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Inflammatory Bowel Disease and Cancer an update from Digestive Disease Week Atlanta, 2001

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Epidemics: When Public Health and Human Rights Collide Epidemics Then & Now University of Chicago s Summer Institute for Educators June 29, 2006 – PowerPoint PPT presentation

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Title: Inflammatory Bowel Disease and Cancer an update from Digestive Disease Week Atlanta, 2001


1
Epidemics When Public Health and Human Rights
CollideEpidemics Then NowUniversity of
Chicagos Summer Institute for EducatorsJune 29,
2006
John Schumann, MD Assistant Professor of
Medicine MacLean Center for Clinical Medical
Ethics Human Rights Program University of Chicago
2
(No Transcript)
3
Objectives
  • Define Epidemics
  • Explore concepts of Human Rights Health HR
  • Discuss the inherent collisions
  • Abrogating an individuals rights
  • Case examples
  • Rights (priorities) to scarce resources
  • What is the publics right to information during
    an outbreak?
  • Vaccinations or medications
  • Links to literature

4
Influenza pandemic, 1919
WPA Poster, 1930s
Avian flu, 2007(?)
5
Epidemics
  • In epidemiology, an epidemic (from Greek epi-
    upon demos people) is a disease that appears as
    new cases in a given human population, during a
    given period, at a rate that substantially
    exceeds what is "expected", based on recent
    experience (the number of new cases in the
    population during a specified period of time is
    called the "incidence rate").
  • Defining an epidemic can be subjective, depending
    in part on what is "expected". An epidemic may be
    restricted to one locale (an outbreak), more
    general (an "epidemic") or even global
    (pandemic). Because it is based on what is
    "expected" or thought normal, a few cases of a
    very rare disease like rabies may be classified
    as an "epidemic", while many cases of a common
    disease (like the common cold) would not.

6
Epidemics
  • Common diseases that occur at a constant but
    relatively high rate in the population are said
    to be "endemic". An example of an endemic disease
    is malaria in some parts of Africa (for example,
    Liberia) in which a large portion of the
    population is expected to get malaria at some
    point in their lifetimes.
  • Famous examples of epidemics include the bubonic
    plague epidemic of Medieval Europe known as the
    "Black Death", the Great Influenza Pandemic
    concurring with the end of World War I, and the
    current AIDS epidemic, which some also consider
    to be of pandemic proportions.

7
Epidemics
  • Non-biological usage
  • The term is often used in a non-biological sense
    to refer to widespread and growing societal
    problems, for example, in discussions of mental
    illness or drug addiction.

-from Wikipedia
8
Biomedical Epidemics

                                          Sita and Ram Patan are typical of the people living in the colony. Both lost their parents when they were children and for sixteen years earned their living by begging at the railway station. After his parents died, Ram became mentally ill for two years. They married ten years ago, but after five years Ram contracted leprosy and both were forced to come and live in the leper colony. Now Ram has been cured but Sita has caught the disease and is currently receiving treatment. They go out together every day to beg, with her sitting in a small wooden trolley. Two years ago their home was destroyed in the cyclone and rebuilt with help from Niswass. Over the past five years the NISWASS students have worked continuously with the people in Jagannath colony. Progress has been slow, but they have managed to build a washing block on the site, set up savings schemes and helped people make use of existing medical facilities. They are now approaching the local council in an attempt to get ownership of the colony land. Gradually they are helping the people of this cruelly degraded community to recover some sense of human dignity and some measure of control over their own lives.
                  Even after they have been fully cured, the lepers are forced to live apart from the rest of society, making their living through begging and rag picking, collecting paper and glass from the streets to sell to local scrap merchants. They are treated as little better than animals. The fear and prejudice surrounding the disease is such that the children from the colony are not even allowed to attend the local schools. 'It was a shock when I first came to work in the colony,' Mohan told us. 'I'd never seen such poverty before. These people are treated with utter contempt, as if they are completely useless. Most people ignore them completely. At first I was frightened to come here. But now I have spent time getting to know each family and gradually people here have started to trust me. It makes a huge difference that we're prepared to sit with them, to share their food and listen to their stories. We try to do our best for the people and to enter into their hearts.

Sita and Ram Patan at their home in the Jagannath leper colony
  • -Some examples from this week
  • Contagion
  • Mesopotamia
  • Small pox
  • Diptheria
  • Pertussis
  • Tetanus
  • Cholera
  • Polio
  • Black Death

Ceratophyllus faciatus
9
Social/Political Epidemics
  • Torture
  • Human rights
  • Nuclear weapons
  • Gun violence
  • Domestic violence
  • Accident prevention
  • Capital punishment
  • Female genital mutilation
  • Education (lack of access or equal opportunity)

10
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11
Public Health Prevents Epidemics
  • Elvis Presley gets vaccinated for Polio (1956)

12
Human Rights
  • Universal declaration of human rights (1948)

13
Human Rights
  • Universal Declaration of Human Rights (UDHR)
  • Article I
  • All human beings are born free and equal in
    dignity and rights. They are endowed with reason
    and conscience and should act towards one another
    in a spirit of brotherhood.
  • Article 2
  • Everyone is entitled to all the rights and
    freedoms set forth in this Declaration, without
    distinction of any kind, such as race, colour,
    sex, language, religion, political or other
    opinion, national or social origin, property,
    birth or other status.

14
UDHR (1948)
  • Article 3
  • Everyone has the right to life, liberty and
    security of person.
  • Article 4
  • No one shall be held in slavery or servitude
    slavery and the slave trade shall be prohibited
    in all their forms.
  • Article 5
  • No one shall be subjected to torture or to cruel,
    inhuman or degrading treatment or punishment.

15
UDHR (1948)
  • Article 9
  • No one shall be subjected to arbitrary arrest,
    detention or exile.
  • Article 13
  • (1) Everyone has the right to freedom of movement
    and residence within the borders of each State.
  • (2) Everyone has the right to leave any country,
    including his own, and to return to his country

16
UDHR (1948)
  • Article 25
  • (1) Everyone has the right to a standard of
    living adequate for the health and well-being of
    himself and of his family, including food,
    clothing, housing and medical care and necessary
    social services, and the right to security in the
    event of unemployment, sickness, disability,
    widowhood, old age or other lack of livelihood in
    circumstances beyond his control.
  • (2) Motherhood and childhood are entitled to
    special care and assistance. All children,
    whether born in or out of wedlock, shall enjoy
    the same social protection.

17
Is it ever OK to limit human rights?
18
Is it ever OK to limit human rights?
19
Torture
20
Lancet 2004 364 725-29
21
The article became a bookpublished June 27, 2006
22
Siracusa Principles (1985 update to the 1966
ICCPR)
  • The restriction is provided for and carried out
    in accordance with the law.
  • The restriction is in the interest of a
    legitimate objective of general interest.
  • The restriction is strictly necessary in a
    democratic society to achieve the objective.
  • There are no less intrusive and restrictive means
    available to reach the same goal.
  • The restriction is not imposed arbitrarily, i.e.,
    in an unreasonable or otherwise discriminatory
    manner.

23
Why Protect Public Health using a Human Rights
Framework?
  • Now more than ever
  • Darfur, AIDS, Avian Flu, Tsunami, Katrina
  • Disparities at home
  • Curricula?
  • Engagement

24
Doctor-Global Level Issues
  • Disparity of resource allocation
  • Industrialized economies vs. rest
  • Disparity in health outcomes
  • TB/AIDS
  • Malaria
  • Maternal/child health
  • Preventable diseases
  • Nutrition

25
Severe Acute Respiratory Syndrome (SARS)
26
Quarantine
  • Quarantine refers to the separation and
    restriction of movement of persons who, while not
    yet ill, have been exposed to an infectious agent
    and therefore may become infectious. Quarantine
    of exposed persons is a public health strategy,
    like isolation, that is intended to stop the
    spread of infectious disease. Quarantine is
    medically very effective in protecting the public
    from disease.
  • States generally have authority to declare and
    enforce quarantine within their borders. This
    authority varies widely from state to state,
    depending on state laws. The Centers for Disease
    Control and Prevention (CDC), through its
    Division of Global Migration and Quarantine, also
    is empowered to detain, medically examine, or
    conditionally release persons suspected of
    carrying certain communicable diseases. This
    authority derives from section 361 of the Public
    Health Service Act (42 U.S.C. 264), as amended.

27
Severe Acute Respiratory Syndrome (SARS)
28
Siracusa Principles (1985 update to the 1966
ICCPR)
  • The restriction is provided for and carried out
    in accordance with the law.
  • The restriction is in the interest of a
    legitimate objective of general interest.
  • The restriction is strictly necessary in a
    democratic society to achieve the objective.
  • There are no less intrusive and restrictive means
    available to reach the same goal.
  • The restriction is not imposed arbitrarily, i.e.,
    in an unreasonable or otherwise discriminatory
    manner.

29
What is the publics right to information?
30
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31
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32
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33
World Health Organization
  • Promoter of Health and Human Rights
  • Handles outbreaks and sets policy regarding
    global health problems

34
www.phrusa.org
35
Health Care Justice
36
The Special Role of the Physician
  • Healer/Comforter
  • Intermediary
  • Interpreter
  • Advocate
  • Oath-taker
  • Seeker of Excellence (outstanding care, quality
    improvement, scientific advancement)
  • Societal Respect
  • High-Mindedness

37
The Special Role of the Physician
  • Societal responsibility
  • Ethical imperative
  • No other profession like itso much trust with
    personal and private information
  • Seek social justice, global health

38
(No Transcript)
39
Ken Fox, MD, Pritzker Class of 1989 Pediatrician,
Erie Family Health Center, Chicago Medical
Director, Reach out and Read Soros Physician
Advocacy Fellow
40
Ken Fox, MD, Pritzker Class of 1989 Epidemic
Literacy
41
(No Transcript)
42
Allen Keller, MD Internist, Bellevue Hospital,
New York Member, Physicians for Human Rights
(PHR) Founder, NYU Program for Survivors of
Torture
43
Allen Keller, MD Epidemic Torture
44
(No Transcript)
45
Paul Farmer, MD, PhD Infectious Disease, BWH,
Boston Founder, Partners in Health Global
Reduction in death from AIDS/TB in the worlds
poorest nations
46
Paul Farmer, MD, PhD Epidemic HIV/AIDS, TB,
Poverty, Global Apathy
47
Links to Literature
  • Albert Camus (1913-1960)
  • The Plague (1946)

48
Links to Literature
  • Randy Shilts (1951-1994)
  • Chronicler of the disease that killed him
  • FDA approval of protease inhibitors in 1995-96

49
Links to Literature
50
Links to Literature
  • Jose Saramago receives the 1998 Nobel Prize in
    Literature

51
Conclusions
  • Epidemic control paradigm of public health
    protection
  • Broadened definition to include social/global
    issues
  • Explored human rights/health interactions and
    seen the inevitable conflicts and strategies for
    mitigating diminishment of individual rights
  • Highlighted medical and informational priorities
  • Some links to literature with which you can
    explore these issues in the classroom

52
Questions?
  • John Schumann, MD
  • Email schumann_at_uchicago.edu
  • Phone 773-834-3247
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