Today, December 10th, is Human Rights Day, and in honor of this day we have three blog posts looking at the intersection of health and human rights.
Shilpa Alex writes about her experience working at a palliative care clinic in Uganda, and the toll that inadequate health care takes there.
Kelly Lau’s post reflects on health and human rights closer to home, reflecting on the state of health in refugee and indigenous populations.
Benjamin Langer discusses a recent report on global governance and the political determinants of health and discusses what the CFMS Global Health Advocacy Program is working on this year.
Enjoy the triple-header and remember, as the Lancet report concludes: “Health is a precondition, outcome, and indicator of a sustainable society, and should be adopted as a universal value and a shared social and political objective for all.”
Health and Human Rights in Uganda
by Shilpa Alex
The WHO considers the right to health as a fundamental right of every human being. Not a right to be healthy, but a right to accessible, available, appropriate, good quality health care, services and goods. The equitable distribution of these essentials for health such as good infrastructure, affordable housing, access to affordable nutrition, a clean environment, education, and access to health care and essential drugs, inevitably fall on individual governments to execute. Politics and population health are thus remarkably intertwined. A stable, non-corrupt, democratic government can go a long way in establishing the right to health, especially in developing countries.
An example - I spent a few weeks this past summer doing a medical internship in a town in Uganda, which had a tertiary care health center and a few smaller primary health centers. And yet, the NGO-based palliative care clinic that I worked in saw patients as young as 8 months old with pneumonia coming in because the oxygen machines had broken down in the pediatric intensive care unit at the local hospital and they had nowhere else to go. We also saw patients that would refuse or put off treatments because they couldn't afford it, or because it was too long and difficult a journey to get to the clinic, or because they needed the money to be able to send their kids to school.
There were multiple barriers to good quality health care and many social and systemic factors leading to poor health. No doubt the Government of Uganda has made strides in providing better healthcare to its citizens over the last couple of decades,but the gaps in the system were more than evident. Similar situations exist in developed countries as well, even though healthcare and primary education are funded by the government and mandated to be universally accessible to all. Rural and northern Manitoba is one example that is much closer to home - access to medical care and equipment, affordable housing, and good quality food are some issues I’ve come across as a medical student. Health inequity is, unfortunately, a global issue, leaving some sections of the population more vulnerable than others.
I believe the key to implementing the universal right to health begins with educating the people about what their rights are, and enabling the people to advocate for them. Framing international law around the language of health as a right in international development projects is a necessary and vital part of the process. But a grassroots approach of rights education and empowerment among populations affected by health inequity will go farther than short-term solutions to addressing global health issues by sending medical professionals and equipment on placements, as I learned in Uganda. 2015 is the year of Global Action to build on the eight Millennium Development Goals by the UN and I hope to see new sustainable development goals furthering the overall health and well being of individuals across the globe.
References –
http://www.un.org/millenniumgoals/beyond2015-news.shtml
http://www.who.int/mediacentre/factsheets/fs323/en/
Health and Human Rights in Canada
by Kelly Lau
Today marks the 64th International Day of human rights: a day to reflect upon the standards of basic human dignity, equality and freedom. Often they are taken for granted, and easily forgotten in a peaceful country such as Canada.
To me, they are a reminder that there is still much work to be done.
Two populations in particular, Indigenous peoples and refugees and migrants living in Canada, or in other words, the ones here before European colonization and those newly arrived, are people that have faced gross human rights challenges in Canada.
Even in one of the wealthiest countries in the world, tens of thousands of indigenous peoples live in poverty with inadequate housing, access to basic water, food and education. The gap in fulfillment of human rights between indigenous and non-indigenous peoples has long been recognized yet little progress has been made. Even the UN Special rapporteur called on Canada to do inquiries into Canada’s missing Aboriginal women, stating that “Canada faces a crisis when it comes to the situation of indigenous peoples of the country”. According to Amnesty International and 2014 RCMP data, Indigenous women are four times more likely to be murdered than non-indigenous women.
Organizations such as Amnesty International have called out Canada’s systemic marginalization including environmental laws that fail to protect the land and water of Aboriginal territory as well as widespread failure to uphold the rights of Indigenous peoples.
Internationally, Canada has not fared much better. Despite Canada having a long celebrated history of being a strong proponent for human rights, this reputation has declined in the past few years. In 2012 Canada reformed its immigration process shifting towards a system that values applicants more based on their economic value rather than humanitarian basis. An example was making the process of refugee claimants less objective including discriminating claims based on so-called “safe countries of origin”. As a result, persecuted peoples based on gender, sexual orientation or those minorities persecuted in countries democratic an safe for most have found it even more difficult to seek refuge in Canada. Many refugee claimants for a point were denied healthcare while lingering here in limbo, unable to work, unable to fully build a life here despite having been forced to flee and leave everything behind.
However, this story has its positives. Due to the loud, passionate outcry of the health and law profession, an arduous legal battle forced the Canadian government to reverse some of the cuts to refugee health. There are still problems with the refugee system, yet this successful advocacy shows us that progress is possible.
Ultimately, human rights are a powerful frame to empower the marginalized.
Recognizing the shortcomings in basic rights of Indigenous and refugee and migrant populations in Canada is the first step to action. Today, lets celebrate the UN Declaration of Human Rights and work towards human dignity for all.
Political Determinants of Health
by Benjamin Langer
Human Rights Day is celebrated every year on December 10th, commemorating the December 10th, 1948 signing of the Universal Declaration of Human Rights, one of the greatest moral achievements in human history. Article 25 of the declaration states that:
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.
This article enshrines the right to health as fundamental and inalienable to all human beings, an assertion to which we as medical students must turn when faced with situations in which this right remains unfulfilled for our patients. Reading the Declaration is an inspiring experience, and one is left with a profound appreciation of humanity’s capacity to dream of a world free of suffering and injustice. However, we also need to remember that declaration is one thing, and implementation is another. Human Rights are not a natural category but a human construction, and their realization is tenuous if our commitment to continually work towards it wavers.
One of the most important works on health and human rights published this year was the report of the Lancet-University of Olso Commission on Global Governance for Health, titled “The political origins of health inequity: prospects for change”. It tackles the stickiest of all determinants of health, and yet the one arguably needing to be addressed before all others can be managed: the power differential between various groups with regard to the allocation of resources necessary for a healthy life. After all, the world is made not only of governments and citizens alone - other players such as transnational corporations, international humanitarian organizations, and global civil society all have their interests and struggle over resources. In all this chaos, essentially anarchy at the global level since there is no world government, the Lancet report maintains the strong stance that inequalities in health that are avoidable by reasonable means are not just bad for people and are to be remedied based on the relief of suffering, but are unfair and morally unacceptable. The report identifies five different areas of governance that need to be addressed in order to remedy some of these power differentials:
First, participation and representation of some actors, such as civil society, health experts, and marginalised groups, are insufficient in decision-making processes (democratic deficit). Second, inadequate means to constrain power and poor transparency make it difficult to hold actors to account for their actions (weak accountability mechanisms). Third, norms, rules, and decision-making procedures are often impervious to changing needs and can sustain entrenched power disparities, with adverse effects on the distribution of health (institutional stickiness). Fourth, inadequate means exist at both national and global levels to protect health in global policy-making arenas outside of the health sector, such that health can be subordinated under other objectives (inadequate policy space for health). Lastly, in a range of policy-making areas, there is a total or near absence of international institutions (eg, treaties, funds, courts, and softer forms of regulation such as norms and guidelines) to protect and promote health (missing or nascent institutions).
It goes on to discuss various case studies, from the health impacts of cutting public health care as part of the implementation of austerity measures to mitigating the high cost of new lifesaving medications in places where people cannot afford to pay for them, arguing that addressing these areas of governance will make for a more resilient response truer to a human rights agenda. This report is a good starting place for those looking for new ideas for health and human rights advocacy, and lays out a solid approach for thinking about the issues.
The CFMS Global Health Advocacy Program is working on the issue of Access to Medicines as our overarching advocacy theme. The program will be looking at the impact of gaps in pharmaceutical coverage in Canada, as well as shining a spotlight on the so-called Neglected Tropical Diseases, which lack treatments because their patient population is too poor to be a viable market for pharmaceutical companys' interest. In both of these issues, it will take ingenuity and political will to realize an unrealized human right to health for millions of people. However, with the guidance of a commitment to human rights and social justice, we can make it happen.
