The role of education in promoting health and human rights.

For some time now, health professionals working on health promotion have considered government policies as significant components of a structural approach to addressing individual- and community-level outcomes. However, most of us have not yet identified the links between disease and injury prevention, premature mortality and human rights. In fact, it is not strange for health professionals to view human rights as the domain of lawyers, political scientists and activists. It is my contention that developments in the contemporary world suggest this situation needs to be remedied urgently if we are to make progress in reaching national and global health goals.

The link between health--defined by the World Health Organization (WHO) as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity"--and human rights gained recognition during the 1990s in universities and among advocacy groups. It became the focus of national and international conferences, academic journals and university courses, as well as centres such as the Harvard University's Francois-Xavier Bagnoud Center for Health and Human Rights. It also formed part of the guidelines and mandate of WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS), as well as lawsuits such as those initiated by South Africa's Treatment Action Campaign to compel the Government to treat its citizens with antiretroviral medicines.

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By its very nature, linking health and human rights calls for combining academic research and teaching with a commitment to service and policy development. The late Dr. Jonathan Mann, a renowned researcher and champion of human rights, and his colleagues worked on linking health with human rights in dealing with the challenges arising from the HIV/AIDS pandemic and from abuses perpetrated by state and non-state actors. Case study analyses of Iraq, Afghanistan, Timor-Leste, Guatemala, Colombia, Rwanda and Haiti offer evidence that human rights abuses have had dire consequences on health. The connection is also apparent in contested issues, such as women's reproductive rights, female genital mutilation, and the treatment of refugees and internally displaced people, as well as the rights of ethnic and minority groups. The work mission and activities of institutions such as the Physicians for Human Rights, Global Lawyers and Physicians, Human Rights Watch and Amnesty International further suggest that advocacy on behalf of individuals and communities whose health and well-being are affected by government policies is a worthwhile strategy.

This progress and evidence must be counterbalanced with the recognition that health professionals have at times been complicit in abuses, such as eugenics and exclusionary practices against mentally ill and other stigmatized individuals, thereby perpetuating disparities in health care. The Nuremberg trials of Nazi doctors also brought such complicity to light and can be seen as the precursor to the stringent institutional review board protocols aimed at protecting research subjects. However, it must be remembered that these health professionals have also been victimized because of serving opponents of dictatorial regimes. Thus, they need to be critically aware of how their role in human rights can affect government policies.

The design and implementation of effective health systems can improve health and alleviate human suffering. State action on the UN Millennium Development Goals (MDGs), such as reducing poverty, improving access to water and sanitation, and reducing maternal and infant mortality, are tied to health. Each of these MDGs requires commitment, collaboration between various stakeholders and prioritization by Governments. At the international level, the United Nations human rights treaty system illustrates the link between health and human rights. Article 25 of the Universal Declaration on Human Rights (1) and the International Convention on the Elimination of All Forms of Racial Discrimination address policies that allow discriminatory practices, such as those seen in the Tuskegee syphilis study in the United States. (2) Similarly, the International Covenant on Economic, Social and Cultural Rights (3) and the Convention on the Elimination of All Forms of Discrimination against Women (4) also address the issue of health.

The UN Commission on Human Rights has investigated the right to the highest attainable standard of physical and mental health, and advocated the right to education. It has also initiated action on the right to food and adequate housing, extreme poverty, the causes and consequences of violence against women, and the adverse effects of the illicit movement and dumping of toxic and dangerous products and wastes on the enjoyment of human rights. Clearly, the Commission's work can alleviate human suffering, prevent physical and psychological harm, and thereby lead to improved individual and population health. Combined with the human rights instruments and remedies offered by regional organizations, such as the African Union and the European Union, this demonstrates the potential health impacts of human rights advocacy.

The challenge is awareness. Measured by surveys of graduate students taking health and human rights courses, it is clear that public knowledge of human rights instruments is relatively limited. Thus, education can provide the bridge towards making this link a part of the local, national and regional calculuses in policy. Information dissemination efforts initiated under the aegis of the United Nations Decade for Human Rights Education (1995-2004) can serve as the starting point, while courses taught in universities and specialized seminars, as well as media efforts, can serve as a conduit for raising awareness.

Efforts are publicized that are aimed at holding Governments accountable for housing, food and provision of health care, as well as torture and other acts of violence resulting in physical harm to individuals. The Human Rights Commission's annual meetings can serve as a venue for advocating improvements in issues that affect health, such as stigmatization of and discrimination against people living with HIV/AIDS and their access to available therapies, and the plight of refugees and internally displaced people. It is thus incumbent on human rights advocates and health professionals to intensify education efforts during this last year of the Decade, in order to provide the groundwork for long-term strategies aimed at linking health and human rights in creative and lasting ways. Universities can be in the forefront of providing leadership in human rights education, with the goal of promoting health in particular and the emergence of a culture of peace in general.

Notes

1 (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.

2 The details of this unethical treatment of African-Americans are documented in James Jones' Bad Blood.

3 In Articles 11 and 12 of the Covenant, the State Parties recognize the right of everyone to an adequate standard of living for himself and his family, including adequate food, clothing and housing, the right to be free from hunger and the right to the enjoyment of the highest attainable standard of physical and mental health.

4 The United Nations has noted that "the Convention is the only human rights treaty which affirms the reproductive rights of women and targets culture and tradition as influential forces shaping gender roles and family relations". (http://www.un.org/womenwatch/daw/cedaw/)

Alex Otieno teaches in the Sociology and Anthropology and the MA Program in International Peace and Conflict Resolution at Arcadia University, Pennsylvania. Prior to this, he worked with non-governmental organizations involved in HIV/AIDS and homelessness in Philadelphia and Nairobi, Kenya.

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