Values, Policies and Rights

What can human rights do for health and health equity in South Africa

As South Africa enters its second decade of democracy, we find that health gains anticipated in 1994 remain unrealized for the majority of our people, particularly the poorest in society. Why is it that, despite a Constitution hailed as the most progressive in the world, a victorious liberation movement and a set of governmental and non-governmental institutions designed to promote human rights in our society, we have failed to translate the provisions of our Bill of Rights into reality? To understand this contradiction, we need to understand, firstly, what are human rights; secondly, the relationship between health and human rights; and, thirdly, how human rights commitments can be translated into health-generating conditions and material gains in health for those who need it most. There are potential contradictions between a human rights approach and broad strategies for Primary Health Care, but these arise because of an incomplete or selective understanding of human rights, sometimes deliberately so, intended to further neo-liberal or imperialist political agendas.

What are human rights?

Human rights can be described as claims (material or social) that individuals make on society that are essential for their dignity and well-being. Rights are usually incorporated in national and international law (although Apartheid South Africa flouted this). The impetus for developing a human rights infrastructure was the revelation of the atrocities committed by the Nazis in World War II. As a result, the United Nations adopted the Universal Declaration of Human Rights (UDHR) based on the idea that "all human beings are born free and equal in dignity and rights." Unlike principles of medical ethics, once a treaty is ratified by a state, it becomes law and binds its conduct.

A human rights approach implies the use of rights as a set of standards to develop policy; or to monitor and analyse policy to hold governments accountable; or as a lobbying and advocacy tool to mobilise civil society.

However, human rights are not a uniformly understood set of concepts and principles and there is much dispute about rights. Two broad categories of rights emerged following the UDHR, civil and political rights (like traditional freedoms of speech, movement, the vote etc) and socio-economic rights (to housing, water, health, education etc). Driven primarily by Cold War political agendas this is a false dichotomy, since rights are indivisible. One cannot enjoy civil and political rights unless socio-economic conditions are such that you are adequately clothed, educated, fed and healthy enough to exercise civil and political rights.

Another criticism is that rights are generally framed as belonging to individuals, who are seen to exist in isolation, a typical Western philosophical tradition. In contrast, traditional societies are constructed on a web of relations - social, economic, cultural and political - in which humans exist as social beings and where social interactions, clashes and conflicts, form the basis of social relations. This has given rise to some suspicion of rights as a culturally imposed practice.

Further details: /newsletter/id/30820
What factors are associated with recent intimate partner violence? Findings from the WHO multi-country study on women's health and domestic violence
Abramsky T, Watts CH, Garcia-Moreno C, Devries K, Kiss L, Ellsberg M et al: BMC Public Health 11(109), 16 February 2011

Despite a growing body of research into risk factors for intimate partner violence (IPV), methodological differences limit the extent to which comparisons can be made between studies. The authors of this study used data from ten countries (including Namibia and Tanzania) from the World Health Organisation’s Multi-country Study on Women's Health and Domestic Violence to identify factors that are consistently associated with abuse across sites. Standardised population-based household surveys were conducted between 2000 and 2003, with one woman aged 15-49 years randomly selected from each sampled household. Those who had ever had a male partner were asked about their experiences of physically and sexually violent acts. The researchers found that, despite wide variations in the prevalence of IPV, many factors affected risk similarly across sites. Secondary education, high socio-economic status and formal marriage offered protection, while the risk of IPV increased with alcohol abuse, cohabitation, young age, attitudes supportive of wife beating, having outside sexual partners, experiencing childhood abuse, growing up with domestic violence, and experiencing or perpetrating other forms of violence in adulthood. The strength of the association was greatest when both the woman and her partner had the risk factor. The authors conclude that current IPV prevention programmes should pay greater attention to transforming gender norms and attitudes, addressing childhood abuse and reducing harmful drinking. Development initiatives to improve access to education for girls and boys may also have an important role in violence prevention.

What is the Rights Based Approach all about?

In the last few years, there has been growing talk amongst development actors and agencies about a “rights-based approach” to development. Yet what exactly this consists of remains unclear. For some, its grounding in human rights legislation makes such an approach distinctive, lending it the promise of re-politicising areas of development work that have become domesticated as they have been “mainstreamed” by powerful institutions like the World Bank. Others complain that like other fashions it has become the latest designer item to be seen to be wearing and has been used to dress up the same old development. This paper from the Institute for Development Studies (IDS) seeks to unravel some of the tangled threads of contemporary rights talk.

Whither human rights in African international relations?
Mindzie MA: SAIIA Occasional Paper 39, August 2009

Strict observance of state sovereignty, once a mainstay of international relations, has given way to a global concern to protect human rights wherever they are threatened. On paper, at least, Africa shares this international commitment in its establishment of monitoring bodies like the African Commission on Human and Peoples’ Rights and the African Union’s Peace and Security Council. But how central are human rights to the actual conduct of international relations by the continent? Are they merely a ‘variable concern’? There are no simplistic answers to this question. Africa has long been committed to supporting the rule of law, safeguarding refugees, protecting women and children, encouraging youth participation, and promoting democracy. But, as ever, national interest still plays an important role when it comes to defining how the continent relates to the world. The author argues that China’s policy of non-interference in the internal affairs of its trading partners has the potential to foster corruption, fuel armed conflicts and encourage human rights violations. African governments, it is proposed, should ensure that their emerging foreign policy solutions, whatever they are, do not compromise the commitment they have already made to foster human rights and good governance.

WHO D-G highlights women's health needs on International Women's Day
Chan M: World Health Organisation, 7 March 2007

This year's International Women's Day was devoted to ending impunity for violence against women and girls. The Director General of the World Health Organisation, Dr Chan, began her speech with a reminder that women have particular needs and face specific health issues but, how the health needs of women are given neither the attention nor the prominence they deserve. Each year, for example, more than half a million women die from complications related to pregnancy and childbirth alone - a number that has hardly changed in 20 years.

WHO guidelines for drinking-water quality
World Health Organization: WHO, Geneva, 2017

The WHO guidelines for drinking-water quality provide recommendations to support countries in developing drinking-water quality regulations and standards, as well as the associated risk management strategies. The guidelines provide an authoritative basis for the effective consideration of public health in
setting national or regional drinking-water policies and actions; provide a comprehensive preventive risk management framework for health protection, from catchment to consumer, that covers policy formulation and standard setting, risk-based management approaches and surveillance; emphasize achievable practices and the formulation of sound regulations that are applicable to low-income, middle-income and industrialized countries alike; summarize the health implications associated with contaminants in drinking water, and the role of risk assessment and risk management in disease prevention and control; summarize effective options for drinking-water management; and provide guidance on hazard identification and risk assessment.

WHO Independent Global High-level Commission on NCDs
World Health Organization: WHO, Geneva, February 2018

The first-ever WHO Independent Global High-level Commission on Noncommunicable Diseases (NCDs) aims to identify and propose bold and practical ways to curb the world’s leading causes of death and illness. The Commission was announced in 2017 by Dr Tedros Adhanom Ghebreyesus, Director-General WHO. The Commissioners will recommend actions to accelerate progress in tackling NCDs, primarily cardiovascular disease, cancers, diabetes and respiratory disease, and promoting mental health and well-being. NCDs kill 15 million people between the ages of 30 and 69 each year. Low- and lower-middle income countries are particularly affected by NCDs with almost 50% of premature deaths from NCDs occurring in these countries. In addition, NCDs are responsible for the deaths of 7 in 10 people across all ages globally, equivalent to approximately 40 million people. In 2015, world leaders committed to reduce premature deaths from NCDs by one third by 2030 as part of the Sustainable Development Goals. Recent WHO reports indicate that the world will struggle to meet that target.

WHO opens public consultation on draft sugars guideline
World Health Organisation: 5 March 2014

WHO is launching a public consultation on its draft guideline on sugars intake. When finalized, the guideline will provide countries with recommendations on limiting the consumption of sugars to reduce public health problems like obesity and dental caries (commonly referred to as tooth decay). Comments on the draft guideline will be accepted via the WHO web site from 5 through 31 March 2014. Anyone who wishes to comment must submit a declaration of interests. An expert peer-review process will happen over the same period. Once the peer-review and public consultation are completed, all comments will be reviewed, the draft guidelines will be revised if necessary and cleared by WHO’s Guidelines Review Committee before being finalized.

WHO Report on the Global Tobacco Epidemic 2013: Enforcing bans on tobacco advertising, promotion and sponsorship
World Health Organisation: 2013

The continued success in global tobacco control is detailed in 2013’s WHO Report on the Global Tobacco Epidemic. It presents the status of the MPOWER measures, with country-specific data updated and aggregated through 2012. In addition, the report provides a special focus on legislation to ban tobacco advertising, promotion and sponsorship (TAPS) in WHO Member States, as well as in-depth analyses of TAPS bans were performed, allowing for a more detailed understanding of progress and future challenges in this area. The progress in reaching the highest level of achievement in tobacco control is a sign of the growing success of the WHO Framework Convention on Tobacco Control (WHO FCTC) and provides strong evidence that there is political will for tobacco control on both national and global levels. About 2.3 billion people are now covered by at least one tobacco control measure at the highest level of achievement. This is due to the actions taken by many WHO Member States to fight the tobacco epidemic. These countries can be held up as models of action for the many countries that need to do more to protect their people from the harms of tobacco use, the report concludes.

WHO Secretariat's publications policy questioned at board meeting
SUNS, 30 May 2008

Among the questions raised at the WHO's 123rd Executive Board meeting were the need and rationale for the new publications policy, what the present policy is, and what will be the criteria for determining which issues have "policy implications for the Organisation" and which comprise "controversial health related issues" and thus have to go through additional clearance by the Director-General's Office. Other concerns raised included how the centralisation of the clearance process may remove the clearance authority of the WHO's regional directors, the broad definition of the term "publications" as it covers "materials that are issued by WHO to the public in whatever format and through whatever channel" including advocacy and training materials, how the policy will affect timely support by WHO to countries, and concerns about "self-censorship" as a result of the policy and transparency in the process.

Further details: /newsletter/id/33212