High level speakers at the December 2020 United Nations General Assembly pointed to the growing inequalities and stress to health, social, economic and democratic systems caused by COVID-19, calling for a range of collective interest driven responses and measures for a sustainable recovery. The pandemic, lockdown and other responses, along with underfunded, poorly prepared and overstretched public sector social and health systems in many countries worsened many dimensions of health and well-being that were already facing deficits, generating a rising health and social debt in communities, the scale and long-term consequences of which are as yet unknown, especially for the most marginalised in society. Rather than ‘getting back to normal’, the authors argue that recovery and ‘reset’ demands change to tackle the inequalities, conditions, services, socioeconomic and environmental policies that made people susceptible and vulnerable to COVID-19. Economic recovery should not replicate the features of the global economy that are generating pandemic and other crises. The authors suggest further that for global aspirations to translate into benefit for communities, an equitable recovery should include significant investment in: (1) universal, public sector, primary health care-oriented health services; (2) redistributive, universal rights-based and life course based social protection; and (3) people, especially in early childhood and in youth, as drivers of change.
Values, Policies and Rights
The UN General Assembly later this month will begin negotiations over the content of the Sustainable Development Goals (SDGs), to succeed the Millennium Development Goals (MDGs) in 2015. The draft SDGs contain very few explicit references to human rights, and are conspicuously silent on their role as a universal normative framework for sustainable development. This article explores how human rights advocates should navigate these contentious issues over the coming year. Three key shifts in strategy are presented as necessary to turn the tables on the stale geo-political dynamics that threaten to undermine the SDGs as an endeavour that is truly transformative and human rights-centred. Firstly, human rights advocates need to underscore the extraterritorial obligations of wealthier states to respect and protect human rights beyond their borders, and to cooperate internationally in their fulfilment. Secondly, advocates must counter the corporate influence on the post-2015 process with a much stronger push for corporate accountability. Thirdly, the human rights community must build more effective platforms and alliances with development, social justice and environmental movements to amplify the human rights voice in these debates, avoiding the fragmentation and issue-specific silos that have characterized advocacy to date.
Recognising the intrinsic role of health in achieving international development goals, the United Nations (UN) General Assembly has adopted a resolution on global health and foreign policy which encourages Member States to plan or pursue the transition towards universal access to affordable and quality health-care services. It urges Member States, civil society and international organisations to incorporate universal health coverage in the international development agenda and in the implementation of the internationally agreed development goals, including the Millennium Development Goals. The Assembly also recognised the importance of universal coverage as part of a transition to a more sustainable, inclusive and equitable economy. The resolution encourages Member States to continue investing in health-delivery systems to increase and safeguard the range and quality of services and meet the health needs of their populations. It calls on Member States to recognise the links between the promotion of universal health coverage and other foreign policy issues, such as the social dimension of globalisation, inclusive and equitable growth and sustainable development.
More than half way into the 74th World Health Assembly, a serious discussion on the efforts to address vaccine inequities is noted in this article to have been conspicuous by its absence. What has instead dominated much of the Assembly proceedings are talks for a pandemic treaty to address health emergencies in the future, and the important, but continuing push towards investigations on the origins of the virus, among other matters. In an issue that recaps the discussions at the current World Health Assembly, the Geneva Health Files in this piece notes "it seems that there has not been enough attention on the here and the now in the midst of all the discussions on preparedness. In our view, this risks looking away from and a silent acceptance to the mounting deaths from COVID-19. It also shows unwillingness to acknowledge and accept the limitations of the current mechanisms that have not met expectations on not only vaccine equity but an overall international mechanism for meeting the needs on diagnostics and treatments for COVID-19". In a packed agenda for the week long remote meeting, the question is raised of why there is no dedicated forum to discuss why vaccines have not been delivered as promised, including to seek accountability for this and to revisit assumptions made about the mechanisms set up for this, including the ACT Accelerator and COVAX.
This paper explores the legal and normative potential of the right to health to mitigate the restrictive impact of trade-related intellectual property rules on access to medicines, as evidenced by the global outcomes of the seminal pharmaceutical company litigation in South Africa in 2001. The author argues that the litigation and resulting public furor provoked a paradigm shift in global approaches to AIDS treatment in sub-Saharan Africa. She argues further that this outcome illustrates how human rights in concert with social action were able to effectively challenge dominant claims about the necessity of stringent trade-related intellectual property rights in poor countries, and ergo, to raise the priority of public health needs in related decision-making. The author explores the causal role of rights in achieving these outcomes through the analytical lens provided by international legal compliance theories, and in particular, the model of normative emergence proposed by Martha Finnemore and Kathryn Sikkink. She suggests that the AIDS medicines experience offers strategic guidance for realizing the right to health’s transformative potential with regard to essential medicines more generally.
Most public health practitioners acknowledge the value of human rights in promoting human well-being. However, there is potential for tension between human rights approaches and public health objectives such as equity, access and efficiency, particularly in developing countries where resource constraints exacerbate balancing of competing priorities. This potential tension may stem from inappropriate conceptualizations of human rights and how they should be operationalised in a public health context. For example, where human rights are conceived as individual entitlements, public health officials could erroneously equate this to favouring individuals over the welfare of the community to the detriment of equity. Health and health care are recognized as human rights, which span the full range of civil, political and socio-economic rights, many of which are essential requirements for health.
For South Africa's anti-abortion campaigners, 1 February 2007 is a day of sadness and mourning. But for the government and women's rights groups, it was a day for victory and celebration. Ten years ago, on 1 February 1997, the Choice on Termination of Pregnancy Act came into effect, becoming one of the most liberal abortion laws in the world. Records show a steady access to services nationally and progress towards greater service provision. A 1998-2001 mortality study by the Medical Research Council (MRC) found there was a reduction of up to 91 percent in deaths from unsafe abortions. But detractors such as Doctors for Life and the Christian Action Network continue to decry its existence and have mounted one legal challenge after the next to have it scrapped.
Prior to 2007, forced sex with male children in South Africa did not count as rape but as "indecent assault", a much less serious offence. This study sought to document prevalence of male sexual violence among school-going youth. Teams visited 5162 classes in 1191 schools, in October and November 2002. A total of 269,705 learners aged 10-19 years in grades 6-11. Of these, 126,696 were male. Schoolchildren answered questions about exposure in the last year to insults, beating, unwanted touching and forced sex. They indicated the sex of the perpetrator, and whether this was a family member, a fellow schoolchild, a teacher or another adult. Respondents also gave the age when they first suffered forced sex and when they first had consensual sex. Some 9% (weighted value based on 13915/127097) of male respondents aged 11-19 years reported forced sex in the last year. Of those aged 18 years at the time of the survey, 44% (weighted value of 5385/11450) said they had been forced to have sex in their lives and 50% reported consensual sex. Perpetrators were most frequently an adult not from their own family, followed closely in frequency by other schoolchildren. Some 32% said the perpetrator was male, 41% said she was female and 27% said they had been forced to have sex by both male and female perpetrators. Male abuse of schoolboys was more common in rural areas while female perpetration was more an urban phenomenon. This study uncovers endemic sexual abuse of male children that was suspected but hitherto only poorly documented. Legal recognition of the criminality of rape of male children is a first step. The next steps include serious investment in supporting male victims of abuse, and in prevention of all childhood sexual abuse.
The fifty-sixth session of the WHO Regional Committee for Africa in Addis Ababa, Ethiopia ended with the adoption of seven resolutions aimed at scaling up action in critical areas that are key to improving the health and socio-economic situation in Africa. Three of the resolutions endorsed three health strategy documents developed by the Brazzaville-based WHO Africa Regional Office on health financing, the renewal and acceleration of HIV prevention, and the optimal survival, growth and development of African children.
The Women’s Working Group on Financing for Development (WWG on FfD), recognize that the financial and economic crisis represents a critical political opportunity to make significant structural changes in the global development macroeconomic and financial architecture that reflect rights-based and equitable principles. This statement reflects on the actions to respond to the current crisis with alternative policy approaches that harmonize with international standards and commitments to gender equality, women’s rights and human rights and empowerment.