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25

Questions
&
Answers
on
Health
&
Human
Rights
Health & Human Rights
Publication Series
Issue No.1, July 2002 World Health Organization

2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s

Acknowledgements:
25 Questions and Answers on Health and Human Rights was made
possible by support from the Government of Norway and was written
by Helena Nygren-Krug, Health and Human Rights Focal Point, WHO,
through a process of wide-ranging consultations. In particular,
substantive guidance was provided by Andrew Cassels, Andrew
Clapham, Sofia Gruskin and Daniel Tarantola. Jenny Cook should also
be acknowledged for background research, input and support.
Additionally, input was provided by Robert Beaglehole, Gian Luca
Burci, Nick Drager, Nathalie Drew, Alison Lakin, Debra Lipson, Craig
Mokhiber, Bill Pigott, Geneviève Pinet, Nicole Valentine, Javier
Velasquez, Simon Walker, and Dan Wikler. Finally, Catherine Browne,
Annette Peters, Dorine Da re-van der Wal and Daryl Somma are
thanked for their support.

WHO Library Cataloguing-in-Publication Data
Questions and answers on health and human rights.
(Health and human rights publication series)
1.Human rights - 2. Public health - 3.Health policy - 4.International law - 5.Guidelines - I. World Health Organization - II. Series
ISBN 92 4 154569 0 (NLM classification: WA 30)
ISSN 1684-1700

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25 Questions
& Answers
on
Health & Human
Rights

World Health Organization

2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s “It is my aspiration that health will finally be seen not as a blessing to be wished for. but as a human right to be fought for.” United Nations Secretary General. Kofi Annan 4 .

We are learning from other United Nations agencies. WHO is actively engaged in increasing its understanding of human rights in relation to health. and other stakeholders. the international community. Attention to human rights is growing worldwide. WHO is striving to make this right a reality for everyone. Gro Harlem Brundtland Geneva July 2002 © WHO 5 .2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Foreword he enjoyment of the highest attainable standard of health as a T fundamental right of every human being was enshrined in WHO’s Constitution over fifty years ago. The United Nations human rights mechanisms provide important avenues towards increasing accountability for health. It is in this context that WHO has launched the Health and Human Rights Publication Series. We have chosen 25 Questions and Answers as the first in this series. I hope this Q & A will provide guidance to a broad audience interested in the relationship between health and human rights. suggesting answers to key questions which explore the linkages between different aspects of health and human rights. The human rights discourse provides us with an inspirational framework as well as a useful guide for analysis and action. paying particular attention to the poorest and most vulnerable. In our daily work.

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8 How can poor countries with resource limitations be held to the same human rights standards as rich countries? 14 Q.6 What international human rights instruments set out governmental commitments? 12 Q.23 What is meant by a rights-based approach to development? 26 Q.4 What is meant by “the right to health”? 9 Q.20 How do health and human rights principles apply to poverty reduction? 23 Q. refugee law and humanitarian law interact with the provision of health assistance? 27 Q.18 How do ethics relate to human rights? 22 Q.22 How does international human rights law influence international trade law? 25 Q.2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Table of Contents Abbreviations and Acronyms 6 Section 1: Health and Human Rights Norms and Standards 7 Q. What happens if the protection of public health necessitates the restriction of certain human rights? 18 Q.7 What international monitoring mechanisms exist for human rights? 12 Q.14 What implications could human rights have for evidence-based health information? 19 Q.12.5 How does the principle of freedom from discrimination relate to health? 11 Q.17 How do human rights apply to situational analyses of health in countries? 21 Section 3: Health and Human Rights in a Broader Context 22 Q.10 What are governmental human rights obligations in relation to other actors in society? 15 Section 2: Integrating Human Rights in Health 16 Q.9 Is there.13.1 What are human rights? 7 Q.3 What is the link between health and human rights? 8 Q.19 How do human rights principles relate to equity? 22 Q.25 How does human rights relate to health development work in countries? 28 Annex I: Legal Instruments 29 Annex II: United Nations Human Rights Organizational Structure 32 7 .21 How does globalization affect the promotion and protection of human rights? 24 Q.24 How do human rights law. under human rights law. an obligation of international cooperation? 14 Q.2 How are human rights enshrined in international law? 7 Q.11 What is meant by a rights-based approach to health? 16 Q.What is the value-added of human rights in public health? 18 Q.15 How can human rights support work to strengthen health systems? 20 Q.16 What is the relationship between health legislation and human rights law? 21 Q.

Social and Cultural Rights (1966) ILO International Labour Organisation IMF International Monetary Fund NGO Non-Governmental Organization OHCHR United Nations Office of the High Commissioner for Human Rights PAHO Pan-American Health Organization PRSP Poverty Reduction Strategy Paper UN United Nations TRIPS Trade Related Aspects of Intellectual Property Rights UDHR Universal Declaration of Human Rights (1948) UNDP United Nations Development Programme UNDAF United Nations Development Assistance Framework UNGASS United Nations General Assembly Special Session UNICEF United Nations Children’s Fund WANAHR World Alliance for Nutrition and Human Rights WHO World Health Organization WTO World Trade Organization 8 . Inhuman or Degrading Treatment or Punishment (1984) CCA Common Country Assessment CCPOQ Consultative Committee on Programme and Operational Questions CDF Comprehensive Development Framework CEDAW Convention on the Elimination of All Forms of Discrimination Against Women (1979) CERD International Convention on the Elimination of All Forms of Racial Discrimination (1963) CRC Convention on the Rights of the Child (1989) ECOSOC Economic and Social Council IACHR Inter-American Commission on Human Rights ICCPR International Covenant on Civil and Political Rights (1966) and its two Protocols (1966 and 1989) ICESCR International Covenant on Economic.Abbreviations and Acronyms ACC Administrative Committee on Coordination CAT Convention against Torture and Other Cruel.

• Are universal. The West United Nations System and Human Rights: economic. • Are legally protected. Q. The Eastern bloc argued to the con- behalf of the ACC by the Consultative Committee on Governmental obligations with regard to trary that rights to food. regardless of their polit.33.(3) They War had overshadowed and polarised human Committee on Coordination (ACC). Human argued that civil and political rights had priority Guidelines and Information for the rights are principally concerned with the rela. the duty of States. protecting individuals and time that States were prepared to turn the provi- groups against actions that interfere with fun. The encompass what are known as civil. (4) In turn. and that economic and social rights were mere Resident Coordinator System. promote and protect all human rights and in customary international law. Geneva. same emphasis.1 What are human rights? © WHO/PAHO Human Rights:(1) • Are guaranteed by international standards. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Section 1: Health & Human Rights Norms and Standards Q. indivisi- Handbook for UN Staff (ICCPR). attainable standard of backgrounds must be borne in mind. protect and fulfil. on Human Rights. 1993. by the human rights law. March of respect. footnote 23 national and regional particularities and • International human rights treaties are of General Comment 14 on various historical. of Action adopted at the World Conference 137/23). However. economic and cultural systems. human rights globally in a fair and equal p. Vienna. national Covenant on Civil and Political Rights (3) Human Rights: A Basic “All human rights are universal. sions of the Declaration into binding law.” • United Nations conferences generate non- adopted at the World Conference on Human binding consensual policy documents. 1999. to therein reflect principles which are binding (E/C. many norms and standards enshrined Social and Cultural Rights in May 2000). While the significance of provide and promote (Section II.(4) ondary. (2) This means that they in 1966 – the International Covenant on Economic. (5) Vienna Declaration and Programme of Action fundamental freedoms. such Rights. approved on tionship between the individual and the state.(2) In the aftermath of World War II. apply to everyone Social and Cultural Rights (ICESCR) and the Inter- everywhere. and it is these instruments that encapsu- Staff College Project. CESCR dated 4 July 2000). (United Nations General Assembly document A / CONF. 1948). and with the to fulfil contains obligations to facilitate.12/2000/4. numerous treaties. on the same footing. although Committee on Economic. political and social rights. it is health adopted by the • Declarations are non-binding. health and education Programme and Operational Questions human rights broadly fall under the principles were paramount and civil and political rights sec- (CCPOQ) at its 16th Session. Hence two separate treaties were created 2000. rights into two separate categories. Since then. the international community adopted the Universal Declaration of Human rights are legally guaranteed by Human Rights (UDHR. the Cold (1) Administrative damental freedoms and human dignity. 14-25 June Vienna Declaration and Programme as declarations and programmes of action. rights enshrined • Oblige states and state actors. • Are interdependent and interrelated. the obligation manner. • Protect individuals and groups. declara- issued by the Office of the ble and interdependent and interrelated. aspirations. late human rights.2 How are human • Focus on the dignity of the human being. High Commissioner for tions and other legal instruments have been Human Rights (OHCHR) The international community must treat and the United Nations adopted. ical.3. in international law? • Cannot be waived or taken away. cultural.(5) 9 . paragraph 5. cultural and religious the right to the highest binding on governments that ratify them.

nor did the people consider human rights as a The normative content of each right is fully Western or Northern imposition. article 15 of the ICESCR. It was articulated in human rights instruments. 8. Vol. injury • Violations or lack of attention to human or abuse.” Health and Human Rights: An International Journal. 9 and 12 of the CRC. Examples of the links between Health and Human Rights (7) Article 7. lined in Questions 4 and 5. The prohibition of harmful traditional practices against women is also articulated in the Declaration on the Elimination of Violence Against Women. Brennan T. protect • Participation: The right to “…active.. In particular. ing traditional practices prejudicial to the • Vulnerability and the impact of ill health can health of children” shall be taken. articles 7. article 5 of CERD. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s “It was never the people who complained of the universality of human rights. 1994. mal- rights can have serious health conse. 1. 10 . • Harmful traditional practices: “Effective and mote or violate human rights in the ways appropriate measures with a view to abolish- they are designed or implemented. The prohibition of violence against women is also articulated in the Declaration on the Elimination of Violence Against Women.3 What is the link or punishment. social and educa- There are complex linkages between health and tional measures to protect the child from all human rights: forms of physical or mental violence.” (7) • Violence against children: ”All appropriate legislative. and Fineberg HV. including article 25 of the ICCPR. and General Recommendation 24 on Women and Health of the Committee on the Elimination of all forms of Discrimination Against Women. (9) be reduced by taking steps to respect. including sexual quences. meaningful participation. CRC. 13 and 14 of CEDAW. (8) • Health policies and programmes can pro. and articles 3. (10) Article 2. “Health and Human Rights. The right to participation is also articulated in other human rights instruments. Declaration on the Right to Development. 1999. free and and fulfil human rights. In often their leaders who did so. No. 1993. respectively. Gruskin S. CRC. neglect or negligent treatment.. 1.” relation to the right to health and freedom from discrimination. the normative content is out- United Nations Secretary-General.” shall be taken. Gostin L. ICCPR. Exam- Kofi Annan ples of the language used in human rights instruments to articulate the normative content of some of the other key human rights relevant to health follows: • Torture: “No one shall be subjected to torture or to cruel. Lazzarini Z. no one shall be between health subjected without his free consent to medical and human rights? or scientific experimentation. (9) Article 24. including the CAT and article 37 of the CRC. inhuman or degrading treatment Q. 1986. (8) Article 19. administrative. The prohibition of torture is also articulated in other human rights instruments. treatment or exploitation. (6) abuse.” (10) (6) Mann J.

The Constitution was adopted by tion of Persons with Mental Illness. the Committee on Eco- of CEDAW. housing.” (11) • Privacy: “No one shall be subjected to The right to the highest attainable standard of arbitrary or unlawful interference with his health (referred to as “the right to health”) was (11) Article 19. the prohibition against torture.” © Grégoire Ahongbonon United Nations High Commissioner • Information: “Freedom to seek. The most authoritative interpretation of the right an adequate standard of living. ade- (20) Basic Documents. adopted a General Comment (18) Article 9. care and necessary social services. (18) and article 11 ICESCR. and 33 of the CRC. including ade- (16) Article 11. and article 26 Not only does this impact negatively on their have ratified) obligations. (23) General Comments The right to social security is also articulated in other serve to clarify the nature and content of indi- human rights instruments. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Q. 17 adopted by the World Health Assembly in and 24 of the CRC. The General Comment of the CRC. crimination on the grounds of mental illness. education. equality. enjoyment of the benefits of scientific progress quate housing. CRC. life. (19) 18 February 1992.. are particularly vulnerable to discrimination. 24. everyone to be free from hunger…” (16) and articles 19. 1998. adequate food and the fundamental right of including article 5 of CERD. World Health Organization. ICESCR. other human rights. and article advantages of breast-feeding. ICESCR. (19) access to information. prohibits dis.” (12) first reflected in the WHO Constitution (1946) (20) The right to information • Scientific progress: The right of everyone to is also articulated in other and then reiterated in the 1978 Declaration of human rights instruments. (13) and articles 13. • Education: The right to education. on the right to health. applications. education. 11 . including the right to food. the including article 16 rights instruments. work. to health is outlined in Article 12 of the ICESCR. participation. • Standard of living: Everyone has the right to (15) Article 24. human rights instruments. and article 27 • Right to social security: The right of everyone of the CRC. The right to the highest attainable standard of (14) Article 13. laws. Social and Cultural Rights. institutions. ICCPR. knowledge of child health and nutrition. (15) health in international human rights law is a The right to education is • Food and nutrition: “The right of everyone to also articulated in other claim to a set of social arrangements – norms. the Principle 1 (A/RES/46). nomic. The right to food is also quate food. vidual rights and States Parties’ (those states that articles 11. privacy. (21) It has been firmly endorsed in a wide The right to privacy is also ing access to education in support of basic articulated in other human range of international and regional human rights instruments. an enabling environment – articles 10 and 16 of CEDAW. Alma Ata and in the World Health Declaration 14 and 16 of the CEDAW. which moni- (17) Article 25 UDHR to social security. 28 that can best secure the enjoyment of this right. The United Nations Resolution on the Protec- 2001. etc. enjoy the benefits of scientific progress and its including articles 10. and medical articulated in other human which has been ratified by 145 countries (as of rights instruments. clothing. housing. ICESCR. Mary Robinson impart information and ideas of all kinds.. (17) including article 12 May 2002). (14) includ- (12) Article 17. and the freedoms of asso- (21) WHA51. Forty-third Edition. Persons suffering from mental disabilities including article 5 of CERD. ICESCR. receive and for Human Rights. non-discrimination. of accidents. ICCPR. the International Health Conference in 1946. affecting their rights to employment. including social insurance.4 What is meant by “the right to health”? “The right to health does not mean the right to be healthy. annex. hygiene and 40 of the CRC. nor does it mean that poor governments must put in place expensive health services for which they have no resources. But it does require governments and public authorities to put in place policies and action plans which will lead to available and accessible health care for all in the shortest possible time. To ensure that this happens is the challenge facing both the human rights community and public health professionals. and its applications. nation in many other aspects of their lives. tors the Covenant.7. Geneva. privacy. (22) of CEDAW. assembly and movement. ability to access appropriate treatment and recognized that the right to health is closely relat- UN General Assembly Resolution on the Protection care but the stigma associated with mental ed to and dependent upon the realization of of Persons with Mental illness means that they experience discrimi. 13 and 14 of CEDAW. environmental sanitation and the prevention (13) Article 15. ciation. Illness and the Improvement of Mental Health Care. In May 2000.

What Does This Mean For Our Nation And World? Indiana Law adolescents. such as ethnic minorities and indigenous populations. Functioning public health and as access to safe and potable water and health-care facilities. Article 25(1) of the UDHR affirms that access to health-related education and informa. and persons with HIV/AIDS. National Recognition (24) General Comment 14. Similarly. clothing. (29) the enjoyment of the highest attainable standard of physical and mental health”. (25) health is recognized in numerous international tional and environmental conditions. Social and Cultural Rights of 1988 (the Protocol entered into force in 1999). without All Countries Countries that Countries that Countries that discrimination on any of the prohibited grounds. housing. sensitive to the full realization of this right”. goods and “everyone has a right to a standard of living adequate tion. Health facilities. 34. 193 such as safe and potable drinking-water and adequate sanitation facilities. within the jurisdiction of food. page 1465. as adequate sanitation. including in rural areas. goods and services. goods and servic- European Social Charter of 1961 as revised. and instruments. (28) “the right of everyone to • Information accessibility. while article 12(2) (c) Acceptability. out discrimination. goods and services must be accessible to all. trained medical and professional personnel 109 receiving domestically competitive salaries. According to article 12(1) of the Covenant. in the Underlying Health-care being designed to respect confidentiality and CERD of 1963. All health facilities. older persons. the African es must be scientifically and medically appro- Charter on Human and Peoples’ Rights of 1981 and priate and of good quality (30). clinics and other health-related 142 buildings. the right to health has been The following graph illustrates the number of countries proclaimed by the Commission on Human that recognize the right to health at different levels: Rights and further elaborated in the Vienna Declaration and Programme of Action of 1993 and other international instruments. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Further. hospitals. States Parties recognize • Economic accessibility (affordability). especially vulnerable or Constitutions marginalized groups. the Additional Protocol to the American Convention on Human Rights in the Area of Economic. children. sufficient quantity. the gender and life-cycle requirements. (23) General Comment 14. nutrition and housing. goods enumerates. persons with disabilities Review. (27) law. The International Human Right to Health: women. Vol. and 83 essential drugs. the CEDAW improve the health status of those concerned. (25) This should include of a Right to Health the underlying determinants of health. 12 . of 1979 and in the CRC of 1989. an adequate supply of safe well as programmes. healthy occupa. the Committee interpreted the right to The General Comment sets out four criteria by health as an inclusive right extending not only which to evaluate the right to health: (24) to timely and appropriate health care but also to the underlying determinants of health.” The ICESCR provides the ping dimensions: • Non-discrimination. and medical care and the State party. have to be available in (22) The human right to food. 2001. Accessibility has four overlap- necessary social services. a number of and services must be respectful of medical “steps to be taken by the States Parties “… to achieve ethics and culturally appropriate. Kinney. Additionally. as well as right to health is recognized. Source: Eleanor D. Several regional determinants human rights instruments also recognize the right to health. Ratified the Ratified Regional Recognize (27) Health facilities. such (a) Availability. such as the (d) Quality. (26) Health facilities. including on sexual and reproductive services have to be accessible to everyone with- for the health of himself and his family. goods ICESCR Treaties with a a Right to Health and services must be within safe physical reach for all Right to Health in their National sections of the population. by way of illustration. Health facilities. inter alia. in law and in fact. (b) Accessibility. as defined by the WHO Action Programme on Essential Drugs. including health. (26) most comprehensive article on the right to health in international human rights The Right to Health • Physical accessibility.

as when lead poisoning treat equal cases equally – must be based on warnings are given without concern for objective and reasonable criteria intended to financial ability to ensure lead abatement.5 How does the principle must be affordable for all. 9.” (32) (30) This requires. lates a fundamental human rights principle and sexual orientation. national or affordable for all. violence against women and the historically dominant-language message on television. (A/RES/48/104). on the grounds of race. are Vulnerable and marginalized groups in soci. which has the intention or effect of to have personal health data treated with practice. Jonathan Mann (33) 13 . safe and “Public health practice is heavily Discrimination manifests itself in a com- potable water. like breast cancer or sickle cell The prohibition of discrimination does not mean disease. civil. impact upon health. underlying determinants of health. p. skilled medical restricted access to health services. Payment for health-care of freedom from services.3. now be summarized as proscribing “any placing the burden on public health to 20 December 1993. In other status. and burdened by the problem of inadvertent adequate sanitation. discrimination can manifest itself in nullifying or impairing the equal enjoyment or confidentiality. as well as to rights. disability. property. political or other opinion. Report. has to be based on the principle of equity. No. inter alia. (31) problems uniquely relevant to certain groups. and ideas concerning health issues. birth. However. social or accessibility of information should not impair the right often lies at the root of poor health status. (29) Accessibility includes eties tend to bear an undue proportion of health social origin. colour. language. For example. as well as services related to the discrimination relate underlying determinants of health. religion. Volume 27. May-June 1997. which may directly or indirectly. goods and services Q. For example. or a problem ‘ignores’ the actual that differences should not be acknowledged. inadvertent discrimination is so prevalent that all public health policies (31) Declaration on In relation to health and health-care the grounds and programmes should be considered the Elimination of Violence against Women. (32) General Comment 14. 85th plenary meeting. outreach the Declaration on the Elimination of Violence activities may ‘assume’ that all popu- against Women recognizes the link between lations are reached equally by a single.” (33) The Hastings Center means and entitlements for their procurement. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s © WHO/PAHO (28) Health facilities. whether privately or publicly provided. unequal power relations between men and or analysis ‘forgets’ to include health women. health status (including HIV/AIDS). plex variety of ways. physical or mental the right to seek. response capability of different popu- only that different treatment – and the failure to lation groups. personnel. discrimination. scientifically approved and unexpired drugs and hospital equipment. Overt or implicit discrimination vio. Indeed. to health? ensuring that these services. political. receive and impart information problems. rectify imbalances within a society. sex. inadequately targeted health programmes and exercise of the right to health. for non-discrimination have evolved and can discriminatory until proven otherwise. discrimination in access to health care and the affirm and ensure its respect for human preamble.

the end of the session. 1995) and the World Conference society. Once this decision is made. widely available to their own populations. 14 . 1995). 1979. to at least one human rights treaty that to facilitate the dialogue between the State (36) Convention on the Rights of the Child. addresses health-related rights. Thus reports can play an important catalytic ulation and Development (Cairo. and contain legally bind- monitoring ing obligations for the governments that mechanisms exist become parties to them.” The implementation of the core human rights Building upon these core documents. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Q. the right to health. 2001). and to make them the World Conference on Human Rights (Vien. contributing to the promotion of nation- World Summit for Social Development (Copen. (35) Convention on the agencies such as WHO can play an important Elimination of All Forms role in providing relevant health information of Discrimination Against Every country in the world is now party Women. the Fourth World Conference on ing the engagement and participation of civil Women (Beijing. Racial Discrimination. other treaties is monitored by committees of inde- international human rights treaties have pendent experts known as treaty monitoring focused on either specific groups or categories bodies. encourag- hagen. © WHO / P. including Party and the treaty monitoring body. “constructive dialogue” with governments sidered in their totality. there is a com- mitment to act in accordance with the provi. Virot sions of the treaty concerned. however. 1989. (34) serviced by the United Nations. Xeno. 1994). (36) or on specific issues. na.6 What international human rights instruments set out governmental commitments? Governments decide freely whether or not to become parties to a human rights treaty. and generally fostering a process of Against Racism. Together these docu. the role. the International Conference on Pop. At phobia and Related Intolerance (Durban. Treatment or Punishment. improve its human rights record.7 What international set out in the Universal Declaration of Human Rights (UDHR. on how to live up to their human rights obli- gations. and a number of rights Inhuman or Degrading related to conditions necessary for health. 1984. (37) Convention Against Torture and other Cruel. (37) In considering a normative monitoring body which meets regularly to framework of human rights applicable to review State Party reports and to engage in a health. concluding observations which include rec- (34) International Convention on the cations of meeting government’s human rights ommendations on how the government can Elimination of All Forms of Racial Discrimination. created under the auspices of and of populations. for human rights? ments are often called the “International Bill of Human Rights. States are required to submit their progress from United Nations world conferences such as reports to the treaty bodies. public scrutiny of governmental policies. six major human rights treaties has its own such as torture. Based on the principle of transparen- The Declarations and Programmes of Action cy. The key interna- tional human rights treaties. 1948). the treaty body makes provide guidance on some of the policy impli. Specialized 1963. human rights provisions must be con. al debate on human rights issues. the International Covenant on Economic. 1993). Social and Cultural Rights (ICESCR. obligations. 1966) further elaborate the content of the rights Q. such as racial minorities. Each of the women (35) and children. 1966) and the International Covenant on Civil and Political Rights (ICCPR.

The African regional human rights instrument is the African Charter on Human and Peoples’ Rights. In addition. the and coordination. protection dards on mental disability rights. harmful traditional practices. of the key role specialized agencies can play within international monitoring mecha- the post of High Commissioner for Human nisms. In the Asia- © Pacific region. constituting the first time the latter has devoted a section to mental disability rights. a human rights system forms a part of the Council of Europe. a 55 member state organization.coe. sale Human Rights) concerning the rights of per- of children. The High American Convention on Human Rights and Commissioner’s mandate extends to every the American Declaration on the Rights and aspect of the United Nations human rights Duties of Man. (38) The 15 member state organization — the European Union — has detailed rules concerning human rights issues and has inte- grated human rights into its common foreign policy. the Commission on Human Rights and the Sub-Commission on the Promotion and Protection of Human Rights. In turn. the IACHR has issued the Recommendation for the Promotion and Protection of the Rights of the Mentally Ill (28 February 2001). The regional human rights mechanism for the Americas is located within the Organization of American States and is based upon the American Convention of Human Rights. These bodies The collaboration between PAHO/WHO appoint special rapporteurs and other and the Inter-American Commission on independent experts and working groups to Human Rights (IACHR. extensive consultations among WHO/PAHO Governments are underway concerning the Other mechanisms for monitoring human possible establishment of regional human rights in the United Nations system include rights arrangements.htm. PAHO/WHO offers technical opinions Rights was created in 1994 to head the United and assistance on the interpretation of the Nations human rights system. In addition. As a result of this technical assistance. the body responsible monitor and report on thematic human rights for overseeing the American Convention on issues (such as violence against women.int/ Treaty/EN/CadreListe Traites. (39) (38) http://conventions. IACHR incorporates these standards into final reports of relevant individual cases and in country reports. In Europe. 15 . which is located within the Organization of African Unity. is an example torture) or on specific countries. in light of international stan- activities: monitoring. (39) This recommendation was included in the IACHR annual report (2001). has separate mechanisms and agreements. promotion. Key human rights instruments are the European Convention on the Protection of Human Rights and Funda- mental Freedoms and the European Social Charter. and sons with mental disabilities. the Organization for Secu- rity and Cooperation in Europe (OSCE). 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Regional arrangements have been established within existing regional intergovernmental organizations.

an obligation of international cooperation? Malaria. but requires all countries to show interdependence. adopted by General Assembly individually and through international resolution 41/128 of 4 December 1986. and the Committee identify indicators and priate means. (41) ICESCR. remedies as well as administrative. This neither requires nor precludes any particular form of government or economic system being used as the vehicle for the steps in question. it is important to Steps towards the full realization of rights distinguish the inability from the unwillingness must be deliberate. national benchmarks to provide realistic targets islative measures and the provision of judicial to be achieved during the next reporting period. Any deliberately retro- gressive measures require the most careful human rights consideration and need to be fully justified by standards as reference to the totality of the rights provided rich countries? for in the human rights treaty concerned and in the context of the full use of the maximum avai- lable resources. where the human rights instruments refer to the State’s resources. under human rights law. placing a tremendous burden on the economies of developing countries. zation of human rights is an obligation of all Comment 3 on the nature of States Parties ditiously and effectively as possible towards States. (42) Adopted by resources. who is party to the Covenant to “take steps. clearly as possible towards meeting a govern. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Q. Fifth and wealthier countries. the Declaration on the Right obligations adopted by the Committee on that goal. It is therefore relevant to both poorer to Development (42) emphasizes an active Economic. (40) All appro.8 How can poor countries with resource limitations be held to the same realization of rights. In this regard. © WHO/PAHO In accordance with Articles 55 and 56 of the Charter of the United Nations. Article 2 (1). and mutual interest. Article 3. international The principle of progressive realization of human cooperation for development and the reali- (40) ICESCR General rights (41) imposes an obligation to move as expe. especially 16 . (43) Declaration on In addition. Social and Cultural Rights. assistance and cooperation. During the reporting process the State Party ment’s human rights obligations. educational and social measures. it should be noted that although the human rights paradigm concerns obligations of States with respect to individuals and groups within their own jurisdictions. Similarly. Q. as it acknowledges the programme of international assistance and Session 1990 (E/1991/23).9 Is there. the ICESCR requires each State the Right to Development. they include international assistance and cooperation. concrete and targeted as of a State Party to comply with its obligations. constraints due to the limits of available cooperation based on sovereign equality. HIV/AIDS and tuberculosis are examples of diseases which disproportionate- ly affect the world’s poorest populations. In this context. including the adoption of leg. must be used in this regard. financial. (43) the General Assembly in its resolution 41/128 constant progress in moving towards full of 4 December 1986.

mental health systems must ensure the unglobalcompact.” (45) lation against infringements of the right to health. based upon international human rights (health insurance companies. includes such and an accessible means of redress if indivi- methods as . and other relevant human rights provisions. An example of this is the obligation of and technical meetings for the purpose of governments to ensure the regulation of the consultation and study organized in conjunc. “the framework of international rights means that governments are responsible cooperation” is referred to. Increasing attention to the human rights (45) ICESCR. existence of social safety nets and other 17 . the Sphere Project’s (draft) Charter in relation to other on the business agenda. that the needs of develop. tobacco industry in order to protect its popu- tion with the Governments concerned. quality information.. jurisdiction. resulted in human rights being placed higher for example. etc. which acknowl. furnishing of technical assis. human rights dards. the achievement of the rights . The role of ensure that third parties conform with human specialized agencies is recognized in human rights standards by adopting legislation. Article 23.10 What are In the corporate and NGO contexts. etc. to the maximum of mechanisms to ensure that vulnerable popu- its available resources. the right to information. For example... Article 2. duals are denied access to these goods and tance and the holding of regional meetings services. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s © WHO/PAHO economic and technical. the cies and other measures to assure adequate ICESCR stresses that “international action for access to health care.).org. (46) there is a proliferation of voluntary codes which reflect governmental international human rights norms and stan- (44) ICESCR. for ensuring that non-state actors act in con- edges. formity with human rights law within their ing countries should be taken into conside. with several busi- on Minimum Humanitarian Standards in Disaster actors in society? nesses beginning to incorporate concern for Relief provides a comprehensive catalogue human rights into their daily operations. with a view to achieving lation groups have access to the services and progressively the full realization of the rights structures they need. (47) of technical standards for NGO and other international relief workers As government roles and responsibilities on matters such as food. Governments are obliged to ration in the area of health. for instance. (47) http: // www. nutrition. poli- rights treaties in this context.. Q.” (44) The obligation of the State to protect human In this spirit. recognized [herein]. water and include increased reliance on non-state actors sanitation.. govern- law. (46) In the area of obligations implications of work in the private sector has humanitarian assistance.

actions relating to children. such as the and men. could be as follows: recognizing the individual characteristics of the population groups concerned. programmes and strategies — chil. prisoners. in Independent Countries refugees. in specific human rights instruments. these differences. religious and linguistic ✓Ensuring equality and freedom from concerning Indigenous and Tribal Peoples in minorities. In all ✓Safeguarding human dignity. implemented. both biological and sociocultural factors play • Making human rights an integral dimension a significant role in influencing the health of of the design. economic and social. recognizing that legislation. 169. • Assessing and addressing the human rights implications of any health policy. 1989) and the International Convention erly. within these A rights-based approach to health entails processes. especially the most vulnerable or mar- ginalized sections of the population. for example. weight. monitoring men and women. Substantive elements to apply. implementation. discrimination. 18 . internally displaced persons. eco. on the Protection of the Rights of All Migrant nomically disadvantaged or otherwise mar- Workers and Members of their Families (1990). ethnic. adolescents. persons with disabilities. programme or ✓Using a gender perspective. • The views of the child shall be given due and human rights. (49) In include: other words. in law • Using human rights as a framework for health and in fact. women. and that policies and pro- and evaluation of health-related policies and grammes must consciously set out to address programmes in all spheres. International Labour Organisation Convention national. the guiding principles of the Convention on the ✓Paying attention to those population groups Rights of the Child should be applied. immigrants and migrants. the eld. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Section 2: Integrating Human Rights in Health © WHO/PAHO Q. (49) Many are spelt out dren (girls and boys). the way health programmes are designed or (No. without discrimination on any of development. ginalized and/or vulnerable groups. (48) See Question 3 the characteristics of those affected by health for an explanation of the links between health policies. These considered most vulnerable in society. recognizing and acting upon • The best interests of the child shall be a primary consideration. advertent or inadvertent. including political. (48) the prohibited grounds. indigenous and tribal populations.11 What is meant by a rights-based approach to health? A rights-based approach to health refers to the ✓Ensuring health systems are made accessible processes of: to all.

✓Promoting and protecting the right to educa- tion and the right to seek. Annex. ment. the right to information should not impair the right to privacy. and physical disability leads bility for. Grodin M. to heal people with disease or disability”. rights. Safeguards Equality and freedom from discrimination ✓Making the attainment of the right to the Dissaggregation highest attainable standard of health the explicit ultimate aim of activities. which means that personal health data should be treated with confidentiality. Mann J. Introduction.4/1985/4. stages of programme development. receive and impart information and ideas concerning health issues. ✓Increasing transparency in. Transparency Siracusa principles ✓Making explicit linkages to international human rights norms and standards to high. Participation (50) Eds. ✓Ensuring free. However. tions to respect. (50) migrants and other domestically “unpopu- lar” groups. tion of rights in the field of health. 4. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s ✓Disaggregating health data to detect under- lying discrimination. by incorporating redress ✓Only limiting the exercise or enjoyment of a mechanisms in case of impingements on right by a health policy or programme as a health-related rights. last resort. 19 . Human rights expressly linked political rights. goals and protection of human rights (51) The Siracusa principles on the limitation Accessibility and derogation provisions ✓Identifying benchmarks and indicators to Concrete government obligations in the international covenant on civil and ensure monitoring of the progressive realiza. For example.(51) (See Question 13). Respect for the dignity and privacy of individuals can facilitate more sensitive and ✓Incorporating safeguards to protect against humane care. in order to address power imbal- ances. 1999). © WHO/PAHO It has been demonstrated that “respect for human rights in the context of HIV/AIDS. protect and fulfil human Optimal balance between public health (Routledge. health as a key consideration at all to markedly better prevention and treat. and only considering this legiti- mate if each of the provisions reflected in the Siracusa principles is met. policy or programme Information with the desired public health objectives and ensuring the optimal balance between good Gender public health outcomes and the promotion Human dignity and protection of human rights. para. UN Doc. programme or legislation. which have Attention to vulnerable groups as their objective the enhancement of health. Right to education Annas G. Possible “ingredients” in a rights-based approach to health: ✓Juxtaposing the human rights implications of Right to health any health legislation. E/CN. and accounta- mental illness. Benchmarks and indicators light how human rights apply and relate to a Accountability health policy. and effective participation of beneficiaries of health devel- opment policies or programmes in decision- making processes which affect them. ✓Articulating the concrete government obliga. Privacy Gruskin S. Health and Human Rights: A Reader. Stigmatization and discrimina- tion thwart medical and public health efforts majoritarian threats upon minorities. meaningful.

(52) wise discriminatory manner. ners in countries. fever. Interference with freedom of movement when • Consistent guidance to states as human instituting quarantine or isolation for a serious rights cross-cut all United Nations activities. • Enhanced governmental accountability for • The restriction is in the interest of a legiti- health. international financial • There are no less intrusive and restrictive institutions. ships with relevant actors of civil society. mate objective of general interest. definitions of concepts and population groups). means available to reach the same objective. Siracusa Principles. conscience and religion. to limit human rights at certain times. not be restricted in any circumstance such as itable construct). known as the the underlying determinants of health. goal. and freedom • A tool to enhance health outcomes by using a of thought. Public health is sometimes used by states as a ground for limiting the exercise of human rights. • A powerful authoritative basis for advocacy • The restriction is strictly necessary in a and cooperation with governments. are met: • A standard against which to assess the per. syphilis. communicable disease — for example. and • Existing international mechanisms to monitor • The restriction is not drafted or imposed arbitrarily. democratic society to achieve the objective. • The restriction is provided for and carried formance of governments in health. out in accordance with the law.g.13 What happens the value-added if the protection of human rights of public health in public health? necessitates the restriction Overall.e. and in the building of partner. culosis — are examples of restrictions on rights 20 . analyze and respond to ces set out in human rights law. i. Ebola • Increased scope of analysis and range of part. Even in circumstances where limitations on grounds of protecting public health are basically permitted. Limitation human rights approach to designing. A key factor in determining if the necessary protections exist when rights are restricted is that each one of the five criterion of the Siracusa Principles must be met. they should be of limited duration and subject to review. in an unreasonable or other- the realization of health as a human right. tional organizations. typhoid or untreated tuber- (52) See Question 7. and derogation clauses in the international menting and evaluating health policies and human rights instruments recognize the need programmes. vocabulary and form of when all of the narrowly defined circumstan- guidance to identify. freedom from torture and slavery. imple. human rights may benefit work in the of certain human area of public health by providing: rights? • Explicit recognition of the highest attainable standard of health as a “human right” (as There are a number of human rights that can- opposed to a good or commodity with a char. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Q. © WHO • An “empowering” strategy for health which The Siracusa Principles includes vulnerable and marginalized groups engaged as meaningful and active Only as a last resort can human rights be interfered with to achieve a public health participants.12 What is Q. interna. • Accepted international norms and standards (e. Such interference can only be justified • A useful framework.

par- ticipation and non-discrimination. indicating the data Edition. However. such as privacy. sessional Working Group on the draft declaration could human rights was established in 1995 in accordance with Commission on Human have for evidence. has the burden For example. or incarcerates. This includes the choice of the methods of data collection which must include considerations on how to ensure respect for human rights. (54) ditional markers could detect discrimination on the basis of ethnicity against indigenous and tribal peoples which is considered an underly- ing determinant of their overall poor health sta- tus. the preservation of public order. a state which restricts the movements of.g. Oxford Textbook of Public Health. enjoyment of a wide range of human rights. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s that may. The draft ple. on grounds such as national security or needed to tackle complex health challenges. Fourth against the community’s major infectious the collection of evidence. norms and standards should therefore stimulate 21 . (54) General Comment 14.14 What implications indigenous and tribal peoples from other (55 The open-ended inter- population groups. In other words. government or fails to provide immunization Tanaka H. the development of a declaration on the is being prepared for consideration and rights of indigenous populations (55) stems from adoption by the General Assembly during the the recognition that this is a vulnerable and International Decade of the World’s Indigenous marginalized population group lacking full People. For exam- © WHO/PAHO ple. the ILO Convention Concerning Indige- nous and Tribal Peoples (56) provides an authori- tative basis for identifying and differentiating Q. Retels R. Oxford University Press. Convention Concerning Indigenous and Tribal health and education. be nec- essary for the public good. disaggregating data beyond tra- paragraphs 28-29. Oxford. or Group has the sole purpose of elaborating a behaviour (e. sexual orientation or the use draft declaration on the of alcohol or other potentially harmful sub- rights of indigenous peoples. The existence of human rights and Tarantola D (refer to footnote 49). Collecting personal information from indi- Rights resolution 1995/32 and Economic and Social based health viduals about their health status (e. More widely accepted is the notion that human rights are relevant to the way in which health data should be collected. (57) on the rights of indigenous peoples”. state. considering the stances) has the potential for misuse by the draft contained in the The process that gives birth to an international. (53) By contrast. The Working information? infection. HIV Council resolution 1995/32. Secondly. cancer or genetic disorders). and therefore could be considered legitimate under international human rights law. available to others. diseases. under certain circumstances. per- sons with HIV/AIDS. refuses to allow doctors (53) Gruskin S and to treat persons believed to be opposed to a Tarantola D in Ed. the estab- Peoples in Independent Countries (Convention lishment of human rights norms and standards 169) adopted by the International Labour is itself evidence of a serious problem and gov- Organisation on 27 June 1989. (56) The International Labour Organisation including rights to political participation. whether directly or because this infor- annex to resolution 1994/45 of 26 August 1994 ly recognized human right is generated from mation is intentionally or inadvertently made entitled draft “United Nations declaration the pressing reality on the ground. Mc Ewen J. For exam. Beaglehole R. the political sensitivities which underpin human rights in exposing how dif- ferent population groups are treated and why. international instruments can be helpful in defining various population groups. (in press).g. hampers the extent to which human rights are welcomed as a driving force for data collection. of justifying such serious measures. ernmental recognition of the importance of (57) Gruskin S addressing it.

ty which are considered most vulnerable (e. religious. Human rights norms and standards “Toward a Measure of Dignity: Indicators or “by when. 4-8 September 2000. Montreux. p. the right of those potentially affected by health policies. development. targets or severity of disease.” as these are appropriately also form a strong basis for health systems to for Rights-Based Development”. (New York and Oxford: Oxford tool for creating a culture of accountabili. and fairness in financial contribution. ty and for realizing human rights. to assess how health and other systems interact to achieve key social goals.g. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Indicators United Nations agencies’ work on health indicators. University Press. Human rights were integrated which to evaluate existing health policies and in the CCA indicator framework which lead to programmes. and governmental respons- (58) See Mokhiber. frequency and would not include benchmarks. and to show how different policies contribute towards improving health systems perfor- mance. refugees (60) The World Health Report 2000 Health and migrants. designed to measure “what is”. ential treatment of individual groups of people lopment indicators. human rights tion to ensure a common framework for the design. but which is consistently Human rights provide a standard against measurable.(58) marginalized population groups. on a right-by-right basis. to define and measure health. Human Development Report 2000 (59) racial monitories). and human development indicators can assist in Q.15 How can forging common agendas. (60) In particular with regard to the responsiveness of the health system.g. © WHO/PAHO 22 . conveying information that may be qualitati- ve or quantitative. C. The UNDG working to strengthen group on Common Country Assessment (CCA) Indicators adopted the definition of an health systems? indicator as a variable or measurement. including highlighting the differ- the goal of developing a list of simple deve. Human Development “Information and statistics are a powerful attention on those population groups in socie- Report 2000. Human (59) United Nations rights moves beyond averages and focuses Development Programme. for example. programming. manifestations. and health system processes (e. This in. human rights norms and standards have been incorporated shaping the definitions of the various domains being measured. use and assessment support work of indicators is needed. national and Systems: Improving Performance. developed in country-specific.” indigenous and tribal populations. G. 2000). participatory prioritize the health needs of vulnerable and Session I-PL 4. 10. World Health Report 2000: WHO Framework on Health Systems Performance Assessment In working towards an evidence-based model of health. or answer definitely “what should be” es to it. Greater coordina. national processes. strategies and stan- dards to participate in the process in which decisions affecting their health are made). human rights indicators. The fundamental prin- ciples underlying these indicators are: to clarify the boundaries of health systems. goals. WHO developed health system performance indicators in its World Health Report 2000. responsiveness. ethnic. as well as putting forward specific human rights which may help guide health policy.

(1999). conversely. 99. broaden the scope of situational health analysis in countries. including in relation views of civil society organizations are another to quarantine and isolation. Finally. allow new partners to be identified. and how civil society move- and appropriateness in line with both human ments represent them. United population groups that are justified as neces. In the design and development policies impact upon the status of review of health legislation.17 How do human rights apply to situational analyses of health in countries? Increased attention to human rights may.g. Given that human rights obligations rel- the relationship evant to health rest with the government as a whole. New areas of attention include consideration of the health components of national human rights action © WHO/PAHO plans and. In this context. finance. such as national food and nutrition policies and plans. on their face or application. Two examples in this rights (including independent human rights regard are health policies concerning the invol. draws attention to how national legislation and tion of the right to health. children’s affairs. and secondly. as a result. etc. Justice Min- to support their approach may raise a host of istries and those with responsibility for human human rights concerns. e. the Public’s Health: A study of Infectious behaviour that are justified as necessary to pre. ombudsper- Disease Law in the United States”. Review. institutions). social affairs. Restrictive laws and policies that deliberately Practical implications may be to engage at the focus on certain population groups without national level with a greater range of Ministries sufficient data. human rights treaty monitoring bodies and the it their public health laws.1. epidemiological and otherwise. health and human rights goals need to between health figure in policies and plans which may be gen- legislation and erated outside the health sector per se but human rights law? which have a strong bearing on health. No. the inclusion of human rights in national health strategies and action Q. (61) issue for consideration. national human rights commissions. also constitute fruitful partners for and Tarantola D. they violate human rights. inter- and Lazzarini Z. Nations agencies and other intergovernmental (61) Gostin L. Vol. Burris S. and providing the means to rectify any violation which exists. human rights think-tanks and research insti- (62) Gruskin S Government capacity to develop national tutes. Q. Health legislation can be an important vehicle The focus on vulnerable population groups towards ensuring the promotion and protec. This includes developing the tools to review health-related laws and policies to determine whether. national human rights institutions. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s human rights obligations needs to be strength- ened. untary sterilization of women from certain education. (62) sons. 23 . the reports to rights and public health goals. and organizations working on human rights. which institutions work to protect vide a useful tool to determine its effectiveness their best interests. and comments from the United Nations HIV/AIDS has caused many countries to revis. “The Law and sodomy statutes criminalizing same-sex sexual national and national human rights NGOs. such groups. women’s affairs. human rights pro. other than Health Ministries. Columbia Law vent the spread of HIV/AIDS. sary for their health and well-being. firstly. refer to footnote 48.16 What is plans. health policy and legislation that conforms to advancing the global health agenda.

human rights addressing intrastate relations. sensus-building process. such as human ishment. standards of value practice where human rights do not provide a and goodness in outcomes and consequences definite answer. (63) This means 3 eliminating disparities in health and in health’s major determinants that are systema- tically associated with underlying social disadvantage within a society. (A/RES/41/128). Geneva. Ethics is particularly useful in areas of duties. It has been used to embrace policy- related issues. reinforces the principle of equity. which accounts in part for the group. (64) Declaration on damental issues. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Section 3: Health & Human Rights in a broader context Q. These interna. The focused attention on vul- Human rights refer to an internationally agreed nerable and disadvantaged groups in society upon set of principles and norms embodied in in international human rights instruments international legal instruments. Q. Also. In other words. guide the distribution of opportunities for well-being. such as the accessibility.18 How do ethics relate to human rights? Work in ethics needs to take into account human rights norms and standards. in new and of action. rather than their social privileges. at the tional human rights principles and norms are international level. For example. most notably the Right to Development. not been applied or codified. not only in Ethics are norms of conduct for individuals and substance but also in relation to the processes of for societies. to Development. individuals representing this group complexity within each ethical outlook. These norms derive from many ethical discourse and reasoning. Ethics should be participants in any determination of as a system of norms employs many compo. WHO. affor- dability and acceptability of available health © WHO/PAHO care services. sources. cooperation to realize rights as well as 1996. tions among Member States on a range of fun.19 How do human rights principles relate to equity? Equity means that people’s needs. the ethical implications of the issues affecting nent concepts. including obligations and them. standards of fairness. for example. Within the human rights discourse. human rights instruments (63) Equity in Health and the result of deep and long-standing negotia. and justice in emerging areas where human rights law has allocation of resources and in reward and pun. cloning. are generated by governments through a con. address equity by encouraging international Health Care: A WHO/SIDA Initiative. cultural tradition. (64) 24 . where issues concern a specific population and reflection. including religion. virtues of character. the principle of equity is increasingly serving as an important non- legal generic policy term aimed at ensuring fairness. in the United Nations Declaration on the Right 4 December 1986.

and the right to security in the addressing poverty and ill-health. Social and Cultural Rights”. as well as human rights monitoring at the terized by sustained or chronic deprivation of international level. disability. and thus provides a potential avenue to Human rights empower individuals and com. exclusion and further poverty. treatable. ID21 ments to introduce disability legislation.”(66) programmes. Poverty and Development. (68) Overall. (65) The Committee legal remedies.” (67) work to ensure non-discrimination and equal opportunity for persons with disabili- ties. including necessary good governance. in Africa and Asia are preventable or page 235. including legislation. by malnutrition and poor sanitation (67) Voices of the Poor: • 70 per cent of childhood blindness Crying Out for Change. old age or other and obligations. demanding consideration of a spectrum of adequate standard of living and other civil. transparency. go “upstream” to prevent persons with dis- munities by granting them entitlements that abilities from becoming poor. (68) Human rights and poverty reduction These impairments then lead to discrimi- strategies: A discussion paper.12/2001/10). Human A report from Action on Disability and rights can help to equalize the distribution and Development looks at the vicious circle lin- exercise of power both within and between king poverty and disability. Chapter 7. choices. ’Social Ill-being: and 50 per cent of hearing impairment Left Out and Pushed Down’. level. political and social rights. also requires the active and informed partici. Professor Manfred Nowak. As economic and social rights. cation. administrative and political on Economic. such as the social. • One hundred million people world wide Economic. they have encouraged many govern- for International Development (DFID). democracy and health and well-being. (69) Highlights. demand accountability: effective Declaration of Human Rights.20 How do health and human rights principles apply to poverty reduction? The right to a standard of living adequate for Accountability. World Bank 2000. prepared by nation. disabled children take for granted. is to find ways to weaken the web of powerlessness Disability can become a cause of poverty and to enhance the capabilities of poor and poverty can also be a risk factor for dis- women and men so that they can take more ability. Department ceable. polices and cultural. The Professor Paul Hunt. • 98 per cent of disabled children in deve- (1948). security provide a holistic framework to poverty reduc- and power necessary for the enjoyment of an tion. and for policy and practice. economic. imple. are increasingly gaining weight The scale of exclusion is dramatic: (65) Article 25 UDHR through increased normative clarity and appli. Social and Cultural Rights on 4 May. human rights the resources. Member States. right to health. Although not legally enfor- (69) Disability. Legal rights event of sickness. paragraph 8. economic. statement adopted by the Committee on pation of the poor in the formulation. are essential ingredients to social services. at the domestic and interna- lack of livelihood is enshrined in the Universal tional level. “The challenge for development profes- sionals. Standard Rules on the Equalisation of Professor Siddiq Osmani Opportunities for People with Disabilities for the UN Office of the High Commissioner for Human have been endorsed by all United Nations Rights (February 2002). January 2002. capabilities. Social and Cultural Rights has accountability mechanisms at the domestic defined poverty as “a human condition charac. 25 . mitigating the powerlessness of the basic cause of disabled people’s poverty is poor. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Q. and political exclusion. Human rights provide a legal frame- control of their lives. approaches. may affect them. give rise to legal obligations on others. A human rights approach the day-to-day interactions that non- on Economic. mentation and monitoring of strategies which have preventable impairments caused 2001 (E/C. they will provide an important tool for loping countries are denied any formal (66) “Poverty and the education and excluded from many of International Covenant poverty reduction. It argues that the societies.

human rights obligations. Social and Cultural Rights has such as new life-saving drugs. May 1998. Official corporate business. all else will fail.(70) These trends serve to reduce the role acceptance of.” (72) Report of the Secretary-General time increase the role and responsibilities of on the work of the private (non-state) actors. and within all to the Third Ministerial Conference of the World a range of activities with a view to facilitating countries. or lack of (71) Statement by the Committee on Economic.1 (A/54/1). Supplement No. as proclaimed in the international instruments. of the state in economic affairs. as well as Within the human rights community. policies and programmes which promote nomic-political realm of globalization. certain the governments that have created and manage trends associated with globalization have raised them. the inherent dignity and Social and Cultural Rights. investment and rewarding entrepreneurial from either a lack of respect for.(71) trends include: an increasing reliance upon the free market. these respect for those rights. but also those in civil society. the engagement with glo- balization. General Assembly. contributed to greater marginalization of peo- ple and countries that have been denied access In this context. Human rights analysts are concerned that such 26 . 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Q. paragraph 5.”(72) Globalization is a term used to cover many dif- ferent phenomena. 1999. the globalization process has and enforce human rights. Located primarily in the eco. Human Rights. sive domain of the state. people. especially for the most vulnerable mem. Respect for human rights. If we lose sight of this fundamental truth. has underscored that “the pursuit of development. and at the same equality of all human beings. lifting many people from pover- ty and bringing greater awareness of people’s trends limit the ability of the state to protect the entitlement to basic human rights. especially those in United Nations High Commissioner for Organization. is central to our mandate. there are problems stemming Trade Organization. “Although we refer to our world as a global tions in determining national policies. the privatization of sense of closeness towards neighbour and (70) Statement by the functions previously considered to be the exclu. information. Social and Cultural Rights. to take whatever measures they can in the concern with respect to their effect on states’ context of globalization to assist governments to capacity to ensure the protection of human act in ways which are compatible with their rights. services. cutbacks village it is a world sadly lacking in the in public sector spending. and the management of change must all yield to human rights imperatives rather than the reverse. the United Nations Committee to markets. 54th session. and to seek to devise bers of society. community which the word village Committee on Economic. a significant growth in the influence of international financial markets and institu. and ideas across national borders. and the deregulation of implies. In many vulnerable from adverse effects of globalization. however.21 How does globalization affect the promotion and protection of human rights? The Secretary-General of the United Nations. 1999. cases. In each region. emphasized the strong and continuous respon- sibility of international organizations. This © WHO/PAHO process has brought benefits to many peoples and countries. Mary Robinson Records. goods. most of which concern increasing flows of money. initiative. Kofi Annan. and essential goods on Economic.

61-69. Also in relation to the question of access to drugs. ping countries. and related aspects of Intellectual Property recognizing that “human rights are the first Rights on human rights . the United Nations human rights system has begun addressing trade laws and practices in relation to human rights law and. Social and Cultural Rights recognizes “the right of everyone to enjoy would promote the availability. with respect to access to drugs for develo- from any limitations by third parties. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Q.22 How does international human rights law influence international trade law? Recently. as well as ensure They are also asked to adopt legislation or freedom of scientific enquiry. accessibility the benefits of scientific progress and its and affordability for all without discrimination applications. Article 1. (74) This report notes (E/CN. Article 15 of the International Covenant States are called upon to pursue policies which on Economic.33). sioner for Human Rights.”(75) of June 2001 (E/CN.RES. the relationship between the Agreement on the Trade Related Aspects of Intellectual (73) Commission on Property Rights (TRIPS) and human rights was Human Rights resolution 2001/33: Access to considered in a report to the Subcommission on medication in the context of pandemics such as Human Rights. The implica- other measures to safeguard access to such tions of this right for health issues have only pharmaceuticals and medical technologies recently begun to be explored. For example.4. (74) Report of the High that of the 141 Members of the WTO. last year. 27 . for example.2001. In an unprecedented move. Members should therefore Rights both Sub-Commission on implement the minimum standards of the the Promotion and Protection of Human TRIPS Agreement bearing in mind both their Rights on intellectual property rights and human rights obligations as well as the flexi- human rights.) (75) Vienna Declaration and Programme of Action. and scientific research. the Commission on Human Rights last year © WHO adopted a resolution on access to medication in the context of pandemics such as HIV/AIDS (73) which reaffirms that access to medication in this context is a fundamental element for the progressive realization of the right to health. by the High Commis- HIV/AIDS. the impact of the agreement on trade bility inherent in the TRIPS Agreement. in turn.2/2001/13 paras. the question of access to drugs has been increasingly addressed in the context of human rights. adopted 20 April 2001.4/Sub. Fifty-second session responsibility of Governments. develop and diffuse science used to treat pandemics such as HIV/AIDS.” This right places obligations of scientifically appropriate and good quality on governments to take the steps necessary pharmaceuticals and medical technologies to conserve. the World Trade Organization (WTO) and other organizations dealing with trade have begun to consider the human rights implications of their work. 111 have Commissioner for Human ratified the ICESCR.

non-discrimination and attention to vulnerabi- lity. © WHO/Stills “A rights-based approach to development sets the achievement of human rights as an objective of development. accountability. standards United Nations Secretary-General. but that the obligations to respond to the inalienable development process must. when needed. and principles of the international human Kofi Annan rights system into the plans. In this regard. approach implies that performance stan- Briefing Paper. rights of individuals. Institute. but in terms of society’s the Right to Development (1986). describes situations not simply in terms opment itself is not only a human right as rec. OHCHR demand justice as a right. It invokes the interna- tional apparatus of human rights account- ability in support of development action. has advocated a rights-based approach to and gives communities a moral basis from development as a conceptual framework for which to claim international assistance the process of human development that is nor. it is concerned with not just civil and political rights but also with eco- (76) Overseas Development nomic. dards be set. in itself. This approach integrates the norms. empowers people to tent with human rights. “What can the implementation of a rights-based we do with a rights-based approach to development?”. within the “A rights-based approach to development United Nations system and beyond. In all of these. of human needs. It uses thinking about human rights as a scaffolding of development policy. empowerment and express linkage to international human rights instruments.” (76) 28 . or of developmental ognized in the United Nations Declaration on requirements. be consis. The norms and stan- dards are those contained in the wealth of inter- national treaties and declarations. The principles include those of participation. 1999 (3) September.23 What is meant by a rights-based approach to development? There is increasing recognition. not as charity. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Q. policies and processes of development. that devel.” matively based on international human rights. social and cultural rights. Further.

2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Q. humanitarian law and refugee which in wartime protect persons who are law are distinct yet closely related branches of not or no longer participating in the hos- tilities and which limit methods and the international legal system. for humanitarian action by the United Nations birth or wealth. or any similar criteria. sex. The central instru- and refugee law were developed within the ments of humanitarian law are the four United Nations framework and thus have 1949 Geneva Conventions and their two similar underpinnings. has profoundly different origins and uses different mechanisms for its implementa- tion. refugee law and humanitarian law interact with the provision of health assistance? The large number and changing nature of emergencies and conflicts. Fresh attention is being drawn to the international legal frame- work for dealing with these emergencies. All branches of law have. In and its agencies as well as other actors. colour.24 How do human rights law.An overview of concepts to medical care in some circumstances could and issues. The sick and wounded. constitute a war crime. has prompted the need for new thinking and approaches within the United Nations system and beyond. a Efforts are under way to ensure that interna- fundamental common objective: the respect for tional human rights and humanitarian law human dignity without any discrimination principles provide the standard and reference whatsoever as to race. medical equipment. Health addition. Humanitarian law is the law of armed conflict or the law of wars: a body of rules Human rights. imple- objectives and conceptual similarities. human rights law and refugee law and their applicability in a changing crisis environment. Additional Protocols of 1977. however. Kracht. they share a great number of detailed practices in preparing for. Moreover. in particular the relationship between humani- tarian law. religion. Human rights means of warfare. Development Consultant and health workers. including the explosion of religious and ethnic turmoil around the world. 29 . hospitals Co-Coordinator of the World Alliance for Nutrition and various medical units (including medical and Human Rights (WANAHR) Human Rights transportation) are all protected under humani- and Humanitarian Law and tarian law principles. and evaluating the impact of health assistance in the context of an armed conflict need to be grounded within a framework of (77) See paper by Uwe international law. denying access Principles in Emergencies . assessing. (77) Refugee law acts to protect refugees by spelling out specific legal provisions protecting the human rights of refugees most notably through the United Nations Convention Relating to the Status of Refugees © Helena Nygren-Krug (1950) and its protocol (1966). however. menting. Humanitarian law. prepared for UNICEF.

© WHO/PAHO This parallels the principles enunciated in the World Bank’s Comprehensive Development Framework (CDF). and the inter- emphasis on human rights. org/ccpoq/documents should be promptly and confidentially trans. that key sectoral issues (e. and migrants requires a special Poor (81) and other poverty studies. (82) Human rights and poverty reduction strategies with norms. The close correspondence between “the realities of particular vulnerability of refugees. indicators and benchmarks) http://accsubs.unsystem.g. para. the key concerns of pover- attention. March 2000. that effective moni- CCPOQ at its 16th Session. in relation to all parties. stan- poverty reduction strategies: dards and values that have a high-level of global A discussion paper. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Q. The CCA and UNDAF Guidelines refer to the imple- mentation of United Nations Conventions and Declarations and underscore the importance of taking full account of human rights in both these processes. including Poverty Reduction Strategy dimension can help ensure that strategies pay Papers (HRPRS Guidelines). Within these national human rights normative framework. integrated and coordinated United Nations support to government follow-up to the Conferences and the implementation of Conven- tions at the field level. are (80) Idem. these toring methods (e. the joint World Bank/IMF Overall. Thus. has highlighted the particular attention to vulnerable groups.” as identified by Voices of the displaced. that integrate human rights within the United Nations According to United Nations Guidelines. groups. humanitarian action in the field of Poverty Reduction Strategy Paper (PRSP) initia- health represents action towards the fulfilment tive. (79) In March 2000. tion of human rights in poverty reduction strate- tions. rights violations. Once received. consideration of the human rights gies. the integra- (78) Guiding Principles on Internal Displacement exist that provide guidance in ensuring pro. immediate and intermediate (as well as long- system. and that accessible mechanisms /manual/human-rights- gui. Moreover. mitted to OHCHR for processing…”(79) of accountability. (82) 30 . For example. attention to human rights will help to unaccompanied minors. persons with disabil. approved on United Nations staff in the field. in the OHCHR to produce guidelines for the integra- provision of health care in emergency situa. generally not reject complaints of human Geneva. women as single heads of households. “should behalf of ACC by the term) targets are identified. tion of human rights into anti-poverty strategies (1998). and remain. ensure that the key concerns of poor people ities. Furthermore.pdf. 59. legitimacy. are established. instituted. (80) The Common Country Assess- ment (CCA) and the United Nations Develop- ment Assistance Framework (UNDAF) provide the major principles upon which a human rights- based approach to development is founded. hous- important reference for the collective effort to ing.g. that the active and Information for the and ill-health. The CCAthus helps to facilitate efforts for coherent. the formal design of which reflects human of the right to health in situations where the rights concepts and standards. tection in emergencies against exposure of will help to ensure that vulnerable individuals the ACC issued the Human Rights Guidelines and vulnerable groups to risk-factors of disease and groups are not neglected. A project of the threats to health are greatest. internally poor people. human rights provide (81) Refer to footnote 68. health and food) receive due attention. Specific human rights principles ty reduction strategies. education.25 How does human rights relate to health development work in countries? Human rights are upheld as a cross-cutting issue in the United Nations’ development work at country level. footnote 57. and the elderly are in need of special become. (78) informed participation of the poor is provided Resident Coordinator System which is an for.

Geneva Convention for the Amelioration of the Condition of Wounded. 169) concerning Indigenous and Tribal Peoples in Independent Countries (1989). 2000). 29) concerning Forced Labour (1930). Maternity Protection Convention (No. and the Protocol Additional to the Geneva Conventions relating to the Protection of Victims of International Armed Conflicts (Protocol 1) (1977) and the Protocol relating to the Protection of Victims of Non-International Armed Conflicts (Protocol II) (1977) . Geneva Convention relative to the Protection of Civilian Persons in Time of War (1949). Inhuman or Degrading Treatment or Punishment (1984). Social and Cultural Rights (1966). 182) on the Prohibition and Immediate Action for the Elimination of the Worst Forms of Child Labour (1999). 105) on Abolition of Forced Labour (1957). Sick and Shipwrecked Members of Armed Forces at Sea (1949). Geneva Convention relative to the Treatment of Prisoners of War (1949). 183. Convention relating to the Status of Refugees (1950) and its Protocol (1967). Convention against Torture and Other Cruel. International Convention on the Elimination of All Forms of Racial Discrimination (1963). International Convention on the Protection of the Rights of All Migrant Workers and Members of their Families (1990).2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Annex I: Legal Instruments © WHO/PAHO International treaties and conventions (in chronological order) relevant to health & human rights Convention (No. Convention (No. Convention (No. United Nations Charter (1945). Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field (1949). Convention (No. Convention on the Elimination of All Forms of Discrimination Against Women (1979) and its Protocol (1999). 31 . International Covenant on Economic. Convention for the Suppression of the Traffic in Persons and of the Exploitation of the Prostitution of Others (1949). Convention on the Prevention and Punishment of the Crime of Genocide (1948). Convention on the Rights of the Child (1989). International Covenant on Civil and Political Rights (1966) and its two Protocols (1966 and 1989).

Universal Declaration on the Human Genome and Human Rights (1997). Principles of Medical Ethics relevant to the Role of Health Personnel. Declaration on the Rights of Disabled Persons (1975). Declaration on the Use of Scientific and Technological Progress in the Interests of Peace and for the Benefit of Mankind (1975). Punishment and Eradication of Violence against Women “Convention of Belem do Para.“Protocol of San Salvador” (1988). particularly Physicians. Inter-American Convention on the Elimination of All Forms of Discrimination Against Persons With Disabilities. Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (1991). Convention on the Prevention. Groups and Organs of Society to Promote and Protect Universally Recognized Human Rights and Fundamental Freedoms (1998). African Charter on Human and Peoples’ Rights (1981). Declaration on the Rights of Persons Belonging to National or Ethnic. European Social Charter (1961). Protocol to the American Convention on Human Rights to Abolish the Death Penalty (1990). Religious and Linguistic Minorities (1992). Declaration on the Right and Responsibility of Individuals. Regional instruments (in chronological order) in relation to health & human rights American Declaration of the Rights and Duties of Man (1948). European Convention on Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (1997). norms and standards (in chronological order) relevant to health &human rights Universal Declaration of Human Rights (1948). United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities (1993).2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s International declarations. American Convention on Human Rights (1969). European Convention for the Protection of Human Rights and Fundamental Freedoms (1950) and its Eleven Protocols (1952 . Social and Cultural Rights . Guiding Principles on Internal Displacement (1998). Arab Charter on Human Rights (1994). in the Protection of Prisoners and Detainees against Torture and Other Cruel. Inter-American Convention to Prevent and Punish Torture (1985). Inhuman or Degrading Treatment or Punishment (1982). African Charter on the Rights and Welfare of the Child (1990). (1999). (revised 1996). Additional Protocol to the American Convention on Human Rights in the Area of Economic.1994). Declaration on the Right to Development (1986).” (1994). United Nations Principles for Older Persons (1991). 32 . Declaration on the Elimination of Violence Against Women (1993).

Second United Nations Conference on Human Settlements (Habitat II). Beijing (1995): Beijing Declaration and Platform for Action. Copenhagen Plus 5 (2000). 1994: Programme of Action. Protection and Development of Children and Plan of Action for Implementing the World Declaration. and its follow-up. New York (1990): World Declaration on the Survival. Fourth World Conference on Women. Durban (2001): Durban Declaration and Programme of Action. United Nations Conference on Environment and Development. World Summit for Social Development. United Nations General Assembly Special Session (UNGASS) on AIDS (2001): Declaration of Commitment on HIV/AIDS “Global Crisis – Global Action. International Conference on Population and Development. Beijing Plus 5 (2000). Declaration of the World Food Summit: Five Years Later. Copenhagen (1995): Copenhagen Declaration on Social Development and Programme of Action of the World Summit for Social Development. World Conference on Human Rights. 33 . Racial Discrimination Xenophobia and Related Intolerance. Cairo.” World Conference Against Racism. International Alliance Against Hunger (2002). and its follow-up. Second World Assembly on Ageing (2002): Political Declaration and Madrid International Programme of Action on Ageing. Rome (1996): Rome Declaration on World Food Security and World Food Summit Plan of Action. World Food Summit. the United Nations General Assembly Special Session (UNGASS) on Children (2002): A World Fit for Children. and its follow-up. Vienna (1993): Vienna Declaration and Programme of Action. Istanbul (1996): Istanbul Declaration on Human Settlements. and its follow-up. Rio de Janeiro (1992): Rio Declaration on Environment and Development and Agenda 21.2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s International conference documents and their follow-up (in chronological order) relevant to health & human rights World Summit for Children.

Social and Cultural Rights (CESCR) SECRETARIAT TRUSTEESHIP COUNCIL Other Subsidiary bodies Human Rights Committee (HRC) Commitee against Torture (CAT) INT. (83) Secretary General GENERAL ASSEMBLY SECURITY COUNCIL ECONOMIC AND SOCIAL Treaty-monitoring bodies COUNCIL (Conventional mechanisms) Commitee on Economic. Emphasis is given to those bodies and programmes with major human rights responsibilities. on Crime Prevention OF JUSTICE & Criminal Justice Commitee on the Elimination of Racial Discrimination (CERD) Commitee on the Elimination of Discrimination Commission on the againts Women (CEDAW) status of Women United Nations Hight Commissioner system Commitee on the Right of the Child (CRC) for Human Rights Humanitarian Commission on Country and Thematic Special Rapporteurs… Int. http://www.htm 34 . which is not exhaustive. Switzerland (83) This organizational chart is used courtesy of the Office of the High Commissioner for Human Rights. describes the functioning of the United Nations system in the field of human rights. COURT Com. 2 5 Q u e st i o n s & A n swe r s o n H e a lt h a n d H u m a n R i g h t s Annex II: United Nations Human Rights Organizational Structure This chart. whereas the green ones indicate bodies or programmes serviced by the Office of the United Nations High Commissioner for Human Rights.ch/ hrostr. Criminal Trust Funds Human Rights (Extra-Conventional mechanisms) Tribunal for ex-Yugoslavia Working Groups Technical cooperation Int.unhchr. The purple areas indicate six principle © WHO/PAHO organs of the United Nations. Criminal Sub-Commission on Tribunal for Human Rights the Promotion and Protection Rwanda Field Presences of Human Rights Working Groups Copyright 1997 Office of the United Nations High Commissioner for Human Rights Special Committee on Israeli Practices in Occupied Territories Geneva.

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It is intended as a practical guide to generate increased clarity and understanding among WHO staff and other health. attempts to answer key questions that come to mind in exploring the linkages between health and human rights.1 For more information. In this context. development and human rights practitioners about the important synergy between health and human rights.who.int/hhr . WHO has launched the Health and Human Rights Publication Series to explore the complex relationship between health and human rights regarding various health challenges. please contact: Helena Nygren-Krug Health and Human Rights Strategy Unit Director General’s Office World Health Organization 20. avenue Appia – 1211 Geneva 27 – Switzerland Tel. (41) 22 7912523 – Fax: (41) 22 7914726 www.The enjoyment of the highest attainable standard of health as a fundamental right of every human being was enshrined in WHO’s Constitution over fifty years ago. WHO strives to make this right a reality for everyone. paying particular attention to the poorest and most vulnerable. 25 Questions and Answers on Health and Human Rights. The first in this series. Health & Human Rights Publication Series Issue No.