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Global Health and Human Rights


A Rights Based Approach to Health. Global Efforts Addressing the Determinants of Health ... Children's Rights Information Network ... – PowerPoint PPT presentation

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Title: Global Health and Human Rights

Global Health and Human Rights
  • Hon. Carolyn Bennett, MD MP

  • QUIZ
  • A Rights Based Approach to Health
  • Global Efforts Addressing the Determinants of
  • Canadas International Human Rights Commitments
  • Unequal Health Outcomes
  • Health Inequality in Canada
  • Health Inequality Globally
  • Public Health 101 Health vs Health Care
  • How You Can Make a Difference

Textbook of International Health,2nd Edition,
Oxford University Press, USA, 1999Paul F. Basch
  • QUIZ
  • 1. All people have a right to health care
    provided by their government.

International Health Quiz
  • 2. Peoples indigenous cultural traditions
    should be respected even if known to be harmful
    to their health.

International Health Quiz
  • 3. In wealthy countries most health problems are
    caused by inappropriate personal behaviour.

International Health Quiz
  • 4. The most urgent health need in poor countries
    is for more doctors and hospitals.

International Health Quiz
  • 5. The best medicine is the least medicine.

International Health Quiz
  • 6. Most health problems originate in the
    environment and can be combated only by the whole

International Health Quiz
  • 7. Population control in the developing
    countries is the worlds most urgent health

International Health Quiz
  • 8. Most of the major endemic communicable
    diseases will disappear by themselves following
    economic development.

International Health Quiz
  • 9. The provision of medical care to people in
    poor countries is a good vehicle to promote
    religious or political viewpoints.

International Health Quiz
  • 10. A persons genes basically determine his or
    her health and not much can be done about it.

International Health Quiz
  • 11. If we eradicated smallpox we can do the same
    for any disease if we really want to.

International Health Quiz
  • 12. People in the wealthy countries have a moral
    obligation to help people in poor countries.

International Health Quiz
  • 13. The saving of lives from disease and
    starvation may produce more problems than it

International Health Quiz
  • 14. Governments in most poor countries are
    corrupt, so foreign aid is generally a waste of
    money and effort.

International Health Quiz
  • 15. The main health problems in developing
    countries are caused simply by lack of water and

International Health Quiz
  • 16. To help reduce the burden of illness in the
    world one must first become a physician.

International Health Quiz
  • 17. Most people in developing countries really
    do not want modern biomedical science.

International Health Quiz
  • 18. The world is running out of many important
    resources so we must all learn to get by with

International Health Quiz
  • 19. The best argument to a government official
    for financing health services is that it is good
    economic investment.

International Health Quiz
  • 20. As soon as we learn to control one disease
    another comes up look at AIDS. The whole effort
    is basically useless.

A Rights-Based Approach to Health
  • The right to health means that governments must
    generate conditions in which everyone can be as
    healthy as possible.
  • Such conditions range from ensuring availability
    of health services, healthy and safe working
    conditions, adequate housing and nutritious
  • Source World Health Organization, Fact Sheet
    The Right to Health,

Linkages Between Health and Human Rights
Linkages Between Health and Human Rights
  • Violations or lack of attention to human rights
    can have serious health consequences.
  • Health policies and programmes can promote or
    violate human rights in their design or
  • Vulnerability to ill-health can be reduced by
    taking steps to respect, protect and fulfil human

Global Efforts
  • International Covenant on Economic, Social and
    Cultural Rights (the Covenant)
  • Ratified in December 1966
  • 157 States have ratified the Covenant
  • General Comment 14
  • The Eight Millennium Development Goals
  • 2005 World Summit
  • Bangkok Charter for Health Promotion in a
    Globalized World

The Covenant
  • Article 12 of the Covenant states
  • 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
  • The Committee on Economic, Social and Cultural
    Rights (CESR), which monitors the Covenant and
    issues General Comments, has rightly recognised
    that the right to health is closely related to
    and dependent upon the realization of other
    rights, such as the rights to food, housing and
    freedom of movement.

General Comment 14
  • The right to health extends not only to timely
    and appropriate health care but also to the
    underlying determinants of health,
  • Such as
  • Access to safe and potable water
  • Adequate sanitation
  • An adequate supply of safe food
  • Nutrition and housing
  • Healthy occupational
  • Environmental conditions
  • Access to health-related education
  • Information, including on sexual and reproductive

General Comment 14
  • The right to health contains four elements
  • Availability
  • Accessibility
  • Acceptability
  • Quality

The Right to Health
Eight Millennium Development Goals
  • Eradicate extreme poverty and hunger
  • Achieve universal primary education
  • Promote gender equality and empower women
  • Reduce child mortality
  • Improve maternal health
  • Combat HIV/AIDS, malaria and other diseases
  • Ensure environmental sustainability and
  • Develop a global partnership for development.

2005 World Summit
  • Reaffirmed the values of the UN and the
    objectives of the Millennium Development Goals.
  • They agreed to implementing policies that would
    ensure adequate investment in a sustainable
    manner in
  • Health
  • Clean water and sanitation
  • Housing and education
  • The provision of public goods and social safety
    nets to protect vulnerable and disadvantaged
    sectors of society

The Bangkok Charter for Health Promotion in a
Globalized World
  • The Bangkok Charter call on all governments at
    all levels to tackle poor health and inequalities
    as a matter of urgency.
  • Local, regional and national governments must
  • give priority to investments in health
  • within and outside the health sector
  • provide sustainable financing for health

  • Since World War II, Canada has played an active
    role in advancing, defending, and expanding the
    reach of human rights at the United Nations, and
    around the world, while also providing assistance
    to others to develop their human rights regimes.

  • International Covenant on Economic, Social and
    Cultural Rights (CESCR) May 19, 1976
  • International Covenant on Civil and Political
    Rights (CCPR) - May 19, 1976
  • Optional Protocol to the International Covenant
    on Civil and Political Rights (CCPR-OP1) - May
    19, 1976
  • Second Optional Protocol to the International
    Covenant on Civil and Political Rights (CCPR-OP2)
    aimed at abolition of the death penalty Nov.
    25, 2005
  • International Convention on the Elimination of
    All Forms of Racial Discrimination (CERD) Oct.
    14, 1970
  • Convention on the Elimination of All Forms of
    Discrimination against Women (CEDAW) Dec. 10,

  • Convention against Torture and Other Cruel,
    Inhuman or Degrading Treatment or Punishment
    (CAT) June 24 1987
  • Convention on the Rights of the Child (CRC)
    Dec. 13, 1991
  • International Convention on the Protection of the
    Rights of All Migrant Workers and Members of
    Their Families (MWC)
  • Convention on the Rights of Persons with
    Disabilities Mar. 30 2007
  • American Convention on Human Rights
  • Additional Protocol to the American Convention on
    Human Rights in the Area of Economic, Social, and
    Cultural Rights

Health Inequality in Canada
  • UN Committee on Economic Social and Cultural
    Rights 2006 Concluding Observations for Canada
    identified a number of subjects of concern which
    are direct determinants of health, notably
  • The governments restrictive interpretation of
    its obligations under the Covenant
  • The lack of legal redress available to
    individuals when governments fail to implement
    the Covenant
  • The absence of a legally enforceable right to
    adequate social assistance benefits for all
    persons in need on a non-discriminatory basis

Health Inequality in Canada, Continued
  • The disparities that still persist between
    Aboriginal peoples and the rest of the Canadian
  • The absence of an official poverty line.
  • The insufficiency of minimum wage and social
    assistance transfers to ensure the realization of
    the right to an adequate standard of living for
  • The authorization given to provinces and
    territories to deduct the amount of the child
    benefit under the National Child Benefit from the
    amount of social assistance received by parents
    on welfare.

Health Inequality in Canada, Continued
  • United Nations Special Rapporteur on adequate
    housing during his visit to Canada observed that
  • Everywhere that I visited in Canada, I met
    people who are homeless and living in inadequate
    and insecure housing conditions. On this mission
    I heard of hundreds of people who have died, as a
    direct result of Canadas nation-wide housing
  • Source United Nations Special Rapporteur on
    adequate housing, Miloon Kothari, Mission to
    Canada Preliminary Observations, Ottawa, 22
    October 2007.

Health Inequality in Canada, Continued
  • In recent review by United Nations authorities,
    including most recently the May 2006 period
    review of Canadas compliance with the
    International Covenant on Economic, Social and
    Cultural Rights, Canadas continuing failure to
    incorporate these international legal standards
    into Canadian domestic law has been noted with
    growing concern.

Health Inequality in Canada, Continued
  • Canadians are among the healthiest people in the
    world, but some Canadians are not as healthy as
  • The following are significant factors associated
    with health disparities that can cause early
    deaths, disease, disability, and distress
  • Socio-economic status
  • Aboriginal identity
  • Gender
  • Geographic location

Health Inequality in Canada, Continued
Health Status People with Disabilities
  • Numerous studies have reported that the health
    status of people with disabilities is
    significantly worse than the general Canadian
  • Disabled Canadians encounter more difficulties
    with their health and generally score a lower
    rating on their self-reported well-being
  • Individuals with a disability are more likely to
    report difficulties in accessing health care
    services compared to the non-disabled.

Health Status People with Disabilities contd
  • An increased chronic disease prevalence and lower
    life expectancy has been reported among Canadian
    disabled compared to the general population.
  • People with disabilities have been reported to
    utilize more health care services, take more
    prescriptions and spend more days in hospital
    compared to the non-disabled Canadian population.

Aboriginal Health Status
  • Aboriginal health inequalities in Canada are
    among the starkest.
  • First Nations overall mortality is 45 higher
    than for Canada (based on the 2000 aged
    standardized rates).
  • Rate of First Nations youth suicide (10 to 19
    years) was 4.3 times greater than that for Canada
    in 2000.
  • Inuit suicide rate (all ages) is 11 times higher
    than the Canadian rate. 83 of suicides are
    male, and 83 are under 30 years of age.

Infant Mortality Rates
Health Inequality Globally
  • The WHO Fact File highlights the reality of
    global health inequalities
  • Poverty, social exclusion, poor housing and poor
    health systems are among the main social causes
    of ill health.
  • Differences in the quality of life within and
    between countries affect how long people live. A
    child born in Japan has a chance of living 43
    years longer than a child born in Sierra Leone.
  • The probability of a man dying between the ages
    of 15 and 60 is 8.2 in Sweden, 48.5 in the
    Russian Federation, and 84.5 in Lesotho.
  • In Australia, there is a 20-year gap in life
    expectancy between Australian Aboriginal and
    Torres Strait Islander peoples, and the
    Australian average.

Health Inequality Globally, Continued
  • Low- and middle-income countries account for 85
    of the worlds road deaths.
  • In 2002, nearly 11 million children died before
    reaching their fifth birthday 98 of these
    deaths were in developing countries.
  • Inequality in income is increasing in countries
    that account for more than 80 of the worlds
  • Few governments have explicit policies for
    tackling socially determined health inequalities.

Health Inequality Globally, Continued
Dr. Harry Jeene African Medical and Relief
FoundationNGO presentation WHA 2007
  • Life is a right
  • What we are left with is terminal disease

Developing countries Jeene
  • Investing in a number of interventions have
    proven to be enormously cost effective,
  • eg H20 and immunization
  • In developing countries there is still a huge
    under-expenditure in these interventions, with a
    resulting massive suffering and loss of life, and
    loss of development opportunities.

Ministries of Diseases Jeene
  • Mirroring the way Northern countries are
    structured, developing countries also fund health
    as a set of diseases.
  • Communicable diseases still form the main burden
    of disease in the developing world, but
    non-communicable and chronic diseases are growing
    fast in importance
  • In the richer countries AIDS, though communicable
    is becoming a chronic disease. Curing or
    mitigation disease
  • The vast majority of health expenditure goes
    toward hospital treatment of chronic disease This
    is certainly the case in the OECD
  • Almost all expenditure is on mitigation. Very
    little money is invested in prevention

Developing countries Jeene
  • Budgets are still overwhelmed by the enormous
    burden of communicable diseases
  • Communicable diseases have a high priority in
    population perception, and thus on the ability of
    policy makers to set priorities for healthy
    public policies

Chronic Diseases Jeene
  • Policy makers are the lucky ones to have survived
    the communicable diseases
  • The temptation for these mature people to spend
    money on mitigating chronic diseases is therefore
  • As most decision makers are male, female health
    issues are particularly hard to get on the agenda
  • (Some female health ministers, not enough female
    finance ministers)

Changing disease patterns Jeene
  • World-wide over-nutrition has taken over
  • Urbanization and a more sedentary lifestyle have
    been major contributors
  • Copying a western lifestyle with intense pressure
    from the commercial promotion of instant
    satisfaction foodstuffs is another major factor.

  • Obesity is a major cause of non-communicable
  • CVS, including cerebral
  • diabetes, including blindness
  • arthritis
  • -sub-fertility
  • depression, stigmatization
  • The complexity of "free-choice" is increasing in
    a globalizing world.

A changing world Deene
  • In a world where disease conditions are changing,
    we need a changing approach to health
  • It is enormously expensive to treat established
    hypertension, angina or diabetes
  • We need to pay more attention to health
    promotion, going beyond prevention rather than
    seeing health as curative and hospitals as key to

Health Promotion in partnership Deene
  • There is not much profit to be made in Health
    Promotion, certainly not for the pharma, fast
    food and entertainment industries,
  • neither for the donors who require quick wins,
    direct attributions and an increasing preference
    for commodities.
  • There is even little in it for the formal health
    care providers, including those in primary health
  • Major shifts in thinking are required, and these
    can only be driven by communities working as full
    and equal partners with the formal health system,
    especially at the Primary Care level.

Dr. Deene
  • Alma Ata
  • We have missed our 2000 target
  • We are missing our 2015 MDG targets (and where
    are health promotion, chronic conditions, mental
    health and trauma in these MDG's'anyway ?)
  • Civil Society will have to exercise much more
    pressure to get health promotion on the agenda,
    North and South.

We, the people Deene
  • We applaud the move towards one UN system.
  • Do not forget that we, the people, elect you as
    government and thus this UN
  • We will hold you to account for producing and
    implementing legal frameworks that promote the
    health of us, the people.

Em PHA sis on the wrong syl LAB le

  • Fleeing the medical model.
  • Embracing the medicine wheel

Blame Hippocrates?
Medical Model
  • Tyranny of the acute
  • Repair shop
  • Top-down cult of efficiency
  • Central command and control

Affirm Hygeia
HYGEIA Goddess of Health
Public Health 101
Right ?
Right ?
1.Do you think we should have a
  • A) strong fence at the top of the cliff
  • B) state of the art fleet of ambulances and
    paramedics waiting at the bottom ?

2. Would you prefer
  • A) Clean air
  • B) Enough puffers and respirators
  • for all

3. Would you prefer that wait-times were reduced
  • A) a falls program to reduce preventable hip
  • B) private orthopaedic hospitals and more

4.Should we invest in
  • A) early learning, child care, literacy, the
    early identification of learning disabilities and
    bullying programmes
  • B) increase the budget for young offenders

5.Should we
  • A) assume that the 'grey tsunami' will bankrupt
    our health care system
  • B) include our aging population in the planning
    of strategies to keep them well

6. Is the best approach to food security
  • A) food banks and vouchers
  • B) Income security, affordable housing, community
    gardens and community kitchens and a national
    food policy

7. Pick the one that is NOT correct
  • Pandemic Preparedness should focus on
  • Tamiflu for all
  • Working with the vets to keep avian flu a disease
    of birds
  • Making sure people wash their hands especially
    the doctors and nurses
  • Research on vaccines
  • Community care plans for our most vulnerable

8.Governments should boast about
  • how much they spent on the sickness care system
  • the health of their citizens, leaving no-one

teachable moments
  • 2003
  • Canada 44 died of SARS
  • France14,000 died in the heat wave
  • 2005..Katrina, Kasheshewan

Beyond borders. SARS as a teachable moment
  • Beyond silos
  • Departments
  • Disciplines
  • Beyond jurisdictional squabbling
  • Naylor report 4 Cs
  • Collaboration
  • cooperation,
  • communication
  • clarity of who does what and when
  • Germs dont respect borders
  • Neither do the social contagions
  • Nor the humanitarian imperatives

Social Determinants of Health vsChoose
Health(modifiable risks)
(No Transcript)
The Causes of the Causes
  • Versus
  • The Causes

Commission on the Social Determinants of Health
  • The CSDH Interim Report illustrates
  • the disparities in population health among
    different regions of the world.
  • These differences in health occur along a number
    of axes of social stratification including
    socioeconomic, political, and cultural.
  • Exacerbating the situation is the migration of
    health professionals from developing countries to
    industrialized ones.

Sir Michael Marmot
  • The worst thing for a physician is to patch
    people up and send them straight back into the
    situation that made them sick in the first place.
  • Evidence is not enough. There has to be the
    desire, the political will for change. Given that
    will - a big given but I am an optimist - the
    evidence of what works will be a great help.

  • Important principles underlying all human rights,
    including the right to health.
  • Fairness
  • Respect
  • Equality
  • Dignity

Ilona Kickbusch
  • Health diplomacy
  • Analyzing the systems that work. Leadership,
  • Role of universities in health literacy

Zimmerman Glouberman
  • Romanow discussion paper 8
  • Complex adaptive system
  • Example Brazil v.s. Africa

The mobilization of shameIrwin Cotler

Management 101 If its measured it gets
noticed, if its noticed it gets done
Florence Nightengale
  • To understand Gods thoughts we must study
    statistics, for these are the measure of His

  • If a picture is worth a thousand words,
  • a map is worth a thousand pictures.

The Public Health Map Generator is a secure,
web-based mapping application, accessible only to
clients registered with the GIS Infrastructure at
the Public Health Agency of Canada.
GIS User

All of the Infrastructures services, including
the Public Health Map Generator, are available at
no cost to all public health professionals in
With the Public Health Map Generator, you can
produce high quality, detailed maps of your own
health data, in combination with extensive
geography from our spatial data warehouse
How Can You Make a Difference!
  • What needs to be done
  • Fairness, Respect, Equality and Dignity (FRED)
  • take immediate steps to comply with concluding
    observations from UN Committee on Economic Social
    and Cultural Rights
  • reproductive health and maternal mortality is one
    potential area for focused attention.
  • Another area of special attention internationally
    is the fight against malaria.

Places Where You Can Get Involved to Make a
  • Canadian HIV/AIDS Legal Network
  • Action Canada for Population and Development
  • Pivot Legal Society http//
  • Interights http//
  • Childrens Rights Information Network
  • Population Action International

Leaders Working on the Right to Health
  • Timothy Caulfield
  • Research Director of the Health Law Institute at
    the University of Alberta
  • Rebecca Cook
  • Professor and Faculty Chair in International
    Human Rights, and Co-Director of the
    International Programme on Reproductive and
    Sexual Health Law in the Faculty of Law at the
    University of Toronto. 
  • Jocelyn Downie
  • Professor at the Faculties of Law and Medicine at
    Dalhousie University
  • Colleen Flood
  • Associate Professor of Law at the University of
  • Barbara von Tigerstrom
  • Assistant Professor at the University of
    Saskatchewan, Faculty of Law.

100 years ago
  • Every nation that permits people to remain under
    the fetters of preventable disease and permits
    social conditions to exist that make it
    impossible for them to be properly fed, clothed
    and housed so as to maintain a high degree of
    resistance and physical fitness and, who
    endorses a wage that does not afford sufficient
    revenue for the home, a revenue that will make
    possible the development of a sound mind and
    body, is trampling on a primary principle of
  • Dr. Charles Hastings, Medical officer of health
    for Toronto, 1907

We are not tinkers, who patch and mend what is
broken. We must be watchmen, guardians of the
life and health of our generation, so that
stronger and more able generations may come
after. Dr. Elizabeth Blackwell first woman
physician North AmericaWanless Report UK
2003commissisoned by Gordon Brown