Health and Human Rights

Fist the impact positive and negative of health

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Unformatted text preview: es. The first two are already well documented, although requiring further elaboration, while the third represents a central hypothesis calling for substantial additional analysis and exploration. F ist, the impact (positive and negative) of health policies, programs, and practices on human rights will be considered. This linkage will be illustrated by focusing on the use of state power,in the context of public health. Thesecond relationship is based on the understanding that human rights violations have health impacts. It is proposed that all rights violations, particularly when severe, widespread, and sustained, engender important health effects, which must be recognized and assessed. This process engages health expertise and methodologies.in helping to understand how well-being is affected by violations of human rights. The third part of this framework is based on an overarching proposition: that promotion and protection of human rights and promotion and protection of health are fundamentally linked. Even more than the first two proposed relationships, this intrinsic linkage has strategic implications and potentially dramatic practical consequences for work in each domain. he nrst Relatlonshlp: The Impact of Health PoUcles, Programs and M c e n on Human Rlghts Around the world, health care is provided through many diverse public and private mechanisms. However, the responsibilities of public health are carried out in large measure through policies and programs pcwulgqted, implemented, and enforced by, or with support from, the state.> herefore, T t this first linkage may be best explored by consideri~ghe i qpact of public health policies, programs, and practices on human rights. The three central functions of public health are: assessing health needs m d problems; developing policies designed to address priority health issues; M ann et al. and assurhg programs t okp1ement strategic health goals.12 Potenti~1eneb fitsat0a nd b v & w o n h-ri@s 1 118y~urn thepursuit of each a fthe& i majar areas.cif- p'ablia health-responsi ilirp. b : ~ m e n t ~ h v o l vtoll-&on of d a a on hportanehealzh es p W - Win a ,ppw1abn. Howeveq &ta are not c o w e d on d possibb kithproblems, nor does t he selkmion of which issuess o asses. e r n i a n -SOZ&&& P ~ Whus, a state's failure t o r e o m o a ckno~le&eM t h Z. r c Health and H uman Rights affects pEimqilp :the African-American population; or; more globally, maternal mortality, breast cance'q and other health problems of women). of The thirdcore f u~~ctionpublic health, to assure servicescapable of realizing.policy gods, is also closely linked with the right to nondiscrimination. When health and social services do not take logistic, financial, and sociocultural barriers to.their access and enjoyment into account, intentional or unintentional discrimination may readily occur. For example, in clinics for maternal and child health, details such as hours of service, accessibility via public transportation and availability of day care may strongly and adversely influence serwice utilization.13 It is essential to recognize that in seeking to fulfill each of its core functions and respo~sibilities,public health may burden human rights. In t he past, o when r ekicti@ns n human rights were recognized, they were often simply justified as necessary to protect public health. Indeed, public health has a long tradition, anchored in the history of infectious disease control, of limiting the "rights of the few" for the "good of the maily." Thus, coercive measures such as.mandatory testing and treatment, quarantine and isolation are consideked basic measures of traditionalcommun~cableisease control.14 d The principle that certain rights must be restricted in order to p rotax the community is explicitly recognized in the International Bill of Human Rights: limitations are considered permissible to "(secure) due recognition and respect for &e rights and freedoms of others and of meeting the just requirements of morality, public order and the general welfare in a democratic society" (LlDHR, Article 29). However, the permissible restriction of rights is bound in'several ways. First, certain rights (e.g., right t o life, right to be free from torture) are considered inviolable under any circumstances. Restriction of other rights must be: in the interest of a legitimate objective; determined by law; ihposed in the least intrusive means .possible; not imposed arbitrarily; and strictly necessary in a "democratic society" to achieve its purposes. Unfortunately, public health decisions to restrict human rights have frequently been made in' an uncritical, unsystematic, and unscientific mannel: Therefore, the prevailing assumption that public health, as articulated through specific policies and programs, is an unalloyed public good that does not require consideration of human rights norms must be chal1enged:For the present, it ,may be usefu...
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