Health and Human Rights
AIDS Advocacy- How to Do It, How Not To
Published August 28, 2009 @ 07:48PM PT
This week saw some really outstanding writing and thinking about global HIV advocacy, and some ugly stereotypes. This includes incredible videos, disturbing print graphics, and a blogger training manual for how to write about AIDS
IRIN , the United Nations news network, has produced four amazing videos about HIV. Each films profiles someone fighting AIDS, including an activist, an educator, a Catholic bishop, and a TV presenter. It’s hard to make a film about HIV that contains a sense of hope without being previous or overly romantic. These films manage to do it.
The Sociological Images blog features two print ads about HIV. Both of them seem to blame women for the spread of AIDS, and feature the naked female body. I know the ad featured about is supposed to tell us that HIV can happen to everyone, but I don’t think that is the message it sends. Both images just seem to tell me that women are dirty spreaders of disease, and I doubt I’m alone in that. (This blog post on how cool alone is not a marketing strategy might shed some light on what went wrong.)
Maybe the advertisers could have learned something from the Blogging Positively Guide, which is a resource for how to write about HIV. My favorite piece of advice is to remember that although in practice most blogs only have about twelve readers, anything you write could end up seen by a million people. I also really liked their examples of organizations and individuals who use blogging to fight AIDS.
Bonus related link: This isn’t about HIV, but it is about advocacy. The Aid Watch blog has a post criticizing a new cinema ad campaign from Doctors With Borders. Aid Watch hates the video, and thinks it’s way over the line, demonizing Africa and creating a sense of hopelessness. The Aid Watch commenters disagree.
Weekly Highlights, July 26 – August 1 2009
Published August 02, 2009 @ 04:05AM PT
Basics
Living in Central Asia, Alanna has first-hand experience with the pesky little sandflies that transmit the tropical disease leishmaniasis. Read her post Five Things to Know About Leishmaniasis to learn all about it. Also, learn about the five medical conditions that account for 80% of maternal deaths: severe bleeding, infections, hypertensive disorders, obstructed labor, and unsafe abortions.
As a first post in the series, "Things That Work," Alanna talks about Health Visitors: nurses, doctors or trained volunteers that conduct home visits and give people basic health education and care. Health visitors are one way to increase health care access, but What Does Access to Medical Care Really Mean? Alanna explains three main forms of access: geographic, financial, and cultural. And guest blogger Michael Keizer teases apart the differences between inequities and inequalities in his post The Health Equation.
News & Analysis
News broke out on Tuesday that the Cambodian government has been relocating people living with AIDS into a de facto "AIDS colony," one without clean water or sanitary facilities.
This week's Friday Futures explores Obesity. Alanna warns that, with increased meat consumption and urbanization, the developing world that is at risk for a rise in obesity. But urbanization is not just a risk factor for obesity. Given the higher population density and lack of healthcare in slums, Alanna thinks that Swine Flu is Going to Hit Megacities Hard.
Alanna has written about the Guttmacher Institute study that found withdrawal may be an effective method of birth control. In response to a New York Times article about this study, guest blogger Mara Gordon explores the tricky question, "What is a publication's responsibility when it comes to controversial health news?"
Career Advice
Alanna gives the pros and cons to Joining the Peace Corps as part of your global health career. One key point to remember is that the Peace Corps is not an international development organization, but a US public diplomacy agency. Also, you may be interested in a Very Interesting Vacancy at Center for Global Development (CGD). Alanna thinks the CGD is "the clearest, sanest voices out there on global development and health."
The Rights-Based Approach to Global Health
Published July 06, 2009 @ 04:36PM PT
Discussions about health and human rights since the 1980s, even within the limitation of the lack of a truly integrated approach, have led to real progress: the rights-based approaches to health and development have made human rights integral to many discussions of global health work.
There is no single, canonical rights-based approach: rights-based approaches are many and diverse. However, while keeping this in mind, some common elements can be identified.
As the name implies, the rights-based approach uses human rights as its starting point for discussions about health: it looks at health through a ‘human rights lens'. As a result, it demands attention for many societal root causes for health issues. However, it does not address explicitly the impact of health on human rights conditions, nor does it readily recognise the interdependent relationship of the two. It puts a strong emphasis on process, making it as important as the health outcomes per se.
Its success has also been its failure. It has been immensely successful in putting human rights in the limelight as a determining factor for health and as a valuable tool for discussions about health and health policies. However, in doing so, it has neglected the intricate links between the two, to the point where it is sometimes accused of doing away with the classical public health approach, or even with ‘social justice', even when those approaches are more productive. Although advocates of the approach contend that the rights-based approach never meant to protect individual rights at all costs, they do not address the fact that this is how it works out in many practical cases - nor that even when it doesn't work out like that, its practitioners still tend to put more weight on individual human rights than on collective rights.
A last word
This was the last posting in the series on health and human rights. The series is the condensation of a personal search for the interface between two of my most abiding interests. This search, although satisfying by itself, has left me less satisfied with where we are today. Although the intricate and interdependent nature of health and human rights is recognised, the most important exponent of the movement, the rights-based approach, is highly rights-focussed; in practice, its entails primacy of (individual) human rights over (global) public health.
In my view, a new, practical synthesis of health and human rights needs to be found. My vision of an integrated field of health with human rights is output-oriented, but not solely output in the health sense: human rights and health outputs are treated as equal and (more importantly) mutually reinforcing. It integrates the fields in any health or human rights program from start to finish:
- When selecting a possible issue for intervention, by querying implications for health and human rights.
- When first designing the program, by continuously querying the intended and likely results for both health and human rights.
- When implementing the program, by linking back to public health and human rights theory and practice.
- When monitoring and evaluating the program, by incorporating both health and human rights indicators.
This is an ambitious (perhaps over-ambitious) program. However, it will deliver a new challenge to practitioners of both (global) health and human rights; hopefully making us practitioners of health-with-human-rights.
Weekly Highlights, 6/28/09 - 7/04/09
Published July 05, 2009 @ 02:29PM PT
(Photo Credit: Hugh Sturrock. Wellcome Images)
June 27 was US National HIV Testing Day. Do you know your status? Alanna tells her own Experience Getting Tested for HIV, and offers the advice, "Getting tested for HIV is hard the first time, but it gets easier. And if you do have HIV, getting tested will save your life."
This wee, guest blogger Michael Keizer shows how Global Health and Human Rights are Made for Each Other; better health improves human rights, and ensuring human rights improves health.
In light of the bad economy, many people are flocking to graduate school, but Alanna spells out for us When Not to Go to Grad School. Also, if you have trouble getting things done, check out Alanna's useful tips for Being Productive.
In last week's "Friday Futures," Alanna predicted The End of the Physician. She expanded her thoughts a bit further in her post, Supporting Physicians to Improve Health Care, arguing that healthcare needs to be a team effort between physicians, non-physician clinicians and technology. And in this week's "Friday Futures", Alanna warns of The Growing Threat of Malaria.
In her post, Fear, Sex, and Pandemic - Part One, guest blogger Carol Dunn comments on the initial over-reaction, and the current under-reaction to swine flu, stating that pandemic risk communicators need to understand the irrationality of human reaction to threats.
Alanna gave an overview on a recently released report on Innovative Financing for Health Systems, concluding that that there's No Magic Bullet for getting more money for health.
For more global health reading, check out this week's Recommended Readings to learn about Disability-Adjusted Life Years (DALYS), a new female condom effort in Uganda, swine flue resistance, and more.
Global Health vs Human Rights
Published June 22, 2009 @ 06:47AM PT
(Actors playing lepers. The treatment of lepers as late as 1996 in some developed countries would not be acceptable under current understanding of their human rights. Photo credit: SantiMB @ flickr).
"It is my aspiration that health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." - Kofi Annan
Global health efforts can have a powerful impact on human rights, even separate from their impact on health-as-a-human-right. They can promote other human rights in various ways; on the other hand however, limitations on e.g. the right to freedom have sometimes been justified with public or global health considerations.
Like I have said before: human rights rarely (if ever) deal with absolutes. Here, too: in most (going out on a limb, I would say: probably all) human rights instruments, rights limitations are possible, e.g. "...for the purpose of promoting the general welfare in a democratic society" (ICESCR art. 4). Global health considerations could be seen as "promoting the general welfare". This has been frequently invoked in the context of infectious diseases, e.g. HIV/AIDS, SARS, XDR-TB, and most recently swine flu.
This was recognised at an early stage, and in 1984 the Commission on Human Rights of the UN Economic and Social Council formulated the so-called 'Siracusa Principles', which give guidance when limitations of human rights are necessary. These Principles, although not part of any international treaty, are seen as highly authoritative interpretations of (amongst others) the ICESCR. The main Principles are:
- lawfulness: the restriction must be enshrined in law;
- necessity: the restriction must be "necessary", i.e. must respond to a pressing general need, pursue a legitimate goal, and be proportionate to that goal;
- subsidiarity: from all possible option, the least intrusive and restrictive must be chosen;
- non-arbitrariness: the restriction is not unreasonable or discriminatory.
The Siracusa Principles are highly restrictive in that they put a very high threshold before they justify limitations as acceptable. This is not always well understood, and sometimes limitations on human rights are argued based on selective reading from the Principles.
Based on the dictum that "[h]ealth policies and programs should be considered discriminatory and burdensome on human rights until proven otherwise", Gostin and Mann developed a more comprehensive approach to limitations on human rights and their impact. In their ‘human rights impact assessment', six steps lead to an assessment of the acceptability of a health intervention. The analysis encompasses trade-offs between rights encroachment and health improvement, and includes an assessment whether liberty-limiting interventions target only significant risk and are the least intrusive alternatives.
In a nutshell: global and public health considerations can be used to justify putting limitations on human rights - but only in rare circumstances and under strict conditions. Anything new here? Only for those who still cherish the idea of human rights as absolutes.
Health and Human Rights - Four Things to Consider
Published June 15, 2009 @ 08:57AM PT
- One of the most important means to the realisation of the right to health is national legislation. International treaties are binding for its parties, i.e. the states, but normally those states' citizens have no way to directly claim their rights (with some exceptions based on regional human rights treaties in e.g. Europe). Incorporation of their norms into national law makes it possible for its citizens to use these norms in its national courts of law. This can be done either explicitly (by enacting laws that repeat or elaborate these laws) or implicitly (by legislating that treaties have so-called ‘direct action'). In fact, there have been cases of the successful use of the right to health as enshrined in local legislation to force governments to act; e.g. in the case of the Treatment Action Campaign in South Africa (which managed to force the national government to treat AIDS patients with anti-retroviral drugs), and in similar cases in Venezuela and India.
- I always find it very surprising that there is no generally accepted theory of global health law. This is remarkable in view of its importance and of the existence of theories of law for most other areas. It will be clear that for the further development of legal instruments for global health, such a theory will be indispensable.
- It should not be forgotten that universal rights are often balanced by universal duties. Solomon R. Benatar probably expresses this best in his 2001 article on South Africa's transition: "[w]ho will meet the duties required to honour rights if members of society see themselves only as holders of rights?" This is especially important in the context of health: almost any action will have repercussions on somebody's health, and hence your right to health places obligations on others, usually your government. The Trieste Carta of Human Duties, although slightly whimsical, can be a helpful tool to draw attention to this other side of the coin.
- Although we will probably all agree that it is just as well that there is a human right to health, it is doubtful whether it has any discernible impact on the health status of populations yet. A recently published study showed no correlation between ratification of a number of human rights treaties and the health status of populations. Does that mean that we should abandon health as a human right, as it does not help us in the end anyway? No, for one very simple reason: we are still at the beginning. Most countries have only recently included the right to health in their legal systems (see point 1.), and the use of the right in legal argument and legal challenges is even newer. As the legal battle for health progresses, we should see a bigger impact.
Finally: if you are interested in the interplay between human rights and global health, your first point of call (no, second, after this blog, of course) should be the excellent twice-yearly journal Health and Human Rights, and the linked OpenForum blog for updates in between.
Weekly Highlights May 31- June 6
Published June 07, 2009 @ 07:51AM PT
If you want to buff up on your global health knowledge, check out Alanna's posts this week on Why Fighting Malaria is Hard and Five Things to Know About Indoor Air Pollution. Both include information that's enlightening and not immediately obvious.
Guest blogger Michael Keizer has written several posts on health and human rights. This week, he takes Another Look at Health As a Human Right, and focuses on what our moral obligations are regarding health.
For Career Wednesday, Alanna provides some useful advice on How to Leave a Job You Hate (which turns out to be the same as how to leave a job you love) and tips on preparing a Global Health Resume
Alanna's article on Circumcision and HIV prompted strong, emotional responses in the comments section. In a follow-up post, she further explained the scientific evidence that circumcision protects against HIV transmission, as well as other infectious diseases.
You may have noticed that global health is field filled with acronyms. Turns out Alanna has a few pet peeves. Check out this amusing post on Especially Annoying Global Health Acronyms, which includes acronyms that stand for different things, are misleading or include prepositions.
A new feature started this week called Comment of the Week, where the smartest, funniest, or most eye-catching comment is highlighted, and the author of the comment will receive Change.org coins to the charity of their choice. Congrats to Patrick Mayne for being this week's commenter of the week!
After all the media attention on swine flu in April and May, the latest public health scare seems to have disappeared off the radar. You may be wondering, What Happened to Swine Flu? Read on to learn about potential changes in WHO's pandemic alert system, silly rumors, and future possibilities.
