Called to Action

Called to Action

Health as a Human Right

For countless members of the public health profession, human rights and social justice are, as one SPH student puts it, "the reason I decided to go into public health in the first place."

You don't have to be a freshly minted School of Public Health alum to remember the all-school symposium. It was conceived in 1998 as a day of "thinking broadly and intensely as a community about a public health issue." It comes around every other year in the fall to give students experience at a professional-style conference. Classes are canceled so students can participate, but not all do. Attendance some years has tapered off to embarrassingly small numbers before the final speakers come to the podium.

But suddenly in 2010, students were not bailing at the breaks. And when question times came around, they were jumping up and beating the usual faculty discussants to the microphones. They wanted to talk—to comment and to ask—about health reform, "hyperincarceration" in the U.S. and the plight of prisoners, environmental justice, trafficking of sex workers, and oppressed populations in all corners of the globe.

The right to health, it became clear, is a subject that current SPH students care deeply about.

Which is not to say no one cared about aging, genetically modified organisms, and other topics of previous SPH all-school symposia. But with 2010's symposium and related film series on "Health and Human Rights: Reframing the Public Health Agenda," the symposium's planners tapped into a topic especially meaningful to young adults who are choosing careers in public health in growing numbers.

"My goal with the symposium is to have people think about a human rights–based approach to the work we do, and how we connect all this," said Siobán Harlow, professor of epidemiology and 2010 program chair and moderator. She teaches one of the main courses on health and human rights offered at SPH (see class syllabus.)

The symposium and its website gave students grounding in the major international documents and treaties of human rights, beginning in 1946, when the constitution of the World Health Organization (WHO) first defined a right to health as "one of the fundamental rights of every human being." In the 1990s, the groundbreaking work of Jonathan Mann of WHO's Global Programme on AIDS began to articulate how people living with HIV and AIDS needed more protection against discrimination. The publication of General Comment 14 on the Right to Health by the United Nations' Committee on Economic, Social and Cultural Rights followed, as did more human rights framework for health policies and programs.

Today's human-rights approach to health aims to establish a legal and social obligation on the part of the state and other institutions to guarantee the appropriate and equitable conditions for all people to be healthy, SPH symposium materials explained. "Often described as ensuring a 'basic right to health,' this perspective is also now codified in the constitutions of several nations." The day's speakers interpreted the scope of that obligation in diverse ways, ranging from what it means in war-torn regions and among vulnerable populations close to home.

The first symposium speaker was Sofia Gruskin, JD, director of the Program on International Health and Human Rights at Harvard SPH. "From countries around the world, we're seeing how concrete application of human rights concepts and methods are relevant in mental health, tobacco, and chronic disease and a whole host of new issues," she said. "The blessing, or you could call it the curse, of the language of human rights is that it's language that everybody feels they can own and use in whatever way that they like," Gruskin said.

Gruskin also pointed out that the United States has ratified many international documents related to rights (on the subjects of racial discrimination, civil and political rights, and torture) but not all. The U.S. and Somalia failed to ratify 1989's Convention on the Rights of the Child. And in 2002, the U.S. and Australia were the only developed countries who voted against the United Nations Commission on Human Rights resolution establishing a human rights monitoring mechanism: a Special Rapporteur on the right to the highest attainable standard of health.

Throughout the SPH symposium, nearly a dozen prominent speakers discussed how they do public health work in a human rights framework. For example:

  • Robert Bullard, of the Environmental Justice Resource Center at Clark Atlanta University, focused on the double burden of poverty and pollution, "the link between where you live and your quality of life," and zip-code predictors of health access and opportunity.
  • Eric Stover, of the Human Rights Center at Berkeley, talked about using public health theories and methods in international investigations of torture and the dangers of land mine zones in postwar countries. "Children are the ones who take cattle out to graze," he said, explaining their ongoing vulnerability to fields that haven't been de-mined.
  • Fritz Scheuren explained the momentum behind Statistics without Borders, a group set up so statisticians could use their discipline to enhance human health and well-being. "When all is said and done, more is said than is done," he said. "Information is part of the second response. Statisticians use our discipline to enhance human welfare."

Afternoon discussion sessions gave students more time to interact with the speakers. Harlow said she hoped they would project forward, to consider how future "public health careers might be reframed if you were to undertake your work using a human rights framework." Event evaluations indicate support for that hope. Three-quarters of student respondents rated the symposium excellent, and only three percent assessed it negatively.

"I am always simultaneously encouraged and discouraged when considering human rights," first-year SPH student Katie Sloter blogged the day after the symposium. "I am discouraged by the lack of enforcement mechanisms in peacekeeping activities, and the inherent despair in the atrocities that human beings continue to perpetrate against one another.

"However, even in discussing torture, land mines, devastating natural disasters, I see a glimpse of humanity in the fact that there are those who still respond, and strive to turn rhetoric into action. Every professional at the symposium has seen that something needs to be done to give voice to the most vulnerable people in our world. They have seen that sitting back and watching is unacceptable; and so they have devoted their lives and careers to removing what despair they can and adding what joy they can. This is, after all, the reason I decided to go into public health in the first place. As individuals we cannot win against the vastness of human rights violations, but as a collection of professionals in medicine, law, education, economics, public health, we can try."

Health as Social Justice

Probably every health or social issue that came up at the SPH all-school symposium on health and human rights in October was revisited numerous times a month later at the American Public Health Association Annual Meeting and Exposition in Denver. The nominal theme for 2010 was "Social Justice: A Public Health Imperative," and tens of thousands of public health professionals, students, and academics were on hand to network and converse.

For Michiganders wondering exactly how to align their new right-to-health perspective with the imperative of social justice in public health, an answer might not have been immediately apparent. Whereas the SPH symposium had offered up a body of international legal "instruments" as a framework for designing and implementing public health programs—and potentially for educating the workforce for these programs—social justice seemed even more susceptible to the blessing and curse of application to every problem. At hundreds of tables at the huge APHA exposition, nonprofit organizations and commercial vendors stood ready to dispense their social justice credentials along with giveaways of condoms, reuseable grocery bags, and granola snacks.

APHA President Georges C. Benjamin's welcome message highlighted plenary sessions on "timely public health and social justice issues relating to climate change, the oil spill in the Gulf of Mexico, the earthquake in Haiti, and ensuring access to quality nutrition." His only other mention of social justice, however, was obliquely as a core value of public health practice. He left the heavy lifting of framing the year's theme to opening session speaker Cornel West, an activist for social justice in American society.

West rose to the challenge with passionate rhetoric: "If you're concerned about justice, you want fairness—and not just for your side of town," he proclaimed animatedly, his trademark halo of hair bobbing as he gestured. "The fundamental question in talking about justice is what kind of human being will you choose to be? What kind of virtues, what kind of character, what kind of values do you want to exemplify in your life?"

Values and strategies were explored at hundreds of conference presentations. In the lively dialogue closing out session 3296, "Social Justice and the Socially Marginalized: The Time Is Right for a Global Action Plan," dozens of Europeans, Canadians, and Americans agreed on the need for evidence-based initiatives in the pursuit of equal protection of all. Some discussants suggested, however, that Americans who believe their Constitutional Bill of Rights already guarantees sufficient rights don't always come to the plate and play nice with "foreigners" on the worldwide stage. These Americans see participation with international instruments of human rights as superfluous. Social justice can thus seem a more palatable framework for good works and morality in this country, appealing to the best of our democratic principles.

"Public health is social justice in action," came a call from the middle of the room, as people were standing to leave.

Researchers on health disparities find social justice inherently important to what they do. For example, when SPH Assistant Professor Derek Griffith presented at session 4119: "Men of Color: Implications for Health," he talked about "how social determinants get into the body." His research has shown that unique structural pressures lead black men to relegate their own health needs lower than activities related to fulfilling social roles as employees, fathers, and husbands. "Data suggest that interventions designed to improve black men's eating behaviors and physical activity should consider how they cope with chronic life stressors," he concluded.

In a presentation on racial and ethnic colorectal cancer disparities, SPH doctoral student Elizabeth Becker charted complex factors contributing to why African Americans have lower cancer survival rates. She argues that if we are to better understand the complexities of disparities, we must assess interactions among gender, race, age, geographic location, and socioeconomic factors. She also envisions a more proactive and socially just way to pursue population health, investing in preventive care more, rather than mainly in curative practices. "I want to see the United States institute health days instead of just sick days," she said.

Months after the 2010 APHA annual meeting closed, endless discussion continues with multiple daily postings on "issues relevant to and making explicit links between social justice and public health" via the Spirit of 1848 Listserv. Anyone can sign up to be part of the "network linking politics, passion, and public health" via the website www.spiritof1848.org.

"By making connections, we can overcome some of the isolation that we feel," its mission statement says, "and find others with whom we can develop our thoughts, strategize, and enhance efforts to eliminate social inequalities in health."

If you have your own ideas about how the right to health can best be championed in social justice and human rights frameworks, you can comment below.

They Said It

"All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood."
—Article 1 of the United Nations Universal Declaration of Human Rights, 1948

At the 2010 UM SPH Schoolwide Symposium, Health and Human Rights: Reframing the Public Health Agenda:

  • "In war zones, we send in teams to survey the exposure to violence… We need more public health students joining the field of human rights. The theory you're learning now will help you understand phenomena you encounter."
    —Eric Stover, Director of the Human Rights Center, University of California, Berkeley
  • "I don't think we can call ourselves the land of the free anymore. The U.S. imprisons more people per capita than any other country in the world. And it is predominantly young African-American men we're locking up... But if we treat their diseases—mainly addiction and mental illness—they stay out of prison."
    —Josiah Rich, MD, The Center for Prisoner Health and Human Rights at The Miriam Hospital, Providence, Rhode Island
  • "Dangers and pitfalls can emerge from well-intentioned humanitarian campaigns... Politics premised on the ideal of the egalitarian heterosexual couple cannot imagine a place for prostitution outside the scope of exploitation... The unspoken sexual and carceral assumptions that prevail amongst these well-intentioned social activists can often end up doing more harm than good."
    —Elizabeth Bernstein, Barnard College, Columbia University

At the 2010 American Public Health Association Annual Meeting, Social Justice: A Public Health Imperative:

"Every generation has to regenerate democratic possibilities."
—Cornel West, Princeton University

"Human rights is about the avoidance of wrongs, regardless of status. Social justice is a philosophy rooted in the values of equality and mutuality. When it comes to health, they can be seen as two different ways of getting to doing what's 'right.' "
Cheryl Easley, Dean, University of Alaska, Anchorage, College of Health and Social Welfare; former APHA president; former UM Nursing School faculty member.

Article by Mary Beth Lewis

Watch video presentations from SPH's 2010 symposium, “Health and Human Rights: Reframing the Public Health Agenda."

Health and Human Rights: A Timeline
The right to health first emerged as a social right in 1946 in the World Health Organization Constitution. Two years later, the U.N. General Assembly formally adopted the concept in its Universal Declaration of Human Rights, and in 1966 the binding International Covenant on Economic, Social, and Cultural Rights detailed the progressive realization of the right to health through four concrete steps, including access to health facilities, goods, and services. Today the right to health is accepted as a fundamental component of human rights, and every country in the world is party to at least one human-rights treaty that addresses health-related rights.

Created in conjunction with the SPH 2010 symposium, this timeline tracks major developments in the evolution of health and human rights since World War II.

1945: U.N. International Court of Human Justice established.

1946: WHO Constitution defines a Right to Health, stating “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.”

1948: Universal Declaration of Human Rights (UN); Convention on the Freedom of Association and Protection of the Right to Organize, International Labour Organization (ILO) Convention on the Prevention and Punishment of the Crime of Genocide, UN

1949: Convention on the Right to Organize and Collective Bargaining

1950: European Convention on Human Rights; Convention for Suppression of Traffic in Persons and Exploitation of Prostitution of Others (UN)

1951: Convention on the Status of Refugees (UN)

1953: European Commission on Human Rights and Court of Human Rights are created

1957: Convention Concerning Abolition of Forced Labor; Convention Concerning Indigenous and Tribal Populations

1960: Inter-American Commission on Human Rights established, Organization of American States (OAS); Convention against Discrimination in Education adopted by the UN Educational, Scientific, and Cultural Organization (UNESCO)

1964: The Omnibus Civil Rights Bill bans discrimination in voting, jobs, public accommodation, and other activities (US)

1965: International Convention on the Elimination of All Forms of Racial Discrimination (UN)

1966: International Covenant on Civil and Political Rights (UN)

1966: International Covenant on Economic, Social and Cultural Rights (UN)

1968: First World Conference on Human Rights

1969: American Convention on Human Rights (OAS)

1973: International Convention on Suppression and Punishment of the Crime of Apartheid (UN)

1975: Declaration on Rights of Disabled Persons (UN)

1978: Declaration of Alma-Ata

1979: International Convention on the Elimination of All Forms of Discrimination against Women (UN)

1981: African Charter of Human and People’s Rights, Organization for African Unity

1984: Convention against Torture and Other Cruel, Inhumane or Degrading Treatment or Punishment (UN)

1986: Declaration on the Right to Development (UN)

1989: Convention on the Rights of the Child (UN)

1990: The Americans with Disabilities Act (US); International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families (UN); UM School of Natural Resources and Environment convenes the first environmental justice conference in the U.S.

1993: The Second World Conference on Human Rights adopts the Vienna Declaration and Programme of Action

1994: First UN High Commissioner for Human Rights, José Ayala Lasso, takes his post

1999: Convention Concerning the Prohibition and Immediate Action for the Elimination of the Worst Forms of Child Labour (ILO)

2000: General Comment on the Right to Health 14 published (UN); Millennium Declaration Resolution (UN, the MDGs)

2001: General Assembly Special Session on HIV/AIDS (UN)

2002: International Criminal Court established (UN)

2006: Convention on the Rights of Persons with Disabilities (UN); International Convention for the Protection of All Persons against Enforced Disappearances (UN)

2007: Declaration of the Rights of Indigenous Peoples (UN)