eBriefing

The Work Ahead of Us: Public Health and Human Rights

The Work Ahead of Us
Reported by
Theresa Wizemann

Posted February 02, 2009

Presented By

Johns Hopkins Bloomberg School of Public Health and the New York Academy of Sciences

Overview

On December 10, 1948, the United Nations General Assembly adopted a set of 30 human rights principles with the goal of ensuring individual rights and freedoms worldwide. In addition to affirming rights such as freedom, equality, education, and due process, the Universal Declaration of Human Rights (UDHR) addresses the most basic of individual rights—the right to personal health and wellbeing. Six decades later, while there are many success stories, human rights violations worldwide continue to have dire consequences for public health.

To commemorate the 60th anniversary of the UDHR, the Johns Hopkins Bloomberg School of Public Health and the New York Academy of Sciences cosponsored a conference on December 5, 2008. Michael J. Klag, dean of the Bloomberg School, welcomed over 150 participants to the Academy's conference center in downtown New York City where speakers discussed the human rights challenges that compound public health concerns both at home and abroad.

Sample Media


Chris Beyrer

Video Interview
Connecting Human Rights and Public Health


Epidemiologist Chris Beyrer explains how in the absence of human rights, public health suffers. He is working in Burma to conduct public health research and provide health services to internally displaced people.

Use the tabs above to view a meeting report and multimedia from the event.


Speakers in this eBriefing:

Joe Amon (Human Rights Watch)
Chris Beyrer (Johns Hopkins Bloomberg School of Public Health)
Laurie Garrett (Council on Foreign Relations)
Patricia Gatling (New York City Commission on Human Rights)
Michael Klag (Johns Hopkins Bloomberg School of Public Health)
Gara LaMarche (The Atlantic Philanthropies)
Robert Lawrence (Johns Hopkins Bloomberg School of Public Health)
Nevanethem Pillay (United Nations)
Ellis Rubinstein (The New York Academy of Sciences)
Leonard Rubenstein (Physicians for Human Rights)
Ruth Wedgwood (Johns Hopkins School of Advanced International Studies)


Presented by:

Johns Hopkins Bloomberg School of Public Health

Public Health and Human Rights: Challenges Around the World


Discussion 1
  • 00:01
    1. Introduction by Laurie Garrett
  • 07:26
    2. Joe Amon
  • 16:33
    3. Ellis Rubinstein
  • 24:33
    4. Ruth Wedgewood
  • 36:25
    5. Further Discussio

Connecting Human Rights and Public Health


Chris Beyrer (Johns Hopkins University)

Public Health and Human Rights: Keynote Address


Navanethem Pillay
  • 00:01
    1. Introduction
  • 05:03
    2. Establishment of the right to health
  • 06:53
    3. Crucial aspects of health rights
  • 10:03
    4. Progress and challenges
  • 18:15
    5. The role of public health workers
  • 23:35
    6. State obligations to protect health right

Public Health and Human Rights: Struggles at Home


Discussion 2
  • 00:01
    1. Introduction of panelists and discussion topics
  • 05:37
    2. Gatling on physician participation in torture
  • 07:34
    3. Robert Lawrence on social determinants of health
  • 16:10
    4. Gara LaMarche on access to health care in the U.S.
  • 26:06
    5. Leonard Rubenstein on torture
  • 37:18
    6. Panelists additional comments
  • 44:35
    7. Gatling on educating the publi

Public Health and Human Rights: Closing Remarks


Chris Beyrer
  • 00:01
    1. Introduction
  • 02:11
    2. Human rights violations and public health crises
  • 07:30
    3. Integrating human rights into public health effort

Web Sites

The Atlantic Philanthropies
The Atlantic Philanthropies award grants strategically focused to have an impact on critical social problems related to older adults, children, people with little or no access to health care, people who are being denied basic human rights, and people struggling to live in peace with their neighbors.

The Council on Foreign Relations
The Council on Foreign Relations is an independent, nonpartisan think tank serving as a resource for its members, government officials, business executives, journalists, civic leaders, and others to help them better understand the foreign policy choices, including issues of human rights and of health, facing the United States and other countries.

Heinz R. Pagels Human Rights of Scientists Award
The New York Academy of Sciences' human rights award is given to scientists in recognition of the contributions they made to safeguard or advance the human rights of scientists throughout the world.

Human Rights Watch
Human Rights Watch is an independent organization dedicated to defending and protecting human rights, focusing international attention where human rights are violated. The health Web page highlights current issues in human rights as they related to health.

Johns Hopkins Bloomberg School of Public Health
The Johns Hopkins Bloomberg School of Public Health is dedicated to the education of a diverse group of research scientists and public health professionals, a process inseparably linked to the discovery and application of new knowledge, and through these activities, to the improvement of health and prevention of disease and disability around the world.

New York City Commission on Human Rights
The New York City Commission on Human Rights implements and enforces the New York City Human Rights Law, which is one of the most rigorous civil rights laws in the nation.

Physicians for Human Rights
Physicians for Human Rights (PHR) mobilizes health professionals to advance health, dignity, and justice and promotes the right to health for all. PHR investigates human rights abuses and works to stop them.

United Nations Office of the High Commissioner for Human Rights
The Office of the High Commissioner for Human Rights is mandated to promote and protect the enjoyment and full realization, by all people, of all rights established in the Charter of the United Nations and in international human rights laws and treaties. The full text of the Universal Declaration of Human Rights is available on the OHCHR Web site, as are the UN Millennium Development Goals, and the 1966 International Covenant on Economic and Social Rights.


Commentary

An unnatural disaster in Burma. Editorial by Chris Beyrer and Frank Donaghue, The Boston Globe, December 2, 2008.

Speakers

Joe Amon, PhD

Human Rights Watch
web site

Joe Amon is the director of the Health and Human Rights Division at Human Rights Watch based in New York. He joined the organization in 2005 as the head of its HIV/AIDS program, and has worked on a wide range of issues including access to antiretroviral and drug dependency treatment, HIV testing, the rights of migrants to access health care, unproven AIDS 'cures,' and evidence- and rights-based HIV prevention. Prior to joining Human Rights Watch, Amon worked for more than 15 years conducting research, designing programs, and evaluating interventions related to HIV, hepatitis, malaria, and guinea worm eradication.

Chris Beyrer, MD, MPH

Johns Hopkins Bloomberg School of Public Health
e-mail | web site

Chris Beyrer is professor in the Departments of Epidemiology, International Health, and Health, Behavior, and Society at the Johns Hopkins Bloomberg School of Public Health. He serves as director of Johns Hopkins Fogarty AIDS International Training and Research Program, which provides advanced training in HIV/AIDS research for scientists and providers from Africa, Asia, Latin America, and the Russian Federation. He is the founder and director of the Center for Public Health and Human Rights at Johns Hopkins. He also serves as associate director for Public Health of the Johns Hopkins Center for Global Health. In 2008 Beyrer was elected to the Governing Council of the International AIDS Society as representative for North America.

Laurie Garrett

Council on Foreign Relations
web site

Laurie Garrett is the senior fellow for Global Health at the Council on Foreign Relations in New York. She is an expert on global health with a particular focus on newly emerging and re-emerging diseases, public health, and their effects on foreign policy and national security. Garrett is an award-winning journalist and best-selling author. She is a member of the National Association of Science Writers, and served as the organization's president during the mid-1990s. She currently serves on the advisory board for the Noguchi Prize, François-Xavier Bagnoud (FXB) Center for Health and Human Rights, and the Health Worker Global Policy Advisory Group.

Patricia L. Gatling

New York City Commission on Human Rights
web site

Patricia L. Gatling is the commissioner and chair of the New York City Commission on Human Rights under Mayor Michael R. Bloomberg. She is in charge of enforcing the Human Rights Law and combating discrimination in New York City. She worked as a senior trainer with John Jay College of Criminal Justice, as part of the U.S. State Department's International Law Enforcement Academy (ILEA), teaching "Human Dignity and the Law" in newly emerging democratic countries, such as Botswana, Thailand, and Budapest, and at the Dubai Police Academy International Conference in the United Arab Emirates. Gatling has also served on the New York City Charter Revision Commission.

Michael J. Klag, MD

Johns Hopkins Bloomberg School of Public Health
e-mail | web site

Michael J. Klag is dean of the Johns Hopkins Bloomberg School of Public Health, the oldest and largest school of public health in the world. Before joining the school as dean, he was the first vice dean for clinical investigation at the Johns Hopkins School of Medicine where he instituted new policies and procedures for oversight of human subject research. Klag is a world-renowned kidney disease epidemiologist whose research focuses on the prevention and treatment of hypertension and kidney disease. He serves as an adviser and consultant to a number of organizations including the National Institutes of Health, National Kidney Foundation, and the American Society of Nephrology.

Gara LaMarche

The Atlantic Philanthropies
web site

Gara LaMarche is president and CEO of the Atlantic Philanthropies. Before joining Atlantic, LaMarche was vice president and director of U.S. programs for the Open Society Institute and associate director of Human Rights Watch and director of its Free Expression Project. He teaches at New York University's Wagner School of Public Service, and has been an adjunct professor at New School University and the John Jay College of Criminal Justice. LaMarche serves on the boards of PEN American Center, The White House Project and the National Committee for Responsive Philanthropy, and on the Leadership Council of Hispanics in Philanthropy.

Robert S. Lawrence, MD

Johns Hopkins Bloomberg School of Public Health
e-mail | web site

Robert S. Lawrence is the Center for a Livable Future Professor in the Department of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health, where he also serves as Professor of Health Policy and Management and International Health. He is the founding director of the Johns Hopkins Center for a Livable Future and directs the Health and Human Rights Certificate Program. Lawrence is a founding member of Physicians for Human Rights (PHR), a human rights advocacy group that shared the 1997 Nobel Peace Prize for its work to ban anti-personnel landmines. He currently chairs PHR's Board of Directors, and has participated in human rights investigations in Chile, Czechoslovakia, Egypt, El Salvador, Guatemala, the Philippines, South Africa, and Kosovo.

Navanethem Pillay

United Nations
web site

Navanethem Pillay is the United Nations high commissioner for human rights. A South African Tamil, she was the first non-white woman on the High Court of South Africa, and has served as a judge of the International Criminal Court and president of the International Criminal Tribunal for Rwanda. Her four-year term as high commissioner for human rights began on September 1, 2008.

Ellis Rubinstein

New York Academy of Sciences
web site

Ellis Rubinstein is the president and CEO of the New York Academy of Sciences. Rubinstein came to the Academy after more than 13 years with the American Association for the Advancement of Science, where he served for a decade as editor of Science magazine. Before that, he was editor-in-chief of The Scientist, senior editor of Newsweek, and managing editor of Science 86 and IEEE Spectrum. Rubinstein's work as a writer and editor has earned three National Magazine Awards.

Leonard S. Rubenstein

Physicians for Human Rights
web site

Leonard S. Rubenstein is Jennings Randolph Senior Fellow at the United States Institute of Peace and President of Physicians for Human Rights. He has 30 years of experience in investigation, analysis, and advocacy on health and human rights domestically and internationally in areas including health systems in the developing world; the protection of health in armed conflict and post-conflict reconstructions; gender, racial and, ethnic inequality in health; and U.S. interrogation policy. He has written extensively both for scholarly publications and in major media such as The New York Times, Washington Post, and Boston Globe. He is member of the Committee on Scientific Freedom and Responsibility of the American Association for the Advancement of Science, the Governing Council of the American Public Health Association and the Board of Directors of the International Federation of Health and Human Rights Organizations. He is the recipient of numerous awards, including the Congressional Minority Caucuses' Healthcare Hero Award.

Ruth Wedgwood

Johns Hopkins School of Advanced International Studies
web site

Ruth Wedgwood is the Burling Professor of International Law and Diplomacy and director of the international law and organizations program at the Johns Hopkins School of Advanced International Studies, in Washington, DC. In 2002, she was elected as the U.S. member of the United Nations Human Rights Committee, a treaty body that monitors the human rights compliance of 165 state parties with the International Covenant on Civil and Political Rights. She was reelected to a second term in 2006. She is a former vice president of the American Society of International Law, former chair of the Council of International Affairs of the Association of the Bar of the City of New York, and currently is vice-chairman of Freedom House, a bipartisan human rights organization that supports the development of democracy.


Theresa Wizemann

Theresa M. Wizemann is a science writer based in Doylestown, PA. Her writing focuses on biomedical science, health, and technology, including public policy, regulatory policy, biotechnology, and pharmaceutical research. Wizemann holds a PhD in microbiology and molecular genetics, awarded jointly from Rutgers University and the University of Medicine and Dentistry of New Jersey. She completed her postdoctoral research at the Rockefeller University in New York and is a former ASM/AAAS Congressional Science Fellow.

Sponsor

Johns Hopkins Bloomberg School of Public Health

On December 10, 1948, the United Nations General Assembly adopted a set of 30 human rights principles with the goal of ensuring individual rights and freedoms worldwide. In addition to affirming rights such as freedom, equality, education, and due process, the Universal Declaration of Human Rights (UDHR) addresses the most basic of individual rights—the right to personal health and wellbeing. Six decades later, while there are many success stories, human rights violations worldwide continue to have dire consequences for public health.

To commemorate the 60th anniversary of the UDHR, the Johns Hopkins Bloomberg School of Public Health and the New York Academy of Sciences cosponsored a conference on December 5, 2008. Michael J. Klag, dean of the Bloomberg School, welcomed over 150 participants to the Academy's conference center in downtown New York City where speakers discussed the human rights challenges that compound public health concerns both at home and abroad.

Much progress ... so much more to be done

"While impressive progress has been achieved during this time, old and new forms of discrimination and exclusion, as well as violations of civil political, economic, social, and cultural rights persist," Navanethem Pillay, United Nations High Commissioner for Human Rights, said in her keynote address. She stressed that all human rights must be addressed as an indivisible, interdependent whole. Economic, social, and cultural rights cannot be fully achieved where civil and political rights are curtailed, and vice versa. The full enjoyment of many other human rights depends on the realization of the right to health. This includes adequate access to goods, services, and facilities, not just in case of illness or emergency, but in the normal life cycle of an individual.

Although the UDHR itself is not a binding legal treaty, it has given rise to human rights provisions in the laws of many countries, and its principles are embodied in subsequent conventions and treaties, imparting legal obligations on party states. In particular, Pillay said, the 1966 International Covenant on Economic and Social Rights is of crucial importance. The covenant, which the U.S. has signed but not ratified, recognizes "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health", and requires party states to take action to achieve full realization of the rights espoused in the covenant.

Under international human rights law (IHRL), the right to health includes freedoms (e.g., the right to be free from nonconsensual and uninformed medical treatment, medical experimentation, forced HIV testing, and degrading treatment) and entitlements (e.g., the right to a system of prevention, treatment, and control of disease, access to essential medicines, reproductive healthcare, and education to prevent unhealthy or risky behavior). IHRL does not prescribe how health care should be delivered; rather it calls for a public heath system that guarantees services are available to all, especially the poor, vulnerable, and marginalized. According to the UN Committee on Economic, Cultural, and Social Rights, public health facilities, goods, services, and programs must be: (a) available; (b) accessible, both physically and financially; (c) acceptable, i.e., gender sensitive, confidential, culturally appropriate; and (d) of good scientific medical quality.

"A world that is greatly out of balance in matters of health is neither stable nor secure."

Progress in health is at the core of most of the UN Millennium Development Goals. "A world that is greatly out of balance in matters of health is neither stable nor secure," Pillay said. Ensuring the right to health is not charity. National health policies should reflect international legal obligations, and an accountability system is needed to translate the right to health into tangible and measurable national standards. Pillay noted that some of the positions taken by the UN and WHO have recently been challenged and there is some controversy regarding the extent of states' legal obligations.

Pillay called upon health professionals to become more active in countering discrimination by, for example, providing simple, accurate information to users of health services, using technology to reduce information and knowledge gaps, and prioritizing research and development in areas where the poorest are left unprotected, such as neglected tropical diseases. Protection of patient privacy, confidentiality, and dignity, and ensuring informed consent prior to any intervention, are also paramount.

Pillay noted that the vast majority of health professionals do adhere to the highest ethical standards, but some are complicit to violations, knowingly or not. Political economic, cultural, and social pressures, as well as personal views, can influence the day-to-day care decisions of a health professional. Pillay stressed that decisions made by health professionals can mean the difference between protection and violation of human rights. She also noted that health professionals and scientists often find themselves under threat, forced to commit violations by societal or state pressure, or find themselves suffering severe consequences for defending their patients' rights or the common good. Health professionals need human rights training, as well as access to independent judicial systems and avenues for redress to protect their own human rights. Pillay concluded by urging all to join in a concerted effort to ensure that human rights remain at the core of the global health agenda.

Challenges around the world: local crises, global consequences

Session moderator Laurie Garrett of the Council on Foreign Relations introduced the concept of "R2P," the Responsibility to Protect. R2P is a relatively new instrument that invokes the "right of humanitarian intervention," basically, protection by force of people at risk in another state. Garrett cited the aftermath of Cyclone Nargis in Myanmar as an example of a public health crises having impact generally limited to the people of a particular country, and the melamine contamination of milk in China as an example of a health situation that can quickly have global health consequences. It's still not clear if R2P is a working principle, if it could be used to ensure the right to health, or what the threshold to invoke it would be.

While entitlements and accountability can be costly to implement, freedoms and obligations offer opportunities for immediate, cost-effective actions, said Joseph Amon of Human Rights Watch. Some barriers to health and human rights have nothing to do with resources—for example, government tolerance of violence against a particular group, such as gay men. Simply enforcing the laws already on the books could begin to address these barriers. Amon also discussed government obligations versus the role of private donors, who in some cases provide more money for aid than the governments. This can present a conundrum for international donors who want to provide assistance, but in doing so must turn a blind eye to the structural and political issues that created the need for aid in the first place. Garrett noted that in some cases the donors offer aid but only under certain conditions. Amon said that governments must assure that the conditions of the aid are consistent with their obligations under human rights law.

Ellis Rubinstein, president of the New York Academy of Sciences, noted that it is not enough to create health infrastructure. Trade policy, nutrition, food supply, basic education, and connectivity/communications technology all have tremendous impact on health. He also expressed concern that while individual researchers are adept at global collaboration, universities need to work with each other more effectively to address public health concerns.

Some governments hide behind "customary and indigenous practice" as cover for their half-hearted attempts at advancing human rights, said Ruth Wedgwood of Johns Hopkins University, and most women around the world are governed by customary practice. She also highlighted the need for capacity building, noting that many countries cannot produce statistics on health and simply do not know the scope of their own problems.

Garrett challenged the panel to consider how the right to health can be enforced, noting that WHO has data on countries that have clear human rights violations, but cannot release that data publicly. Amon said that negative media attention can be very effective in getting governments to act. Rubinstein said that communications made possible by mobile networks and the Internet have enhanced issue transparency and health information exchange worldwide, and Wedgewood stressed the need for freedom of the Internet noting that there are may countries that control access to content.

Struggles at home: ensuring access, ending torture

People fall into two basic rights groups, said Robert Lawrence of the Bloomberg School of Public Health. People in need are rights holders; those providing services are duty bearers. What, for example, is the duty of the City of New York to provide access to high quality public education, or to require nutrition labeling of fast food? "Structural violence" is a concept used to describe when government, through its policies, fails to create an enabling environment, resulting in structural inequities and the inability of some people to meet their basic needs. While not everyone will end up with equality in health, Lawrence said, we need to strive for policies that ensure everyone has equal opportunity for access to social determinants of health.

In the U.S. there has historically been a false dichotomy drawn between health and human rights, said Gara LaMarche of the Atlantic Philanthropies, categorizing health or education as "good things", and civil rights, freedom of the press, or due process as rights. He noted that the U.S. mindset has been changing in recent years, and cited President-elect Obama's comment in a debate that healthcare should be a right for every American, a real break from the conventional political view.

Moderator Patricia Gatling of the New York City Commission on Human Rights then set the panel off in a more unsettling direction: physician participation in torture. Leonard Rubenstein of Physicians for Human Rights said there is no such thing as "torture lite." The "milder" methods, such as isolation or sleep deprivation, can have devastating impacts. Nor is there such a thing as "a little bit" of torture, he said, and torture begets torture, with actions expanding beyond "authorized" practices. Health and science have been corrupted by torture, Rubenstein said, with the government cherry picking theories and data to justify actions, attempting to change ethical standards to enable psychologists and physicians to participate, saying that "first do not harm" only applies to clinical treatment, and not intelligence activities, and having doctors treat torture victims only so they can be further tortured.

LaMarche urged physicians to be advocates for health and human rights, noting that physicians are perceived as highly credible and can bring recognition to human rights issues. Rubenstein added that human rights training needs to be an integral part of the curriculum for all health professionals.

Next steps: building the evidence base, training the advocates

Eager to help those in need, some groups are calling for depoliticizing aid. But separating humanitarian efforts from human rights, said Chris Beyrer of the Bloomberg School of Public Health, leads to bad public health outcomes and prolongs regimes that are the root cause of that suffering. The cholera epidemic in Zimbabwe, for example, is something we are all eager to respond to, he said, but we have to be mindful of the fact that this is a health emergency that is entirely manmade, a result of policies, fraudulent elections, and the failure of the international community to assist Zimbabwe's citizens in achieving democracy.

In his closing comments, Beyrer offered the following for consideration. First, we need to increase understanding of human rights issues and the impact of our research, programs, and policies on human rights. He noted that at Hopkins, bioethics training is mandatory, but human-rights training is not. Second, we need to build the scientific evidence base for rights-based interventions. Advances in technology can be employed to assess the impact of human rights interventions on health, and the negative outcomes associated with violation of human rights. Finally, Beyrer concurred with the need for advocacy, noting that rights have rarely been respected, protected, and fulfilled out of unprompted good governance. Gains are most commonly made by sustained advocacy efforts and we need to train health professionals to be effective advocates. It's not easy to engage in advocacy, and it's very difficult to fund, he said, but it's an essential part of making advances. Beyrer concluded, suggesting that if the new U.S. administration is indeed going to embrace health as a right, now is the golden opportunity for advocacy.