If you are a fan of crime dramas as I am, you've probably
heard the familiar expression, "You have the right to remain
silent; you have the right to an attorney..." This oft
repeated phrase captures a set of rights known as Miranda
Rights. As Americans, we are aware of our rights as citizens.
We pound our chests and claim our entitlements when those
rights are being violated. In a famous 1964 case, Supreme
Court Justice Potter Stewart in his opinion statement on
obscenity said, "I know it when I see it."[1] Human
rights are many times just the opposite. You know it when you
don't see it or don't have it; you know it when your rights
are being violated. But where do those rights come from, and
is the right to health among them?
Human Rights are understood as an arm of international law
which includes the United Nations Charter, the 1948 Universal
Declaration of Human Rights, the International Covenant on
Civil and Political Rights, and the International Covenant on
Economic, Social and Cultural Rights. Human rights are a set
of beliefs about the societal basis of human well-being and
about what people need to maintain their human dignity. Human
rights describe the relationships between individuals and
society, specifically government. They are a kind of pact; we
pledge our allegiance to our country, and governments pledge
to respect, protect, and fulfill our human rights.
But what does this have to do with public health? The World
Health Organization (WHO) defines health as "...a state of
complete physical, mental and social well-being and not merely
the absence of disease or infirmity."[1] Health can
further be understood through the Declaration of Alma-Ata,
which states that health is seen as a "social goal whose
realization requires the action of many other social and
economic sectors in addition to the modern health
sector."[2] Every country in the world has signed
at least 1 international human rights treaty that address
health-related rights.[3]
Enter Human Rights
Human rights provide a system for public health
professionals to reconnect with the populations we serve.
Human rights are a set of distinct values that are agreed upon
around the world. Further, they are codified in international
treaties that have been adopted by most countries. By
combining human rights principles with public health methods,
we find a common language through which we can communicate. We
obtain a junction for collaboration and cross-disciplinary
education with others familiar with the human rights language.
Finally, we discover a set of ethical principles based on
human dignity and nondiscrimination.
United Nations Secretary General Kofi Annan has stated, "It
is my aspiration that health will finally be seen not as a
blessing to be wished for, but as a human right to be fought
for." The international human rights documents define the
right to health and outline the steps to be taken in order to
achieve it. Article 25.1 of the Universal Declaration of Human
Rights states, "Everyone has the right to a standard of living
adequate for the health and well-being of himself and of his
family, including food, clothing, housing, and medical care
and necessary social services, and the right to security in
the event of unemployment, sickness, disability, widowhood,
old age, or other lack of livelihood in circumstances beyond
his control."[4] Article 12.2 of the International
Covenant on Economic, Social, and Cultural Rights further
outlines, "...the steps to be taken by the states parties to
the present Covenant to achieve the full realization of this
right shall include those necessary for:
- The provision for the reduction of the stillbirth rate
and of infant mortality and for the healthy development of
the child;
- The improvement of all aspects of environmental and
industrial hygiene;
- The prevention, treatment, and control of epidemic,
endemic, occupational, and other diseases; and
- The creation of conditions which would assure to all
medical service and medical attention in the event of
sickness.[4]"
Public health professionals are obligated to work towards
the achievement of these objectives in 2 ways. First, if we
choose to adopt the principles and rights outlined in the
human rights corpus as a set of public health ethics then we
are morally bound to focus our efforts towards the fulfillment
of the right to health. Second, many public health
professionals are employed by federal, state, and local
governments. As such, these public health professionals are
also state actors. States act as signatories to international
treaties and, by extension, state actors are legally bound to
respect, protect, and fulfill the rights outlined in the
treaties to which the state is a party.
The former United Nations High Commissioner for Human
Rights, Mary Robinson, has stated, "The right to health does
not mean the right to be healthy...but it does require
governments and public authorities to put in place policies
and action plans which will lead to available and accessible
healthcare for all in the shortest possible time. To ensure
that this happens is the challenge facing both the human
rights communities and public health professionals."
Many public health professionals around the world have
actively been incorporating the principles of human rights
into public health practice. In April 2005, 300 of these
practitioners will gather in Atlanta, Georgia, for a
conference entitled Lessons Learned from Rights-Based
Approaches to Health. Cosponsored by the Emory University
Institute of Human Rights, CARE USA, the US Centers for
Disease Control and Prevention, WHO, Doctors for Global
Health, and the human rights offices of the Carter Center,
featured speakers will include former US President, Jimmy
Carter; former United Nations High Commissioner for Human
Rights, Mary Robinson; and United Nations Special Rapporteur
on the Right to Health, Paul Hunt. As conference planning
chair, I invite you to join us for this exciting conference to
learn more about how human rights and health may be
incorporated to achieve the challenge set forth by High
Commissioner Robinson.
Acknowledgements
The author wishes to acknowledge the conference planning
committee members, the conference cosponsors, and generous
donors to the upcoming conference Lessons Learned from
Rights-Based Approaches to Health (April 14-16, 2005; Atlanta,
Georgia).