Abstract
If the 2010 CPHA conference is a bellwether of mainstream Canadian public and global health practice, its dearth of human rights papers suggests that, outside a small scholarly cohort, human rights remain marginal therein. This potential ‘rights gap’ conflicts with growing recognition of the relationship between health and human rights and ergo, the importance of human rights education for health professionals. This gap not only places Canadian health research outside the growing vanguard of academic research on health and human rights, but also ignores a potentially influential tool for achieving health equity. I suggest that human rights make a distinctive contribution to such efforts not replicated within other social justice and equity approaches, making human rights education a crucial complement to other ethical training. These contributions are evident in the normative specificity of the right to health in international law and its legally binding nature, in the success of litigation, the successful advocacy for AIDS treatment and the growing adoption of rights-based approaches to health. Canadian academic and research institutions should take up their rightful place within health and human rights research, education and practice globally, including by ramping up human rights-oriented education for health professionals within Canadian universities.
Key words: Human rights, public and global health, Canada
Résumé
Si la conférence de 2010 de l’ACSP est un indicateur du courant dominant parmi les praticiens canadiens de la santé publique et de la santé mondiale, le manque criant de communications sur les droits humains montre qu’en dehors d’une petite cohorte d’universitaires, c’est un sujet qui reste en marge. Or, on admet de plus en plus qu’il existe un lien entre la santé et les droits humains, d’où l’importance que les professionnels de la santé soient sensibilisés à cet enjeu. Non seulement la recherche en santé au Canada demeure-t-elle à l’écart du mouvement croissant de la recherche universitaire sur la santé et les droits humains, mais elle néglige un outil potentiellement influent pour atteindre l’équité en santé. J’avance que les droits humains apportent un élément distinctif à la lutte pour l’équité en santé, non couvert par d’autres approches de justice sociale et d’équité; cela fait de l’éducation sur les droits humains un complément essentiel aux autres formations déontologiques. L’importance de l’approche des droits humains se voit dans la spécificité normative du droit à la santé en droit international, dans son caractère juridiquement contraignant, dans les jugements favorables qui ont été rendus, dans la promulgation efficace du traitement du sida et dans l’adoption croissante d’approches fondées sur les droits en matière de santé. Les établissements d’enseignement et de recherche devraient prendre la place qui leur revient au sein de la recherche, de l’enseignement et des pratiques sur la santé et les droits humains dans le monde, notamment en privilégiant une formation orientée sur les droits humains pour les professionnels de la santé dans les universités canadiennes.
Mots clés: droits homme, santé publique, santé, mondiale, Canada
Footnotes
Conflict of Interest: None to declare.
References
- 1.Schrecker S, Chapman AR, Labonté R, De Vogli R. Advancing health equity in the global marketplace: How human rights can help. Soc Sci Med. 2010;71(8):1520. doi: 10.1016/j.socscimed.2010.06.042. [DOI] [PubMed] [Google Scholar]
- 1a.Orbinski J, Beyrer C, Singh S. Violations of human rights: Health practitioners as witnesses. Lancet. 2007;370(9588):698. doi: 10.1016/S0140-6736(07)61346-4. [DOI] [PubMed] [Google Scholar]
- 1b.Gruskin S, Mills EJ, Tarantola D. History, principles, and practice of health and human rights. Lancet. 2007;370(4):449. doi: 10.1016/S0140-6736(07)61200-8. [DOI] [PubMed] [Google Scholar]
- 1c.Denburg AE. Global child health ethics: Testing the limits of moral communities. Public Health Ethics. 2010;3(3):239. doi: 10.1093/phe/phq023. [DOI] [Google Scholar]
- 2.VanderPlaat M, Teles N. Mainstreaming social justice: Human rights and public health. Can J Public Health. 2005;96(1):34. doi: 10.1007/BF03404011. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2a.Edwards NC, MacLean Davison C. Social justice and core competencies for public health: Improving the fit. Can J Public Health. 2008;99(2):130. doi: 10.1007/BF03405460. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Mann J, Gruskin S, Grodin MA, Annas GJ, editors. Health and Human Rights: A Reader. New York, NY: Routledge; 1999. [Google Scholar]
- 4.Gruskin S, Mills EJ, Tarantola D. History, principles, and practice of health and human rights. The Lancet. 2007;370(4):449. doi: 10.1016/S0140-6736(07)61200-8. [DOI] [PubMed] [Google Scholar]
- 4a.Hunt P. The human right to the highest attainable standard of health: New opportunities and challenges. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2006;100(7):603. doi: 10.1016/j.trstmh.2006.03.001. [DOI] [PubMed] [Google Scholar]
- 4b.Farmer P. Challenging orthodoxies: The road ahead for health and human rights. Health and Human Rights. 2008;10(1):1. doi: 10.2307/20460084. [DOI] [PubMed] [Google Scholar]
- 4c.Beyrer C, Pizer HF, editors. Public Health and Human Rights: Evidence-Based Approaches. Baltimore, MD: Johns Hopkins University Press; 2007. [Google Scholar]
- 5.World Conference on Human Rights . The Vienna Declaration and Programme of Action. 1993. [Google Scholar]
- 5a.Rodriguez-Garcia R, Akhter MN. Human rights: The foundation of public health practice. Am J Public Health. 2000;90(5):693. doi: 10.2105/AJPH.90.5.693. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Harvard School of Public Health . Health and Human Rights Database. 2010. [Google Scholar]
- 7.Some opposition to human rights within public health circles may stem from the view that human rights as individualistic claims conflict with collective public health imperatives. While such conflicts can occur, international human rights law does permit certain rights (including health) to be limited in service of collective interests, and therefore for the most part conflict can be avoided or reduced (the case of routine testing for HIV as a case in point). See United Nations Economic and Social Council. Siracusa principles on the limitation and derogation provisions in the International Covenant on Civil and Political Rights Rep. No. U.N. Doc. E/CN.4/1985/4, Annex; 1985.
- 8.Nixon S, Forman L. BMC International Health and Human Rights. 2008. Exploring the synergies between human rights and public health ethics: A whole greater than the sum of its parts. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8a.Braveman P, Gruskin S. Defining equity in health. J Epidemiol Community Health. 2003;57(4):254. doi: 10.1136/jech.57.4.254. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.United Nations Committee on Economic . Social, and Cultural Rights. General comment no. 14: The right to the highest attainable standard of health. 2000. [Google Scholar]
- 10.Meier BM. Advancing health rights in a globalized world: Responding to globalization through a collective human right to public health. J Law Med Ethics. 2007;35(4):545. doi: 10.1111/j.1748-720X.2007.00179.x. [DOI] [PubMed] [Google Scholar]
- 10a.Forman L. Trade rules, intellectual property and the right to health. Ethics Int Affairs. 2007;21(3):337. doi: 10.1111/j.1747-7093.2007.000103.x. [DOI] [Google Scholar]
- 11.Universal Declaration of Human Rights . GA Res. 217 (III), UN GAOR, 3d Sess. Supp. No. 13, UN Doc A/810. 1948. [Google Scholar]
- 12.These include: United Nations. International Convention on the Rights of the Child. 1989. [Google Scholar]
- 13.Palmer A, Tomkinson J, Phung C, Ford N, Joffres M, Fernandes KA, et al. Does ratification of human-rights treaties have effects on population health. Lancet. 2009;373(9679):1987. doi: 10.1016/S0140-6736(09)60231-2. [DOI] [PubMed] [Google Scholar]
- 13a.Hsieh A, Amon JJ. Ratification of human rights treaties: The beginning not the end. Lancet. 2009;374(9688):447. doi: 10.1016/S0140-6736(09)61443-4. [DOI] [PubMed] [Google Scholar]
- 14.Gloppen S. Litigation as a strategy to hold governments accountable for implementing the right to health. Health and Human Rights. 2008;10(2):21. doi: 10.2307/20460101. [DOI] [PubMed] [Google Scholar]
- 14a.Hogerzeil H V, Samson M, Casanovas J V, Rahmani-Ocora L. Is access to essential medicines as part of the fulfillment of the right to health enforceable through the courts. Lancet. 2006;368(9532):305. doi: 10.1016/S0140-6736(06)69076-4. [DOI] [PubMed] [Google Scholar]
- 15.See for example. Minister of Health and another v. Treatment Action Campaign and others (2002) 5 S.Afr.L.R. 721 (S.Afr.Const.Ct), where a social group successfully claimed access to drugs to prevent perinatal transmission of HIV/AIDS on the basis of international and domestic human rights protections, with the court order ultimately assuring the establishment of a national perinatal program.
- 16.Backman G, Hunt P, Khosla R, Jaramilla-Strouss C, Mekuria Fikre B, Rumble C, et al. Health systems and the right to health: An assessment of 194 countries. Lancet. 2008;372(9655):2047. doi: 10.1016/S0140-6736(08)61781-X. [DOI] [PubMed] [Google Scholar]