Health and Human Rights

(Photo credit: The Opportunity Agenda)

It is precisely though this historic effort to explore and promote values in the world for which we share responsibility, articulated in philosophy and in actions, that we express confidence in our own lives, in our community, and in the future of our world.

- Jonathan Mann about why to work on health and human rights

Over the last decade, human rights have taken centre stage in many ethical discussions concerning health. Their relevance for anybody's health is now accepted by most - especially as they oblige states, which are often the most visible actors in the global health arena. This has been reinforced by the inclusion of health as a human right.

However, there is still a big difference between general, abstract acceptance on the one hand, and acceptance of their implications and corollaries on the other: intense and, at times, bitter disputes have raged and continue to rage about their applicability to various health issues. This has always been even more pronounced when applied to public health: human rights by their nature protect individuals first, whereas public health (as the name implies) looks not only to the individual but to the collective as well. Obviously, public health approaches are hugely important for global health and different approaches to (and even definitions of) global health have led to more or less attention for human rights aspects of global health, and at times even to clear infringements.

Over the next couple of weeks I will explore the interface between global health and human rights, with a specific focus on public health and human rights. I will look at the implications of health as a human right, the conflicts between global (public) health and human rights, the way health and human rights influence each other, and how public health and human rights practitioners have dealt with these issues.

Some definitions

Sadly, much of the discussions around global health and human rights are actually based on misunderstandings about various concepts of ‘human rights', ‘health', ‘public health', etcetera. To prevent too many of those misunderstandings (although it will probably not be possible to prevent them all), I will need to start this series with the boring part: a very short glossary of terms.

• Health. Seems simple, doesn't it? Yet the discussion about health and human rights has been endlessly confused by the existence of two separate and competing definitions of health: the definition by the World Health Organisation (WHO) and the definition in the (interpretations of) International Covenant on Economic, Social and Cultural Rights (ICESCR). The definition used by WHO in its constitution clearly sees health as an aspirational goal when it describes it as "a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity". A more realistic concept is used by the ICESCR and its interpretations; it sees health as something that depends on the context of the society one lives in and of one's "biological and socio-economic preconditions". I will write more about this, but when I use the word ‘health' without any further qualifiers, I would usually refer to the ICESCR definition.
• Human rights. Again one that leads to endless misunderstandings. I will use the term in the sense of internationally recognized, universal, legally enshrined and inalienable protections of human dignity and fundamental freedoms. This means that you can tell your kid with a clear conscience that there is no human right to the keys of your car. You can refer them to me if they don't believe you.
• Public health. As opposed to individual health care, public health is mainly concerned with measures that improve or restore health to (large parts of) whole populations. Often but not exclusively, public health deals with preventive rather than curative health activities.