Pan American Health Organization

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• Overview of PAHOs work on Health and Human
  Rights
• PAHOs policies on Health and Human Rights
• Human Rights and access to medicines
• Conference PAHO/WCL March 2012

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• The use of international human rights
  principles, treaties and standards is seen in
  PAHO and WHO not as an optional tool to promote
  and protect public health, but as an essential
  strategy to improve the health of the people
  around the world
• Dr. Mirta Roses
• Georgetown Law Center, October 2006
• Director Pan American Health Organization/Regiona
  l Office of the World Health Organziation
  (PAHO/WHO)

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Links between Health and Human Rights Law

• Violations of human rights can affect negatively
  the physical and mental health of individuals
• Health policies, laws, programs and plans can
  affect positively or negatively the exercise of
  the basic human rights and freedoms of the most
  vulnerable groups and
• Enjoyment of health and the exercise of human
  rights are both essential requirements to reach
  well-being and a healthy life

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Exercise of Basic Human Rights and the Most
vulnerable in the Context of Public Health

• Persons with disabilities
• Persons living with HIV/AIDS
• Persons with mental disorders
• Older persons
• Indigenous peoples
• Health and related human rights and freedoms of
  women and children/adolescents in the context of
  sexual and reproductive health
• Access to essential medicines.

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SO6 Tobacco Control (Res. CD50.R6)
SO7 Indigenous Peoples (Res. CD47/13)
SO3 Disabilities (Res. CD47/15)
SO 7 Indicator 7.4.1 Ethics and Human Rights
Based approaches to health at a national
regional and global levels
SO4 SO7 Maternal Mortality and Gender
Response (Res. CD49/13)
SO3 Oral Health (Res CD49/13)
SO3 Mental Health (Res. CD49.11/11)
SO4 Older Persons (Res.CD49/8)
SO2 HIV/AIDS (Res. CD45.R10)
SO4 Adolescents (Res.CD49.12)
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CONSTITUTION OF WHO

• The enjoyment of the highest attainable
  standard of health is one of the fundamental
  rights of every human being without distinction
  of race, religion, political belief, economic or
  social conditionConstitution of WHO (1946)

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PAHO Resolution CD 50 R.8Health and Human
Rights

• Recently adopted (October 2010) by PAHOs Member
  States
• URGES
• health authorities to use human rights treaties
  and standards to REFORM their national health
  policies, plans, programs and laws in a manner
  consistent with universal and regional human
  rights instruments (treaties, standards and
  technical guidelines)

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PAHOS RESOLUTION

• Strengthen health authorities to work with human
  rights entities
• Strengthen health authorities to provide support
  for the formulation of health policies and plans
  consistent with h.r. instruments
• Support PAHO in the formulation/reform of
  national plans/legislation incorporating h .r.
  instruments
• Strengthen training programs for health workers
• Adopt measures to disseminate h.r. instruments
  in the legislative and judicial branches

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• Disseminate applicable human rights instruments
  among civil society organizations
• Facilitate PAHO technical cooperation with UN/OAS
  treaty bodies
• To train PAHO staff and incorporate gradually
  h.r. Instruments in the work of technical areas
• Stimulate collaboration and research with
  academic actors, private sector and other social
  actors and
• Share good practices and experiences among PAHO
  Member States

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PAHO Strategic Plan 2008-2012

• PAHO Strategic Plan 2008-2012 states that
• Human rights law, as enshrined in international
  and regional human rights conventions and
  standards, offers a unifying conceptual and legal
  framework for these strategies as well as
  measures by which to evaluate success and clarify
  the accountability and responsibilities of the
  different stakeholders involved.
• Human Rights is included in PAHOS Strategic
  Plan in Regional Expected Result 7.4
• Ethics and human-rights based approaches to
  health promoted within PAHO/WHO at a national,
  regional and global levels

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Capacity Building/Training Resolution CD50R8
Health and Human Rights urge Member States to
strengthening technical capacity
Formulation/Review National Health Plans And
Legislation Resolution CD50R8 Health and Human
Rights" urge Member States to support PAHO's
Technical cooperation
Technical Collaboration with Human Rights
Treaties Bodies, Special Rapporteur, Academics
Institutions, Collaborating Center And Private
Sector
Tools and Research Guidelines
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International and Regional Human Rights
Instruments to advance Access to Medicines
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The enjoyment of the highest attainable standard
of health

• Constitution of WHO
• one of the fundamental rights of every human
  being without distinction of race, religion,
  political belief, economic or social condition
• International Covenant on Economic and Social
  Rights protects
• the right of everyone to the enjoyment of the
  highest attainable standard of physical and
  mental health (Article 12)
• Protocol of San Salvador of the OAS protects
• the right to health (Article 10)

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General Comment 14Committee on Economic, Social
and Cultural Rights the right to the highest
attainable standard of health

• The Committee on Economic, Social and Cultural
  Rights (CESCR) published General Comment No. 14
  to address substantive issues arising in the
  implementation of Article 12 of the ICESCR.
• The CESCR explained that the right to health is
  neither the right to be healthy nor the right to
  health care. Instead, the right to health
  embraces a wide range of socio-economic factors
  that promote conditions in which people can lead
  a healthy life.
• Elements of the right to health The right to
  health is composed of the following essential
  elements (a) availability (b) accessibility
  (c) acceptability and (d) quality. These
  elements are interrelated and legally
  enforceable.
•  

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• (d) good quality (limited accesibility, with
  administrative, geographical, economical,
  cultural and social barriers, long waiting lists,
  no adequate offer of services).

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INTERNATIONAL COVENANT ON ECONOMIC, SOCIAL AND
CULTURAL RIGHTSArticle 12

• 1. The States Parties to the present Covenant
  recognize the right of everyone to the enjoyment
  of the highest attainable standard of physical
  and mental health.
• 2. The steps to be taken by the States Parties to
  the present Covenant to achieve the full
  realization of this right shall include those
  necessary for a) The provision for the reduction
  of the stillbirth-rate and of infant mortality
  and for the healthy development of the child b)
  The improvement of all aspects of environmental
  and industrial hygiene c) The prevention,
  treatment and control of epidemic, endemic,
  occupational and other diseases and d) The
  creation of conditions which would assure to all
  medical service and attention

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• Article 15
• 1. The States Parties to the present Covenant
  recognize the right of everyone
• ..
• (b) To enjoy the benefits of scientific progress
  and its applications

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Protocol of San SalvadorArticle 10

• Article 10
• Right to Health
• 1. Everyone shall have the right to health,
  understood to mean the enjoyment of the highest
  level of physical, mental and social well-being.
• 2. In order to ensure the exercise of the right
  to health, the States Parties agree to recognize
  health as a public good and, particularly, to
  adopt the following measures to ensure that
  right
• a. Primary health care, that is, essential health
  care made available to all individuals and
  families in the community
• b. Extension of the benefits of health services
  to all individuals subject to the State's
  jurisdiction
• c. Universal immunization against the principal
  infectious diseases
• d. Prevention and treatment of endemic,
  occupational and other diseases
• e. Education of the population on the prevention
  and treatment of health problems, and
• f. Satisfaction of the health needs of the
  highest risk groups and of those whose poverty
  makes them the most vulnerable.

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LEGAL OBLIGATIONS OF STATES

• Respect States must respect human rights and
  can not directly or indirectly violate the human
  rights and fundamental freedoms of persons living
  with HIV/AIDS
• Protect States must take measures to prohibit
  third parties form violating human rights and
  fundamental freedoms of persons living with
  HIV/AIDS and
• Fulfill States must take Positive Legislative,
  Budgetary, Administrative and Judicial measures
  to fulfill human rights

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LIMITATION OF RIGHTS IN THE CONTEXT OF ACCESS TO
MEDICINES

• Right to life
• Right to personal integrity (moral, physical and
  psiquical)
• The rights of the child and
• The rights of the family

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The Siracusa Principles in the context of access
to medicines

• Restriction in accordance with the law
• Compatible with the ratified international
  instruments
• Legitimate aim
• Strictly necessary for promoting well-being
• Proportional to the aim

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Mechanisms of Protection

• Country reports (UN treaty bodies)
• Individual cases (IACHR, under the American
  Declaration and the Inter-American Convention on
  violence against women and Domestic
  Tribunals/Ombudspersons)
• On site observations (IACHR and UN Special
  Rapporteur on the Right to Health)
• Precautionary measures (IACHR, under the American
  Declaration)
• Hearings (NGOs and speciliazed agencies) and
• Formulation of specific standards (mental health)

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International JurisprudenceAccess to medicines

• Jorge Odir Miranda v. El Salvador (2001)
• By failing to provide free of charge
  antiretroviral drugs essential for the treatment
  of
• HIV/AIDS, the State of El Salvador has violated
  the provisions contained in the American
  Convention on Human Rights, together with the
  provisions of article XI of the
• American Declaration of the Rights and Duties of
  Man. and Article 10 of the Additional
• "Protocol of San Salvador". In consequence, it
  has violated the right to health of Jorge Odir
• Miranda Cortez and the other persons referred
  to in the instant case.
•   In the opinion of the IACHR, the response of
  the Salvadoran State in this case is consistent
  with progressive development of the right to
  health.  Therefore, while the Commission has
  determined violation of article 25 of the
  American Convention based on the conduct of the
  judicial authorities, the measures of the
  administrative authorities have accorded with the
  international obligations provided at 26 of the
  aforesaid international instrument.

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• Amicable setlement the State agreed to
• Authorize the purchase of antirretrovirals
• Measures to prevent HIV transmision
• Establish a fund to purchase anti-retroviral
  treatment
• Nowadays around 1,700 receive medication for HIV
  treatment through the State.

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Life and Health Conditions- Indigenous Peoples

• Poverty and systemic poverty
• Low salaries
• Unemployment
• Migration
• School desertion
• Illiteracy indexes - female
• Lack of land and territory
• Epidemiological profile
• Preventive diseases

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• Two important cases in which the Court used an
  expansive definition of Article 4 right to
  life.
• 1. Case Yakye Axa v. Paraguay (17 June,2005)
• 2. Case Sawhoyamaxa v. Paraguay (29 March,
  2006)
• adequate medicines...vaccines, latrines, or
  other type of sanitary services adequate for
  communal settlement.

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• Evolutionary interpretation of the right to
  life which emphasized a positive obligation to
  protect the conditions necessary for life.
• States must adopt any measures that may be
  necessary to create an adequate statutory
  framework to discourage any threat to the right
  to life to establish an effective system of
  administration of justice able to investigate,
  punish and repair any deprivation of lives by
  state agents, or by individuals and to protect
  the right of not being prevented from access to
  conditions that may guarantee a dignified life,
  which entails the adoption of positive measures
  to prevent the breach of such right.

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• Colombia Tutela No. 505/92 Constitutional
  Court
• Right to due process and the right to health are
  protected by the Constitution.
• protecction againts HIV/AIDS immediate
  application
• Ximenes Lopes/Brasil and Alban cornejo v. Ecuador

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INAUGURAL CONFERENCE

• The principal aim of the inaugural conference is
  to underscore the relevance of the collaborative
  effort to improve equity in health and to
  identify new leaders for years to come.
• Based on the PAHO Resolution on Health and Human
  Rights (CD 50 R.8) approved by the PAHO Directing
  Council on October

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• The white papers will all have a basic structure
  
• Overview situation analysis by region
• Comparative framework
• Trends
• Public health actions needed consistent with
  international human rights treaties and
  standards.  
• The papers will be ready by the Feb. 15. On-line
  discussions will start by Feb 16.

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Example of Targets for Public Health Actions
based on Trends in Mental Health

• Living Conditions in Psychiatric Institutions and
  Other Mental Health Facilities
• Community-Based Mental Health Services and Living
  Arrangements
• Participation of Consumers/Family Members in
  Mental Health Decision-making
• Participation of Civil Society in Promotion and
  Protection of Human Rights
• Role of he Media in Promoting and Protecting the
  Rights of Persons

1. Awareness-raising, Training and Dissemination of
   International Human Rights Norms and Standards.
2. Status of National Health Law, Policies, and
   Plans
3. Exercise of Civil, Political, Economic, Social
   and Cultural Rights and Freedoms Fundamental
4. National Monitoring Mechanism
5. Policies and Procedures for Admission

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The human right to the highest attainable
standard of healthTHANK YOU!