen to migrate to urban areas.
Rural-urban migrants are a vulnerable group, due in large part to China’s hukou system. Migrant workers are also likely to live in unsanitary and overcrowded conditions, take up physically demanding jobs, and receive low wages.[3] Moreover, there are other government restrictions that make legitimate employment difficult for migrant workers in urban areas[4]—though the Chinese government has been gradually relaxing its control on rural-urban migration. For example, some municipal governments have restricted migrant workers to certain industries and corporations.[5] Indeed, most migrants hang on the lowest rung of the urban socio-economic ladder.
Given the difficulties faced by rural-urban migrants, they are particularly susceptible to poor mental health.[6] In fact, Yang & Luo (2008) showed a statistically significant difference in psychosocial characteristics between migrants and non-migrants, with migrants faring far worse than non-migrants. Mental disorders are an often-overlooked non-communicable disease, particularly in low- and middle-income countries. Mental disorders in general are responsible for 10% DALYs lost in low- and middle-income countries; depression alone is responsible for 3.4% of DALYs lost.[7]
Migrants are also more susceptible to other chronic conditions than the general Chinese population. The process of migration and the status of migrants make them prone to psychological distress and anxiety, which is associated with greater levels of alcohol consumption and intoxication.[8] High-risk drinking is associated with several chronic conditions, including hypertension, heart disease, and hormonal problems, as well as damage to the liver and pancreas.[7]
Susceptibility of migrants to chronic conditions is also related to level of education. Migrants are generally less educated than non-migrants, and rural residents less educated than urban residents.[2] Level of education—as well as socioeconomic status[7]—has many repercussions for health behaviors. For example, less educated, poor people are more likely to smoke than more educated, wealthy people. Exacerbating the situation is certainly China’s role as the largest producer of cigarettes in the world.[9] Finally, level of education may also influence individuals’ diet and physical activity behaviors, affecting their risk for cardiovascular disease and diabetes.
It is clear that non-communicable diseases are a growing problem in China, and that rural-urban migrants are particularly susceptible to chronic conditions. As is emphasized in the class reading on the topic (Yang et al., 2008), prevention is key to curbing the rise of non-communicable diseases. However, in order to effectively addresses non-communicable diseases in China, more attention must be shifted to rural-urban migrants. Specifically, given the ever-increasing countryside-to-city migration, the hukou system must be reassessed so that migrants can receive the same health care and other social benefits available to urban residents. This would be an important step in addressing non-communicable diseases among a large and vulnerable group in China. Bringing about change in the hukou system policy, however, may take many years. In the meantime, migrant communities should be the target of interventions to prevent and treat non-communicable diseases.
References
[1] Yang G, Kong L, Zhao W, Wan X, Zhai Y, Chen L, & Koplan J (2008). Emergence of chronic non-communicable diseases in China. The Lancet, 372: 1697-1705.
[2] Yang X & Luo H (2008). Migration, urbanization, and drug use and casual sex in China: A multilevel analysis. Environment and Planning (Advance online publication). Retrieved February 26, 2009, from http://www.envplan.com/epa/fulltext/aforth/a40297.pdf.
[3] Wong D & Leung G (2008). The functions of social support in the mental health of male and female migrant workers in China. Health & Social Work, 33(4), 275-285.
[4] Hong Y et al. (2006). Rural-to-urban migrants and the HIV epidemic in China. AIDS and Behavior, 10(4), 421-430.
[5] Li X et al. (2006). Health indicators and geographic mobility among young rural-to-urban migrants in China. World Health & Population, 8(2), 5-21.
[6] Wong D & Son HX (2008). The resilience of migrant workers in Shanghai China: the roles of migration stress and meaning of migration. International Journal of Social Psychiatry, 54(2), 131-143.
[7] Skolnik R (2008). Essentials of global health. Sudbury, MA: Jones and Bartlett Publishers.
[8] Lin D et al. (2005). Alcohol intoxication and sexual risk behaviors among rural-to-urban migrants in China. Drug and Alcohol Dependence, 79, 103-112.
[9] Hesketh T et al. (2007). Smoking, cessation and expenditure in low income Chinese: cross sectional survey. BioMed Central Public Health, 7(29).
Monday, March 16, 2009
Public Health and Heat Waves
A natural disaster refers to any naturally occurring, catastrophic event that disrupts human activity. These disasters can range from the volcanos and earthquakes to more common events such as landslides and floods. Here in Southern California, we deal with a variety of natural disasters, but one in particular stands out. Heat waves occur each year and thanks to global warming, these yearly events are worsening. Therefore, it is necessary for public health officials to develop preventative relief plans as well as new measures for alleviating health issues related to yearly heat waves.
Global warming has led to a slow, but steady increase in temperatures each year, particularly in the hot summer months. Heat waves like those that have scorched Europe and the United States are becoming more frequent because of global warming. Several recent studies suggest that human-generated emissions of heat-trapping gases have produced both higher overall temperatures and greater weather variability, which raise the odds of longer, more intense heat waves. Research in Switzerland suggest that since 1880 the duration of heat waves in Western Europe has doubled and the number of unusually hot days in the region has nearly tripled.
Here, in the U.S., researchers at the National Climatic Data Center in Asheville, N.C, reported that nighttime summer temperatures across the country have been unusually high for the past eight years, a record streak. Researchers at the climate-analysis branch of the National Center for Atmospheric Research in Colorado have stated that “There are very good reasons to believe that the current U.S. heat wave is at least partly caused by global warming." In addition, the National Oceanic and Atmospheric Administration reported that the first six months of 2006 are the hottest on record in the United States, and last month ranks as England's hottest July since recordkeeping began in 1659.
Another study in the Journal of Geophysical Research showed that for more than 70 percent of the land researchers had surveyed worldwide, the number of warm nights each year had increased and the number of cold nights had declined, between 1951 and 2003. The researchers concluded, "This implies a positive shift in the distribution of daily minimum temperature throughout the globe."
Experts in the field of geological and atmospheric research agree that it is important to pay attention to the high temperatures that have blanketed the United States and Europe over the past few years and therefore, it is necessary for public health officials to prepare for the possible implications of these increasing temperatures.
Before worrying about the health-related aspects of heat waves, government officials should first implement strategies for staying cool and safe during heat waves. The first act that should be focused on is spreading awareness about upcoming heat waves. This information is already advertised on the news, in newspapers, and on the internet, but it is important for this information to reach all groups of people, particularly those who are at a higher risk fro health-related effects such as the elderly and young children. The government should prepare announcements regarding upcoming heat waves and they should create a list of criteria that should be followed during each heat wave event. For example, all individuals should avoid being outdoors during peak hours between 10am and 4pm. This should be made especially clear in schools and nursing homes since these are places with high risk groups.
Secondly, precautions should be taken for individuals who do venture outdoors. For one, sunscreen is absolutely necessary. Perhaps public officials can look into allocating funds that would supply sunscreen in public bathrooms so that individuals would have access to this necessary precautionary substance. Also, sunscreen should be kept at schools, preschools, and nursing homes to further prevent any chronic health issues that may result from excessive sun exposure during a heat wave.
While spreading the word of an upcoming heat wave is the number one thing that health officials can do to prevent unnecessary illness and death, we also need to make it clear the steps that the public should follow in the case of a heat wave. On top of sunscreen, those who are going outdoors should also wear protective clothing, including hats and, light clothing. Active individuals should wait until dusk to walk or run outdoors and active jobs such as gardening, cleaning, painting, etc. should also be done during a safer hour.
It is most vital that public health officials reach out to schools and nursing homes since that is the population that is most at risk. Perhaps, county departments of public health can develop a binder with guidelines that state which months are most dangerous due to heat wave occurrence as well as the precautions that should be taken during these times. Preventative health is the most effective way for officials to decrease unnecessary death and illness due to heat waves.
While prevention is the most important step in most public health campaigns, there also needs to be a strong post-disaster plan. A public awareness system will help to inform individuals of an impending heat wave, but people need to know what to do should they fall ill or find someone else in need of medical attentions.
First and foremost, the general public should be aware of the first signs of heat exhaustion. These include, dizziness, headaches, muscle cramps, weakness, etc. Any individual experiencing these symptoms or are responsible for the care of someone else experiencing these symptoms should go indoors, cool down by either taking a cool bath or sitting in front of a fan and drink plenty of water. Nursing home staff and hospital staff should be extra alert during a heat wave because patients suffering from dementia or mental disorders may not let someone know if they are experiencing signs of heat exhaustion.
Heatstroke is another serious illness that must be monitored carefully in order to prevent a progression of early signs and symptoms. Heatstroke symptoms mimic those of heat exhaustion except that aggression, irritability, and convulsions may also occur. In either case, it is important for those suffering these symptoms to go indoors immediately, find ways to stay cool and if the symptoms persist, call an ambulance.
Most of post-disaster care is performed by caretakers and medical officials, but there are still steps that public health officials can take to help alleviate health-related illnesses during a heatstroke. During increased temperatures, government officials should station “cooling vans” in areas with large crowds. These vans should be stocked with plenty of water and disposable ice packs to help cool those in need. Outdoor malls, restaurants and shopping areas should be encouraged to have plenty of shade and even misters to help cool down the public. Nursing homes and hospitals should keep all patients indoors and should conserve energy during other months so that electricity funds can be allocated towards keeping facilities well air conditioned during the warm months.
In conclusion, it is important to recognize that public health officials play a major role in all natural disasters. For all types of natural disasters, public health officials should create a comprehensive preventative plan that clearly states what officials and the public should do to help prevent unnecessary illness and death. Secondly, officials should create a clear-cut plan stating exactly what measures need to be taken in the event of a natural disaster. Natural disasters are not preventable, but illness and death often are. In the United States and particularly in Southern California, heat waves are a common natural disaster. Government funds should be put towards creating strong preventative plans as well as measures that should be taken each year when these heat waves occur. Only through planning and effective allocation of resources can we help prevent future deaths and illnesses from imminent heat waves
Resources
1.)http://www.dh.gov.uk/en/AboutUs/MinistersAndDepartmentLeaders/ChiefMedicalOfficer/Features/DH_4135398
2.) http://www.disastersrus.org/emtools/Heatwave/heatwave.htm
3.) http://dels.nas.edu/dr/docs/shoaf.pdf
4.) www.wikipedia.com
5.) http://www.euro.who.int/Document/Gch/Annex_heatwaves_info.pdf
6.)http://esciencenews.com/sources/science.blog/2009/02/25/study.analyzes.2006.california.heat.waves.substantial.effect.morbidity.0
7.) http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/04/17/MNGFCP9UL41.DTL
Global warming has led to a slow, but steady increase in temperatures each year, particularly in the hot summer months. Heat waves like those that have scorched Europe and the United States are becoming more frequent because of global warming. Several recent studies suggest that human-generated emissions of heat-trapping gases have produced both higher overall temperatures and greater weather variability, which raise the odds of longer, more intense heat waves. Research in Switzerland suggest that since 1880 the duration of heat waves in Western Europe has doubled and the number of unusually hot days in the region has nearly tripled.
Here, in the U.S., researchers at the National Climatic Data Center in Asheville, N.C, reported that nighttime summer temperatures across the country have been unusually high for the past eight years, a record streak. Researchers at the climate-analysis branch of the National Center for Atmospheric Research in Colorado have stated that “There are very good reasons to believe that the current U.S. heat wave is at least partly caused by global warming." In addition, the National Oceanic and Atmospheric Administration reported that the first six months of 2006 are the hottest on record in the United States, and last month ranks as England's hottest July since recordkeeping began in 1659.
Another study in the Journal of Geophysical Research showed that for more than 70 percent of the land researchers had surveyed worldwide, the number of warm nights each year had increased and the number of cold nights had declined, between 1951 and 2003. The researchers concluded, "This implies a positive shift in the distribution of daily minimum temperature throughout the globe."
Experts in the field of geological and atmospheric research agree that it is important to pay attention to the high temperatures that have blanketed the United States and Europe over the past few years and therefore, it is necessary for public health officials to prepare for the possible implications of these increasing temperatures.
Before worrying about the health-related aspects of heat waves, government officials should first implement strategies for staying cool and safe during heat waves. The first act that should be focused on is spreading awareness about upcoming heat waves. This information is already advertised on the news, in newspapers, and on the internet, but it is important for this information to reach all groups of people, particularly those who are at a higher risk fro health-related effects such as the elderly and young children. The government should prepare announcements regarding upcoming heat waves and they should create a list of criteria that should be followed during each heat wave event. For example, all individuals should avoid being outdoors during peak hours between 10am and 4pm. This should be made especially clear in schools and nursing homes since these are places with high risk groups.
Secondly, precautions should be taken for individuals who do venture outdoors. For one, sunscreen is absolutely necessary. Perhaps public officials can look into allocating funds that would supply sunscreen in public bathrooms so that individuals would have access to this necessary precautionary substance. Also, sunscreen should be kept at schools, preschools, and nursing homes to further prevent any chronic health issues that may result from excessive sun exposure during a heat wave.
While spreading the word of an upcoming heat wave is the number one thing that health officials can do to prevent unnecessary illness and death, we also need to make it clear the steps that the public should follow in the case of a heat wave. On top of sunscreen, those who are going outdoors should also wear protective clothing, including hats and, light clothing. Active individuals should wait until dusk to walk or run outdoors and active jobs such as gardening, cleaning, painting, etc. should also be done during a safer hour.
It is most vital that public health officials reach out to schools and nursing homes since that is the population that is most at risk. Perhaps, county departments of public health can develop a binder with guidelines that state which months are most dangerous due to heat wave occurrence as well as the precautions that should be taken during these times. Preventative health is the most effective way for officials to decrease unnecessary death and illness due to heat waves.
While prevention is the most important step in most public health campaigns, there also needs to be a strong post-disaster plan. A public awareness system will help to inform individuals of an impending heat wave, but people need to know what to do should they fall ill or find someone else in need of medical attentions.
First and foremost, the general public should be aware of the first signs of heat exhaustion. These include, dizziness, headaches, muscle cramps, weakness, etc. Any individual experiencing these symptoms or are responsible for the care of someone else experiencing these symptoms should go indoors, cool down by either taking a cool bath or sitting in front of a fan and drink plenty of water. Nursing home staff and hospital staff should be extra alert during a heat wave because patients suffering from dementia or mental disorders may not let someone know if they are experiencing signs of heat exhaustion.
Heatstroke is another serious illness that must be monitored carefully in order to prevent a progression of early signs and symptoms. Heatstroke symptoms mimic those of heat exhaustion except that aggression, irritability, and convulsions may also occur. In either case, it is important for those suffering these symptoms to go indoors immediately, find ways to stay cool and if the symptoms persist, call an ambulance.
Most of post-disaster care is performed by caretakers and medical officials, but there are still steps that public health officials can take to help alleviate health-related illnesses during a heatstroke. During increased temperatures, government officials should station “cooling vans” in areas with large crowds. These vans should be stocked with plenty of water and disposable ice packs to help cool those in need. Outdoor malls, restaurants and shopping areas should be encouraged to have plenty of shade and even misters to help cool down the public. Nursing homes and hospitals should keep all patients indoors and should conserve energy during other months so that electricity funds can be allocated towards keeping facilities well air conditioned during the warm months.
In conclusion, it is important to recognize that public health officials play a major role in all natural disasters. For all types of natural disasters, public health officials should create a comprehensive preventative plan that clearly states what officials and the public should do to help prevent unnecessary illness and death. Secondly, officials should create a clear-cut plan stating exactly what measures need to be taken in the event of a natural disaster. Natural disasters are not preventable, but illness and death often are. In the United States and particularly in Southern California, heat waves are a common natural disaster. Government funds should be put towards creating strong preventative plans as well as measures that should be taken each year when these heat waves occur. Only through planning and effective allocation of resources can we help prevent future deaths and illnesses from imminent heat waves
Resources
1.)http://www.dh.gov.uk/en/AboutUs/MinistersAndDepartmentLeaders/ChiefMedicalOfficer/Features/DH_4135398
2.) http://www.disastersrus.org/emtools/Heatwave/heatwave.htm
3.) http://dels.nas.edu/dr/docs/shoaf.pdf
4.) www.wikipedia.com
5.) http://www.euro.who.int/Document/Gch/Annex_heatwaves_info.pdf
6.)http://esciencenews.com/sources/science.blog/2009/02/25/study.analyzes.2006.california.heat.waves.substantial.effect.morbidity.0
7.) http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/04/17/MNGFCP9UL41.DTL
Saturday, March 14, 2009
Ara's Blog #2 (for April 6): War & Emergencies_
The following discussion illustrates the impact of violence and injuries (in LAMICs), the guidelines for providing health services in disaster emergency response and the framework of health policy development for emergency preparedness.
“Just under a third of injuries worldwide (32.8%) are recognizably intentional; half of these are self-inflicted and half result from interpersonal violence and war” (Murray 2006) Violence kills more than 1.6 million people worldwide each year, accounting for 14% of male deaths and 7% of female. (WHO, 2002). Furthermore, “the mortality burden from all types of injuries in high-income countries is 10% of that in low/middle-income countries” (Hofman, 2005). In addition to the gaps in having an organized and skilled healthcare workforce within an emergency response system, low-and-middle-income countries experience significant post-conflict, non-communicable diseases (mainly psychological) that affect productivity and overall well-being of families and communities (Hofman, 2005).
The public health approach to violence is based on four key steps (Dahlberg 2002): 1) understanding the magnitude and scope of violence at the local, national and international levels 2) determining the etiology of violence and factors that increase susceptibility to committing or being victims of violence 3) formulating and implementing effective interventions 4) and dissemination of effective programs.
While the nature of violent acts, can be physical, sexual, psychological or an act of neglect, the difficulty of properly addressing the specific health needs incurred by violence remains in the measurement of violence and its actual impact (Dahlberg, 2002). Data on fatalities and war-related deaths can indicate the extent of violence in a particular country. These data can also be used for identifying groups at high risk for violence and monitoring their health. Potential sources of the various types of information include: individuals; agency or institutional records; government records; and population-based and other surveys. However, calculating rates from these sources is not always possible because population data are often unavailable or unreliable—especially among migrant/refugee populations whereby the objective of proper record and consensus tracking is challenging. Lastly, data on violence generally come from a variety of independent organizations and with lack of uniformity between and within countries (especially LAMICs),
The Sphere Project (2004) outlines the minimal standards for health service delivery during disaster response. It lists 6 essential standards: prioritizing health services; supporting national and local health systems; coordination; primary health care; clinical services; and health information systems.
In prioritizing health services: the major causes of morbidity and mortality should be properly identified and monitored; health authorities at all government levels should be involved in the design and implementation of health interventions; and, collaboration with multi-sector agencies to ensure proper health service delivery implementation in coordination with water, shelter, and food securities.
In supporting national and local health systems, there should namely be an immediate identification of a lead health authority to serve as a supervisory role during multi-agency and/or multi-national collaborations to address conflict-affected areas (the MOH is the primary lead, if present and capable). Secondly, there should be an emphasis on supporting existing resources (hospitals, workforce, etc.) rather than deploying a foreign field hospital and place further strains on the country’s limited resources.
In the coordination standard, the main action to ensure is the establishment of proper duties and responsibilities of local and national health authorities to develop a streamlined and effective operating mechanism. In providing the standards of primary health care, there should be an emphasis in disseminating health education information in addition to establishing proper referral systems among the various health centers and personnel. Most notably, these services must be carefully adapted to cultural and social norms to ensure compliance and adherence to treatments.
In providing the standards of clinical services, there should be proper monitoring and evaluation by adequate clinical health staff in regard to drug management (due to the scarcity of drugs and its susceptibility to being misused and even mismanaged in procurement). Lastly, with providing health information systems, a standardized health information system (HIS) is implemented by all health agencies to routinely collect relevant data on demographics, mortality, and morbidity and health services
Developing a policy response to violence and injuries may consist of three phases (Schopper, 2006).
Phase 1: Initiate the policy development process. This can be accomplished by various steps; initiating with an Assessment step. An epidemiological assessment may provide policy makers with the proper morbidity and mortality data relating to violence and injury (challenges: the reliability of data collection methods). An intervention assessment may be conducted whereby an evaluation of the country’s existing resources and programs devoted to prevention is methods are analyzed. An assessment of the existing policy development is essential to determine the direction of future legislation as well as the knowledge gaps to address. A stakeholder analysis will provide insight as to who may be proponents or opponents of injury prevention policies. Stakeholders may include: elected officials, commissions, regional/local governments (at state/govt. level); universities and researchers (academia level); advocacy groups and sponsors (NGO level). The second step would entail raising awareness of violence and injury. Examples include: World Refugee Day, UN International Day in Support of Victims of Torture, and Human Rights Day. The third step involves identifying the proper leadership and affirming political commitment—namely to serve as a coordinating role to ensure the involvement of the various stakeholders is properly incorporated into the policy development process.
Phase 2 involves the actual policy development. This phase essentially focuses on setting the priorities, defining responsibilities for implementation, identifying necessary resources for implementation, and developing a monitoring mechanism to ensure the timely policy development.
Phase 3 involves the approval of stakeholders, government and state entities. The stakeholder’s approval would be most advantageous—in light of political ambiguity—as they are most likely to be the advocates for the intended policy development.
In closing, how are we to address the various logistical/operational challenges faced in international disaster response? (IFRC, 2005) With regard to human resources, how can we expedite the processes in ensuring timely arrival of relief workers without the various international legal red tape surrounding the recognition and protection of relief workers? With regard to financial resources, how can we expedite the processes involving the transfers of funds between international communities to conflict-affected regions? With regard to equipment, how can we ensure safety in delivery of the necessary goods to our target regions? And lastly, how can we incorporate effective coordination (information and resources) among humanitarian agencies to maximize use of scarce resources?
____________________________
Dahlberg L.L., Krug E.G. Violence: a global public health problem. WHO report on Violence and Health, 2002
Hofman K., Primack A., Keusch G., Hrynkow S. Addressing the Growing Burden of Trauma and Injury in Low-and-Middle-Income Countries. AMJPH January 2005, v.95 (1): 13-17
International Federation of Red Cross (IFRC). International disaster response laws, rules and principles (IDRL). Jan 2005
Murray, S. Public Health. Editorial. CMAJ Feb 28, 2006 v.174(5): 620-21
Schopper D, Lormand JD,Waxweiler R (eds). Developing policies to prevent injuries and violence: guidelines for policy-makers and planners. Geneva,World Health Organization, 2006.
Sphere Project: Humanitarian Charter and Minimum Standards in Disaster Response. pp249-310 (2004)
World Health Organization (WHO). World report on violence and health. Geneva: WHO; 2002. Available: www.who.int/violence_injury_prevention/en (accessed March 14, 2009)
“Just under a third of injuries worldwide (32.8%) are recognizably intentional; half of these are self-inflicted and half result from interpersonal violence and war” (Murray 2006) Violence kills more than 1.6 million people worldwide each year, accounting for 14% of male deaths and 7% of female. (WHO, 2002). Furthermore, “the mortality burden from all types of injuries in high-income countries is 10% of that in low/middle-income countries” (Hofman, 2005). In addition to the gaps in having an organized and skilled healthcare workforce within an emergency response system, low-and-middle-income countries experience significant post-conflict, non-communicable diseases (mainly psychological) that affect productivity and overall well-being of families and communities (Hofman, 2005).
The public health approach to violence is based on four key steps (Dahlberg 2002): 1) understanding the magnitude and scope of violence at the local, national and international levels 2) determining the etiology of violence and factors that increase susceptibility to committing or being victims of violence 3) formulating and implementing effective interventions 4) and dissemination of effective programs.
While the nature of violent acts, can be physical, sexual, psychological or an act of neglect, the difficulty of properly addressing the specific health needs incurred by violence remains in the measurement of violence and its actual impact (Dahlberg, 2002). Data on fatalities and war-related deaths can indicate the extent of violence in a particular country. These data can also be used for identifying groups at high risk for violence and monitoring their health. Potential sources of the various types of information include: individuals; agency or institutional records; government records; and population-based and other surveys. However, calculating rates from these sources is not always possible because population data are often unavailable or unreliable—especially among migrant/refugee populations whereby the objective of proper record and consensus tracking is challenging. Lastly, data on violence generally come from a variety of independent organizations and with lack of uniformity between and within countries (especially LAMICs),
The Sphere Project (2004) outlines the minimal standards for health service delivery during disaster response. It lists 6 essential standards: prioritizing health services; supporting national and local health systems; coordination; primary health care; clinical services; and health information systems.
In prioritizing health services: the major causes of morbidity and mortality should be properly identified and monitored; health authorities at all government levels should be involved in the design and implementation of health interventions; and, collaboration with multi-sector agencies to ensure proper health service delivery implementation in coordination with water, shelter, and food securities.
In supporting national and local health systems, there should namely be an immediate identification of a lead health authority to serve as a supervisory role during multi-agency and/or multi-national collaborations to address conflict-affected areas (the MOH is the primary lead, if present and capable). Secondly, there should be an emphasis on supporting existing resources (hospitals, workforce, etc.) rather than deploying a foreign field hospital and place further strains on the country’s limited resources.
In the coordination standard, the main action to ensure is the establishment of proper duties and responsibilities of local and national health authorities to develop a streamlined and effective operating mechanism. In providing the standards of primary health care, there should be an emphasis in disseminating health education information in addition to establishing proper referral systems among the various health centers and personnel. Most notably, these services must be carefully adapted to cultural and social norms to ensure compliance and adherence to treatments.
In providing the standards of clinical services, there should be proper monitoring and evaluation by adequate clinical health staff in regard to drug management (due to the scarcity of drugs and its susceptibility to being misused and even mismanaged in procurement). Lastly, with providing health information systems, a standardized health information system (HIS) is implemented by all health agencies to routinely collect relevant data on demographics, mortality, and morbidity and health services
Developing a policy response to violence and injuries may consist of three phases (Schopper, 2006).
Phase 1: Initiate the policy development process. This can be accomplished by various steps; initiating with an Assessment step. An epidemiological assessment may provide policy makers with the proper morbidity and mortality data relating to violence and injury (challenges: the reliability of data collection methods). An intervention assessment may be conducted whereby an evaluation of the country’s existing resources and programs devoted to prevention is methods are analyzed. An assessment of the existing policy development is essential to determine the direction of future legislation as well as the knowledge gaps to address. A stakeholder analysis will provide insight as to who may be proponents or opponents of injury prevention policies. Stakeholders may include: elected officials, commissions, regional/local governments (at state/govt. level); universities and researchers (academia level); advocacy groups and sponsors (NGO level). The second step would entail raising awareness of violence and injury. Examples include: World Refugee Day, UN International Day in Support of Victims of Torture, and Human Rights Day. The third step involves identifying the proper leadership and affirming political commitment—namely to serve as a coordinating role to ensure the involvement of the various stakeholders is properly incorporated into the policy development process.
Phase 2 involves the actual policy development. This phase essentially focuses on setting the priorities, defining responsibilities for implementation, identifying necessary resources for implementation, and developing a monitoring mechanism to ensure the timely policy development.
Phase 3 involves the approval of stakeholders, government and state entities. The stakeholder’s approval would be most advantageous—in light of political ambiguity—as they are most likely to be the advocates for the intended policy development.
In closing, how are we to address the various logistical/operational challenges faced in international disaster response? (IFRC, 2005) With regard to human resources, how can we expedite the processes in ensuring timely arrival of relief workers without the various international legal red tape surrounding the recognition and protection of relief workers? With regard to financial resources, how can we expedite the processes involving the transfers of funds between international communities to conflict-affected regions? With regard to equipment, how can we ensure safety in delivery of the necessary goods to our target regions? And lastly, how can we incorporate effective coordination (information and resources) among humanitarian agencies to maximize use of scarce resources?
____________________________
Dahlberg L.L., Krug E.G. Violence: a global public health problem. WHO report on Violence and Health, 2002
Hofman K., Primack A., Keusch G., Hrynkow S. Addressing the Growing Burden of Trauma and Injury in Low-and-Middle-Income Countries. AMJPH January 2005, v.95 (1): 13-17
International Federation of Red Cross (IFRC). International disaster response laws, rules and principles (IDRL). Jan 2005
Murray, S. Public Health. Editorial. CMAJ Feb 28, 2006 v.174(5): 620-21
Schopper D, Lormand JD,Waxweiler R (eds). Developing policies to prevent injuries and violence: guidelines for policy-makers and planners. Geneva,World Health Organization, 2006.
Sphere Project: Humanitarian Charter and Minimum Standards in Disaster Response. pp249-310 (2004)
World Health Organization (WHO). World report on violence and health. Geneva: WHO; 2002. Available: www.who.int/violence_injury_prevention/en (accessed March 14, 2009)
Wednesday, March 11, 2009
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.
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.
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