Global Health vs Human Rights

(Actors playing lepers. The treatment of lepers as late as 1996 in some developed countries would not be acceptable under current understanding of their human rights. Photo credit: SantiMB @ flickr).

"It is my aspiration that health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." - Kofi Annan

Global health efforts can have a powerful impact on human rights, even separate from their impact on health-as-a-human-right. They can promote other human rights in various ways; on the other hand however, limitations on e.g. the right to freedom have sometimes been justified with public or global health considerations.

Like I have said before: human rights rarely (if ever) deal with absolutes. Here, too: in most (going out on a limb, I would say: probably all) human rights instruments, rights limitations are possible, e.g. "...for the purpose of promoting the general welfare in a democratic society" (ICESCR art. 4). Global health considerations could be seen as "promoting the general welfare". This has been frequently invoked in the context of infectious diseases, e.g. HIV/AIDS, SARS, XDR-TB, and most recently swine flu.

This was recognised at an early stage, and in 1984 the Commission on Human Rights of the UN Economic and Social Council formulated the so-called 'Siracusa Principles', which give guidance when limitations of human rights are necessary. These Principles, although not part of any international treaty, are seen as highly authoritative interpretations of (amongst others) the ICESCR. The main Principles are:

• lawfulness: the restriction must be enshrined in law;
• necessity: the restriction must be "necessary", i.e. must respond to a pressing general need, pursue a legitimate goal, and be proportionate to that goal;
• subsidiarity: from all possible option, the least intrusive and restrictive must be chosen;
• non-arbitrariness: the restriction is not unreasonable or discriminatory.

The Siracusa Principles are highly restrictive in that they put a very high threshold before they justify limitations as acceptable. This is not always well understood, and sometimes limitations on human rights are argued based on selective reading from the Principles.

Based on the dictum that "[h]ealth policies and programs should be considered discriminatory and burdensome on human rights until proven otherwise", Gostin and Mann developed a more comprehensive approach to limitations on human rights and their impact. In their ‘human rights impact assessment', six steps lead to an assessment of the acceptability of a health intervention. The analysis encompasses trade-offs between rights encroachment and health improvement, and includes an assessment whether liberty-limiting interventions target only significant risk and are the least intrusive alternatives.

In a nutshell: global and public health considerations can be used to justify putting limitations on human rights - but only in rare circumstances and under strict conditions. Anything new here? Only for those who still cherish the idea of human rights as absolutes.