This is clearly a very exciting and exhilarating time to be working in health and human rights but it is a difficult job too. For we are creating, participating in, and witnessing an extraordinary moment in social history the emergence of a health and human rights movement at the intersection and at the time of two enormous paradigm shifts. Stimulated in the first instance by pressures within each field, both public health and human rights are undergoing major transformations, so that the linkages between them, and the outcomes of their association have now become dynamic and even more challenging than may have been evident just a few years ago.
The challenge of applying human rights concepts in analysis and response to health problems, such as violence, has helped reveal previously unrecognized difficulties and limitations in traditional human rights work; similarly, efforts to define, expand and protect human rights in health-relevant settings, such as sexual rights and health, uncover substantial gaps or inconsistencies in health thinking and practice.
New work is both needed, and underway, within each of the recognized elements of “health and human rights”. In public health, we are struggling mightily with a major paradigm shift. Public health involves “ensuring the conditions in which people can be healthy,” and we do know that the so-called “societal factors” constitute the major determinants of health status. Yet despite much research (usually focusing on socioeconomic status as the principle variable) we are painfully aware of our ignorance about precisely what these societal determinants actually are.
The health and human rights linkage, as seen from the public health side, proposes based at this time more on insight and experience than data that modern human rights provides a better guide for identifying, analyzing and responding directly to critical societal conditions than any Framework inherited from the biomedical or recent public health tradition. Thus, promoting and protecting health is proposed to depend upon the promotion and protection of human rights and dignity.
The consequences of this line of thinking are nothing short of revolutionary for public health practice. Public health has traditionally sought, through application of standard epidemiological techniques, to identify risk factors associated with disease, disability and premature death; these risk factors were considered to reside at an individual level, such as tobacco smoking, over-eating, excess alcohol intake, lack of exercise; and then, based on this analysis, public health sought to stimulate individual behavior change through information, education, and clinic-based services.
In contrast to take a health and human rights analysis which is to say a societally based analysis seriously, requires uncovering the rights violations failures of rights realization, and burdens on dignity which constitute the societal roots of health problems.
Human rights are also undergoing a major paradigm shift. The concept of rights is expanding rapidly, propelled by increased knowledge and experience, changing societal challenges and conditions, and realization of the inherent limits in the earlier rights concepts and practices. The earlier categories of positive and negative rights are blurred, new rights are conceptualized, rights concepts are expanded by considering how rights are affected by important non-state actor, and state responsibility is increasingly invoked in areas of life which used to be considered part of a private sphere outside the ambit of rights such as rape and domestic violence. While traditional modes of work are still extremely useful as is also the case in public health new forms of action to promote and protect human rights are clearly needed.
One element of what might be called an “ethic of health and human rights work” is the need for inclusiveness and tolerance. We insist upon tolerance of diversity and respect for dignity from others; we must also ensure that we manifest that same tolerance and respect in our own analysis and action. This requires that we transcend solidarity of exclusion to achieve solidarity of inclusion for indeed, this is the only true solidarity.
Any group faced with oppression and discrimination develops, in response, a group solidarity which is most often-unfortunately solidarity of exclusion. This inward thinking, while providing some psychological and practical benefits to members of the group, yields only short-term relief, and is ultimately self-defeating. Perhaps it might be best to work preferentially with others for their rights a perspective based on the understanding that protecting one’s own rights is only possible when rights of others are respected a perspective entirely consistent with modem, crossing-borders human rights thinking.
A second, closely related element of an “ethic of health and human rights” work is to avoid demonizing others. To promote rights of heterosexuals by demeaning gay and lesbian people is absurd and sell-defeating; as is stereotyping men in order to promote women’s rights; or promoting children’s rights by treating parents and other adults only as perpetrators and violators. We must have the courage and intellectual integrity to refuse the methods used by the violators; prejudice expressed by human rights advocates remains prejudice and is unacceptable.
We are in the vanguard of a movement which is also a new kind of movement. For we share much, but we do not seek an officialdom, a dogma or complex organizational structures. Despite uncertainty and in the midst of profound changes in the two fields, health and human rights are increasingly understood and felt to be actually two entirely complementary ways of speaking about and working to ameliorate human suffering in all its forms and whenever it occurs. We share a confidence in the future and in our ability to contribute each in our own ways and yet together to the healing of the world.
Rescue Plan for Planet Earth
