Health meets human rights.

What do doctors and lawyers have in common--besides lawsuits? Are there significant connections between the field of health--peopled by physicians, nurses, and public health specialists--and the field of human rights--peopled by civil rights lawyers, politicians, and activists?

Historically, there have been few recognized common bonds and little communication between health workers and human rights activists. Different perspectives, training, vocabularies, and methods, as well as frequent conflicts, have separated these two communities. However, the many interconnections are there, waiting to be explored.

In Uganda, public health workers discovered that the rate of HIV infections was increasing among married, monogamous women. Despite traditional public health measures--public and private health education and condom distribution--the infection rate continued to soar. A social analysis, which asked women what they thought was actually happening, revealed that many Ugandan women were not able to refuse their husband's unprotected sexual advances; the women feared beatings or being divorced at their husband's whim and abandoned without the protection of fair property rights laws.

Dr. Jonathan Mann, who witnessed this problem firsthand in 1988 as the founding director of the World Health Organization's Global Program on AIDS, says the fact that the women's refusal could result in physical harm or divorce implied that her "vulnerability to HIV was integrally connected with discrimination and unequal rights, involving property, marriage, divorce, and inheritance." Thus, traditional public health measures were doomed to failure.

After recognizing this relationship between HIV infections and human rights violations, a group of Ugandan women were encouraged to lobby effectively for marriage, property, and divorce laws more favorable to women. Eventually, the HIV infection rate in Ugandan wives decreased. It also spurred Mann to become a major proponent for research, understanding, and solutions based on the many linkages between health problems and human rights abuses.

At the end of 1997, Mann will leave his current professorial position at the Bagnaud Center for Health and Human Rights at the Harvard School of Public Health, which opened only four years ago. But during that short time, he has helped focus the world's attention on the linkage between health and human rights by organizing two international conferences--one in 1994 and the other in 1996. the latter attracting more than 500 representatives from fifty nations. A third conference is scheduled to be held at Harvard September 2-4, 1998.

Although still in the planning stages, the 1998 conference will pick up where the previous two left off. The first conference revealed the different viewpoints concerning what connections exist between health and human rights. The second conference shared solutions to specific problems being experienced "in the field." Topics discussed included emerging global infectious disease pandemics, such as HIV/AIDS, ebola virus, tuberculosis, malaria, and cholera Also debated were complicating social factors, such as the presence or absence of democracy, economic status, gender, and warfare,

In the future, Mann feels the need to concentrate in three areas. First, he says the true impact of health policies, programs, and practices on human rights needs to be understood. For example, he warns that data collection to determine whether an individual is infected with HIV or carries a genetic defect has the potential to interfere with privacy, cause discrimination in employment and benefits, or "be misused by the state."

Second, Mann sees research as an ever-more-important tool for reducing the health impacts resulting from violations of human rights, such as torture, imprisonment under inhumane conditions, summary executions, and disappearances. Collaborative medical-human rights efforts by the Boston-based Physicians for Human Rights are already working to clarify allegations of executions in El Salvador and Bosnia by the exhumation of mass graves, as well as torture in Argentina and Cambodia by the physical examinations of alleged victims.

The third area Mann says needs exploring is the actual linkage between health and human rights. He believes medical and nursing schools should incorporate human rights problems and solutions to enhance their current emphasis on technical training. Bioethics and health law, he says, could be used to help "bridge the gap" between the two fields. In the end, Mann hopes the creation of these new perspectives will "offer new avenues for understanding and advancing human well-being in the modern world."

Joseph L. Andrews Jr., M.D., is an internist and chest specialist in Concord, Massachusetts; a lecturer in medicine at Tults University Medical School in Boston, and a human rights and environmental activist He has written for the Boston Globe as well as other publications.