Presented  on  June  21st  2014  in  South  Pasadena  at  the    EMERGENCY  USA  Na=onal  Volunteer  Conference    

EMERGENCY  USA  believes  access  to  medical  treatment  is  a  basic  and  

inalienable  human  right.  

•  Human rights:

•  are primarily about the relationship between the individual and the state

•  are universal, interrelated and indivisible

•  imposes on governments the obligation to respect, protect and fulfill human rights

•  International human rights law:

•  defines what governments can do to us, cannot do to us, and should do for us

•  is meant to be equally applicable to everyone, everywhere in the world, across all borders and across all cultures and religions

• consists of the obligations that governments have agreed they have in order to be effective in promoting and protecting our rights

Defining  Terms:  Human  Rights    

Defining  Terms:  Health      

 •  Health  as  an  aspira7onal  goal:  “Health  is  a  state  of  complete  physical,  mental  and  social  

well-­‐being  and  not  merely  the  absence  of  disease”    Cons=tu=on  of  the  World  Health  Organiza=on,  adopted  by  the  Interna=onal  Health  Conference,  New  York,  19  June-­‐22  July  1946  

 •  Health  as  an  instrumental  goal:  “Ensuring  the  condi=ons  in  which  people  can  be  

healthy”    Ins=tute  of  Medicine,  Future  of  Public  Health,  Summary  and  Recommenda=ons,  Washington,  DC:  Na=onal  Academy  Press,  1988  US  Ins=tute  of  Medicine    

 •  Interna7onal  Health:  “Tradi=onally  defined  by  the  rela=ons  between  states”    

 Lee  K.  Lancet  World  health:  shaping  the  future  of  global  health  coopera=on:  where  can  we  go  from  here?,  Lancet,  vol.  351,  no.  9106,  pp.  899-­‐902  

 •  Global  Health:  “Relates  to  health  issues  that  transcend  na=onal  borders,  class,  race,  

ethnicity  and  culture.    The  term  stresses  the  commonality  of  health  issues  and  requires  a  collec=ve  (partnership-­‐based)  ac=on”    Global  Health  Educa=on  Consor=um,  ‘Global  vs.  Interna=onal,’  hfp://globalhealthedu.org/Pages/GlobalvsInt.aspx  

 •  Health  as  a  right:  “The  right  of  everyone  to  the  enjoyment  of  the  highest  afainable  

standard  of  physical  and  mental  health”    UN.  Ar=cle  12,  Interna=onal  Covenant  on  Economic,  Social  and  Cultural  Rights,  adopted  and  opened  for  signature,  ra=fica=on  and  accession  by  United  Na=ons  General  Assembly  Resolu=on  2200  A(XXI).  New  York:  United  Na=ons,  1966  

     

•  Customary law – Consistent practice with a sense of legal

obligation – General Assembly Resolutions like the Universal

Declaration of Human Rights (UDHR) are evidence of customary law – they are not legally binding

•  International agreements (treaties, conventions, covenants) – Can serve as codification of international

customary law or be valid international law even if no custom precedes it

–  Legally binding for countries who sign on to them

Sources and Evidence of International Law

•  In 1945, human rights was set out as one of the purposes and principles of the UN

•  Took human rights out of national concern and placed squarely into international law – spoke only of promotion, not protection

•  The Universal Declaration of Human rights (UDHR) is a declaration, not a treaty. It has a special place in international law and may have risen to the level of proof of customary law

•  The 2 Covenants further elaborate the rights set out in the UDHR: International Covenant on Civil and Political Rights (CCPR); International Covenant on Economic, Social and Cultural Rights (CESCR)

•  The UN Charter, UDHR and 2 Covenants are often called the International Bill of Human Rights

•  Over 25 other international human rights treaties exist that further elaborate the concepts set out in the International Bill of Human Rights

Modern Human Rights Law

Fundamental Values Underpinning Human Rights

•  Respect for the physical and mental integrity of the person

•  Respect for individual autonomy, including personal and group self-determination

•  Guarantees of the material conditions of existence necessary to lead a productive and fulfilling life

•  Equality and non-discrimination

Interna=onal  Human  Rights  Documents    Relevant  to  Health  

1948:  Universal  Declara=on  of  Human  Rights  (UDHR)    Trea&es:  Legally  binding  on  na0ons  that  have  ra0fied    1965:    Interna=onal  Conven=on  on  the  Elimina=on  of  All  Forms  of  Racial        

Discrimina=on  1966:    Interna=onal  Covenant  on  Economic,  Social,  and  Cultural  Rights  1966:    Interna=onal  Covenant  on  Civil  and  Poli=cal  Rights  1979:    Interna=onal  Conven=on  on  the  Elimina=on  of  All  Forms  of                  

 Discrimina=on  Against  Women  1985:    Conven=on  Against  Torture  1990:    Conven=on  on  the  Rights  of  the  Child    2000:    Conven=on  on  the  Protec=on  of  Migrant  Workers  and  their  Families  (2006)  Conven=on  on  the  Rights  of  Persons  with  Disabili=es  (2006)    Interna=onal  Conven=on  for  the  Protec=on  of  All  Persons                    

 Against  Enforced  Disappearances  

Human Rights Relevant to Health

•  The right to life, survival, and development

•  The right to equality and non-discrimination

•  The right to travel •  The right to bodily integrity

and security of the person •  The right to an identity •  The right to privacy •  The right to seek, receive

and impart information

•  The right to food •  The right to housing •  The right to social security •  The right to be free from

torture •  The right to association •  The right to the benefits of

scientific progress •  The right to education •  The right to health

In  Red  are  items  directly  relevant  to  the  programs    and  ini=a=ves  EMERGENCY  USA  supports  

Further Defining The Right to Health

•  As stated by the UN Committee on Economic, Social, and Cultural Rights, bringing human rights into health programming includes ensuring the –  availability, –  accessibility, –  acceptability and –  quality of health services; and –  ensuring attention to the underlying determinants of health, such

as access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, and healthy occupational and environmental conditions

•  Human rights, such as the right to the highest attainable standard of health, are understood to be progressively implemented by the state to the “maximum of its available resources.”

•  States must “take steps, individually and through international assistance and cooperation, especially economic and technical, to the maximum of its available resources, with a view to achieving progressively the full realization of the rights recognized in the [Economic, Social, and Cultural Rights] covenant by all appropriate means, including particularly the adoption of legislative measures.” ICESCR, Art 2 (1)

Progressive Realization

•  credibility stems from “impartial application of universal norms”

•  methods of work relevant to health include: –  research –  legal representation –  publicity –  training –  investigation –  provision of direct assistance –  intervention at national and international level –  lobbying

Human Rights NGOs

UN Mechanisms Overseeing Health-Related Human Rights UNITED NATIONS HUMAN RIGHTS MECHANISMS

Charter-­‐based  bodies   Treaty  bodies  

General Assembly

Human Rights Council

Special Rapporteurs/Working groups

Country specific

 The  UN  Special  Rapporteur  on  the    right  to  health        

Sub-Commission on Protection and

Promotion of Human Rights

Human Rights Committee (HRC)

Committee on Economic, Social and Cultural Rights (CESCR)

Committee on the Elimination of Discrimination Against Women (CEDAW)

Committee of the Rights of the Child (CRC)

Committee on the Elimination of Racial Discrimination (CERD)

Committee Against Torture (CAT)

Committee on Migrant Workers (CMW)

Thematic: e.g.

Accountability

•  What do we mean by it? •  Who ensures it?

- National level courts -International reporting mechanisms (including treaty monitoring bodies)

- Media - NGOs - World Bank Inspection Panels etc..

A (the) Human Rights-Based Approach

The Genesis of (H)RBAs

•  Rights-based approach to child growth and development (UNICEF 1990s)

•  RBAs in health and development programs (International

Organizations, NGOs…)

•  Human-rights based approach to development programming (UNDP 1998)

UN Secretary General Kofi Annan’s Definition of a RBA (1997)

“A rights-based approach to development describes situations not simply in terms of human needs, or of developmental requirements, but in terms of society's obligations to respond to the inalienable rights of individuals, empowers people to demand justice as a right, not as charity, and gives communities a moral basis from which to claim international assistance when needed.”

UN Statement of Common Understanding of the Human Rights-Based Approach to Development

(1) 1.  All programmes of development co-operation, policies and

technical assistance should further the realisation of human rights as laid down in the Universal Declaration of Human Rights and other international human rights instruments.

2. Human rights standards contained in, and principles derived from the Universal Declaration of Human Rights and other international human rights instruments guide all development cooperation and programming in all sectors and in all phases of the programming process.

•  Human rights standards include the minimum level of programmatic and/or policy-level activity necessary to be able to affirm that a right is being fulfilled. For example, one of the minimum core obligations of the right to health is that health facilities, goods, and services are available, accessible, acceptable, and of high quality (3AQ).

UN Statement of Common Understanding (2) 3.  Human rights principles are:

•  Universality and inalienability •  Indivisibility •  Inter-dependence and Inter-relatedness •  Equality and Non-discrimination •  Participation and Inclusion •  Accountability and Rule of Law

4.  Development cooperation contributes to the development of the capacities of ‘duty-bearers’ to meet their obligations and/or of ‘rights-holders’ to claim their rights.

•  Every individual is a rights-holder •  Duty-bearers are primarily State actors and institutions at

various levels of government, and certain non-state actors who have responsibilities to carry out in response to other actors exercising their rights

In General, a HRBA…

•  Emphasises the process as well as the outcome of programming

•  Draws attention to the most marginalized populations •  Works towards equitable service delivery •  Extends and deepens participation •  Ensures local ownership of development processes •  Strengthens the accountability of all actors

A Human Rights-Based Approach to Health and Development

•  Intrinsic rationale: A HRBA is the right thing to do, morally and legally.

•  Instrumental Rationale: A HRBA can lead to better and more sustainable outcomes because it: –  Has a special focus on groups subjected to discrimination

and suffering from disadvantage and exclusion; –  Emphasizes participation; –  Counts on the accountability of the State and its institutions; –  Gives attention to the capacities and needs of both rights-

holders and duty-bearers, and thus fosters a lasting sense of shared ownership in efforts to improve the community’s well-being, and prepares the actors to work together in other ways to address new challenges arising in the future.

EMERGENCY:  a  Rights  Based  Approach:  

Manifesto for a Human Rights Based Medicine

After the International Workshop “Building Medicine in Africa. Principles and Strategies” hosted at San Servolo Island, Venice, Italy, on May 14 -15, 2008

and in accordance with the spirit and the principles of the Universal Declaration of Human Rights, stating that

“All human beings are born free and equal in dignity and rights” (art.1) “Everyone has the right... to medical care” (art.25)

“The recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom,

justice and peace in the world” (Preamble)

WE HEREBY DECLARE the “Right to be Treated” as a basic and inalienable right belonging to each

and every member of the human community.

WE THEREFORE ADVOCATE the implementation of health systems and projects solely devoted to

preserve, extend and improve the life of the people in need and based on the following principles:

Equality Every human being has the right to be cured regardless his

economic and social condition, gender, race, language, religion and opinions. Standards of health care, set by the progress of

medical knowledge, must be delivered equally and without discrimination to all patients.

Quality

High quality health systems must be based on community’s needs, up to date with the achievements of medical science, and not oriented, shaped or determined by lobbies and corporations

involved in the health industry.

Social Responsibility Governments must have the health and well being of their citizens

as their priority, and allocate adequate human and financial resources. The services provided by health systems and

humanitarian projects in the health sector must be accessible to and free of charge for all.

As  Health  Authori=es  and  Humanitarian  Organiza=ons    

WE  RECOGNIZE  EQS  (Equality,  Quality,  Social  responsibility)  based  health  systems  and  projects  as  respecmul  of  human  rights,  appropriate  to  develop  medical  science  and  effec=ve  

in  promo=ng  health  by  strengthening  and  genera=ng  human,  scien=fic  and  material  resources.  

 WE  COMMIT  

To  plan  and  develop  EQS  based  policies,  health  systems  and  projects.  To  cooperate  among  us  to  iden=fy  common  needs  in  the  health  sector  and  design  

joint  programs.    

WE  APPEAL  To  other  Health  Authori=es  and  Humanitarian  Organisa=ons  to  sign  this  

Manifesto  and  to  join  in  promo=ng  an  EQS  based  medicine.  To  donors  and  to  the  interna=onal  aid  community  to  support,  fund  and  par=cipate  in  designing  and  

implemen=ng  EQS  based  programs.  

Afghanistan:  Status  of  Ra=fica=on  •  Afghanistan  has  ra=fied  the  following:  

–  CERD:    Conven=on  on  the  Elimina=on  of  all  forms  of  Racial  Discrimina=on  –  CCPR:    Covenant  on  Civil  and  Poli=cal  Rights  –  CESCR:    Covenant  on  Economic,  Social  and  Cultural  Rights  –  CAT:    Conven=on  Against  Torture  –  CEDAW:    Conven=on  on  the  Elimina=on  of  All  Forms  of  Discrimina=on  

against  Women  –  CRC:    Conven=on  on  the  Rights  of  Children  –  CRPD:  Conven=on  on  the  Rights  of  Persons  with  Disabili=es  

Not  ra=fied:      –  CMW:  Conven=on  on  the  Protec=on  of  the  Rights  of  All  Migrant  Workers  and  

Members  of  their  Families  –  CPPED:    Conven=on  for  the  Protec=on  of  All  Persons  from  Enforced  

Disappearance  

IRAQ:  Status  of  Ra=fica=on  •  Iraq  has  ra=fied  the  following:  

–  CERD:    Conven=on  on  the  Elimina=on  of  all  forms  of  Racial  Discrimina=on  –  CCPR:    Covenant  on  Civil  and  Poli=cal  Rights  –  CESCR:    Covenant  on  Economic,  Social  and  Cultural  Rights  –  CAT:    Conven=on  Against  Torture  –  CEDAW:    Conven=on  on  the  Elimina=on  of  All  Forms  of  Discrimina=on  

against  Women  –  CRC:    Conven=on  on  the  Rights  of  Children  –  CPPED:    Conven=on  for  the  Protec=on  of  All  Persons  from  Enforced  

Disappearance  

Not  ra=fied:      –  CRPD:  Conven=on  on  the  Rights  of  Persons  with  Disabili=es  –  CMW:  Conven=on  on  the  Protec=on  of  the  Rights  of  All  Migrant  Workers  and  

Members  of  their  Families  

Central  African  Republic:    Status  of  Ra=fica=on  

•  CAR  has  ra=fied  the  following:  –  CERD:    Conven=on  on  the  Elimina=on  of  all  forms  of  Racial  Discrimina=on  –  CCPR:    Covenant  on  Civil  and  Poli=cal  Rights  –  CESCR:    Covenant  on  Economic,  Social  and  Cultural  Rights  –  CEDAW:    Conven=on  on  the  Elimina=on  of  All  Forms  of  Discrimina=on  

against  Women  –  CRC:    Conven=on  on  the  Rights  of  Children  

Not  ra=fied:      –  CAT:    Conven=on  Against  Torture  –  CRPD:  Conven=on  on  the  Rights  of  Persons  with  Disabili=es  –  CMW:  Conven=on  on  the  Protec=on  of  the  Rights  of  All  Migrant  Workers  

and  Members  of  their  Families  –  CPPED:    Conven=on  for  the  Protec=on  of  All  Persons  from  Enforced  

Disappearance  

Sudan:  Status  of  Ra=fica=on  •  Sudan  has  ra=fied  the  following:  

–  CERD:    Conven=on  on  the  Elimina=on  of  all  forms  of  Racial  Discrimina=on  –  CCPR:    Covenant  on  Civil  and  Poli=cal  Rights  –  CESCR:    Covenant  on  Economic,  Social  and  Cultural  Rights  –  CAT:    Conven=on  Against  Torture  –  CEDAW:    Conven=on  on  the  Elimina=on  of  All  Forms  of  Discrimina=on  

against  Women  –  CRC:    Conven=on  on  the  Rights  of  Children  –  CRPD:  Conven=on  on  the  Rights  of  Persons  with  Disabili=es  

Not  ra=fied:      –  CMW:  Conven=on  on  the  Protec=on  of  the  Rights  of  All  Migrant  Workers  

and  Members  of  their  Families  –  CPPED:    Conven=on  for  the  Protec=on  of  All  Persons  from  Enforced  

Disappearance  

Sierra  Leone:  Status  of  Ra=fica=on  •  Sierra  Leone  has  ra=fied  the  following:  

–  CERD:    Conven=on  on  the  Elimina=on  of  all  forms  of  Racial  Discrimina=on  –  CCPR:    Covenant  on  Civil  and  Poli=cal  Rights  –  CESCR:    Covenant  on  Economic,  Social  and  Cultural  Rights  –  CAT:    Conven=on  Against  Torture  –  CEDAW:    Conven=on  on  the  Elimina=on  of  All  Forms  of  Discrimina=on  

against  Women  –  CRC:    Conven=on  on  the  Rights  of  Children  –  CRPD:  Conven=on  on  the  Rights  of  Persons  with  Disabili=es  

Not  ra=fied:      –  CMW:  Conven=on  on  the  Protec=on  of  the  Rights  of  All  Migrant  Workers  

and  Members  of  their  Families  –  CPPED:    Conven=on  for  the  Protec=on  of  All  Persons  from  Enforced  

Disappearance  

United  States:  Status  of  Ra=fica=on  •  The  U.S.  has  ra=fied  the  following:  

–  CERD:    Conven=on  on  the  Elimina=on  of  all  forms  of  Racial  Discrimina=on  –  CCPR:    Covenant  on  Civil  and  Poli=cal  Rights  –  CAT:    Conven=on  Against  Torture  –  CRPD:  Conven=on  on  the  Rights  of  Persons  with  Disabili=es  

Not  ra=fied:      –  CESCR:    Covenant  on  Economic,  Social  and  Cultural  Rights  –  CEDAW:    Conven=on  on  the  Elimina=on  of  All  Forms  of  Discrimina=on  

against  Women  –  CRC:    Conven=on  on  the  Rights  of  Children  (the  U.S.  has  signed  the    

Op=onal  Protocols    CRC:OPSC  and  CRC:OPAC)  –  CMW:  Conven=on  on  the  Protec=on  of  the  Rights  of  All  Migrant  Workers  

and  Members  of  their  Families  –  CPPED:    Conven=on  for  the  Protec=on  of  All  Persons  from  Enforced  

Disappearance  

Acknowledgments:    

Apprecia=on  to  Professor  Sofia  Gruskin    For  permission  to  adapt  and  use  the  content  in  this  presenta=on  

 Source:      USC  Spring  2014  Course  

Global  Health,  Law  and  Human  Rights    

And  Thank  You    To  the  conference’s  special  guest  presenter  

Keely  Badger