Health and Human Rights

Second to wliat extent is respect for human rights

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Unformatted text preview: l to adopt the maxim that health policies and programs should be considered discriminatory and burdensome o n human rights until proven otherwise. Yet this approach raises three related and vital questions. First, why should public health officials be concerned about burdening human rights? Second, to wliat extent is respect for human rights and dignity compatible with, or complementary to, public health goals? Finally, how can an optimal balance between public health goals and human rights norms be negotiated? Justifying public health concern for human rights norms could be based dn the primary value of promoting societal respect for human rights as well s viduals and violations of many d&@iThus, misuse of i d6rmtion about HD&idmion status has led*to: ros~ctionstlre right tto work and t o edu~ of cation; violations of the right to marry and fougd a . f W y ; attacks upon a h o r and reputation; lidta6ioas of k e d o m 06movemmr; arbitray detentun or exile; and even crue1; h bman, a r degading!treatmei~t. % r major task of p ublic~hdths to M o p ~ p o tto p~ m E i i revent and control priority health problems. Important burdens on human rights may 4 the policy-development process. For example, i a g ogertubmred ido%&e scientikk baMs 05' healoh . poKq o r p ~ M,debate on its t -mbro&er m r ehes to hfom.andmvolve tihe pablic in.policydka of seg, m, religim,or language we sy&&nati& a p&xity(e,g.,.sicMexell disease in thePIJnited States, which g Mann et al. Health and Human Rights as on arguments of public health effectiveness. At least to the extent that public health goals are not seriously compromised by respect *forhuman rights norms, public health, as a state function, is obligated to respect human rights and dignity. The major argument for linking human rights and health promotion is described below. However, it is also iinportant t o recognize that contemporary thinking about optimal strategies for disease control has evolved; efforts to confront the most serious global health threats, including cancer, cardiovascular diseae, and other chronic diseases, injuries, reproductive health, infectious diseases, and individual and collective violence increasingly emphasize the role of personal behavior within a broad social context. Thus, the traditional public health paradigm and strategies developed for diseases such as smallpox, often involving coercive approaches and activities that may have burdened human rights, are now understood to be less relevant today. For example, WHO'S strategy for prevenshg. spread of the human immunodeficiencyvirus (HIV)excludes classic practices such as isolation and quarantine (except uqder truly remarkable circumstances) and explicitly calls for supporting and preventing discrimination against HlV-infected people. The idea that human rights and public health rnust.inevitably conflict is increasingly tempered with awareness of their complementarity. Health policy-makers' and practitioners' lack of familiarity with modern human rights concepts and core documents complicates efforts to negotiate, in specific situations and different cultural contexts, the optimal balance between public health objectives and human rights norms. Similarly, human rights workers may choose not FO confront health policies or programs, either to avoid seeming to undervalue community health or due to uncertainty about how and on what grounds to challenge public health officials. Recently, in the context of HIVIMDS, new approaches have been developed, seeking to maximize realization of public health goals while simultaneously protecting and promoting human rights.15 Yet HIVIAIDS is not unique; efforts to harmonize health and human rights goals are clearly possible in other areas. At present, an effort to identify human rights burdens created by public health policies, programs, and practices, followed by negotiation toward an optimal balance whenever public health and human rights goals t appear to conflict, is a necessary minimum. An a pp~oacho realizing health objectives that simultaneously promotes--or a t least respects-rights and dignity is clearly desirable. The Swxqd Relatlonshlp: H ~ i m p a c t R e s u h g from VlolatJons of Human Rights s Health impacts are obvious and inherent in the popular understanding of certain severe human rights violations, such as torture, imprisonment under .inhumane conditions, summary execution, and "disappearmces." For this reason, health experts concerned about human rights have increasingly made their expertik available to help document such abuses.16 Examples of this type of medical-humah rights collaboration include: exhumation of mass graves to examine allegations of executions;l7 examination of t o m e victims;l8 and entry of health personnel into prisons to assess health status.19 However, health impacts of rights violations go beyond these issues in at least two ways. First, the duration and extent of health impacts re...
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