The relationship between health and human rights is explored in a four-paper Series beginning in this week's edition of The Lancet. In an accompanying Comment, Geoffrey Robertson QC, one of the UK's leading human rights lawyers, also offers his thoughts on the Series.
In this first paper, Dr Sofia Gruskin (Harvard School of Public Health, Boston, USA) Dr Edward Mills (British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada) and Dr Daniel Tarantola (University of New South Wales, Sydney, Australia) 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.
They say: "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."
As an example of the complex nature of the human rights -- health relationship, the authors discuss HIV-testing in low income countries. Although voluntary testing has been advocated by most international agencies, the debate is now focussing on whether testing should be voluntary or compulsory. The authors say: "The present argument is that people knowing their HIV status is more important than whether they voluntarily seek testing, because they will be able to accurately inform their partners of their HIV status, modify their behaviours and seek treatment if available."
They add that consequently, the approach known as "routine provider-initiated HIV testing" is becoming more common and this will need to be carefully monitored to check whether the results match the ideology -- i.e. whether such a system will help people access and maintain contact with HIV care services.
This first paper in the Series also discusses the authors' concerns that government roles and responsibilities are being delegated to "non-state actors", such as health insurance companies, the pharmaceutical industry and others, "whose accountability is defined poorly and monitored inadequately."
They conclude by saying three areas in the field of health and human rights urgently need 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 of a research agenda to advance understanding of the associations between health and human rights.
They say: "Increased understanding of human rights is not only of value in itself, but also provides those involved in health planning and care with the necessary tools to create conditions that enable people to achieve optimum health."
In an accompanying Comment, Geoffrey Robertson QC, Doughty Street Chambers, London, UK, says: "The Lancet's important series on health and human rights illustrates some of the ways in which the delivery of medical services must answer to human rights principles."
He concludes: "Another connection between human rights and health can be discerned in the evidence of the resurgence of diseases long thought to have been eradicated, in states which evince no respect for civil rights of their citizens. This causal link serves to emphasise the indivisibility as well as the universality of fundamental rights: freedom from avoidable illness is as essential as freedom from discrimination or persecution. That means that medical services must now be delivered within an ethical framework infused by human rights considerations: dilemmas will remain, but they will be more acceptably resolved."
In an additional accompanying Comment, Professor Paul Hunt, University of Essex, UK, emphasises that, although much neglected, the right to the highest attainable standard of health lies at the heart of the health and human rights movement.
Highlighting the importance of health workers in the delivery of the right to health, he says: "The right to the highest attainable standard of health is an asset and ally, which is at the disposal of all health workers. Why not grasp and use a resource that not only helps to achieve professional objectives, but also helps to fulfil professional responsibilities?"
The paper is found here: http://www.thelancet.com/webfiles/images/clusters/thelancet/press_office/humanrights.pdf
Journal
The Lancet