Universal Human Rights in Theory and Practice

https://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=3186&context=facpub

The legal determinants of health: harnessing the power of law for global health and sustainable development

Introduction Millennium Development Goal (MDG) 7 addresses environmental sustainability, with a target (target 10) to "halve by 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation". (1) Progress towards target 10 contributes significantly to the reduction of child mortality (target 5), major infectious diseases (target 8), maternal health (target 6) and quality of life of slum populations (target 11). It also contributes to gender equality and empowers women, and is linked to school enrolment and attendance, especially of girls (goal 3). Meeting the target would contribute to reducing poverty (target 1) and hunger (target 2) through use of water supply in industry and agriculture, saving productive time in accessing closer water sources and sanitation facilities, and contributing to workforce health. Importantly, improved water supply and sanitation promotes economic equity since the unserved tend to be the poorer and more vulnerable. In working towards the MDG target for water and sanitation, understanding resource requirements, resource gaps and where resources need to be deployed are critical. Corresponding assessments need to be based on reasonable estimates at global, regional and country levels. (2) Furthermore, comparing estimated finances required to existing funding levels helps to mobilize resources and to direct efforts to specific contexts (e.g. rural or urban) and to countries that are not meeting the MDG targets. (3) Since 2000, studies have estimated the cost of attaining one or both of the components of the target for water and sanitation at the global (4-8) and regional (2,9,10) levels. Reviews have compared these, which are in the range of US$ 9 to 30 billion per year at the global level. (11, 12) This wide range is largely explained by the different methodologies and unit cost assumptions. Different approaches to incremental improvement and on adequate service levels also contribute to the differences. Most studies have ignored the costs of maintaining existing coverage levels (the costs of operating, maintaining, monitoring and replacing existing infrastructure and facilities)--these are especially important as the global stock of assets increases and in the light of reports indicating wide variability on effective "working life". Toubkiss concludes, based on global cost studies, that "approximately US$ 10 billion per year would be required to supply low-cost water and sanitation services to people who are not currently supplied, and a further US$ 15 to 20 billion a year to provide them with a higher level of service and to maintain current levels of service to people who are already supplied" (our emphasis). Therefore, future financing studies should consider costs of operation, maintenance and replacement of existing as well as new water and sanitation infrastructure and facilities. (12) A major component of variability for sanitation is technology choice: a low-cost household improved latrine can provide both safety and privacy, yet waterborne sewerage must also include the cost of treatment to reduce health and environmental risks from the discharged wastewater. Thus Toubkiss concludes that in addition to the above costs "up to US$ 80 billion is projected solely for collecting and treating household wastewater". (12) While coverage has been advancing in many countries, recent estimates consistently show the sanitation component of the target to be significantly off-track, with a projected shortfall of 550 million people in 2015 from target achievement. (3) The drinking water component, while formally on-track (within 5% of target), is at the bottom limit of that range with prospects deteriorating. (13) Uneven progress between rural and urban populations is also often cited, and the lower baseline in rural compared to urban areas is well documented. (14) The importance of this is reflected in the fact that, uniquely among MDG indicators, rural-urban disaggregation is specified in the indicator definition, although there is no clear agreement that the target itself applies separately to rural and urban areas. …

Global Costs of Attaining the Millennium Development Goal for Water Supply and sanitation/Couts Globaux De la Realisation De L'objectif Du Millenaire Pour le Developpement Relatif a L'approvisionnement En Eau et a l'assainissement/Costos Mundiales del Logro del Objetivo De Desarrollo del Milenio Sobre El Abastecimiento De Agua Y El Saneamiento

Background : As the Association of South East Asian Nations (ASEAN) gears toward full regional integration by 2015, the cross-border mobility of workers and citizens at large is expected to further intensify in the coming years While ASEAN member countries have already signed the Declaration on the Protection and Promotion of the Rights of Migrant Workers, the health rights of migrants still need to be addressed, especially with ongoing universal health coverage (UHC) reforms in most ASEAN countries This paper seeks to examine the inclusion of migrants in the UHC systems of five ASEAN countries which exhibit diverse migration profiles and are currently undergoing varying stages of UHC development Design : A scoping review of current migration trends and policies as well as ongoing UHC developments and migrant inclusion in UHC in Indonesia, Malaysia, Philippines, Singapore, and Thailand was conducted Results : In general, all five countries, whether receiving or sending, have schemes that cover migrants to varying extents Thailand even allows undocumented migrants to opt into its Compulsory Migrant Health Insurance scheme, while Malaysia and Singapore are still yet to consider including migrants in their government-run UHC systems In terms of predominantly sending countries, the Philippines’s social health insurance provides outbound migrants with portable insurance yet with limited benefits, while Indonesia still needs to strengthen the implementation of its compulsory migrant insurance which has a health insurance component Overall, the five ASEAN countries continue to face implementation challenges, and will need to improve on their UHC design in order to ensure genuine inclusion of migrants, including undocumented migrants However, such reforms will require strong political decisions from agencies outside the health sector that govern migration and labor policies Furthermore, countries must engage in multilateral and bilateral dialogue as they redefine UHC beyond the basis of citizenship and reimagine UHC systems that transcend national borders Conclusions : By enhancing migrant coverage, ASEAN countries can make UHC systems truly ‘universal’ Migrant inclusion in UHC is a human rights imperative, and it is in ASEAN’s best interest to protect the health of migrants as it pursues the path toward collective social progress and regional economic prosperity Keywords : migrant health; migrant workers; ASEAN; Southeast Asia; universal health coverage; health financing ( Published: 24 January 2015) Citation : Glob Health Action 2015,  8 : 25749 -  http://dxdoiorg/103402/ghav825749

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Universal health coverage in 'One ASEAN': are migrants included?

The role of vitamin D in maintaining bone health has been known for decades. Recently, however, the discovery that many tissues expressed the vitamin D receptor and were able to transform the 25-OH vitamin D into its most active metabolite, 1,25-(OH)(2) vitamin D, has led to a very promising future for this "old" molecule. Indeed, observational studies, and more and more interventional studies, are raising the importance of a significant vitamin D supplementation for not-only skeletal benefits. Among them, 25-OH vitamin D has been found to play an important role in prevention of cancers, auto-immune diseases, cardiovascular diseases, diabetes, and infections. Vitamin D deficiency, defined as serum 25-OH vitamin D levels <30 ng/mL, is very common in our population. The cost/benefit ratio and some recently published studies are clearly now in favor of a controlled and efficient vitamin D supplementation in these patients presenting a 25-OH vitamin D level <30 ng/mL. More attention should also be focused on pregnant and lactating women, as well as children and adolescents.

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Vitamin D: current status and perspectives.

A population’s health and well-being is primarily a national responsibility. Every state owes all of its inhabitants a comprehensive package of essential health goods and services under its obligations to respect, protect, and fulfill the human right to health. Yet health is also a global responsibility. Every state has a duty to ensure a safe and healthy world, with particular attention to the needs of the world’s poorest people. Improving health and reducing unconscionable health inequalities is both an international obligation under the human right to health and a matter of global social justice.The mutual obligations of states to safeguard the health of their own inhabitants and the health of people everywhere are poorly defined, with serious adverse consequences for world health. These obligations must be better understood. Central questions of vital importance to the health of the world’s population include: What are the duties of all states to ensure the right to the highest attainable standard of health for all their inhabitants? What are the components of a comprehensive package of essential goods and services under the right to health to which people everywhere are entitled? How specifically can states’ duties to govern well be incorporated into and realized through the health system? One of the most inadequately understood obligations is the responsibility of the international community to augment the capacity of low- and middle-income states to ensure their population’s health, with the specific contours of this obligation ill-defined. Indeed, international financial assistance is framed as “aid,” rather than an expression of mutual responsibility, leaving the flawed impression that international health assistance is a matter of charitable discretion rather than an international human rights obligation. The approach to health assistance as charity rather than as an obligation also means that this assistance is unreliable over the longer-term, leading to the reluctance of low- and middle-income countries to use it for recurrent public health expenditures. Continued and accelerated improvements in global health will require significant and reliable funding at a time of extended economic uncertainty and budget belt-tightening in many countries. Progress on global health therefore risks stagnating unless states have clarity on, accept, and adhere to national and international obligations to respect, protect, and fulfill the human right to health. Translating state obligations into improved health will also require building a more robust and effective global health governance structure. Current global health initiatives are too often undermined by a host of now well-recognized weaknesses: Global health actors do not sufficiently coordinate their activities with each other or the host countries, leading to fragmentation, nor do they make and keep longer-term funding commitments, leading to unpredictability. Development partners do not set the priorities required to meet all human health needs, and lack accountability for their own global health commitments. Host countries are not empowered to take “ownership” of health planning and programs. And the international community does not adequately monitor and evaluate programmatic effectiveness. Our aim is to propose a coherent global health governance framework for the post-MDG period that will clarify national and global responsibilities for health, enable countries to effectively carry out these responsibilities, and create accountability around them. In order to achieve this, we are establishing the Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI). The primary purpose of the JALI is to catalyze and facilitate research, broad consultations, and campaigns that will lead to a global compact. Towards this end, the JALI will rigorously and systematically address the following issues: Clarify the essential package of health goods and services to which all human beings are entitled as part of their right to health; Clarify the responsibility of all states, even the poorest, to provide this essential package of health goods and services to all of their inhabitants; Assess the gap between the conditions (financial and others) for the provision of an essential package of health goods and services, and the domestic capacity of and use of that capacity by poorer countries - the gap for which the international community should take responsibility; Clarify the international responsibility to build the capacity of low- and middle-income states to provide an essential package of health goods and services to their inhabitants; Clarify the principles of good governance, both nationally and globally, including transparency, honesty, and accountability; Propose a coherent global health governance architecture to ensure robust national and global responsibilities for health. In particular, the JALI will answer the following four key questions: What are the essential services and goods guaranteed to every human being under the human right to health? What is the responsibility that all states have for the health of their own populations? What is the responsibility of all countries to ensure the health of the world's population? What kind of global health governance is needed to ensure that all states live up to their mutual responsibilities?

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The Joint Action and Learning Initiative on National and Global Responsibilities for Health

https://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=2848&context=facpub

The next WHO Director-General's highest priority: a Global Treaty on the Human Right to Health

632 www.thelancet.com Vol 370 August 25, 2007 action, GHWA has launched four global task forces: fast-tracking train ing and education, ameliorating harmful aspects of migration, harmonising HIV eff orts with health systems, and charting feasible fi nancing options. In partnership with WHO, GHWA has supported development of tools and guidelines for workforce planning and management. All of these new developments will be presented in Kampala. The Kampala Forum comes at a critical moment when problem recognition has grown enormously but eff ect ive solutions are only beginning to be tested and valid ated. Participants with real-world experiences and early research results will be welcomed at this Forum. The Lancet will publish a special issue on human resources for health the week before the Forum, and now invites for high-quality research papers to be sub mitted on this subject by Nov 1, 2007. The Forum meshes well with current movements to revitalise primary health care on the 60th anniversary of WHO, 30 years after Alma Ata. Kampala promises to be an exciting and critical next step for achieving global goals and re-energising the movement for better health in the 21st century.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61315-4.pdf

Sigrun Møgedal

Papers

The Joint Action and Learning Initiative on National and Global Responsibilities for Health

The next WHO Director-General's highest priority: a Global Treaty on the Human Right to Health

Calcium and vitamin D for osteoporotic fracture risk