Showing papers in "Health and Human Rights in 2012"

Between the court and the clinic: lawsuits for medicines and the right to health in Brazil.

Abstract: Background: The Brazilian Constitution states: “Health is the right of all persons and the duty of the State” Yet individuals in Brazil frequently face barriers to health prevention and treatment One response to these barriers has been a “judicialization” of the right to health, with an increasing number of patients suing the government for access to medicines Objective/Methods: This study uses a mixed methods approach to identify trends in lawsuits for medicines in the southern state of Rio Grande do Sul (RS) and to characterize patient-plaintiffs Electronic registries were used to determine the number of health lawsuits filed between 2002 and 2009 In-depth interviews were conducted with thirty patient-plaintiffs, and 1,080 lawsuits for medicines under review between September 1, 2008 and July 31, 2009 were analyzed to assess socio-demographic, medical, and legal characteristics of patient-plaintiffs Results: Between 2002 and 2009, the annual number of health-related lawsuits against the state of RS increased from 1,126 to 17,025 In 2009, 72% of lawsuits sought access to medicines In-depth interviews revealed that patients are desperate to access medicines for chronic and advanced diseases, and often turn to the courts as a last resort Among the 1,080 lawsuits examined, patient-plaintiffs were more likely to be older than 45 years (68%), retired or unemployed (71%), and low-income (among those who reported income, 53% (n=350) earned less than the national minimum wage) Fifty-nine percent of all cases were represented by public defenders Plaintiffs reported 1,615 diseases and requested 28 drugs on average (range 1-16) Sixty-five percent of the requested drugs were on government pharmaceutical distribution lists; 78% of the 254 drugs on these lists were requested In 95% of the cases analyzed, district courts ruled in favor of plaintiffs Among the 917 cases with a final state high court ruling, 89% were in favor of the plaintiff In justifying their rulings, judges most frequently cited the government’s obligation under the Constitution’s provision of a right to health

Brazilian policy responses to violence against women: government strategy and the help-seeking behaviors of women who experience violence.

Abstract: Over the past three decades, international covenants have been signed and countries have implemented strategies and legislation to address violence against women. Concurrently, strong evidence on the magnitude and impact of violence against women has emerged from around the world. Despite a growing understanding of factors that may influence women’s vulnerability to violence and its effects, key questions about intervention options persist. Using evidence from a WHO household survey on domestic violence, our paper discusses women’s help-seeking patterns and considers these findings in relation to Brazil’s policies and strategies on violence against women. For the WHO survey, data from a large urban center (the city of Sao Paulo) and from a rural region (Zona da Mata Pernambucana [ZMP]) was collected. Findings from this survey indicate that in Sao Paulo, only 33.8% of women who experienced intimate partner violence (IPV) sought help from a formal service provider, including health, legal, social, or women’s support services; in the Forest Zone of the State of Pernambuco, an even smaller proportion (17.1%) sought formal assistance. The majority of women were likely to contact only informal sources of support, such as family, friends, and neighbors. Women who used formal services were primarily those who experienced more severe levels of violence, were severely injured, had children who witnessed the violence, or whose work was disrupted by the violence. Brazil adopted progressive laws and national and local strategies to address violence against women (VAW). Messages about violence and equality now need to reach informal networks and the wider community in order for national anti-violence policies to be successful in supporting women before violence reaches the more extreme levels of severity at which women seek formal help. To translate international standards and national policies into actions that genuinely reach women experiencing violence, states must carefully consider evidence on women’s options and decision making.

Access to health care for undocumented migrants from a human rights perspective: a comparative study of Denmark, Sweden, and The Netherlands.

Abstract: Background Undocumented migrants' access to health care varies across Europe, and entitlements on national levels are often at odds with the rights stated in international human rights law. The aim of this study is to address undocumented migrants' access to health care in Denmark, Sweden, and the Netherlands from a human rights perspective. Methods Based on desk research in October 2011, we identified national laws, policies, peer-reviewed studies, and grey literature concerning undocumented migrants' access to health care in the three involved countries. Through treaties and related explanatory documents from the United Nations and the Council of Europe, we identified relevant international laws concerning the right to health and the rights of different groups of undocumented migrants. A synopsis of these laws is included in the analysis of the three countries. Results Undocumented migrants in Denmark have the right to emergency care, while additional care is restricted and may be subject to payment. Undocumented migrants in Sweden have the right to emergency care only. There is an exception made for former asylum-seeking children, who have the same rights as Swedish citizens. In the Netherlands, undocumented migrants have greater entitlements and have access to primary, secondary and tertiary care, although shortcomings remain. All three countries have ratified international human rights treaties that include right of access to health care services. We identified international treaties from the United Nations and the Council of Europe that recognize a right to health for undocumented migrants and embrace governmental obligations to ensure the availability, accessibility, acceptability, and quality of health services, in particular for specific groups such as women and children. Conclusion In the Netherlands, undocumented migrants' right to health care is largely acknowledged, while in Denmark and Sweden, there are more restrictions on access. This reveals major discrepancies in relation to international human rights law.

Policy reform to shift the health and human rights environment for vulnerable groups: the case of Kyrgyzstan's Instruction 417.

Abstract: Background: Police activities shape behavior and health outcomes among drug users, sex workers, and other vulnerable groups. Interventions to change the policing of drug consumption and sex work in ways that facilitate public health programming and respect for human rights have included policy reforms, education, and litigation. In 2009, the Kyrgyz government promulgated “Instruction 417,” prohibiting police interference with “harm reduction” programs, re-enforcing citizen rights, addressing police occupational safety concerns, and institutionalizing police-public health collaboration. Objectives/Methods: Although ample evidence points to gaps between intended and actual impact of policy and other structural interventions, there is little research on the impact of initiatives designed to align policing, health, and human rights. We conducted a police officer survey to assess links between Instruction 417 knowledge and legal and public health knowledge, attitudes towards harm reduction programs, and intended practices targeting vulnerable groups. Results: In a 319-officer sample, 79% understood key due process regulations, 71.1% correctly characterized law on sex work, 54.3% understood syringe possession law, while only 44.4% reported familiarity with Instruction 417. Most (72.9%) expressed positive attitudes toward condom distribution, while only 56% viewed syringe access favorably. Almost half (44%) agreed that police should refer vulnerable groups to disease prevention programs, but only 20% reported doing so. In multivariate analysis, knowledge of Instruction 417 was associated with significantly better knowledge about (aOR=1.84, 95%CI: 1.12-3.00) and attitudes towards harm reduction programs (aOR=3.81, 95%CI:1.35-10.75), and knowledge of due process for the detention of sex workers (aOR=2.53, 95%CI:1.33-4.80). Younger, junior officers and those in rural areas may not be well-informed about the policy.

Land security and the challenges of realizing the human right to water and sanitation in the slums of Mumbai, India.

Abstract: Addressing the human right to water and sanitation in the slums of Mumbai, India requires disentangling the provision of basic services from a more complicated set of questions around land security and land ownership. Millions of slum-dwellers in Mumbai lack adequate access to safe drinking water and sanitation, which places them at risk for waterborne diseases. Many slums are located in hazardous areas such as flood plains, increasing their susceptibility to climate change-related weather pat terns. Access to water and sanitation in slums generally hinges on whether a dwelling was created prior to January 1, 1995, because those constructed created prior to that date have greater land security. Although the so-called “1995 cut-off rule” looms large in Mumbai slum policy, a closer reading of the relevant laws and regulations suggests that access to water and sanitation could be expanded to slums created after January 1, 1995. State and municipal governments already have the authority to expand access to water services; they just need to exercise their discretion. However, slums located on central government land are in a more difficult position. Central government agencies in Mumbai have often refused to allow the state and municipal governments to rehabilitate or improve access to services for slums located on their land. As a result, an argument could be made that by interfering with the efforts of subnational actors to extend water and sanitation to services to slum-dwellers, the central government of India is violating its obligations to respect the human right to water and sanitation under international and national jurisprudence.

Pillars for progress on the right to health: harnessing the potential of human rights through a Framework Convention on Global Health.

Abstract: Ever more constitutions incorporate the right to health, courts continue to expand their right to health jurisprudence, and communities and civil society increasingly turn to the right to health in their advocacy. Yet the right remains far from being realized. Even with steady progress on numerous fronts of global health, vast inequities at the global and national levels persist, and are responsible for millions of deaths annually. We propose a four-part approach to accelerating progress towards fulfilling the right to health: 1) national legal and policy reform, incorporating right to health obligations and principles including equity, participation, and accountability in designing, implementing, and monitoring the health sector, as well as an all-of-government approach in advancing the public's health; 2) litigation, using creative legal strategies, enhanced training, and promotion of progressive judgments to increase courts' effectiveness in advancing the right to health; 3) civil society and community engagement, empowering communities to understand and claim this right and building the capacity of right to health organizations; and 4) innovative global governance for health, strengthening World Health Organization leadership on health and human rights, further clarifying the international right to health, ensuring sustained and scalable development assistance, and conforming other international legal regimes (e.g., trade, intellectual property, and finance) to health and human rights norms. We offer specific steps to advance each of these areas, including how a new global health treaty, a Framework Convention on Global Health, could help construct these four pillars.

Technology, conflict early warning systems, public health, and human rights.

Abstract: Public health and conflict early warning are evolving rapidly in response to technology changes for the gathering, management, analysis and communication of data. It is expected that these changes will provide an unprecedented ability to monitor, detect, and respond to crises. One of the potentially most profound and lasting expected change affects the roles of the various actors in providing and sharing information and in responding to early warning. Communities and civil society actors have the opportunity to be empowered as a source of information, analysis, and response, while the role of traditional actors shifts toward supporting those communities and building resilience. However, by creating new roles, relationships, and responsibilities, technology changes raise major concerns and ethical challenges for practitioners, pressing the need for practical guidelines and actionable recommendations in line with existing ethical principles.

Lead poisoning in China: a health and human rights crisis.

Abstract: Acute and chronic lead poisoning is occurring throughout China and is a major cause of childhood morbidity. The Chinese government’s emphasis on industrial development and poverty reduction has, over the past three decades, decreased by 500 million the number of people surviving on less than one dollar per day, but has caused signifi cant environmental degradation that threatens public health. Drawing upon in-depth interviews conducted in 2009 and 2010 with families affected by lead poisoning, environmental activists, journalists, government and civil society organization officials in Shaanxi, Henan, Hunan, and Yunnan provinces, as well as a review of scientific and Chinese media, and health and environmental legal and policy analysis, we examine the intersection of civil, political, economic, and social rights related to access to information, screening, treatment, and remediation related to lead poisoning. In-depth interviews in each province uncovered: censorship and intimidation of journalists, environmental activists, and parents seeking information about sources and prevention of lead poisoning; denial of screening for lead poisoning, often based upon arbitrary eligibility criteria; and inadequate and inappropriate treatment being promoted and provided by health facilities. Over the past decade, the Chinese government has prioritized health care and invested billions of dollars towards universal health coverage, and strengthened environmental to address industrial pollution and guarantee access to information on the environment. Yet, despite these reforms, information remains constrained and citizens seeking information and redress are sometimes arrested, in violation of Chinese and international law. Local government officials and national environmental policies continue to prioritize economic development over environmental protection. To effectively address lead poisoning requires an emphasis on prevention, and to combat industrial pollution requires stronger enforcement of existing laws and regulations, as well as accountability of local authorities charged with upholding environmental regulations. In this context, restrictions on such rights as freedom of expression, assembly, and political participation have direct consequences on the realization of the right to health.

Child rights, right to water and sanitation, and human security.

Abstract: The article explores the intersection between child rights, water scarcity, sanitation, and the human security paradigm. The recognition of child rights has been advanced through the 1989 Convention on the Rights of the Child and other international legal instruments, while water rights are increasingly affirmed in international law and through the historic July 2010 United Nations General Assembly resolution that strengthened the legal foundation for water security and human rights. Yet there remains a development gap in terms of child access to clean and secure water sources for basic human development needs. The human security paradigm provides a legal and humanitarian foundation for the extension of child rights related to water and sanitation.

How do national strategic plans for HIV and AIDS in southern and eastern Africa address gender-based violence? A women's rights perspective.

Abstract: Gender-based violence (GBV) is a significant human rights violation and a key driver of the HIV epidemic in southern and eastern Africa. We frame GBV from a broad human rights approach that includes intimate partner violence and structural violence. We use this broader definition to review how National Strategic Plans for HIV and AIDS (NSPs) in southern and eastern Africa address GBV. NSPs for HIV and AIDS provide the national-level framework that shapes government, business, donor, and non-governmental responses to HIV within a country. Our review of these plans for HIV and AIDS suggests that attention to GBV is poorly integrated; few recognize GBV and program around GBV. The programming, policies, and interventions that do exist privilege responses that support survivors of violence, rather than seeking to prevent it. Furthermore, the subject who is targeted is narrowly constructed as a heterosexual woman in a monogamous relationship. There is little consideration of GBV targeting women who have non-conforming sexual or gender identities, or of the need to tackle structural violence in the response to HIV and AIDS. We suggest that NSPs are not sufficiently addressing the human rights challenge of tackling GBV in the response to HIV and AIDS in southern and eastern Africa. It is critical that they do so.

Filling the gap: a learning network for health an human rights in the Western Cape, South Africa.

Abstract: We draw on the experience of a Learning Network for Health and Human Rights (LN) involving collaboration between academic institutions and civil society organizations in the Western Cape, South Africa, aimed at identifying and disseminating best practice related to the right to health. The LN’s work in materials development, participatory research, training and capacity-building for action, and advocacy for intervention illustrates important lessons for human rights practice. These include (i) the importance of active translation of knowledge and awareness into action for rights to be made real; (ii) the potential tension arising from civil society action, which might relieve the state of its obligations by delivering services that should be the state’s responsibility—and hence the importance of emphasizing civil society’s role in holding services accountable in terms of the right to health; (iii) the role of civil society organizations in filling a gap related to obligations to promote rights; (iv) the critical importance of networking and solidarity for building civil society capacity to act for health rights. Evidence from evaluation of the LN is presented to support the argument that civil society can play a key role in bridging a gap between formal state commitment to creating a human rights culture and realizing services and policies that enable the most vulnerable members of society to advance their health. Through access to information and the creation of spaces, both for participation and as a safe environment in which learning can be turned into practice, the agency of those most affected by rights violations can be redressed. We argue that civil society agency is critical to such action.

Human rights and health systems development: confronting the politics of exclusion and the economics of inequality.

Abstract: The social movements of the last two decades have fostered a rights-based approach to health systems development within the global discourse on national and international health governance. In this piece, we discuss ongoing challenges in the cavernous "implementation gap": translating legislative human rights victories into actual practice and delivery. Using accompaniment as an underlying principle, we focus primarily on constructing effective, equitable, and accountable public sector health systems. Public sector health care delivery is challenged by increasingly exclusive politics and inequitable economic policies that fundamentally limit the participatory power of marginalized citizens. Finally, we discuss the role of implementation science in closing the delivery gap in human rights practice.

Integrating interventions on maternal mortality and morbidity and HIV: a human rights-based framework and approach.

Abstract: Maternal mortality and morbidity (MMM) and HIV represent interlinked challenges arising from common causes magnifying their respective impacts and producing related consequences. Accordingly an integrated response will lead to the most effective approach for both. Shared structural drivers include gender inequality; gender-based violence (including sexual violence); economic disempowerment; and stigma and discrimination in access to services or opportunities based on gender and HIV. Further shared system-related drivers also contribute to a lack of effective access to acceptable high-quality health services and other development resources from birth forward. HIV and MMM are connected in both outcomes and solutions: in sub-Saharan Africa HIV is the leading cause of maternal death while the most recent global report on HIV identifies prevention of unintended pregnancy and access to contraception as two of the most important HIV-related prevention efforts.1 Both are central to reducing unsafe abortion--another leading cause of maternal death globally and particularly in Africa. A human rights-based framework helps to identify these shared determinants. A human rights-based approach works to establish the health-related human rights standards to which all women are entitled as well to outline the indivisible and intersecting human rights principles which inform and guide efforts to prevent protect from respond to and provide remedy for human rights violations-in this case related to HIV and maternal mortality and morbidity.The Millennium Declaration and Development Goals (MDGs) help to both set quantifiable goals for achieving the components identified within the human rights-based framework and document the international consensus that no single goal--such as those addressing HIV and MMM--can be achieved without progress on all development goals. Copyright (c) 2012 Fried et al.. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use distribution and reproduction in any medium provided the original author and source are credited.

Associations between human rights environments and healthy longevity: The case of older persons in China

Abstract: Individual health can deteriorate through neglect or violation of human rights, or can improve through favorable health policies and programs on human rights. Yet quantitative associations between human rights and health are insufficiently studied. Based on a nationwide dataset of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) with more than 18,800 adults aged 65 and older in mainland China interviewed in 2002 and 2005 and their follow-ups three years later, we examine how an individual’s longevity and health are associated with some domains of human rights. We use three individual-level variables in early life stages (whether a respondent went to bed hungry, whether they accessed adequate medical services, and how many years of schooling they received), three individual-level variables at present (whether a respondent has adequate housing, whether they have adequate economic resources to support daily subsistence, and whether they receive adequate medical services when needed), and one community-level variable (air quality) as proxies to measure several fundamental domains of human rights in terms of access to adequate food/nutrition, housing/shelter, education, social security, health care, and clean-air environments. An indicator of healthy survival is introduced to measure survivors at sequent follow-ups with a good health condition. Our results demonstrate that better conditions of proxy measures of human rights at different life stages, especially at present, are associated with a higher likelihood of healthy survival after taking various confounding variables into consideration, suggesting the possibility of a significant linkage between good environments in human rights and healthy longevity. These findings may have impor tant implications for promoting better environments in human rights, especially in the context of population aging.

Bridging international law and rights-based litigation: mapping health-related rights through the development of the Global Health and Human Rights Database.

Abstract: The O’Neill Institute for National and Global Health Law at Georgetown University, the World Health Organization, and the Lawyers Collective have come together to develop a searchable Global Health and Human Rights Database that maps the intersection of health and human rights in judgments, international and regional instruments, and national constitutions. Where states long remained unaccountable for violations of health-related human rights, litigation has arisen as a central mechanism in an expanding movement to create rights-based accountability. Facilitated by the incorporation of international human rights standards in national law, this judicial enforcement has supported the implementation of rights-based claims, giving meaning to states’ longstanding obligations to realize the highest attainable standard of health. Yet despite these advancements, there has been insufficient awareness of the international and domestic legal instruments enshrining health-related rights and little understanding of the scope and content of litigation addressing these rights. As this accountability movement evolves, the Global Health and Human Rights Database seeks to chart this burgeoning landscape of international and regional instruments, national constitutions, and judgments for health-related rights. Employing international legal research to document and catalogue these three interconnected aspects of human rights for the public’s health, the Database’s categorization by human rights, health topics, and regional scope provides a comprehensive compilation of health and human rights law. Through these categorizations, the Global Health and Human Rights Database serves as a basis for analogous legal reasoning across states to serve as precedents for future cases, for comparative legal analysis of similar health claims in different country contexts, and for empirical research to clarify the impact of human rights judgments on public health outcomes.

Human rights from the grassroots up: Vermont's campaign for universal health care.

Abstract: In 2008, the Vermont Workers' Center launched the "Healthcare Is a Human Right Campaign," a grassroots campaign to secure the creation of a universal health care system in Vermont. Campaign organizers used a human rights framework to mobilize thousands of voters in support of universal health care. In response to this extraordinary grassroots effort, the state legislature passed health care legislation that incorporates human rights principles into Vermont law and provides a framework for universal health care. The United States has often lagged behind other nations in recognizing economic, social, and cultural (ESC) rights, including the right to health. Nonetheless, activists have begun to incorporate ESC rights into domestic advocacy campaigns, and state and local governments are beginning to respond where the federal government has not. Vermont serves as a powerful example of how a human rights framework can inform health care policy and inspire grassroots campaigns in the United States. This three-part article documents the Vermont Workers' Center campaign and discusses the impact that human rights activity at the grassroots level may have on attitudes towards ESC rights in the United States. The first part describes the Vermont health care crisis and explains why the center adopted international human rights principles for their campaign. The article then goes on to discuss the three-year campaign and analyze the health care reform bill that the Vermont legislature passed. Finally, the article discusses the campaign's local and national impact.

New Zealand's National Health and Disability Advocacy Service: a successful model of advocacy.

Abstract: This paper, in exploring both the debate and practice of advocacy, uses the National Health and Disability Advocacy Service in New Zealand to describe a successful model of advocacy that is based on the concept of empowerment practiced in an independent environment and strengthened by an enforceable framework of consumer rights.