Human Rights and Public Health
Topic outline
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This course is self-paced to work through in your own time, and provides a context and set of resources to enable readers to be able to understand the importance of Human Rights to Public Health. We will present this through a general introduction to the subject and examples of areas where the relationship is particularly important or vulnerable - humanitarian crises, reproductive health, universal health care and the provision of health services, as well as introducing some of the legal aspects of Human Rights. The course is relevant to all, but in particular those with interests in global health. It was originally developed for the Peoples-uni Open Online Courses site.
This work is licensed under a Creative Commons Attribution 4.0 International License.Setting the scene.
We can do no better than quote Jonathan Mann who, in 1996 in Medicine and Public Health, Ethics and Human Rights, said: "There is more to modern health than new scientific discoveries, the development of new technologies, or emerging or re-emerging diseases. World events and experiences, such as the AIDS epidemic and the humanitarian emergencies in Bosnia and Rwanda, have made this evident by creating new relationships among medicine, public health, ethics, and human rights. Each domain has seeped into the other, making allies of public health and human rights, pressing the need for an ethics of public health, and revealing the rights-related responsibilities of physicians and other health care workers." (Note: the link to the paper quoted here shows the abstract only - you will have to pay to read it all. A strange concept for a publication about ethics and human rights! Luckily there are a number of journals that provide open access - see the RSS feeds on the right of the front page of this course.)
As chronicled in 70 years of human rights in global health: drawing on a contentious past to secure a hopeful future, "the Universal Declaration of Human Rights (UDHR), adopted on Dec 10, 1948, established a modern human rights foundation that has become a cornerstone of global health, central to public health policies, programmes, and practices...In 2018, WHO revitalised its commitment to a rights-based approach to health. The 13th General Programme of Work, WHO's 5-year strategy, calls for leadership on equity, gender, and human rights to achieve its 3 billion objective: 1 billion more people accessing UHC, 1 billion more people protected from health emergencies, and 1 billion more people enjoying better health and wellbeing."
It is also worth, as an introduction, reading Editorial: Making the Case: What Is the Evidence of Impact of Applying Human Rights-Based Approaches to Health? "In 2003, the United Nations (UN) outlined the pillars of an HRBA (human rights-based approach) to development, which include universality and inalienability, indivisibility, interdependence and interrelatedness, non-discrimination and equality, participation and inclusion, and accountability and the rule of law.1 Since then, leaders from national governments and UN agencies have repeatedly emphasized the need to operationalize human rights and incorporate them into the implementation of policies, programs, projects, and other health-related interventions with a view to enhancing effectiveness."
How to navigate the course
Each Topic has a short introduction, a set of resources and a forum for reflection. You will see various hyperlinks - click on them to take you either to the resources page or to the linked resources themselves. If you want to post your reflections, please do so - you will receive email copies of posts from those who post after you and can engage in a discussion through the forum if you wish.
You can earn a certificate if you access the resource pages and post a reflection in each section and pass the quiz at the end.
This course has been developed by Professor Richard Heller, with advice from Dr Claudio Schuftan, Ms Annabel Raw, and Mr Carol Ngang.
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The learning outcome of this introduction is: To be able to define the concept of Human Rights in the context of Public Health.
Please read through the resources in the Resources link below and reflect upon the question posed.
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Please reflect on what you consider the most important reason for us to be concerned about human rights as they impact on Public Health
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The learning outcomes of this Topic are: To understand the threats to Human Rights during and following humanitarian emergencies, and the importance of mitigating these threats.
The UNHCR states: "In humanitarian emergencies, human rights considerations are often neglected and their relevance questioned as an immediate priority in the planning and implementation of relief operations. Nevertheless, with an increased recognition of the crucial role of human rights in ensuring long-term and durable solutions, measures to ensure the protection of the human rights of people affected by humanitarian emergencies are increasingly integrated in preparedness, relief, recovery and reconstruction efforts."
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Please reflect on how you think we might best preserve human rights during and in the aftermath of humanitarian emergencies. Do you have examples to share?
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The learning outcome for this section is: To be able to discuss the importance of human rights to women's reproductive health.
The United Nations Human Rights Office of the High Commissioner, in Women’s Human Rights and Gender Equality, reminds us that "Gender equality is at the very heart of human rights and United Nations values. A fundamental principle of the United Nations Charter adopted by world leaders in 1945 is "equal rights of men and women", and protecting and promoting women's human rights is the responsibility of all States." In it section on Sexual and reproductive health and rights, the Office states: "Women’s sexual and reproductive health is related to multiple human rights, including the right to life, the right to be free from torture, the right to health, the right to privacy, the right to education, and the prohibition of discrimination. The Committee on Economic, Social and Cultural Rights and the Committee on the Elimination of Discrimination against Women (CEDAW) have both clearly indicated that women’s right to health includes their sexual and reproductive health. This means that States have obligations to respect, protect and fulfill rights related to women’s sexual and reproductive health....Despite these obligations, violations of women’s sexual and reproductive health rights are frequent. These take many forms including denial of access to services that only women require, or poor quality services, subjecting women’s access to services to third party authorization, and performance of procedures related to women’s reproductive and sexual health without the woman’s consent"
Setting this in the context of inequality, the Office also states in a pamphlet on Maternal Mortality and Morbidity accessed from the page Sexual and reproductive health and rights: "According to the World Health Organization, “The maternal mortality ratio in developing countries in 2013 is 230 per 100,000 live births versus 16 per 100,000 live births in developed countries. There are also large disparities within countries, between women with high and low income and between women living in rural and urban areas.” Often seen as a public health concern, the issue of maternal mortality and morbidity must also be understood as a matter of human rights."
The resources section below provides more in-depth information on the relation between human rights and reproductive health.
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Reflect on what you consider the top priority in improving human rights in reproductive health in your setting
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The learning outcome of this Topic is: To be able to discuss the movement towards Universal Health Coverage in relation to human rights.
A pathway to achieving Universal Health Coverage was identified in the WHO’s 2010 World Health Report Health Systems Financing: the Path to Universal Coverage which "provides an action agenda for countries at all stages of development and proposes ways that the international community can better support efforts in low income countries to achieve universal coverage and improve health outcomes".
UHC is now one of the UN's identified Sustainable Development Goals, 3.8: "Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all".
The World Health Organisation reports a "global coalition of more than 500 leading health and development organizations worldwide is urging governments to accelerate reforms that ensure everyone, everywhere, can access quality health services without being forced into poverty. The coalition emphasises the importance of universal access to health services for saving lives, ending extreme poverty, building resilience against the health effects of climate change and ending deadly epidemics such as Ebola." A bold and ambitious goal.
In the resources below, we start to unpack some of the ways in which Universal Health Coverage, and the health system reform that will be required, can be made relevant to human rights.
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Reflect on the potential for UHC to improve the health of your own population, and the importance of adding a focus on the determinants of health to a focus on health services alone.
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The learning outcome of this Topic is: To be able to discuss a human rights perspective to the provision of health services.
As identified by the World Health Organisation in Health and Human Rights, “The right to the highest attainable standard of health” requires a set of social criteria that is conducive to the health of all people, including the availability of health services, safe working conditions, adequate housing and nutritious foods. Achieving the right to health is closely related to that of other human rights, including the right to food, housing, work, education, non-discrimination, access to information, and participation.
The right to health includes both freedoms and entitlements.
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Freedoms include the right to control one’s health and body (e.g. sexual and reproductive rights) and to be free from interference (e.g. free from torture and from non-consensual medical treatment and experimentation).
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Entitlements include the right to a system of health protection that gives everyone an equal opportunity to enjoy the highest attainable level of health.
Health policies and programmes have the ability to either promote or violate human rights, including the right to health, depending on the way they are designed or implemented. Taking steps to respect and protect human rights upholds the health sector’s responsibility to address everyone’s health.
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Yet, more than one billion people cannot obtain the health services they need, because those services are either inaccessible, unavailable, unaffordable or of poor quality. Widening inequities across the world mean that an estimated 100 million people are pushed into poverty every year when they pay out-of-pocket for health services.
The late Paul Farmer's video I believe in health care as a human right is short and is a good introduction to the topic.
The resources below, provide more information about the issues raised above.
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What would be the first priority, in your setting, for improving health services to reduce any adverse impact on human rights? Is there some action you could take?
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The learning outcome of this Topic is: To understand the concept of the role of legal frameworks might have in upholding human rights in relation to health.
Meir and colleagues, in a paper in Health and Human Rights, state that "National legal frameworks that uphold health-related human rights encourage a rights-based public policy that gives meaning to international treaty obligations and provides for individual causes of action, ensuring human rights accountability for global health advancement. Accordingly, such national law has laid the groundwork for a rapidly expanding accountability movement at the intersection of health and human rights, empowering individuals and groups to raise human rights claims and providing rights-based enforcement for health. Supporting the implementation of human rights, these cases have been shown to provide essential medicines to the sick, to alleviate state infringements on individual liberties, and to restrict harmful determinants of the public’s health......
The O’Neill Institute for National and Global Health Law at Georgetown University, the World Health Organization, and the Lawyers Collective have come together to develop a searchable Global Health and Human Rights Database that maps the intersection of health and human rights in judgments, international and regional instruments, and national constitutions."
The database is an excellent resource and easy to use. Searching through it will provide an excellent introduction to this Topic.
A Lancet Commission on Global Health and the Law has been formed, and states: "Law at the international, national, and subnational levels has been an effective, although often underappreciated, way to safeguard and promote global health. By law we mean the statutes and regulations that express public policy as well as public institutions, including courts, legislatures, and agencies responsible for creating, implementing, and interpreting the law. Law has a fundamental, yet underused and underdeveloped, role in providing solutions to global health challenges. We are, therefore, launching a Lancet–O'Neill Institute, Georgetown University Commission on Global Health and the Law to examine the vital role of law in responding to major global health challenges." You can keep up to date on the activities of the Commission on their web site and you might also like to read the comment by Richard Horton in the Lancet: The rule of law—an invisible determinant of health.
In the resources section below you will be able to explore case studies relating to prisoners' rights, criminalisation as a Public Health approach, informed consent, reproductive and migrant health, and the legal instruments that underpin international human rights
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You can explore some case studies and download some International legal instruments from this set of resources
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Reflect on the role of legal approaches to underpin human rights and health, and the potential for conflicts to arise between human rights and possible benefits to Public Health
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We hope that you have enjoyed the course.
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View Receive a grade Receive a passing gradeOpened: Thursday, 25 July 2019, 5:12 AM
Take this quiz - a score of 7/10 will qualify towards a certificate
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