Who care about human rights anyway? Richard Horton's offline column.

Original link here.

Volume 382, Issue 9902, 26 October–1 November 2013, Pages 1390

Comment

Offline: Who cares about human rights anyway?

• Richard Horton 

Sridhar Venkatapuram surprised, even shocked, his audience at this month's Global Health Lab, hosted by the London School of Hygiene and Tropical Medicine and The Lancet. The question he was asked seemed straightforward enough: what is the contribution of human rights to global health? To many engaged in global health, the right to the highest attainable standard of health is a sacred principle. But Sridhar, a lecturer in global health at King's College London, argued that human rights have very little to do with global health today. Human rights might be talked about, often with great rhetorical energy, but few in global health seriously believe in, let alone understand, what human rights mean. The problem lies with those who lead global health: “I have given up on this particular generation running global health.” The only coherent rights global health leaders truly believe in are civil and political rights. All other rights, including the right to health, are seen as “unAmerican” and “bad philosophy”. Sridhar looked to Isaiah Berlin's two concepts of liberty to understand why this is so. Berlin distinguished between negative and positive liberties. Negative liberty means freedom from interference. Positive liberty suggests mastery over one's environment. Good government, so those running global health today argue, is about leaving people alone. Human rights should be about protecting negative freedoms. They should be about defending us from interference. Right? Wrong. We need new leadership in global health, leadership that is willing to defend positive liberties. The right to health is a positive liberty. It means working to ensure people are given the possibility of leading flourishing lives. A generational change is coming.

Richard Horton

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Gorik Ooms, a human rights lawyer based at the Institute of Tropical Medicine in Antwerp, drew a different distinction. He noted that rights-based advocacy had been a powerful means to secure access to financing for AIDS through the Global Fund and PEPFAR. But why have rights-based arguments not succeeded in winning wider provision for other aspects of global health, such as emergency obstetric care? Partly because the maternal health community is divided as to the best approach to take (facility-based deliveries or community platforms for care?). The result is that the maternal health community, despite adoption of rights-based arguments, seems unable to make a clear or specific demand. They are unable to show that intervening to save the lives of pregnant women is a global public good. And, of course, maternal health has no Global Fund. So although human rights arguments might be important, they are not sufficient to trigger political change. The lessons for universal health coverage (UHC) are clear. UHC certainly should use rights-based advocacy. It has a specific demand and it is manifestly a global public good. But there is no equivalent of a Global Fund. Without a financing mechanism, can universal health coverage succeed?

Richard Horton

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“Human rights do exist!”, proclaimed John Tasioulas, Quain Professor of Jurisprudence at University College London. Indeed, they have “profound implications” for global health. But something is wrong with the way we use human rights arguments in health. Is it correct to say that human rights should be the predominant basis for global health advocacy and policy making? And if rights arguments are used, is the right to health really the most important right we should be considering? The answer to both questions is no. There is much more to global health than human rights. Other rights beyond health matter as much, if not more, than health. Health is only one aspect of what we might call a “good life”. Consider this: imagine the right to health was fully satisfied. Would the world's health problems disappear? Of course not. So why are human rights important? Not because they are the predominant means to improved health and wellbeing, but because they bring a moral dimension to our discussions about the suffering of others and because of the duties they impose on each of us. In sum, what is the contribution of human rights to global health? This perhaps. Human rights arguments have important work to do in global health. But we are still only beginning to discover what that work is. There was one more lesson from this Global Health Lab. We should embrace our philosophers. Philosophers may not have perfect answers, but they ask more precise and disturbing questions than many of us are prepared (or feel comfortable) to ask.

With thanks to Martin McKee, Erika Richardson, and Bayard Roberts.

Richard Horton

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Richard Horton

Amnesty Int'l: Sierra Leone: Pregnant women still denied lifesaving medical care

Notes to Editors

· In April 2010 the Sierra Leone government launched its “Free health care initiative” for pregnant women, lactating mothers and children under 5 at all government-run facilities.
· This report is issued as part of Amnesty International’s ongoing campaign to ensure that women and girls living in Sierra Leone are able to realise their maternal health and sexual and reproductive rights.
· This work is also part of Amnesty International’s global Demand Dignity campaign, launched in 2009.  This campaign aims to expose and combat the human rights violations that drive and deepen poverty.
· Through its work on this issue Amnesty International promotes the empowerment of women and girls and the removal of barriers to the realization of their sexual, reproductive and maternal health rights. For more information visit www.amnesty.org/demand-dignity .

6 September 2011

Sierra Leone: Pregnant women still denied lifesaving medical care

More than a year after the launch of the Free Health Care Initiative, pregnant women and girls in Sierra Leone continue to face serious challenges in accessing the drugs and medical care crucial for safe pregnancy and childbirth, Amnesty International said today.

Under the Initiative, all pregnant women and lactating mothers should receive free treatment at government-run health facilities. However, a new Amnesty International report, At a Crossroads: Sierra Leone’s Free Health Care Policy , reveals that many of these women are being asked to pay for drugs, which they cannot afford.

“The health care system remains dysfunctional in many respects.”  said Erwin van der Borght, Amnesty International’s Africa program director.

“Government figures show that since the introduction of the Initiative, more women are accessing antenatal care and delivering their babies in health facilities. However, many women continue to pay for essential drugs, despite the free health care policy, and women and girls living in poverty continue to have limited access to essential care in pregnancy and childbirth.”

The government of Sierra Leone has introduced some initiatives to address these challenges. These include steps to increase women's access to health services, increasing the pay of health workers and providing those workers with additional training. However, much remains to be done.

“A critical shortcoming within the healthcare system is the absence of any effective monitoring and accountability systems, without which reforms cannot succeed,” said Erwin van der Borght.

The existing processes are poorly resourced and focus on reviewing individual facilities rather than on monitoring the obstacles women face in accessing services. There are no effective complaint mechanisms available to women and girls when their human rights are denied.

A 23-year old woman who had just given birth told Amnesty International:

“My baby was crying a lot and had a fever. Hospital had no drugs for him. Need to pay money. They chased me away. I don’t know how to complain.”  

Monitoring and accountability are vital to the realization of the right to health. An effective framework of monitoring and accountability serves as the basis for promoting changes which allow women and girls to enjoy their right to maternal health and give birth more safely.

“The government has taken some important steps to address these challenges. However, deficiencies in the monitoring and accountability system allow poor practice and mismanagement to go unchallenged, and have provided some people with opportunities to exploit the system and plunder valuable medicines,” said Erwin van der Borght.

Amnesty International welcomes the positive response received from the Ministry of Health and Sanitation on sharing this report with them, but the planned reforms must be translated into action.

Amnesty International is calling on the Sierra Leone government to strengthen and establish systems of monitoring and accountability to ensure health care interventions are accessible to women and girls and to guarantee their access to effective remedies for violations of their human rights.

farmer suicides in India and human rights analysis

INDIA FAILING TO ADDRESS ITS FARMER SUICIDE CRISIS

CHRGJ Urges Indian Government to Respect and Protect Farmers’ Human Rights

(NEW YORK, May 11, 2011)—The Indian government must uphold its human rights obligations by responding immediately to its farmer suicide crisis, said the Center for Human Rights and Global Justice (CHRGJ) in a new report released today. The report, Every Thirty Minutes: Farmer Suicides, Human Rights, and the Agrarian Crisis in India, looks critically at India’s farmer suicide epidemic—which has been claimed the lives of an estimated 250,000 farmers since 1995—and proposes steps that the government should take toward upholding the human rights of this vulnerable population.

“On average, one farmer commits suicide every 30 minutes in India,” said CHRGJ Faculty Director and report co-author Smita Narula. “It’s simply unacceptable to ignore a tragedy of such epic proportions and go on with business as usual. The Indian government’s limited interventions have failed to adequately assess or address this deepening crisis.”

Over the past two decades, economic reforms—which included the removal of agricultural subsidies and the opening of Indian agriculture to an increasingly volatile global market—have increased costs, while reducing yields and profits for many farmers, creating widespread financial distress. As a result, smallholder farmers are often trapped in a cycle of insurmountable debt, leading many to take their lives.

The report focuses on the impact of the agrarian crisis on the human rights of cotton farmers in India. The cotton industry, like other cash crop industries in India, has increasingly come under the control of foreign multinational corporations that promote genetically modified Bt cottonseed and often wield considerable influence over the cost, quality, and availability of other agricultural inputs. Bt cottonseed, which now dominates the Indian cotton sector, requires an abundance of two resources that are already scarce for many smallholder farmers: money and water. Farmers take out loans to purchase the seeds, but when the crop fails due to lack of access to water, they often fall into debt. Many kill themselves by consuming the very pesticide they went into debt to purchase.

Farmer suicides also have a ripple effect, spreading both debt and despair. Often, as the farmer’s family inherits the debt, children drop out of school to become farmhands, and surviving family members’ may themselves commit suicide out of the same desperation.

The Indian government has failed to adequately assess the crisis and farmer suicide statistics—high as they already are—grossly under-estimate the problem. In fact, women, Dalit (so-called untouchables) and Adivasi (tribal community members) farmers who commit suicide are often not counted because they do not have formal title to land.

The Indian government has also failed to provide immediate or long-term relief. Limited debt relief and compensation programs reach few farmers and do not sufficiently repair financial harms. The Indian government has also done little to address underlying factors that have contributed to the crisis, such as lack of access to irrigation and rural credit. Crucially, it has also failed to regulate the conduct of multinational corporations who have enjoyed free reign to conduct business in the country without proper regulatory oversight or accountability mechanisms.

“It’s not uncommon these days for Indian farmers to address their suicide notes to the Indian Prime Minister and President,” added Narula. “This is a direct plea to the government to step in and take decisive action to save the plight of small-holder farmers in India. The Indian government must act now to regulate multinational activity and put farmers’ rights at the center of its agricultural policies.”

The report culminates with a human rights-based analysis of the crisis concluding that the crisis deeply affects a number of human rights of farmers and their families. These include the rights to: life, food, water, health, an adequate standard of living, non-discrimination and equality, and the right to an effective remedy when rights violations take place.

In the report’s conclusion, CHRGJ calls on the Indian government to uphold its human rights obligations by implementing effective preventive and compensation programs, undertaking necessary structural reforms, gathering more information on the suicide crisis and agrarian disaster, and regulating the activity of agribusiness firms. Agribusinesses must also, as a baseline, respect human rights by ensuring that their products and services do not infringe on the human rights of Indian farmers.

For more about CHRGJ’s work on business and human rights, and on economic, social and cultural rights, see: http://www.chrgj.org/publications/reports.html#escr For CHRGJ’s work on caste discrimination in South Asia see: http://www.chrgj.org/projects/discrimination.html

About the Center

The Center for Human Rights and Global Justice (CHRGJ) at New York University School of Law was established in 2002 to bring together the law school’s teaching, research, clinical, internship, and publishing activities around issues of international human rights law. Through its litigation, advocacy, and research work, CHRGJ plays a critical role in identifying, denouncing, and fighting human rights abuses in several key areas of focus, including: Business and Human Rights; Economic, Social and Cultural Rights; Caste Discrimination; Human Rights and Counter-Terrorism; Extrajudicial Executions; and Transitional Justice. Philip Alston and Ryan Goodman are the Center’s Faculty Chairs; Smita Narula and Margaret Satterthwaite are Faculty Directors; Jayne Huckerby is Research Director; and Veerle Opgenhaffen is Senior Program Director.

The International Human Rights Clinic (IHRC)—a project of the Center—is directed by Professor Smita Narula. Amna Akbar is Senior Research Scholar and Advocacy Fellow and Susan Hodges is Clinical Administror. Every Thirty Minutes was researched and authored by IHRC 2010-11 members Lauren DeMartini, Colin Gillespie, Jimmy Pan, and Sylwia Wewiora, as well as by Faculty Director Smita Narula.

Global campaign to Stop Torture in Health Care launched

Global campaigns against forced sterlizations, restrictions and/or denial of pain relieving pallative care, and detention as treatment


Today, a coalition of health and human rights groups has launched the Campaign to Stop Torture in Health Care www.stoptortureinhealthcare.org . This global effort builds on the recent groundswell of civil society activity to protect and advance human rights in health care settings. The Campaign seeks to hold governments accountable for the most egregious abuses perpetrated against citizens in the name of health care.

One particular focus of the Campaign is forced and coerced sterilization. Across the globe, women continue to be forced or coerced by medical personnel to submit to permanent and irreversible sterilization procedures, sometimes even without their knowledge. Cases of forced and coerced sterilization have been reported in North and South America, Africa, Asia, and Europe. Women who are poor or stigmatized - Roma women, women living with HIV, indigenous women, women with physical or intellectual disabilities, women who use drugs - are most likely to be deemed “unworthy” of reproduction. Governments turn a blind eye to these practices in their own public hospitals. Perpetrators are seldom held accountable. Victims rarely obtain justice for this violent abuse of their rights.

From Namibia, Hilma shares with us her fight to overcome the shame and anger she feels after being sterilized without her knowledge in a public hospital because she is HIV+. See her story here:
http://www.youtube.com/watch?v=STxkPfxzDg&feature=player_embedded .

The full announcement about the Campaign launch is here: http://blog.soros.org/2011/03/stop-torture-in-health-care-2/

You can also follow the Campaign on Twitter at @carenottorture.