Health and Human Rights

26 a second problem lies in the definition of poverty

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Unformatted text preview: ian men and women compared with their single (widowed, divorced, never married) counterparts,24 health status differences between minority and majority populations which persist even when traditional measures of socioeconomicstat usare condidered;25 o r reports of differential marital, economic, and educarional outcomes among obese women,'compared with nonobesetwomen.26 ' . A second problem lies in the definition of poverty and its relationship to health status. Clearly, poverty may have different health meanings; for j &- ! : 1. . example, distinctions between the health-related meaning of absolute poverty and relative poverty have been proposed.27 A third, pra2tical difficulty is that the socioeconomic paradigm creates an overwhelming challenge for which health workers are neither trained nor equipped to deal. Therefore, the identification of socioeconomicstatus as the "essential conditionn for good health paradoxically may encourage complacency, apathy, and even policy ~d programmatic paralysis. Howeveq alternative or supplementary approaches are emerging about the nature of the "essential conditionsn for health. For example, the Ottawa Charter far Health Promotion (1986)went beyond poverty to propose that "the fundamental conditions and resources for health are peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice and equityT28 Experience with the global epidemic of HIVIAIDS suggests a further analytic approach, using a rights analysis.29 For example, married, monogamous women in East Africa have been documented to be infected with HN.30 Although these women know about HIV and condoms are accessible in the marketplace, their risk factor is their inability to control their husbands' sexual behavior or to refuse unprotected or unwanted sexual intercourse. Refusal may result in physical harm, or in divorce, the equivalent of social and economic death for the woman. Therefore, women's vulnerability ta HIV -is now recognized to be integrally connected with discrimination and unequal rights, involving property, marriage, divorce, and inheritance. The success of condom vromotion for HIV rev en ti on in this population i$ inherently limited in the absence of legal and societal changes which, by promoting and protecting women's rights, would strengthen their ability to negotiate sexual practice and protect themselves from HIV infection.31 More broadly, the evolving HIVIAIDS pandemic has shown a consistent pattern through which discrimination, marginalization, stigmatization, and, more generally, a lack of respect for the human rights and dignity of individuals and groups heighten their vulnerability to becoming exposed to HIV.32 In this regard, HIVIAIDS may be illustrative of a more general phenomenop in which individual and population vulnerability to disease, disability, and premature death is linked to the status of respect for human rights and dignity. Further exploration of the conceptual and practical dimensions of this relationship is required. For example, epidemiologically identified clusters of preventable disease, excess disability, and premature death could be analyzed t o discover the specific limitations or violations of human rights anddignity that are involved. Similarly, a broad analysis of the human rights dimensions of major health problems such as cancer, cardiovascular disease, and injuries should be developed. The hypothesis that promotion and protection of rights and health are inextricably linked requires much creative exploration ,and rigorous evaluation. 1 1 6. I 18 Mann et al. I 1I Health and Human Rights 19 The concept of an inextricable relationship b edeen health and human rights also has enormous potential practical cons For exdmple, health professionals could consider using the Rights as a coherent guide for assessing health lations; the extent to which human rights are and more comprehensive index of well-being than raditional health status indicators. Health professionals would also have to consider theirresponsibility not only to respect human rights in developing policies, programs, and practices, but to contribute actively from their as health workers to improving societal realization of rights. have long acknowledged the societal roots of health linkage may help health professionals engage in specific and concrete /ways with the full range of those working to promote and protect human ri hts and dignity in each society. From the perspective of human rights, health edperts and expertise may contribute usefully to societal recognition of the ben fits and costs associated with realizing, or failing to respect, human rights nd dignity. This can be accomplished without seeking to justlfy human rig t s arid dignity on health grounds (or for any pragmatic purposes). Rat er, collaboration with health experts can help give voice to the perva ive and serious impact on health associated with lack of respect for rights nd dignity. In addition, the right to health can be developed and made only through dialogue between health and human rights tance of health as a precondition for the...
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