The World Health Organization is establishing the Joint Learning Initiative (JLI) on National and Global Responsibilities for Health to articulate an overarching, coherent framework for sharing the responsibility for health that goes further than the United Nations Millennium Development Goals. The Initiative forges an international consensus around solutions to four critical challenges: defining essential health services and goods; clarifying governments’ obligations to their own country’s inhabitants; exploring the responsibilities of all governments towards the world’s poor; and proposing a global architecture to improve health as a matter of social justice. The first challenge for the JLI is to determine essential health services and goods that every person has a right to expect. The JLI aims to launch a wide participatory process involving all major stakeholders, including international organizations, governments, industry, philanthropists and civil society, and emphasises a bottom-up approach to decision making.
Values, Policies and Rights
New sections of the Children’s Act and the Children’s Amendment Act in South Africa came into effect on 1 April 2010. The Children’s Act dealing with the capacity of children to consent to HIV testing and to access contraceptives have been in effect since 1 July 2007 and the new sections now allow children of 12 years of age to consent to medical treatment, and to surgical operations with the assistance of their parent or guardian. The provisions allowing consent to termination of pregnancy by girls of any age in the Choice on Termination of Pregnancy Act are not affected by this Act.
Navi Pillay, the United Nations High Commissioner for Human Rights, has described as ‘a very significant advance’ the outcome document of the UN’s Millennium Development Goals (MDGs) summit, but noted a number of gaps in some aspects of the global plan of action to eradicate poverty and end social-economic inequality. During the summit, she emphasised that States should take a human rights-based approach to the MDGs, which would mean that development and aid policies should explicitly prioritise the needs of the poorest and most excluded people. But she stressed that, with their emphasis on global average targets, the MDGs often neglect large segments of the world’s population, and may unwittingly exacerbate existing inequalities. The principle of participation, for example, is reflected strongly in relation to the empowerment of women, but there is no explicit recognition of participation as a right, and no specific commitments to guarantee freedom of expression and association or other human rights guarantees necessary for active, free and meaningful participation. Issues of accountability, good governance and the rule of law are referred to in a number of contexts, she said, but in relation to MDG 8, which mandates a global partnership for development, there is still a critical accountability defect because it lacks time-bound targets.
Kenyan human rights activists have filed an appeal for the release of two men imprisoned for defaulting on their tuberculosis (TB) treatment, and are warning that the arrests could discourage other patients from seeking treatment. The appeal has been filed at Kapsabet court in Rift Valley Province. Arrested in August 2010, the two men have been held in police remand in Kapsabet for ‘posing a risk to the health of the wider community’. Under the Public Health Act, they can be held until the district medical officer who ordered their arrest decides they are no longer a public health threat. According to Nelson Otwoma, national coordinator of the Network of People Living with HIV/AIDS in Kenya, the two men have not been isolated, posing a health risk to other inmates. He warned that the arrests could act as a deterrent to patients needing treatment. ‘This is a negative consequence of the government's action’, he added, denouncing criminalisation of the disease. ‘Counselling of those on treatment will have better outcomes,’ he noted.
The Botswana government has passed an amendment to its Employment Act that will bring an end to dismissal based on an individual's sexual orientation or HIV status, but rights groups believe the legislation needs to go further. Civil society organizations in Botswana welcomed the move but said legislation to protect the rights of people living with HIV in the workplace was necessary. The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) noted that ‘tolerance and acceptance of sexual minorities will ensure universal access to prevention, treatment, care and support - crucial for Botswana to achieve its ... goal of zero new HIV infections by 2016’. Gadzani Mhotsha, Secretary General of the Botswana Federation of Trade Unions (BFTU) warned that the legislation was not comprehensive enough in dealing with the serious issues of HIV at the workplace and called for comprehensive legislation, not piecemeal amendments. BONELA also added that a specific HIV Employment Act should be passed that attends to matters of reasonable accommodation for those who are HIV-positive, ensuring they have a safe and supportive environment to access treatment, care and support. Civil society has also called on the government to enact laws prohibiting private sector employers from testing potential employees for HIV and subsequently disqualifying them on the basis of an HIV-positive status.
The criminal use of firearms in South Africa is widespread and a major factor in the country having the third-highest homicide rate in the world. Violence is a common feature of South African society. A firearm in the home is a risk factor in intimate partner violence, but this has not been readily demonstrated in South Africa because of a lack of data, according to this paper. The paper drew on several South African studies including national homicide studies, intimate partner studies, studies with male participants and studies from the justice sector, to discuss the role of gun ownership on gender-based violence. It concludes that guns play a significant role in violence against women in South Africa, most notably in the killing of intimate partners. Although the overall homicide data suggest that death by shooting is decreasing, data for intimate partner violence are not readily available. It was unclear if the overall decrease in gunshot homicides applies to women in relationships. In view of the general role guns play in violence against women, the paper urges the government to keep gun control high on the legislative agenda.
Christiana Figueres, newly appointed executive secretary of the United Nations (UN) Framework Convention on Climate Change (UNFCCC), has voiced the UN’s position on the state of climate change negotiations and said that there is a constructive atmosphere and a growing sense of urgency among governments about climate change mitigation. At Cancun, Mexico, where the sixteenth Conference of the Parties will be held from 29 November–10 December 2010, governments need to go from the politically possible to the politically irreversible, she said. During the last meeting in Bonn, Germany, in June 2010, Figueres said that countries decided that the ‘text before them is now a negotiation text,’ and a ‘party text,’ which shows serious commitment, she said. In addition, comments were heard from ‘very important countries’ that their confidence and trust in the negotiation process was restored, which was not the case at the end of the 2009 conference at Copenhagen. Figueres said that she was expecting governments attending the Cancun meeting to make decisions on the relevant financing mechanism and technology for fighting global climate change, on how to push forward reduction of emissions from deforestation, on adaptation, and on monitoring, she said. At Cancun, four or five decisions could be taken to establish the operational entities that would be the basis for the next chapter of the climate regime.
According to this study, there have been few studies on domestic violence and women in developing countries, including South Africa, which has one of the highest rates of intimate partner violence in the world. The study examined the association between physical intimate partner violence and physical health outcomes and behaviours among South African women. Using data from the cross-sectional, nationally representative South Africa Stress and Health Study, the study assessed exposure to intimate partner violence, health-risk behaviours, health-seeking behaviours and chronic physical illness among a sample of 1,229 married and cohabiting women. It found the prevalence of reported violence was 31%. This correlated with several health-risk behaviours (smoking, alcohol consumption, and use of non-medical sedatives, analgesics and cannabis) and health-seeking behaviours (recent visits to a medical doctor or healer). Intimate partner violence was not significantly associated with chronic physical illness, although rates of headache, heart attack and high blood pressure reached near-significance. The study recommends that public health programmes in South Africa should incorporate interventions to mitigate the impact of violence on victims and reduce the risk of negative behavioural outcomes. Further investigation of the pathways between violence exposure and health behaviours is needed to inform the design of such programming.
Opt-out testing for the human immunodeficiency virus (HIV) incorporates testing as a routine part of health care for all patients unless they refuse. The ethics of this approach to testing in sub-Saharan Africa is a source of controversy. Opt-out HIV testing is expected to improve survival by increasing case detection and thus linking more HIV-infected people to earlier treatment, provided there is effective patient follow-up and programme sustainability. At the population level, these benefits will likely outweigh the potential negative consequences of individuals experiencing HIV-related stigma, according to this article. These justifications appeal to consequentialist moral theories that the acceptability of an action depends upon its outcomes. On the other hand, liberal moral theories state that the autonomy of individuals should always be protected unless restricting autonomy is necessary to protect the welfare of others. Opt-out consent may restrict autonomy and it is unclear whether it would benefit people other than those being tested. Yet, the doctrine of libertarian paternalism proposes that it is justifiable and desirable to use unobtrusive mechanisms to help individuals make choices to maximise their own welfare. Central to this idea are the premises featured by supporters of opt-out consent that individuals will not always make the best choices for their own welfare but they may be influenced to do so in ways that will not compromise their freedom of choice. Also important is the premise that all policies inevitably exert some such influence: opt-in consent encourages test refusal just as opt-out consent encourages acceptance. Based on these premises, the article argues that opt-out testing may be an effective and ethically acceptable policy response to Africa’s HIV epidemic.
In preparation for the Millennium Development Goal (MDG) Summit, held from 20-22 September 2010, in New York, Women in Development Europe (WIDE) launched the new campaign ‘Mobilising for Gender Justice Beyond the MDGs’ to advance gender and social justice for all. WIDE’s view on the MDGs framework is that it offers too narrow and minimalist a focus for measuring development or the advancement of gender equality and women´s rights. WIDE considers that the MDGs’ shortcoming is that the indicators exclude the structural nature of poverty as well as the structural nature of gender inequality. WIDE is inviting participation in the ‘Gender Justice Beyond the MDG Campaign’ to share analysis, opinions, activities and proposals, news, processes, expectations and outcomes of the summit.