Forging the Link Between Health and Human Rights

Forging the Link Between Health and Human Rights, Statement of the Consortium for Health and Human Rights (Francois-Xavier Bagnoud Center for Health and Human Rights; Global Lawyers and Physicians; International Physicians for the Prevention of Nuclear War; and Physicians for Human Rights), issued to mark the 50th Anniversary of the Universal Declaration of Human Rights (1998)

Fifty years ago the United Nations General Assembly adopted the Universal Declaration of Human Rights (UDHR) to guarantee all human beings security, dignity, and well-being in every country of the world. Drafted as a response to the horrors of World War II, the UDHR set the foundation for dozens of international treaties and laws that protect the rights to life and the integrity of the person, to health, food, shelter, clothing, and education, to freedom of expre ssion, to participation in society, and to the benefits of science, to equality in marriage, to move freely within one's country and across borders, to seek a safe haven from persecution, and more.

The United Nations rightly intended that the UDHR be taught at every institution of learning and at every level of education throughout the world. Health professionals have a great stake in the UDHR because human rights and health concerns share the common goals of alleviating suffering and promoting the conditions for health and well-being of all people. These goals represent an ideal that cannot be achieved unless the fundamental rights set forth in the UDHR are recognized, respected, protected, and fulfilled.

The celebration of the 50th Anniversary of the UDHR, throughout 1998 and culminating on Human Rights Day, December 10, 1998, is an occasion for institutions concerned with the teaching and training of health professionals to explore and embrace the critical link between human rights and health.

There are many connections between health and human rights. These are some examples:

Discrimination
Discrimination against ethnic, religious and racial minorities, as well as on account of gender, ***ual orientation, political opinion or immigration status, compromises or threatens the health and well-being and, all too often, the very lives of millions. Discriminatory practices threaten physical and mental health and deny people access to care altogether, deny people appropriate therapies, or relegate them to inferior care. In extreme forms of discrimination, as exemplified by Apartheid, ethnic cleansing and genocide, the devaluation of human beings as "other" has had devastating consequences.

Health Policies That Violate Rights
Violations of human rights exist in the design and implementation of health policies. For example, population policies which fail to respect the conditions necessary for individual decision-making are less effective. In the past few decades, governments a nd international agencies have increasingly recognized that women must be able to make and effectuate free and informed choices about reproduction. Yet these choices are routinely infringed in the design and implementation of health policies, including cl inical decisions. The promotion and protection of such human rights as education, information, privacy, and equal rights in marriage and divorce are necessary if population policies are to be successful.

Torture
Torture remains epidemic in dozens of countries around the world. It brings both acute trauma and long-lasting physical or psychological suffering to victims, their loved ones, and society at large. Physicians themselves become complicit in torture when they certify individuals as able to withstand torture or falsify or fail to report evidence of torture in detention facilities. Physicians, psychologists, and forensic pathologists have been at the forefro nt of efforts to document and expose the practice of torture in dozens of countries. Treatment and prevention programs are emerging on every continent in response to this epidemic.

Compromise of Medical Independence
People seeking health care are often denied the independent judgement of health professionals when the state imposes demands that the professional show greater allegiance to state ends than to the needs of the patient. Prisoners, detainees, undocumented immigrants, military personnel and others are especially vulnerable to the effects of these conflicts of interest.

Lack of Access to Health Care
Throughout the world, in countries rich and poor, people have no access to basic physical and mental health care and to immunizations from infectious disease. Some people have no access because they lack the resources to buy it and the state does not provide it, others because there are no services available in their communities, and others because of discrimination or social stigma, such as their status as prisoners, detainees, refugees, immigrants, or members of a lower class or caste. Victims of displacement, torture, and war, as a result, receive insufficient help in coping with the physical and psychological impact of these traumas.

Lack of Basic Sustenance
One fifth of the world's population live in abject poverty. They lack adequate food, clothing, housing, and social services, and the opportunity to work. Extensive evidence, moreover, demonstrates that, in addition to absolute poverty, relative poverty within nations is associated with both diminished access to health care and to diminished health status.

Inhumane Labor Practices
Inhumane labor practices the world over significantly compromise the health of millions. Women, men, and children toil under brutalizing, unsanitary and hazardous conditions for long hours or work without wages sufficient to support their families' basic needs.

Oppression of Women
In many countries, women are still denied full participation in society and the protection of basic rights. Women work more than two-thirds of the world's working hours, yet they earn less than ten percent of the world's income and own less than one perce nt of the world's property. Also, practices harmful to their health, such as genital cutting, are carried out in some cases to further social policies or cultural traditions. The effects of discrimination on the health of women is devastating.

Violent Conflict Affecting Civilian Populations
Throughout the world, people are exposed to violent conflicts over which they have no control. Consequently, in dozens of ongoing civil and international conflicts, people are suffering the health effects of armed conflict and the systematic disregard for human rights. Since the fall of the Berlin Wall, violent conflict has claimed the lives of some four million people. In early 1997 alone, over 35 million people were refugees or internally displaced as a result of violent conflict and forced to live in conditions contributing to spread of disease, malnutrition, and early death. Moreover, these conflicts are often characterized by rampant and gross disrespect for the principle of medical neutrality, which guarantees the provision of health care without discrimination to all injured and sick combatants and civilians during periods of conflict.

Indiscriminate Harm from Weapons
Every human being's right to life is threatened by the existence and active deployment of the most destructive weapons ever devised--nuclear, biological and chemical weapons. The lives and health of millions of people are jeopardized daily by landmines, which kill and maim indiscriminately, and continue to do so for decades after the cessation of a conflict. The work of health professionals trying to obliterate these weapons has earned recognition with the awarding of two Nobel Peace Prizes--one in 1985 to the International Physicians for the Prevention of Nuclear War and the other, in 1997 to the International Campaign to Ban Landmines--a campaign co-founded by Physicians for Human Rights.

Denial of Dignity
Respect for human dignity is an essential element of health and well-being of all people. In clinical settings, failure to respect dignity has stigmatized people with conditions such as HIV/AIDS and mental or physical disabilities and resulted in denial of access to appropriate treatment and/or being subjected to inappropriate clinical interventions or unwarranted long-term institutionalization.

Unethical Research Practices
Conventional practices in biomedical and behavioral research all too often violate human rights. Contemporary medical research studies often lack adequate informed consent procedures and have disproportionate risks in relationship to benefits. Some member s of the medical research community continue to use disenfranchised and vulnerable populations for human experimentation at great detriment to their physical and mental health.

Lack of Education
Although education is one of the strongest predictors of health status and an intrinsic quality of well-being, more than 900 million adults are illiterate, two-thirds of whom are women, and more than 300 million children are not in primary or secondary sc hool. Health professionals should promote adequate standards of education, which include human rights concerns, because these standards promote health and dignity of all members of the human family.

Exposure to Dangerous Environment
Prevention of environmental hazards, and mitigation of these hazards where they exist, are critical factors in the promotion of health and the prevention of illness. Selective pollution of areas in which poor or minority people or others susceptible to discrimination live, often termed "environmental injustice," is an egregious form of denial of human rights.

Denial of Freedom of Expression
Promoting and protecting human rights is fundamental to promoting and protecting health. Too many nations suppress the independence of the health professions and the uncensored voices of medical and public health officials, compromising the ability to con tain the spread of disease, sustain vaccination and immunization programs, address humanitarian emergencies, raise alarms about environmental threats to health, and put into place effective health policies and programs that reach all members of affected p opulations.


Forge the Link with Us
As this anniversary year begins, we invite all schools of medicine, public health, nursing, and allied health professions to join with us to increase awareness of the inextricable connection between health and human rights. During the past decade, this awareness has led to new education and training about human rights for health professionals. Schools of medicine, public health, and nursing have inaugurated full courses, seminars, short-courses, and sponsored conferences to advance understanding and familiarity about health and human rights.
Activities for the 50th Anniversary of the Universal Declaration of Human Rights can include the following:
• Distribution of copies of the Universal Declaration of Human Rights (see enclosed sample) to all students;
• Support for the development and work of health and human rights student groups;
• Initiation of a health and human rights course;
• Sponsorship of a series of seminars linking human rights to health issues;
• Linkage to other efforts at your university, in your community, and around the world marking the 50th anniversary;
• Declaration of a designated day or month at your university or in your community to celebrate the connection between human rights and health;
• A commemorative event on Human Rights Day, December 10, 1998, the 50th anniversary date; and
• A commitment to undertake an activity in support of human rights
Resources, including publications, syllabi, speakers, and actions are available through our respective organizations.

Health workers have a key role to play in affirming the universality of human rights and in promoting respect for them. By affirming and supporting human rights, practitioners in all fields of health enhance the ethics of their profession and advance their commitment to health.

This statement has been endorsed by the following individuals, health associations and organizations: Antonio Novello, MD, MPH (former Surgeon General); Dr. Julius Richmond, Professor of Health Policy, Emeritus (former Surgeon General); Mary Robinson, United Nations High Commissioner for Human Rights; American Academy of Pediatrics; American College of Physicians; American Public Health Association; American Society of Internal Medicine; Association of American Medical Colleges; Physicians for a National Health Plan; Center for Women's Global Leadership; Doctors Without Borders/Médicins Sans Frontières; Indochinese Psychiatry Clinic; Medical Foundation for the Care of Victims of Torture; People's Decade for Human Rights Education; and Survivors International.