Elsevier

The Lancet

Volume 370, Issue 9585, 4–10 August 2007, Pages 449-455
The Lancet

Series
History, principles, and practice of health and human rights

https://doi.org/10.1016/S0140-6736(07)61200-8Get rights and content

Summary

Individuals and populations suffer violations of their rights that affect health and wellbeing. Health professionals have a part to play in reduction and prevention of these violations and ensuring that health-related policies and practices promote rights. This needs efforts in terms of advocacy, application of legal standards, and public-health programming. We discuss the changing views of human rights in the context of the HIV/AIDS epidemic and propose further development of the right to health by increased practice, evidence, and action.

Introduction

Blatant violation of human rights affecting the health of both individuals and populations continues. Examples include the torture of detainees in Abu-Ghraib prison in Iraq;1 systematic rapes and murders in the Balkans,2 Rwanda,3 Chechnya,4 and Darfur;5 physician involvement in torture,6 botched executions;7 inhumane experimentation;8 and questionable interrogation techniques in the so-called war on terror.1, 9, 10 Such violations of human rights can be engineered by or endorsed by governments, institutions of power, and individuals. These deplorable violations exist alongside more subtle activities that also have severe and longlasting effects on health and human rights such as absence of basic health-care systems;11 policies keeping medicines unaffordable;12 and tolerance of discrimination against groups such as injecting drug users,13 people with mental-health disorders,14, 15 illegal immigrants,16 or homeless people.17 The continuing and foreseeable absence of access to effective care for most people living with most diseases in poor countries can also be viewed as a violation of human rights.18 Therefore human rights should be imperative in delivery of care and implementation of public-health programmes.

Three main relations between health and human rights exist: the positive and negative effects on health of promotion, neglect, or violation of human rights; the effect of health on the delivery of human rights; and the effects of public-health policies and programmes on human rights.19 Despite the advances in the study and advocacy of health and human rights we still do not fully understand the nature of these relationships, how they interact, or their value to medicine and public-health practice. In this article we address the public health aspects of these relations, and highlight where further research and action are needed.

Section snippets

A brief history of health and human rights

Since the Nuremberg trials and the creation of the UN more than 50 years ago, interest in the association between health and human rights has grown. Until the beginning of the AIDS epidemic in the 1980s and the end of the Cold War, these two issues evolved along parallel but distinctly separate tracks,20 perhaps as a consequence of the state-centric (ie, greater political concern for general state and public interests than for specific individuals or communities) view of the world that

Human rights and health policy

The links between human rights and health are best understood by referring to the preface to the WHO constitution, which states that health is the “state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity” and “the highest attainable level of health is the fundamental right of every human being.”31 Governments are therefore responsible for enabling their populations to achieve better health through respecting, protecting, and fulfilling rights

Applying human rights to health

The idea of health and human rights as a subject of study is fairly new, and we need to recognise the different ways in which advances in health and human rights can be achieved. Human rights feature in many different ways in the health work of international non-governmental organisations, governments, civil society groups, and individuals. These ways can be broadly categorised as advocacy, application of legal standards, and programming (including service delivery).45 Some stakeholders use one

Concerns for the future

Government roles and responsibilities are increasingly delegated to non-state actors (eg, biomedical research institutions, health insurance companies, health management organisations, the pharmaceutical industry, and care providers) whose accountability is defined poorly and monitored inadequately. No objective measures are available of the commitment and capacity of governments to ensure that actions taken by the private sector and other players, including civil society, are informed by and

Steps forward

Attention to human rights can be a way to enhance the value and effects of health work by health policymakers, programme developers, health practitioners, and students. Nonetheless, three topics urgently need that further work. The first is the development of adequate monitoring instruments that measure both health and human rights concerns; the second is building evidence of the effects of application of the health and human rights frameworks to health practice; and the third is the creation

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