This report focuses on violence documented in economically marginalised black communities against lesbian, gay, bisexual and transgendered (LGBT) people. The economic and social position of LGBT people in South Africa has a significant impact on their experience, as middle-class members of the group tend to experience less discrimination. The report documents 121 cases of discrimination, harassment, and violence both from private individuals and sometimes state agents, including in terms of police inaction or service provider unwillingness to provide services to this social group. The author highlights that this situation deviates from the equality and non-discrimination on the basis of sexual orientation guaranteed in the Bill of Rights section of the South African Constitution.
Values, Policies and Rights
In many areas of the world where HIV prevalence is high, rates of unintended pregnancy and unsafe abortion have also been shown to be high. Of the estimated 21.6 million unsafe abortions occurring worldwide in 2008 (around one in 10 pregnancies), approximately 21.2 million occurred in developing countries, often due to restrictive abortion laws and leading to an estimated 47,000 maternal deaths and untold numbers of women who will suffer long-term health consequences. Despite this context, little research has focused on decisions about and experiences of women living with HIV with regard to terminating a pregnancy, although this should form part of comprehensive promotion of sexual and reproductive health rights. In this paper, the authors explore the existing evidence related to global and country-specific barriers to safe abortion for all women, with an emphasis on research gaps around the right of women living with HIV to choose safe abortion services as an option for dealing with unwanted pregnancies. The main focus is on the situation for women living with HIV in Brazil, Namibia and South Africa, as examples of three countries with different conditions regarding women's access to safe legal abortions: a very restrictive setting, a setting with several indications for legal abortion but non-implementation of the law, and a rather liberal setting. Similarities and differences are discussed, and the authors outline global and country-specific barriers to safe abortion for all women, ending with recommendations for policy makers and researchers.
The Global Strategy to Reduce the Harmful Use of Alcohol has much to learn from learn from the Framework Convention on Tobacco Control, according to this article. Over the years, many have called for the creation of a Framework Convention on Alcohol Control. Despite this push and despite the fact that alcohol and tobacco are relatively equal in terms of global disease burden, the international community has been less willing to be tough on the alcohol industry. The debate around alcohol is less clear in some ways than work on tobacco. In the case of tobacco, the efforts have focused on eliminating use. In terms of alcohol, the debate is about reducing the harmful level of consumption. In many countries, consumption of alcohol is acceptable and forms part of many cultural events. But the author notes that we need to pay increased attention to the harm alcohol consumption can inflict on others. Often the debate is framed in terms of the individual right to have a drink, neglecting the true extent of the level of harm others can be exposed to by the drinker.
How governments should address sex work is a major topic of debate in Rwanda and other countries. Some constituencies propose harsher punishment of sex workers as the cornerstone of an improved policy. The authors of this paper argue that an adequate policy response to sex work in the Rwandan context must prioritise public health and reflect current knowledge of the social determinants of health. This does not imply intensified repression, but a comprehensive agenda of medical and social support to improve sex workers’ access to health care, reduce their social isolation, and expand their economic options. Evidence from social epidemiology converges with rights-based arguments in this approach. Recent field interviews with current and former sex workers strengthen the case, while highlighting the need for further social scientific and epidemiological analysis of sex work in Rwanda. Rwanda has implemented some measures that reflect a rights-based perspective in addressing sex work. For example, recent policies seek to expand access to education for girls and support sex workers in the transition to alternative livelihoods. These policies reinforce the model of solidarity-based public health action for which Rwanda has been recognised. Whether such measures can maintain traction in the face of economic austerity and ideological resistance remains to be seen.
Public health practitioners and theorists are diverse and have various social goals that they promote, but the unique status of public health can be traced to the fact that most of what it has historically concerned itself with can be classified as the provision of health-related public goods, the author of this paper argues. He asserts that a public goods framework serves as a useful criterion for distinguishing public health from private health, and it explains why public health goals have special urgency. Public health goals, properly understood, generally require collective action to achieve, and can be endorsed by a wide variety of moral and political theories. The public goods account has the further advantage of establishing a relatively clear and distinctive mission for public health. It also allows a consensus of people with different comprehensive moral and political commitments to endorse public health measures, even if they disagree about precisely why they are desirable.
In this statement, a number of international non-governmental organisations (NGOs) working in health express their support for the report by the United Nations (UN) Special Rapporteur on the right to health. They believe the report is of fundamental importance in securing the right to health, in particular because it consolidates years of health and human rights legal analysis, supporting the conclusion that criminal law is an inappropriate tool for regulating sexual and reproductive health matters. Empirical evidence demonstrates that the misuse of criminal laws and punitive policies in the area of sexual and reproductive health cause disproportionate suffering for women; people engaging in same-sex sexual conduct; people identified as lesbian, gay, bisexual and transgender persons; those living with HIV or AIDS; and other groups who already suffer discrimination. The NGOs support the report’s call to immediately decriminalise abortion, ensure access to a full range of modern contraceptive methods, and facilitate access to full, complete, and accurate information on sexual and reproductive health.
The number of abortions among women older than 18 has increased steadily over the past two years in the Western Cape Province, according to South African Health MEC Theuns Botha. Responding recently in the legislature on the impact that illegal abortions have on public health care facilities, Botha said such abortions continued to take place, despite the legal service that was offered at more than 30 health care centres in the province. While health care facilities had treated a number of women with complications arising from illegal abortions, Botha said it was difficult to say how many cases there had been as those known to the department were only of women who volunteered the information during treatment. According to the latest figures from the National Health Department, between 1997 – when legal termination of pregnancy was introduced – and last year, about 702,354 abortions were performed at public health care facilities nationwide. About 528,000 of these involved teenagers. Health Minister Aaron Motsoaledi expressed concern about the number of teenagers who were having abortions, arguing this was proof that young people were engaging in unprotected sex and risking HIV infection. A spokesperson from Marie Stopes – a non-profit organisation offering reproductive health services – called on parents and teachers to talk openly about contraception, saying that research showed that most pregnant teenagers are in poor communities where educational and financial opportunities are limited. Women need to be made aware that abortion is not a form of contraception, she said.
The Rio Declaration is the outcome document of the World Conference on Social Determinants of Health, held from 19-21 October 2011 in Rio de Janeiro, Brazil. In the Rio Declaration, heads of government, ministers and government representatives reaffirm their commitment to take action on social determinants of health to create vibrant, inclusive, equitable, economically productive and healthy societies, and to overcome national, regional and global challenges to sustainable development. They recognise that the current global economic and financial crisis urgently requires the adoption of actions to reduce increasing health inequities and prevent worsening of living conditions and the deterioration of universal health care and social protection systems. They offer specific actions under the following common objectives: to adopt better governance for health and development; to promote participation in policy-making and implementation; to further reorient the health sector towards reducing health inequities; to strengthen global governance and collaboration; and to monitor progress and increase accountability. In the declaration, signatories call upon the World Health Organisation, United Nations agencies and other international organisations to advocate for, co-ordinate and collaborate in the implementation of these objectives.
According to this statement by Latin American social medicine and civil society organisations at the World Conference on Social Determinants of Health, the fundamental cause of the inequalities within and between nations is the neoliberal economy, infused with an exclusively speculative desire for unlimited profit. Capitalism grabs profits and socialises losses, they argue, resorting to new and crueler neoliberal measures that further reduce the fundamental social rights of people. There are abundant resources for all of us on the earth, but the ‘logic’ of the market prevents people from obtaining what they need. In the area of public health, neoliberalism translates into the commercialisation of life, legal protections for intellectual property for the benefit of the medical industrial complex, control of the media in order to create ‘need’ through shock, damage to public health systems, manipulation of civil society, multiple forms of violence and other strategies to colonise the ‘collective thought’. The current dominant societal model, using the lifestyle of affluent Americans as a basis, they argue is not sustainable. The statement concludes with a call for the establishment of global alliances between progressive governments and social movements, and meaningful social participation, as well as support for the creation and consolidation of health systems and social security systems that are universal, free, integral, and public, with coverage for all people for all services.
This study explores and describes the views of drivers and conductors on the causes of workplace violence (WPV) and ways of preventing it in the road passenger transport sector in Maputo, Mozambique. The design was qualitative. Participants were purposefully selected from among transport workers identified as victims of WPV in an earlier quantitative study, and 32 transport professionals were interviewed. The triggers and causes of violence included fare evasion, disputes over revenue owing to owners, alcohol abuse, overcrowded vehicles, and unfair competition for passengers. Failures to meet passenger expectations, e.g. by-passing parts of a bus route or missing stops, were also important. There was disrespect on the part of transport workers, e.g. being rude to passengers and jumping of queues at taxi ranks, and there were also robberies. Proposals for prevention included: training for workers on conflict resolution, and for employers on passenger-transport administration; and promoting learning among passengers and workers on how to behave when travelling collectively. Regarding control and supervision, participants expressed the need for the recording of mileage and for the sanctioning of workers who transgress queuing rules at taxi ranks. They also requested that police or supervisors should prevent drunken passengers from getting into vehicles, and said drivers should refuse to go to dangerous, secluded neighbourhoods. Finally, participants called for an institution to judge alleged cases of employees not handing over demanded revenues to their employer.