25 Questions and Answers on Health and Human Rights

<strong>25</strong> <strong>Questions</strong>& <strong>Answers</strong>onHealth & HumanRightsWorld Health Organization

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human RightsTable of ContentsAbbreviations <strong>and</strong> Acronyms 6Section 1: Health <strong>and</strong> Human Rights Norms <strong>and</strong> St<strong>and</strong>ards 7Q.1 What are human rights? 7Q.2 How are human rights enshrined in international law? 7Q.3 What is the link between health <strong>and</strong> human rights? 8Q.4 What is meant by “the right to health”? 9Q.5 How does the principle of freedom from discrimination relate to health? 11Q.6 What international human rights instruments set out governmental commitments? 12Q.7 What international monitoring mechanisms exist for human rights? 12Q.8 How can poor countries with resource limitations be held to the same human rightsst<strong>and</strong>ards as rich countries? 14Q.9 Is there, under human rights law, an obligation of international cooperation? 14Q.10 What are governmental human rights obligations in relation to other actors in society? 15Section 2: Integrating Human Rights in Health 16Q.11 What is meant by a rights-based approach to health? 16Q.12.What is the value-added of human rights in public health? 18Q.13.What happens if the protection of public health necessitates the restrictionof certain human rights? 18Q.14 What implications could human rights have for evidence-based health information? 19Q.15 How can human rights support work to strengthen health systems? 20Q.16 What is the relationship between health legislation <strong>and</strong> human rights law? 21Q.17 How do human rights apply to situational analyses of health in countries? 21Section 3: Health <strong>and</strong> Human Rights in a Broader Context 22Q.18 How do ethics relate to human rights? 22Q.19 How do human rights principles relate to equity? 22Q.20 How do health <strong>and</strong> human rights principles apply to poverty reduction? 23Q.21 How does globalization affect the promotion <strong>and</strong> protection of human rights? 24Q.22 How does international human rights law influence international trade law? <strong>25</strong>Q.23 What is meant by a rights-based approach to development? 26Q.24 How do human rights law, refugee law <strong>and</strong> humanitarian law interact with the provisionof health assistance? 27Q.<strong>25</strong> How does human rights relate to health development work in countries? 28Annex I: Legal Instruments 29Annex II: United Nations Human Rights Organizational Structure 327

Abbreviations <strong>and</strong> AcronymsACCCATCCACCPOQCDFCEDAWCERDAdministrative Committee on CoordinationConvention against Torture <strong>and</strong> Other Cruel, Inhuman or Degrading Treatmentor Punishment (1984)Common Country AssessmentConsultative Committee on Programme <strong>and</strong> Operational <strong>Questions</strong>Comprehensive Development FrameworkConvention on the Elimination of All Forms of Discrimination Against Women(1979)International Convention on the Elimination of All Forms of Racial Discrimination(1963)CRC Convention on the Rights of the Child (1989)ECOSOCIACHRICCPREconomic <strong>and</strong> Social CouncilInter-American Commission on Human RightsInternational Covenant on Civil <strong>and</strong> Political Rights (1966) <strong>and</strong> its two Protocols(1966 <strong>and</strong> 1989)ICESCR International Covenant on Economic, Social <strong>and</strong> Cultural Rights (1966)ILOIMFNGOOHCHRPAHOPRSPUNTRIPSInternational Labour OrganisationInternational Monetary FundNon-Governmental OrganizationUnited Nations Office of the High Commissioner for Human RightsPan-American Health OrganizationPoverty Reduction Strategy PaperUnited NationsTrade Related Aspects of Intellectual Property RightsUDHR Universal Declaration of Human Rights (1948)UNDPUNDAFUNGASSUNICEFWANAHRWHOWTOUnited Nations Development ProgrammeUnited Nations Development Assistance FrameworkUnited Nations General Assembly Special SessionUnited Nations Children’s FundWorld Alliance for Nutrition <strong>and</strong> Human RightsWorld Health OrganizationWorld Trade Organization8

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human RightsSection 1:Health & HumanRights Norms<strong>and</strong> St<strong>and</strong>ardsQ.1 What are humanrights?©WHO/PAHO(1) AdministrativeCommittee onCoordination (ACC); TheUnited Nations System<strong>and</strong> Human Rights:Guidelines <strong>and</strong>Information for theResident CoordinatorSystem; approved onbehalf of the ACC by theConsultative Committee onProgramme <strong>and</strong>Operational <strong>Questions</strong>(CCPOQ) at its 16thSession, Geneva, March2000.(2) This means that theyapply to everyoneeverywhere.(3) Human Rights: A BasicH<strong>and</strong>book for UN Staffissued by the Office of theHigh Commissioner forHuman Rights (OHCHR)<strong>and</strong> the United NationsStaff College Project, 1999,p.3.(4) In turn, the obligationto fulfil containsobligations to facilitate,provide <strong>and</strong> promote(Section II.33, footnote 23of General Comment 14 onthe right to the highestattainable st<strong>and</strong>ard ofhealth adopted by theCommittee on Economic,Social <strong>and</strong> Cultural Rightsin May 2000),(E/C.12/2000/4, CESCRdated 4 July 2000).(5) Vienna Declaration <strong>and</strong>Programme of Actionadopted at the WorldConference on HumanRights, Vienna, 14-<strong>25</strong> June1993, paragraph 5, (UnitedNations General Assemblydocument A / CONF.137/23).Human Rights: (1)• Are guaranteed by international st<strong>and</strong>ards;• Are legally protected;• Focus on the dignity of the human being;• Protect individuals <strong>and</strong> groups;• Oblige states <strong>and</strong> state actors;• Cannot be waived or taken away;• Are interdependent <strong>and</strong> interrelated;• Are universal. (2)Human rights are legally guaranteed byhuman rights law, protecting individuals <strong>and</strong>groups against actions that interfere with fundamentalfreedoms <strong>and</strong> human dignity. (3) Theyencompass what are known as civil, cultural,economic, political <strong>and</strong> social rights. Humanrights are principally concerned with the relationshipbetween the individual <strong>and</strong> the state.Governmental obligations with regard tohuman rights broadly fall under the principlesof respect, protect <strong>and</strong> fulfil. (4)“All human rights are universal, indivisible<strong>and</strong> interdependent <strong>and</strong> interrelated.The international community must treathuman rights globally in a fair <strong>and</strong> equalmanner, on the same footing, <strong>and</strong> with thesame emphasis. While the significance ofnational <strong>and</strong> regional particularities <strong>and</strong>various historical, cultural <strong>and</strong> religiousbackgrounds must be borne in mind, it isthe duty of States, regardless of their political,economic <strong>and</strong> cultural systems, topromote <strong>and</strong> protect all human rights <strong>and</strong>fundamental freedoms.”Vienna Declaration <strong>and</strong> Programmeof Action adopted at the World Conferencerights enshrinedin international law?In the aftermath of World War II, the internationalcommunity adopted the Universal Declaration ofHuman Rights (UDHR, 1948). However, by thetime that States were prepared to turn the provisionsof the Declaration into binding law, the ColdWar had overshadowed <strong>and</strong> polarised humanrights into two separate categories. The Westargued that civil <strong>and</strong> political rights had priority<strong>and</strong> that economic <strong>and</strong> social rights were mereaspirations. The Eastern bloc argued to the contrarythat rights to food, health <strong>and</strong> educationwere paramount <strong>and</strong> civil <strong>and</strong> political rights secondary.Hence two separate treaties were createdin 1966 – the International Covenant on Economic,Social <strong>and</strong> Cultural Rights (ICESCR) <strong>and</strong> the InternationalCovenant on Civil <strong>and</strong> Political Rights(ICCPR). Since then, numerous treaties, declarations<strong>and</strong> other legal instruments have beenadopted, <strong>and</strong> it is these instruments that encapsulatehuman rights.• International human rights treaties arebinding on governments that ratify them;• Declarations are non-binding, althoughmany norms <strong>and</strong> st<strong>and</strong>ards enshrinedtherein reflect principles which are bindingin customary international law;• United Nations conferences generate nonbindingconsensual policy documents, suchas declarations <strong>and</strong> programmes of action.on Human Rights. (5) Q.2 How are human9

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human Rights“It was never the people who complainedof the universality of human rights, nor didthe people consider human rights as aWestern or Northern imposition. It wasoften their leaders who did so.”United Nations Secretary-General,Kofi AnnanQ.3 What is the linkbetween health<strong>and</strong> human rights?There are complex linkages between health <strong>and</strong>human rights:• Violations or lack of attention to humanrights can have serious health consequences;(6)• Health policies <strong>and</strong> programmes can promoteor violate human rights in the waysthey are designed or implemented;• Vulnerability <strong>and</strong> the impact of ill health canbe reduced by taking steps to respect, protect<strong>and</strong> fulfil human rights.The normative content of each right is fullyarticulated in human rights instruments. Inrelation to the right to health <strong>and</strong> freedom fromdiscrimination, the normative content is outlinedin <strong>Questions</strong> 4 <strong>and</strong> 5, respectively. Examplesof the language used in human rightsinstruments to articulate the normative contentof some of the other key human rights relevantto health follows:• Torture: “No one shall be subjected to tortureor to cruel, inhuman or degrading treatmentor punishment. In particular, no one shall besubjected without his free consent to medicalor scientific experimentation.” (7)• Violence against children: ”All appropriatelegislative, administrative, social <strong>and</strong> educationalmeasures to protect the child from allforms of physical or mental violence, injuryor abuse, neglect or negligent treatment, maltreatmentor exploitation, including sexualabuse...” shall be taken. (8)• Harmful traditional practices: “Effective <strong>and</strong>appropriate measures with a view to abolishingtraditional practices prejudicial to thehealth of children” shall be taken. (9)• Participation: The right to “…active, free <strong>and</strong>meaningful participation.” (10)(6) Mann J, Gostin L,Gruskin S, Brennan T,Lazzarini Z, <strong>and</strong> FinebergHV, “Health <strong>and</strong> HumanRights,” Health <strong>and</strong> HumanRights: An InternationalJournal, Vol. 1, No. 1, 1994.(7) Article 7, ICCPR. Theprohibition of torture isalso articulated in otherhuman rights instruments,including the CAT <strong>and</strong>article 37 of the CRC.(8) Article 19, CRC.The prohibition of violenceagainst women is alsoarticulated in theDeclaration on theElimination of ViolenceAgainst Women, 1993.(9) Article 24, CRC.The prohibition of harmfultraditional practicesagainst women is alsoarticulated in theDeclaration on theElimination of ViolenceAgainst Women, <strong>and</strong>General Recommendation24 on Women <strong>and</strong> Healthof the Committee onthe Elimination of all formsof Discrimination AgainstWomen, 1999.(10) Article 2, Declarationon the Right toDevelopment, 1986.The right to participationis also articulated in otherhuman rights instruments,including article <strong>25</strong> of theICCPR, article 15 of theICESCR, article 5 of CERD,articles 7, 8, 13 <strong>and</strong> 14of CEDAW, <strong>and</strong> articles 3,9 <strong>and</strong> 12 of the CRC.Examples of the links between Health <strong>and</strong> Human Rights10

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human Rights©Grégoire Ahongbonon(11) Article 19, ICCPR.The right to informationis also articulated in otherhuman rights instruments,including articles 10,14 <strong>and</strong> 16 of the CEDAW,<strong>and</strong> articles 13, 17<strong>and</strong> 24 of the CRC.(12) Article 17, ICCPR.The right to privacy is alsoarticulated in other humanrights instruments,including article 16of CEDAW, <strong>and</strong> article40 of the CRC.(13) Article 15, ICESCR.(14) Article 13, ICESCR.The right to education isalso articulated in otherhuman rights instruments,including article 5 of CERD,articles 10 <strong>and</strong> 16 of CEDAW,<strong>and</strong> articles 19, 24, 28<strong>and</strong> 33 of the CRC.(15) Article 24, CRC.(16) Article 11, ICESCR.The right to food is alsoarticulated in other humanrights instruments,including article 12of CEDAW, <strong>and</strong> article 27of the CRC.(17) Article <strong>25</strong> UDHR<strong>and</strong> article 11 ICESCR.(18) Article 9, ICESCR.The right to social securityis also articulated in otherhuman rights instruments,including article 5 of CERD,articles 11, 13 <strong>and</strong> 14of CEDAW, <strong>and</strong> article 26of the CRC.(19) 18 February 1992,UN General AssemblyResolution on the Protectionof Persons with MentalIllness <strong>and</strong> the Improvementof Mental Health Care,Principle 1 (A/RES/46).(20) Basic Documents,Forty-third Edition, Geneva,World Health Organization,2001. The Constitutionwas adopted bythe International HealthConference in 1946.Q.4 What is meantby “the rightto health”?to social security, including social insurance. (18)• Information: “Freedom to seek, receive <strong>and</strong>impart information <strong>and</strong> ideas of all kinds.” (11)• Privacy: “No one shall be subjected toarbitrary or unlawful interference with hisprivacy...” (12)• Scientific progress: The right of everyone toenjoy the benefits of scientific progress <strong>and</strong> itsapplications. (13)• Education: The right to education, (14) includingaccess to education in support of basicknowledge of child health <strong>and</strong> nutrition, theadvantages of breast-feeding, hygiene <strong>and</strong>environmental sanitation <strong>and</strong> the preventionof accidents. (15)• Food <strong>and</strong> nutrition: “The right of everyone toadequate food <strong>and</strong> the fundamental right ofeveryone to be free from hunger…” (16)• St<strong>and</strong>ard of living: Everyone has the right toan adequate st<strong>and</strong>ard of living, including adequatefood, clothing, housing, <strong>and</strong> medicalcare <strong>and</strong> necessary social services. (17)• Right to social security: The right of everyonePersons suffering from mental disabilitiesare particularly vulnerable to discrimination.Not only does this impact negatively on theirability to access appropriate treatment <strong>and</strong>care but the stigma associated with mentalillness means that they experience discriminationin many other aspects of their lives,affecting their rights to employment, adequatehousing, education, etc.The United Nations Resolution on the Protectionof Persons with Mental Illness, prohibits discriminationon the grounds of mental illness. (19)(21) WHA51.7, annex.“The right to health does not mean theright to be healthy, nor does it mean thatpoor governments must put in placeexpensive health services for which theyhave no resources. But it does requiregovernments <strong>and</strong> public authorities to putin place policies <strong>and</strong> action plans whichwill lead to available <strong>and</strong> accessible healthcare for all in the shortest possible time. Toensure that this happens is the challengefacing both the human rights community<strong>and</strong> public health professionals.”United Nations High Commissionerfor Human Rights, Mary RobinsonThe right to the highest attainable st<strong>and</strong>ard ofhealth (referred to as “the right to health”) wasfirst reflected in the WHO Constitution (1946) (20)<strong>and</strong> then reiterated in the 1978 Declaration ofAlma Ata <strong>and</strong> in the World Health Declarationadopted by the World Health Assembly in1998. (21) It has been firmly endorsed in a widerange of international <strong>and</strong> regional humanrights instruments. (22)The right to the highest attainable st<strong>and</strong>ard ofhealth in international human rights law is aclaim to a set of social arrangements – norms,institutions, laws, an enabling environment –that can best secure the enjoyment of this right.The most authoritative interpretation of the rightto health is outlined in Article 12 of the ICESCR,which has been ratified by 145 countries (as ofMay 2002). In May 2000, the Committee on Economic,Social <strong>and</strong> Cultural Rights, which monitorsthe Covenant, adopted a General Commenton the right to health. (23) General Commentsserve to clarify the nature <strong>and</strong> content of individualrights <strong>and</strong> States Parties’ (those states thathave ratified) obligations. The General Commentrecognized that the right to health is closely relatedto <strong>and</strong> dependent upon the realization ofother human rights, including the right to food,housing, work, education, participation, theenjoyment of the benefits of scientific progress<strong>and</strong> its applications, life, non-discrimination,equality, the prohibition against torture, privacy,access to information, <strong>and</strong> the freedoms of association,assembly <strong>and</strong> movement.11

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human Rights(22) The human right tohealth is recognized innumerous internationalinstruments. Article <strong>25</strong>(1)of the UDHR affirms that“everyone has a right to ast<strong>and</strong>ard of living adequatefor the health of himself<strong>and</strong> his family, includingfood, clothing, housing,<strong>and</strong> medical care <strong>and</strong>necessary social services.”The ICESCR provides themost comprehensive articleon the right to health ininternational human rightslaw. According to article12(1) of the Covenant,States Parties recognize“the right of everyone tothe enjoyment of thehighest attainable st<strong>and</strong>ardof physical <strong>and</strong> mentalhealth”, while article 12(2)enumerates, by way ofillustration, a number of“steps to be taken by theStates Parties “… to achievethe full realization of thisright”. Additionally, theright to health isrecognized, inter alia, in theCERD of 1963, the CEDAWof 1979 <strong>and</strong> in the CRC of1989. Several regionalhuman rights instrumentsalso recognize the right tohealth, such as theEuropean Social Charter of1961 as revised, the AfricanCharter on Human <strong>and</strong>Peoples’ Rights of 1981 <strong>and</strong>the Additional Protocol tothe American Conventionon Human Rights in theArea of Economic, Social<strong>and</strong> Cultural Rights of 1988(the Protocol entered intoforce in 1999). Similarly,the right to health has beenproclaimed by theCommission on HumanRights <strong>and</strong> furtherelaborated in the ViennaDeclaration <strong>and</strong> Programmeof Action of 1993 <strong>and</strong> otherinternational instruments.(23) General Comment 14.(24) General Comment 14.(<strong>25</strong>) This should includethe underlyingdeterminants of health,such as safe <strong>and</strong> potabledrinking-water <strong>and</strong>adequate sanitationfacilities, hospitals, clinics<strong>and</strong> other health-relatedbuildings, trained medical<strong>and</strong> professional personnelreceiving domesticallycompetitive salaries, <strong>and</strong>essential drugs, as definedby the WHO ActionProgramme on EssentialDrugs.(26) Health facilities,goods <strong>and</strong> services mustbe accessible to all, in law<strong>and</strong> in fact, withoutdiscrimination on anyof the prohibited grounds.(27) Health facilities, goods<strong>and</strong> services must be withinsafe physical reach for allsections of the population,especially vulnerable ormarginalized groups, suchas ethnic minorities <strong>and</strong>indigenous populations,women, children,adolescents, older persons,persons with disabilities<strong>and</strong> persons with HIV/AIDS,including in rural areas.Further, the Committee interpreted the right tohealth as an inclusive right extending not onlyto timely <strong>and</strong> appropriate health care but alsoto the underlying determinants of health, suchas access to safe <strong>and</strong> potable water <strong>and</strong>adequate sanitation, an adequate supply of safefood, nutrition <strong>and</strong> housing, healthy occupational<strong>and</strong> environmental conditions, <strong>and</strong>access to health-related education <strong>and</strong> information,including on sexual <strong>and</strong> reproductivehealth.The Right to HealthUnderlyingdeterminantsHealth-careThe following graph illustrates the number of countriesthat recognize the right to health at different levels:193All CountriesNational Recognitionof a Right to Health142Countries thatRatified theICESCRThe General Comment sets out four criteria bywhich to evaluate the right to health: (24)(a) Availability. Functioning public health <strong>and</strong>health-care facilities, goods <strong>and</strong> services, aswell as programmes, have to be available insufficient quantity. (<strong>25</strong>)(b) Accessibility. Health facilities, goods <strong>and</strong>services have to be accessible to everyone withoutdiscrimination, within the jurisdiction ofthe State party. Accessibility has four overlappingdimensions:• Non-discrimination; (26)• Physical accessibility; (27)• Economic accessibility (affordability); (28)• Information accessibility. (29)(c) Acceptability. All health facilities, goods<strong>and</strong> services must be respectful of medicalethics <strong>and</strong> culturally appropriate, sensitive togender <strong>and</strong> life-cycle requirements, as well asbeing designed to respect confidentiality <strong>and</strong>improve the health status of those concerned.(d) Quality. Health facilities, goods <strong>and</strong> servicesmust be scientifically <strong>and</strong> medically appropriate<strong>and</strong> of good quality (30) .83Countries thatRatified RegionalTreaties with aRight to Health109Countries thatRecognizea Right to Healthin their NationalConstitutionsSource: Eleanor D. Kinney, The International Human Right to Health:What Does This Mean For Our Nation And World? Indiana LawReview, Vol. 34, page 1465, 2001.12

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human RightsQ.6 What internationalhuman rightsinstrumentsset outgovernmentalcommitments?(34) InternationalConvention on theElimination of All Formsof Racial Discrimination,1963.(35) Convention on theElimination of All Formsof Discrimination AgainstWomen, 1979.(36) Convention on theRights of the Child, 1989.(37) Convention AgainstTorture <strong>and</strong> other Cruel,Inhuman or DegradingTreatment or Punishment,1984.Governments decide freely whether or not tobecome parties to a human rights treaty. Oncethis decision is made, however, there is a commitmentto act in accordance with the provisionsof the treaty concerned. The key internationalhuman rights treaties, the InternationalCovenant on Economic, Social <strong>and</strong> CulturalRights (ICESCR, 1966) <strong>and</strong> the InternationalCovenant on Civil <strong>and</strong> Political Rights (ICCPR,1966) further elaborate the content of the rightsset out in the Universal Declaration of HumanRights (UDHR, 1948), <strong>and</strong> contain legally bindingobligations for the governments thatbecome parties to them. Together these documentsare often called the “International Bill ofHuman Rights.”Building upon these core documents, otherinternational human rights treaties havefocused on either specific groups or categoriesof populations, such as racial minorities, (34)women (35) <strong>and</strong> children, (36) or on specific issues,such as torture. (37) In considering a normativeframework of human rights applicable tohealth, human rights provisions must be consideredin their totality.The Declarations <strong>and</strong> Programmes of Actionfrom United Nations world conferences such asthe World Conference on Human Rights (Vienna,1993), the International Conference on Population<strong>and</strong> Development (Cairo, 1994), theWorld Summit for Social Development (Copenhagen,1995), the Fourth World Conference onWomen (Beijing, 1995) <strong>and</strong> the World ConferenceAgainst Racism, Racial Discrimination, Xenophobia<strong>and</strong> Related Intolerance (Durban, 2001),provide guidance on some of the policy implicationsof meeting government’s human rightsobligations.Every country in the world is now partyto at least one human rights treaty thataddresses health-related rights, includingthe right to health, <strong>and</strong> a number of rightsrelated to conditions necessary for health.Q.7 What internationalmonitoringmechanisms existfor human rights?The implementation of the core human rightstreaties is monitored by committees of independentexperts known as treaty monitoringbodies, created under the auspices of <strong>and</strong>serviced by the United Nations. Each of thesix major human rights treaties has its ownmonitoring body which meets regularly toreview State Party reports <strong>and</strong> to engage in a“constructive dialogue” with governmentson how to live up to their human rights obligations.Based on the principle of transparency,States are required to submit their progressreports to the treaty bodies, <strong>and</strong> to make themwidely available to their own populations.Thus reports can play an important catalyticrole, contributing to the promotion of nationaldebate on human rights issues, encouragingthe engagement <strong>and</strong> participation of civilsociety, <strong>and</strong> generally fostering a process ofpublic scrutiny of governmental policies. Atthe end of the session, the treaty body makesconcluding observations which include recommendationson how the government canimprove its human rights record. Specializedagencies such as WHO can play an importantrole in providing relevant health informationto facilitate the dialogue between the StateParty <strong>and</strong> the treaty monitoring body.©WHO / P. Virot14

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human Rights©WHO/PAHOOther mechanisms for monitoring humanrights in the United Nations system includethe Commission on Human Rights <strong>and</strong> theSub-Commission on the Promotion <strong>and</strong>Protection of Human Rights. These bodiesappoint special rapporteurs <strong>and</strong> otherindependent experts <strong>and</strong> working groups tomonitor <strong>and</strong> report on thematic human rightsissues (such as violence against women, saleof children, harmful traditional practices, <strong>and</strong>torture) or on specific countries. In addition,the post of High Commissioner for HumanRights was created in 1994 to head the UnitedNations human rights system. The HighCommissioner’s m<strong>and</strong>ate extends to everyaspect of the United Nations human rightsactivities: monitoring, promotion, protection<strong>and</strong> coordination.Regional arrangements have been establishedwithin existing regional intergovernmentalorganizations. The African regional humanrights instrument is the African Charter onHuman <strong>and</strong> Peoples’ Rights, which is locatedwithin the Organization of African Unity. Theregional human rights mechanism for theAmericas is located within the Organizationof American States <strong>and</strong> is based upon theAmerican Convention of Human Rights. InEurope, a human rights system forms a part ofthe Council of Europe. Key human rightsinstruments are the European Convention onthe Protection of Human Rights <strong>and</strong> FundamentalFreedoms <strong>and</strong> the European SocialCharter. (38) The 15 member state organization— the European Union — has detailed rulesconcerning human rights issues <strong>and</strong> has integratedhuman rights into its common foreignpolicy. In addition, the Organization for Security<strong>and</strong> Cooperation in Europe (OSCE), a 55member state organization, has separatemechanisms <strong>and</strong> agreements. In the Asia-Pacific region, extensive consultations amongGovernments are underway concerning thepossible establishment of regional humanrights arrangements.The collaboration between PAHO/WHO<strong>and</strong> the Inter-American Commission onHuman Rights (IACHR, the body responsiblefor overseeing the American Convention onHuman Rights) concerning the rights of personswith mental disabilities, is an exampleof the key role specialized agencies can playwithin international monitoring mechanisms.PAHO/WHO offers technical opinions<strong>and</strong> assistance on the interpretation of theAmerican Convention on Human Rights <strong>and</strong>the American Declaration on the Rights <strong>and</strong>Duties of Man, in light of international st<strong>and</strong>ardson mental disability rights. In turn, theIACHR incorporates these st<strong>and</strong>ards intofinal reports of relevant individual cases <strong>and</strong>in country reports. As a result of this technicalassistance, the IACHR has issued theRecommendation for the Promotion <strong>and</strong>Protection of the Rights of the Mentally Ill(28 February 2001). (39)(38)http://conventions.coe.int/Treaty/EN/CadreListeTraites.htm.(39) This recommendationwas included in the IACHRannual report (2001),constituting the first timethe latter has devoted asection to mental disabilityrights.15

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human Rights©WHO/PAHO(44) ICESCR, Article 2.(45) ICESCR, Article 23.(46) In the area ofhumanitarian assistance,for example, the SphereProject’s (draft) Charteron Minimum HumanitarianSt<strong>and</strong>ards in DisasterRelief provides acomprehensive catalogueof technical st<strong>and</strong>ards forNGO <strong>and</strong> otherinternational relief workerson matters such as food,nutrition, water <strong>and</strong>sanitation, based uponinternational human rightslaw.(47) http: // www.unglobalcompact.org.economic <strong>and</strong> technical, to the maximum ofits available resources, with a view to achievingprogressively the full realization of the rightsrecognized [herein].” (44)In this spirit, “the framework of internationalcooperation” is referred to, which acknowledges,for instance, that the needs of developingcountries should be taken into considerationin the area of health. The role ofspecialized agencies is recognized in humanrights treaties in this context. For example, theICESCR stresses that “international action forthe achievement of the rights ... includes suchmethods as ... furnishing of technical assistance<strong>and</strong> the holding of regional meetings<strong>and</strong> technical meetings for the purpose ofconsultation <strong>and</strong> study organized in conjunctionwith the Governments concerned.” (45)Q.10 What aregovernmentalhuman rightsobligationsin relation to otheractors in society?As government roles <strong>and</strong> responsibilitiesinclude increased reliance on non-state actors(health insurance companies, etc.), governmentalhealth systems must ensure theexistence of social safety nets <strong>and</strong> othermechanisms to ensure that vulnerable populationgroups have access to the services <strong>and</strong>structures they need.The obligation of the State to protect humanrights means that governments are responsiblefor ensuring that non-state actors act in conformitywith human rights law within theirjurisdiction. Governments are obliged toensure that third parties conform with humanrights st<strong>and</strong>ards by adopting legislation, policies<strong>and</strong> other measures to assure adequateaccess to health care, quality information, etc.,<strong>and</strong> an accessible means of redress if individualsare denied access to these goods <strong>and</strong>services. An example of this is the obligation ofgovernments to ensure the regulation of thetobacco industry in order to protect its populationagainst infringements of the right tohealth, the right to information, <strong>and</strong> otherrelevant human rights provisions.In the corporate <strong>and</strong> NGO contexts, (46) there is aproliferation of voluntary codes which reflectinternational human rights norms <strong>and</strong> st<strong>and</strong>ards.Increasing attention to the human rightsimplications of work in the private sector hasresulted in human rights being placed higheron the business agenda, with several businessesbeginning to incorporate concern forhuman rights into their daily operations. (47)17

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human RightsSection 2:IntegratingHumanRightsin HealthQ.11 What is meantby a rights-basedapproach to health?©WHO/PAHO(48) See Question 3for an explanation ofthe links between health<strong>and</strong> human rights.(49) Many are spelt outin specific human rightsinstruments, such as theInternational LabourOrganisation Conventionconcerning Indigenous<strong>and</strong> Tribal Peoples inIndependent Countries(No. 169, 1989) <strong>and</strong> theInternational Conventionon the Protection of theRights of All MigrantWorkers <strong>and</strong> Membersof their Families (1990).A rights-based approach to health refers to theprocesses of:• Using human rights as a framework for healthdevelopment. (48)• Assessing <strong>and</strong> addressing the human rightsimplications of any health policy, programme orlegislation.• Making human rights an integral dimensionof the design, implementation, monitoring<strong>and</strong> evaluation of health-related policies <strong>and</strong>programmes in all spheres, including political,economic <strong>and</strong> social.Substantive elements to apply, within theseprocesses, could be as follows:✓Safeguarding human dignity.✓Paying attention to those population groupsconsidered most vulnerable in society. (49) Inother words, recognizing <strong>and</strong> acting uponthe characteristics of those affected by healthpolicies, programmes <strong>and</strong> strategies — children(girls <strong>and</strong> boys), adolescents, women,<strong>and</strong> men; indigenous <strong>and</strong> tribal populations;national, ethnic, religious <strong>and</strong> linguisticminorities; internally displaced persons;refugees; immigrants <strong>and</strong> migrants; the elderly;persons with disabilities; prisoners; economicallydisadvantaged or otherwise marginalized<strong>and</strong>/or vulnerable groups.✓Ensuring health systems are made accessibleto all, especially the most vulnerable or marginalizedsections of the population, in law<strong>and</strong> in fact, without discrimination on any ofthe prohibited grounds.✓Using a gender perspective, recognizing thatboth biological <strong>and</strong> sociocultural factors playa significant role in influencing the health ofmen <strong>and</strong> women, <strong>and</strong> that policies <strong>and</strong> programmesmust consciously set out to addressthese differences.A rights-based approach to health entailsrecognizing the individual characteristics ofthe population groups concerned. In allactions relating to children, for example, theguiding principles of the Convention on theRights of the Child should be applied. Theseinclude:• The best interests of the child shall be aprimary consideration;• The views of the child shall be given dueweight.✓Ensuring equality <strong>and</strong> freedom fromdiscrimination, advertent or inadvertent, inthe way health programmes are designed orimplemented.18

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human Rights✓Disaggregating health data to detect underlyingdiscrimination.✓Ensuring free, meaningful, <strong>and</strong> effectiveparticipation of beneficiaries of health developmentpolicies or programmes in decisionmakingprocesses which affect them.✓Promoting <strong>and</strong> protecting the right to education<strong>and</strong> the right to seek, receive <strong>and</strong> impartinformation <strong>and</strong> ideas concerning healthissues. However, the right to informationshould not impair the right to privacy, whichmeans that personal health data should betreated with confidentiality.©WHO/PAHO(50) Eds. Mann J,Gruskin S, Grodin M,Annas G, Health <strong>and</strong>Human Rights: A Reader,(Routledge, 1999),Introduction, para. 4.(51) The Siracusaprinciples on the limitation<strong>and</strong> derogation provisionsin the internationalcovenant on civil <strong>and</strong>political rights. UN Doc.E/CN.4/1985/4, Annex.It has been demonstrated that “respectfor human rights in the context of HIV/AIDS,mental illness, <strong>and</strong> physical disability leadsto markedly better prevention <strong>and</strong> treatment.Respect for the dignity <strong>and</strong> privacy ofindividuals can facilitate more sensitive <strong>and</strong>humane care. Stigmatization <strong>and</strong> discriminationthwart medical <strong>and</strong> public health effortsto heal people with disease or disability”. (50)✓Only limiting the exercise or enjoyment of aright by a health policy or programme as alast resort, <strong>and</strong> only considering this legitimateif each of the provisions reflected in theSiracusa principles is met. (51) (See Question 13).✓Juxtaposing the human rights implications ofany health legislation, policy or programmewith the desired public health objectives <strong>and</strong>ensuring the optimal balance between goodpublic health outcomes <strong>and</strong> the promotion<strong>and</strong> protection of human rights.✓Making explicit linkages to internationalhuman rights norms <strong>and</strong> st<strong>and</strong>ards to highlighthow human rights apply <strong>and</strong> relate to ahealth policy, programme or legislation.✓Making the attainment of the right to thehighest attainable st<strong>and</strong>ard of health theexplicit ultimate aim of activities, which haveas their objective the enhancement of health.✓Articulating the concrete government obligationsto respect, protect <strong>and</strong> fulfil humanrights.✓Identifying benchmarks <strong>and</strong> indicators toensure monitoring of the progressive realizationof rights in the field of health.✓Increasing transparency in, <strong>and</strong> accountabilityfor, health as a key consideration at allstages of programme development.✓Incorporating safeguards to protect againstmajoritarian threats upon minorities,migrants <strong>and</strong> other domestically “unpopular”groups, in order to address power imbalances.For example, by incorporating redressmechanisms in case of impingements onhealth-related rights.Possible “ingredients”in a rights-based approach to health:Right to healthInformationGenderHuman dignityTransparencySiracusa principlesBenchmarks <strong>and</strong> indicatorsAccountabilitySafeguardsEquality <strong>and</strong> freedom from discriminationDissaggregationAttention to vulnerable groupsParticipationPrivacyRight to educationOptimal balance between public healthgoals <strong>and</strong> protection of human rightsAccessibilityConcrete government obligationsHuman rights expressly linked19

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human RightsQ.12 What isthe value-addedof human rightsin public health?Overall, human rights may benefit work in thearea of public health by providing:• Explicit recognition of the highest attainablest<strong>and</strong>ard of health as a “human right” (asopposed to a good or commodity with a charitableconstruct);• A tool to enhance health outcomes by using ahuman rights approach to designing, implementing<strong>and</strong> evaluating health policies <strong>and</strong>programmes;Q.13 What happensif the protectionof public healthnecessitatesthe restrictionof certain humanrights?There are a number of human rights that cannotbe restricted in any circumstance such asfreedom from torture <strong>and</strong> slavery, <strong>and</strong> freedomof thought, conscience <strong>and</strong> religion. Limitation<strong>and</strong> derogation clauses in the internationalhuman rights instruments recognize the needto limit human rights at certain times.Public health is sometimes used by states as aground for limiting the exercise of humanrights.©WHOA key factor in determining if the necessaryprotections exist when rights are restricted isthat each one of the five criterion of the SiracusaPrinciples must be met. Even in circumstanceswhere limitations on grounds of protectingpublic health are basically permitted, theyshould be of limited duration <strong>and</strong> subject toreview.(52) See Question 7.• An “empowering” strategy for health whichincludes vulnerable <strong>and</strong> marginalizedgroups engaged as meaningful <strong>and</strong> activeparticipants;• A useful framework, vocabulary <strong>and</strong> form ofguidance to identify, analyze <strong>and</strong> respond tothe underlying determinants of health;• A st<strong>and</strong>ard against which to assess the performanceof governments in health;• Enhanced governmental accountability forhealth;• A powerful authoritative basis for advocacy<strong>and</strong> cooperation with governments; internationalorganizations; international financialinstitutions; <strong>and</strong> in the building of partnershipswith relevant actors of civil society;• Existing international mechanisms to monitorthe realization of health as a human right; (52)• Accepted international norms <strong>and</strong> st<strong>and</strong>ards(e.g. definitions of concepts <strong>and</strong> populationgroups);• Consistent guidance to states as humanrights cross-cut all United Nations activities;• Increased scope of analysis <strong>and</strong> range of partnersin countries.The Siracusa PrinciplesOnly as a last resort can human rights beinterfered with to achieve a public healthgoal. Such interference can only be justifiedwhen all of the narrowly defined circumstancesset out in human rights law, known as theSiracusa Principles, are met:• The restriction is provided for <strong>and</strong> carriedout in accordance with the law;• The restriction is in the interest of a legitimateobjective of general interest;• The restriction is strictly necessary in ademocratic society to achieve the objective;• There are no less intrusive <strong>and</strong> restrictivemeans available to reach the same objective;<strong>and</strong>• The restriction is not drafted or imposedarbitrarily, i.e. in an unreasonable or otherwisediscriminatory manner.Interference with freedom of movement wheninstituting quarantine or isolation for a seriouscommunicable disease — for example, Ebolafever, syphilis, typhoid or untreated tuberculosis— are examples of restrictions on rights20

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human Rights(53) Gruskin S <strong>and</strong>Tarantola D in Ed. Retels R,Mc Ewen J, Beaglehole R,Tanaka H, Oxford Textbookof Public Health, FourthEdition, Oxford,Oxford University Press,(in press).(54) General Comment 14,paragraphs 28-29.©WHO/PAHO(55 The open-ended intersessionalWorking Groupon the draft declarationwas established in 1995in accordance withCommission on HumanRights resolution 1995/32<strong>and</strong> Economic <strong>and</strong> SocialCouncil resolution1995/32. The WorkingGroup has the solepurpose of elaborating adraft declaration on therights of indigenouspeoples, considering thedraft contained in theannex to resolution1994/45 of 26 August 1994entitled draft “UnitedNations declarationon the rights of indigenouspeoples”. The draftis being preparedfor consideration <strong>and</strong>adoption by the GeneralAssembly during theInternational Decadeof the World’s IndigenousPeople.(56) The InternationalLabour OrganisationConvention ConcerningIndigenous <strong>and</strong> TribalPeoples in IndependentCountries (Convention169) adopted bythe International LabourOrganisation on 27 June1989.(57) Gruskin S<strong>and</strong> Tarantola D(refer to footnote 49).that may, under certain circumstances, be necessaryfor the public good, <strong>and</strong> therefore couldbe considered legitimate under internationalhuman rights law. (53) By contrast, a state whichrestricts the movements of, or incarcerates, personswith HIV/AIDS, refuses to allow doctorsto treat persons believed to be opposed to agovernment or fails to provide immunizationagainst the community’s major infectiousdiseases, on grounds such as national security orthe preservation of public order, has the burdenof justifying such serious measures. (54)Q.14 What implicationscould human rightshave for evidencebasedhealthinformation?The process that gives birth to an internationallyrecognized human right is generated fromthe pressing reality on the ground. For example,the development of a declaration on therights of indigenous populations (55) stems fromthe recognition that this is a vulnerable <strong>and</strong>marginalized population group lacking fullenjoyment of a wide range of human rights,including rights to political participation,health <strong>and</strong> education. In other words, the establishmentof human rights norms <strong>and</strong> st<strong>and</strong>ardsis itself evidence of a serious problem <strong>and</strong> governmentalrecognition of the importance ofaddressing it. The existence of human rightsnorms <strong>and</strong> st<strong>and</strong>ards should therefore stimulatethe collection of evidence, indicating the dataneeded to tackle complex health challenges.For example, disaggregating data beyond traditionalmarkers could detect discriminationon the basis of ethnicity against indigenous <strong>and</strong>tribal peoples which is considered an underlyingdeterminant of their overall poor health status.However, the political sensitivities whichunderpin human rights in exposing how differentpopulation groups are treated <strong>and</strong> why,hampers the extent to which human rights arewelcomed as a driving force for data collection.More widely accepted is the notion that humanrights are relevant to the way in which healthdata should be collected. This includes thechoice of the methods of data collection whichmust include considerations on how to ensurerespect for human rights, such as privacy, participation<strong>and</strong> non-discrimination. Secondly,international instruments can be helpful indefining various population groups. For example,the ILO Convention Concerning Indigenous<strong>and</strong> Tribal Peoples (56) provides an authoritativebasis for identifying <strong>and</strong> differentiatingindigenous <strong>and</strong> tribal peoples from otherpopulation groups.Collecting personal information from individualsabout their health status (e.g. HIVinfection, cancer or genetic disorders), orbehaviour (e.g. sexual orientation or the useof alcohol or other potentially harmful substances)has the potential for misuse by thestate, whether directly or because this informationis intentionally or inadvertently madeavailable to others. (57)21

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human RightsIndicators(58) See Mokhiber, C. G.“Toward a Measureof Dignity: Indicatorsfor Rights-BasedDevelopment”.Session I-PL 4, Montreux,4-8 September 2000.(59) United NationsDevelopment Programme,Human DevelopmentReport 2000, (New York<strong>and</strong> Oxford: OxfordUniversity Press, 2000),p. 10.(60) The World HealthReport 2000 HealthSystems: ImprovingPerformance.United Nations agencies’ work on healthindicators, human rights indicators, <strong>and</strong>human development indicators can assist inforging common agendas. Greater coordinationto ensure a common framework for thedesign, development, use <strong>and</strong> assessmentof indicators is needed. The UNDG workinggroup on Common Country Assessment(CCA) Indicators adopted the definition of anindicator as a variable or measurement,conveying information that may be qualitativeor quantitative, but which is consistentlymeasurable. Human rights were integratedin the CCA indicator framework which lead tothe goal of developing a list of simple developmentindicators, designed to measure“what is”, on a right-by-right basis. Thiswould not include benchmarks, targets orgoals, or answer definitely “what should be”or “by when,” as these are appropriatelydeveloped in country-specific, participatorynational processes. (58)“Information <strong>and</strong> statistics are a powerfultool for creating a culture of accountability<strong>and</strong> for realizing human rights.”Human Development Report 2000 (59)Q.15 How canhuman rightssupport workto strengthenhealth systems?Human rights provide a st<strong>and</strong>ard againstwhich to evaluate existing health policies <strong>and</strong>programmes, including highlighting the differentialtreatment of individual groups of peoplein, for example, manifestations, frequency <strong>and</strong>severity of disease, <strong>and</strong> governmental responsesto it. Human rights norms <strong>and</strong> st<strong>and</strong>ardsalso form a strong basis for health systems toprioritize the health needs of vulnerable <strong>and</strong>marginalized population groups. Humanrights moves beyond averages <strong>and</strong> focusesattention on those population groups in societywhich are considered most vulnerable (e.g.indigenous <strong>and</strong> tribal populations; refugees<strong>and</strong> migrants, ethnic, religious, national <strong>and</strong>racial monitories), as well as putting forwardspecific human rights which may help guidehealth policy, programming, <strong>and</strong> health systemprocesses (e.g. the right of those potentiallyaffected by health policies, strategies <strong>and</strong> st<strong>and</strong>ardsto participate in the process in whichdecisions affecting their health are made).World Health Report 2000:WHO Framework on Health SystemsPerformance AssessmentIn working towards an evidence-basedmodel of health, WHO developed healthsystem performance indicators in its WorldHealth Report 2000. The fundamental principlesunderlying these indicators are:to clarify the boundaries of health systems;to assess how health <strong>and</strong> other systemsinteract to achieve key social goals; to define<strong>and</strong> measure health, responsiveness, <strong>and</strong>fairness in financial contribution; <strong>and</strong> toshow how different policies contributetowards improving health systems performance.(60) In particular with regard to theresponsiveness of the health system,human rights norms <strong>and</strong> st<strong>and</strong>ards havebeen incorporated shaping the definitionsof the various domains being measured.©WHO/PAHO22

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human Rightshuman rights obligations needs to be strengthened.This includes developing the tools toreview health-related laws <strong>and</strong> policies todetermine whether, on their face or application,they violate human rights, <strong>and</strong> providing themeans to rectify any violation which exists.Q.17 How do human rightsapply to situationalanalyses of healthin countries?(61) Gostin L, Burris S,<strong>and</strong> Lazzarini Z,“The Law <strong>and</strong>the Public’s Health:A study of InfectiousDisease Law in the UnitedStates”, Columbia LawReview, Vol. 99, No.1,(1999).(62) Gruskin S<strong>and</strong> Tarantola D,refer to footnote 48.Q.16 What isthe relationshipbetween healthlegislation <strong>and</strong>human rights law?©WHO/PAHOHealth legislation can be an important vehicletowards ensuring the promotion <strong>and</strong> protectionof the right to health. In the design <strong>and</strong>review of health legislation, human rights providea useful tool to determine its effectiveness<strong>and</strong> appropriateness in line with both humanrights <strong>and</strong> public health goals. In this context,HIV/AIDS has caused many countries to revisittheir public health laws, including in relationto quarantine <strong>and</strong> isolation. (61)Restrictive laws <strong>and</strong> policies that deliberatelyfocus on certain population groups withoutsufficient data, epidemiological <strong>and</strong> otherwise,to support their approach may raise a host ofhuman rights concerns. Two examples in thisregard are health policies concerning the involuntarysterilization of women from certainpopulation groups that are justified as necessaryfor their health <strong>and</strong> well-being, <strong>and</strong>sodomy statutes criminalizing same-sex sexualbehaviour that are justified as necessary to preventthe spread of HIV/AIDS. (62)Government capacity to develop nationalhealth policy <strong>and</strong> legislation that conforms toIncreased attention to human rights may, firstly,broaden the scope of situational health analysisin countries, <strong>and</strong> secondly, as a result, allownew partners to be identified. New areas ofattention include consideration of the healthcomponents of national human rights actionplans <strong>and</strong>, conversely, the inclusion of humanrights in national health strategies <strong>and</strong> actionplans. Given that human rights obligations relevantto health rest with the government as awhole, health <strong>and</strong> human rights goals need tofigure in policies <strong>and</strong> plans which may be generatedoutside the health sector per se butwhich have a strong bearing on health, such asnational food <strong>and</strong> nutrition policies <strong>and</strong> plans.The focus on vulnerable population groupsdraws attention to how national legislation <strong>and</strong>development policies impact upon the status ofsuch groups, which institutions work to protecttheir best interests, <strong>and</strong> how civil society movementsrepresent them. Finally, the reports to<strong>and</strong> comments from the United Nationshuman rights treaty monitoring bodies <strong>and</strong> theviews of civil society organizations are anotherissue for consideration.Practical implications may be to engage at thenational level with a greater range of Ministriesother than Health Ministries, e.g. Justice Ministries<strong>and</strong> those with responsibility for humanrights (including independent human rightsinstitutions), women’s affairs, children’s affairs,education, social affairs, finance, etc. UnitedNations agencies <strong>and</strong> other intergovernmentalorganizations working on human rights, international<strong>and</strong> national human rights NGOs,national human rights institutions, ombudspersons,national human rights commissions,human rights think-tanks <strong>and</strong> research institutes,also constitute fruitful partners foradvancing the global health agenda.23

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human RightsSection 3: Health & Human Rightsin a broader contextQ.18 How do ethics relateto human rights?Ethics are norms of conduct for individuals <strong>and</strong>for societies. These norms derive from manysources, including religion, cultural tradition,<strong>and</strong> reflection, which accounts in part for thecomplexity within each ethical outlook. Ethicsas a system of norms employs many componentconcepts, including obligations <strong>and</strong>duties, virtues of character, st<strong>and</strong>ards of value<strong>and</strong> goodness in outcomes <strong>and</strong> consequencesof action, st<strong>and</strong>ards of fairness, <strong>and</strong> justice inallocation of resources <strong>and</strong> in reward <strong>and</strong> punishment.Work in ethics needs to take into accounthuman rights norms <strong>and</strong> st<strong>and</strong>ards, not only insubstance but also in relation to the processes ofethical discourse <strong>and</strong> reasoning. For example,where issues concern a specific populationgroup, individuals representing this groupshould be participants in any determination ofthe ethical implications of the issues affectingthem. Ethics is particularly useful in areas ofpractice where human rights do not provide adefinite answer, for example, in new <strong>and</strong>emerging areas where human rights law hasnot been applied or codified, such as humancloning.Q.19 How do human rightsprinciples relateto equity?©WHO/PAHO(63) Equity in Health <strong>and</strong>Health Care: A WHO/SIDAInitiative, WHO, Geneva,1996.(64) Declaration onthe Right to Development,4 December 1986,(A/RES/41/128).3Human rights refer to an internationally agreedupon set of principles <strong>and</strong> norms embodied ininternational legal instruments. These internationalhuman rights principles <strong>and</strong> norms arethe result of deep <strong>and</strong> long-st<strong>and</strong>ing negotiationsamong Member States on a range of fundamentalissues. In other words, human rightsare generated by governments through a consensus-buildingprocess.Equity means that people’s needs, rather thantheir social privileges, guide the distributionof opportunities for well-being. (63) This meanseliminating disparities in health <strong>and</strong> inhealth’s major determinants that are systematicallyassociated with underlying socialdisadvantage within a society. Within thehuman rights discourse, the principle of equityis increasingly serving as an important nonlegalgeneric policy term aimed at ensuringfairness. It has been used to embrace policyrelatedissues, such as the accessibility, affordability<strong>and</strong> acceptability of available healthcare services. The focused attention on vulnerable<strong>and</strong> disadvantaged groups in societyin international human rights instrumentsreinforces the principle of equity. Also, at theinternational level, human rights instrumentsaddress equity by encouraging internationalcooperation to realize rights as well asaddressing intrastate relations, most notablyin the United Nations Declaration on the Rightto Development. (64)24

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human RightsQ.20 How do health<strong>and</strong> human rightsprinciples applyto povertyreduction?The right to a st<strong>and</strong>ard of living adequate forhealth <strong>and</strong> well-being, including necessarysocial services, <strong>and</strong> the right to security in theevent of sickness, disability, old age or otherlack of livelihood is enshrined in the UniversalDeclaration of Human Rights. (65) The Committeeon Economic, Social <strong>and</strong> Cultural Rights hasdefined poverty as “a human condition characterizedby sustained or chronic deprivation ofthe resources, capabilities, choices, security<strong>and</strong> power necessary for the enjoyment of anadequate st<strong>and</strong>ard of living <strong>and</strong> other civil,cultural, economic, political <strong>and</strong> social rights.” (66)Accountability, transparency, democracy <strong>and</strong>good governance, are essential ingredients toaddressing poverty <strong>and</strong> ill-health. Legal rights<strong>and</strong> obligations, at the domestic <strong>and</strong> internationallevel, dem<strong>and</strong> accountability: effectivelegal remedies, administrative <strong>and</strong> politicalaccountability mechanisms at the domesticlevel, as well as human rights monitoring at theinternational level. (68) Overall, human rightsprovide a holistic framework to poverty reduction,dem<strong>and</strong>ing consideration of a spectrum ofapproaches, including legislation, polices <strong>and</strong>programmes.(65) Article <strong>25</strong> UDHR(1948).(66) “Poverty <strong>and</strong> theInternational Covenanton Economic, Social<strong>and</strong> Cultural Rights”,statement adopted bythe Committee onEconomic, Social <strong>and</strong>Cultural Rights on 4 May,2001 (E/C.12/2001/10),paragraph 8.(67) Voices of the Poor:Crying Out for Change,Chapter 7, ’Social Ill-being:Left Out <strong>and</strong> PushedDown’, World Bank 2000,page 235.(68) Human rights <strong>and</strong>poverty reductionstrategies: A discussionpaper, prepared byProfessor Paul Hunt,Professor Manfred Nowak,Professor Siddiq Osmanifor the UN Office of the HighCommissioner for HumanRights (February 2002).(69) Disability, Poverty <strong>and</strong>Development, Departmentfor InternationalDevelopment (DFID), ID21Highlights, January 2002.“The challenge for development professionals,<strong>and</strong> for policy <strong>and</strong> practice, is to findways to weaken the web of powerlessness<strong>and</strong> to enhance the capabilities of poorwomen <strong>and</strong> men so that they can take morecontrol of their lives.” (67)Human rights empower individuals <strong>and</strong> communitiesby granting them entitlements thatgive rise to legal obligations on others. Humanrights can help to equalize the distribution <strong>and</strong>exercise of power both within <strong>and</strong> betweensocieties, mitigating the powerlessness of thepoor. As economic <strong>and</strong> social rights, such as theright to health, are increasingly gaining weightthrough increased normative clarity <strong>and</strong> application,they will provide an important tool forpoverty reduction. A human rights approachalso requires the active <strong>and</strong> informed participationof the poor in the formulation, implementation<strong>and</strong> monitoring of strategies whichmay affect them.Disability can become a cause of poverty<strong>and</strong> poverty can also be a risk factor for disability.Human rights provide a legal frameworkto ensure non-discrimination <strong>and</strong>equal opportunity for persons with disabilities,<strong>and</strong> thus provides a potential avenue togo “upstream” to prevent persons with disabilitiesfrom becoming poor.A report from Action on Disability <strong>and</strong>Development looks at the vicious circle linkingpoverty <strong>and</strong> disability. It argues that thebasic cause of disabled people’s poverty issocial, economic, <strong>and</strong> political exclusion.The scale of exclusion is dramatic:• 98 per cent of disabled children in developingcountries are denied any formaleducation <strong>and</strong> excluded from many ofthe day-to-day interactions that nondisabledchildren take for granted.• One hundred million people world widehave preventable impairments causedby malnutrition <strong>and</strong> poor sanitation• 70 per cent of childhood blindness<strong>and</strong> 50 per cent of hearing impairmentin Africa <strong>and</strong> Asia are preventable ortreatable.These impairments then lead to discrimination,exclusion <strong>and</strong> further poverty. TheSt<strong>and</strong>ard Rules on the Equalisation ofOpportunities for People with Disabilitieshave been endorsed by all United NationsMember States. Although not legally enforceable,they have encouraged many governmentsto introduce disability legislation. (69)<strong>25</strong>

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human RightsQ.21 How doesglobalization affectthe promotion<strong>and</strong> protectionof human rights?The Secretary-General of the United Nations,Kofi Annan, has underscored that “the pursuitof development, the engagement with globalization,<strong>and</strong> the management of changemust all yield to human rights imperativesrather than the reverse. Respect for humanrights, as proclaimed in the internationalinstruments, is central to our m<strong>and</strong>ate. If welose sight of this fundamental truth, all elsewill fail.” (72)(70) Statement by theCommittee on Economic,Social <strong>and</strong> Cultural Rights,to the Third MinisterialConference of the WorldTrade Organization, 1999.(71) Statement by theCommittee on Economic,Social <strong>and</strong> Cultural Rights,May 1998, paragraph 5.(72) Report ofthe Secretary-Generalon the work of theOrganization, 1999,General Assembly, OfficialRecords, 54th session.Supplement No.1 (A/54/1).Globalization is a term used to cover many differentphenomena, most of which concernincreasing flows of money, goods, services,people, <strong>and</strong> ideas across national borders. Thisprocess has brought benefits to many peoples<strong>and</strong> countries, lifting many people from poverty<strong>and</strong> bringing greater awareness of people’sentitlement to basic human rights. In manycases, however, the globalization process hascontributed to greater marginalization of people<strong>and</strong> countries that have been denied accessto markets, information, <strong>and</strong> essential goodssuch as new life-saving drugs.Within the human rights community, certaintrends associated with globalization have raisedconcern with respect to their effect on states’capacity to ensure the protection of humanrights, especially for the most vulnerable membersof society. Located primarily in the economic-politicalrealm of globalization, thesetrends include: an increasing reliance upon thefree market; a significant growth in the influenceof international financial markets <strong>and</strong> institutionsin determining national policies; cutbacksin public sector spending; the privatization offunctions previously considered to be the exclusivedomain of the state; <strong>and</strong> the deregulation ofa range of activities with a view to facilitatinginvestment <strong>and</strong> rewarding entrepreneurialinitiative. (70) These trends serve to reduce the roleof the state in economic affairs, <strong>and</strong> at the sametime increase the role <strong>and</strong> responsibilities ofprivate (non-state) actors, especially those incorporate business, but also those in civil society.Human rights analysts are concerned that suchtrends limit the ability of the state to protect thevulnerable from adverse effects of globalization,<strong>and</strong> enforce human rights.In this context, the United Nations Committeeon Economic, Social <strong>and</strong> Cultural Rights hasemphasized the strong <strong>and</strong> continuous responsibilityof international organizations, as well asthe governments that have created <strong>and</strong> managethem, to take whatever measures they can in thecontext of globalization to assist governments toact in ways which are compatible with theirhuman rights obligations, <strong>and</strong> to seek to devisepolicies <strong>and</strong> programmes which promoterespect for those rights. (71)“Although we refer to our world as a globalvillage it is a world sadly lacking in thesense of closeness towards neighbour <strong>and</strong>community which the word villageimplies. In each region, <strong>and</strong> within allcountries, there are problems stemmingfrom either a lack of respect for, or lack ofacceptance of, the inherent dignity <strong>and</strong>equality of all human beings.”United Nations High Commissioner forHuman Rights, Mary Robinson©WHO/PAHO26

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human RightsQ.23 What is meantby a rights-basedapproachto development?There is increasing recognition, within theUnited Nations system <strong>and</strong> beyond, that developmentitself is not only a human right as recognizedin the United Nations Declaration onthe Right to Development (1986), but that thedevelopment process must, in itself, be consistentwith human rights. In this regard, OHCHRhas advocated a rights-based approach todevelopment as a conceptual framework forthe process of human development that is normativelybased on international human rights.This approach integrates the norms, st<strong>and</strong>ards<strong>and</strong> principles of the international humanrights system into the plans, policies <strong>and</strong>processes of development. The norms <strong>and</strong> st<strong>and</strong>ardsare those contained in the wealth of internationaltreaties <strong>and</strong> declarations. The principlesinclude those of participation, accountability,non-discrimination <strong>and</strong> attention to vulnerability,empowerment <strong>and</strong> express linkage tointernational human rights instruments.“A rights-based approach to developmentdescribes situations not simply in termsof human needs, or of developmentalrequirements, but in terms of society’sobligations to respond to the inalienablerights of individuals, empowers people todem<strong>and</strong> justice as a right, not as charity,<strong>and</strong> gives communities a moral basis fromwhich to claim international assistancewhen needed.”United Nations Secretary-General,Kofi Annan©WHO/Stills(76) Overseas DevelopmentInstitute, “What canwe do with a rights-basedapproach to development?”.Briefing Paper,1999 (3) September.“A rights-based approach to developmentsets the achievement of human rights as anobjective of development. It uses thinkingabout human rights as a scaffolding ofdevelopment policy. It invokes the internationalapparatus of human rights accountabilityin support of development action.In all of these, it is concerned with not justcivil <strong>and</strong> political rights but also with economic,social <strong>and</strong> cultural rights. Further,the implementation of a rights-basedapproach implies that performance st<strong>and</strong>ardsbe set.” (76)28

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human RightsQ.24 How do human rightslaw, refugee law<strong>and</strong> humanitarianlaw interact withthe provisionof health assistance?The large number <strong>and</strong> changing nature ofemergencies <strong>and</strong> conflicts, including theexplosion of religious <strong>and</strong> ethnic turmoilaround the world, has prompted the need fornew thinking <strong>and</strong> approaches within the UnitedNations system <strong>and</strong> beyond. Fresh attention isbeing drawn to the international legal frameworkfor dealing with these emergencies, inparticular the relationship between humanitarianlaw, human rights law <strong>and</strong> refugee law<strong>and</strong> their applicability in a changing crisisenvironment. (77)Refugee law acts to protect refugeesby spelling out specific legal provisionsprotecting the human rights of refugeesmost notably through the United NationsConvention Relating to the Status of Refugees(1950) <strong>and</strong> its protocol (1966).©Helena Nygren-Krug(77) See paper by UweKracht, DevelopmentConsultant <strong>and</strong>Co-Coordinator of theWorld Alliance for Nutrition<strong>and</strong> Human Rights(WANAHR) Human Rights<strong>and</strong> Humanitarian Law <strong>and</strong>Principles in Emergencies- An overview of concepts<strong>and</strong> issues, prepared forUNICEF.Human rights, humanitarian law <strong>and</strong> refugeelaw are distinct yet closely related branches ofthe international legal system. Human rights<strong>and</strong> refugee law were developed within theUnited Nations framework <strong>and</strong> thus havesimilar underpinnings. Humanitarian law,however, has profoundly different origins <strong>and</strong>uses different mechanisms for its implementation.All branches of law have, however, afundamental common objective: the respect forhuman dignity without any discriminationwhatsoever as to race, colour, religion, sex,birth or wealth, or any similar criteria. Inaddition, they share a great number of detailedobjectives <strong>and</strong> conceptual similarities.Humanitarian law is the law of armedconflict or the law of wars: a body of ruleswhich in wartime protect persons who arenot or no longer participating in the hostilities<strong>and</strong> which limit methods <strong>and</strong>means of warfare. The central instrumentsof humanitarian law are the four1949 Geneva Conventions <strong>and</strong> their twoAdditional Protocols of 1977.Efforts are under way to ensure that internationalhuman rights <strong>and</strong> humanitarian lawprinciples provide the st<strong>and</strong>ard <strong>and</strong> referencefor humanitarian action by the United Nations<strong>and</strong> its agencies as well as other actors. Healthpractices in preparing for, assessing, implementing,<strong>and</strong> evaluating the impact of healthassistance in the context of an armed conflictneed to be grounded within a framework ofinternational law. The sick <strong>and</strong> wounded,health workers, medical equipment, hospitals<strong>and</strong> various medical units (including medicaltransportation) are all protected under humanitarianlaw principles. Moreover, denying accessto medical care in some circumstances couldconstitute a war crime.29

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human RightsQ.<strong>25</strong> How does humanrights relate tohealth developmentwork in countries?Human rights are upheld as a cross-cutting issuein the United Nations’ development work atcountry level. (80) The Common Country Assessment(CCA) <strong>and</strong> the United Nations DevelopmentAssistance Framework (UNDAF) providethe major principles upon which a human rightsbasedapproach to development is founded. TheCCA <strong>and</strong> UNDAF Guidelines refer to the implementationof United Nations Conventions <strong>and</strong>Declarations <strong>and</strong> underscore the importance oftaking full account of human rights in both theseprocesses. The CCAthus helps to facilitate effortsfor coherent, integrated <strong>and</strong> coordinated UnitedNations support to government follow-up to theConferences <strong>and</strong> the implementation of Conventionsat the field level.©WHO/PAHO(78) Guiding Principleson Internal Displacement(1998).(79) In March 2000,the ACC issued the HumanRights Guidelines <strong>and</strong>Information for theResident CoordinatorSystem which is animportant reference forthe collective effort tointegrate human rightswithin the United Nationssystem, approved onbehalf of ACC by theCCPOQ at its 16th Session,Geneva, March 2000,http://accsubs.unsystem.org/ccpoq/documents/manual/human-rightsgui.pdf,para. 59.(80) Idem.(81) Refer to footnote 68.(82) Human rights <strong>and</strong>poverty reduction strategies:A discussion paper,footnote 57.Overall, humanitarian action in the field ofhealth represents action towards the fulfilmentof the right to health in situations where thethreats to health are greatest. Moreover, in theprovision of health care in emergency situations,consideration of the human rightsdimension can help ensure that strategies payparticular attention to vulnerable groups. Theparticular vulnerability of refugees, internallydisplaced, <strong>and</strong> migrants requires a specialemphasis on human rights. Within thesegroups, women as single heads of households,unaccompanied minors, persons with disabilities,<strong>and</strong> the elderly are in need of specialattention. Specific human rights principlesexist that provide guidance in ensuring protectionin emergencies against exposure ofvulnerable groups to risk-factors of disease<strong>and</strong> ill-health. (78)According to United Nations Guidelines,United Nations staff in the field, “shouldgenerally not reject complaints of humanrights violations. Once received, theseshould be promptly <strong>and</strong> confidentially transmittedto OHCHR for processing…” (79)This parallels the principles enunciated in theWorld Bank’s Comprehensive DevelopmentFramework (CDF), the joint World Bank/IMFPoverty Reduction Strategy Paper (PRSP) initiative,the formal design of which reflects humanrights concepts <strong>and</strong> st<strong>and</strong>ards. A project of theOHCHR to produce guidelines for the integrationof human rights in poverty reduction strategies,including Poverty Reduction StrategyPapers (HRPRS Guidelines), has highlighted theclose correspondence between “the realities ofpoor people,” as identified by Voices of thePoor (81) <strong>and</strong> other poverty studies, <strong>and</strong> the internationalhuman rights normative framework.Thus, attention to human rights will help toensure that the key concerns of poor peoplebecome, <strong>and</strong> remain, the key concerns of povertyreduction strategies. For example, the integrationof human rights into anti-poverty strategieswill help to ensure that vulnerable individuals<strong>and</strong> groups are not neglected; that the active <strong>and</strong>informed participation of the poor is providedfor; that key sectoral issues (e.g. education, housing,health <strong>and</strong> food) receive due attention; thatimmediate <strong>and</strong> intermediate (as well as longterm)targets are identified; that effective monitoringmethods (e.g. indicators <strong>and</strong> benchmarks)are established; <strong>and</strong> that accessible mechanismsof accountability, in relation to all parties, areinstituted. Furthermore, human rights providepoverty reduction strategies with norms, st<strong>and</strong>ards<strong>and</strong> values that have a high-level of globallegitimacy. (82)30

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human RightsAnnex I:LegalInstruments©WHO/PAHOInternational treaties <strong>and</strong> conventions(in chronological order) relevantto health & human rightsConvention (No. 29) concerning Forced Labour (1930);United Nations Charter (1945);Convention on the Prevention <strong>and</strong> Punishment of the Crime of Genocide (1948);Convention for the Suppression of the Traffic in Persons <strong>and</strong> of the Exploitationof the Prostitution of Others (1949);Geneva Convention for the Amelioration of the Condition of the Wounded <strong>and</strong> Sick in ArmedForces in the Field (1949);Geneva Convention for the Amelioration of the Condition of Wounded, Sick <strong>and</strong> ShipwreckedMembers of Armed Forces at Sea (1949);Geneva Convention relative to the Treatment of Prisoners of War (1949);Geneva Convention relative to the Protection of Civilian Persons in Time of War (1949),<strong>and</strong> the Protocol Additional to the Geneva Conventions relating to the Protection of Victimsof International Armed Conflicts (Protocol 1) (1977) <strong>and</strong> the Protocol relating to the Protectionof Victims of Non-International Armed Conflicts (Protocol II) (1977) ;Convention relating to the Status of Refugees (1950) <strong>and</strong> its Protocol (1967);Convention (No. 105) on Abolition of Forced Labour (1957);International Convention on the Elimination of All Forms of Racial Discrimination (1963);International Covenant on Economic, Social <strong>and</strong> Cultural Rights (1966);International Covenant on Civil <strong>and</strong> Political Rights (1966) <strong>and</strong> its two Protocols (1966 <strong>and</strong> 1989);Convention on the Elimination of All Forms of Discrimination Against Women (1979)<strong>and</strong> its Protocol (1999);Convention against Torture <strong>and</strong> Other Cruel, Inhuman or Degrading Treatment or Punishment(1984);Convention on the Rights of the Child (1989);Convention (No. 169) concerning Indigenous <strong>and</strong> Tribal Peoples in Independent Countries (1989);International Convention on the Protection of the Rights of All Migrant Workers <strong>and</strong> Membersof their Families (1990);Convention (No. 182) on the Prohibition <strong>and</strong> Immediate Action for the Elimination of the WorstForms of Child Labour (1999);Maternity Protection Convention (No. 183, 2000).31

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human RightsInternational declarations,norms <strong>and</strong> st<strong>and</strong>ards(in chronological order) relevantto health &human rightsUniversal Declaration of Human Rights (1948);Declaration on the Use of Scientific <strong>and</strong> Technological Progress in the Interests of Peace<strong>and</strong> for the Benefit of Mankind (1975);Declaration on the Rights of Disabled Persons (1975);Principles of Medical Ethics relevant to the Role of Health Personnel, particularly Physicians,in the Protection of Prisoners <strong>and</strong> Detainees against Torture <strong>and</strong> Other Cruel, Inhumanor Degrading Treatment or Punishment (1982);Declaration on the Right to Development (1986);Principles for the Protection of Persons with Mental Illness <strong>and</strong> the Improvement of MentalHealth Care (1991);United Nations Principles for Older Persons (1991);Declaration on the Rights of Persons Belonging to National or Ethnic, Religious <strong>and</strong> LinguisticMinorities (1992);United Nations St<strong>and</strong>ard Rules on the Equalization of Opportunities for Persons with Disabilities (1993);Declaration on the Elimination of Violence Against Women (1993);Universal Declaration on the Human Genome <strong>and</strong> Human Rights (1997);Declaration on the Right <strong>and</strong> Responsibility of Individuals, Groups <strong>and</strong> Organs of Society toPromote <strong>and</strong> Protect Universally Recognized Human Rights <strong>and</strong> Fundamental Freedoms (1998);Guiding Principles on Internal Displacement (1998).Regional instruments(in chronological order)in relation to health& human rightsAmerican Declaration of the Rights <strong>and</strong> Duties of Man (1948);European Convention for the Protection of Human Rights <strong>and</strong> Fundamental Freedoms (1950)<strong>and</strong> its Eleven Protocols (1952 - 1994);European Social Charter (1961), (revised 1996);American Convention on Human Rights (1969);African Charter on Human <strong>and</strong> Peoples’ Rights (1981);Inter-American Convention to Prevent <strong>and</strong> Punish Torture (1985);Additional Protocol to the American Convention on Human Rights in the Area of Economic,Social <strong>and</strong> Cultural Rights - “Protocol of San Salvador” (1988);Protocol to the American Convention on Human Rights to Abolish the Death Penalty (1990);African Charter on the Rights <strong>and</strong> Welfare of the Child (1990);Convention on the Prevention, Punishment <strong>and</strong> Eradication of Violence against Women“Convention of Belem do Para.” (1994);Arab Charter on Human Rights (1994);European Convention on Human Rights <strong>and</strong> Dignity of the Human Being with regard tothe Application of Biology <strong>and</strong> Medicine: Convention on Human Rights <strong>and</strong> Biomedicine (1997);Inter-American Convention on the Elimination of All Forms of Discrimination Against PersonsWith Disabilities. (1999).32

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human RightsInternational conference documents<strong>and</strong> their follow-up(in chronological order) relevantto health & human rightsWorld Summit for Children, New York (1990): World Declaration on the Survival, Protection<strong>and</strong> Development of Children <strong>and</strong> Plan of Action for Implementing the World Declaration,<strong>and</strong> its follow-up, the United Nations General Assembly Special Session (UNGASS) on Children(2002): A World Fit for Children;United Nations Conference on Environment <strong>and</strong> Development, Rio de Janeiro (1992):Rio Declaration on Environment <strong>and</strong> Development <strong>and</strong> Agenda 21;World Conference on Human Rights, Vienna (1993): Vienna Declaration <strong>and</strong> Programmeof Action;International Conference on Population <strong>and</strong> Development, Cairo, 1994: Programme of Action;World Summit for Social Development, Copenhagen (1995): Copenhagen Declaration on SocialDevelopment <strong>and</strong> Programme of Action of the World Summit for Social Development,<strong>and</strong> its follow-up, Copenhagen Plus 5 (2000);Fourth World Conference on Women, Beijing (1995): Beijing Declaration <strong>and</strong> Platform for Action,<strong>and</strong> its follow-up, Beijing Plus 5 (2000);Second United Nations Conference on Human Settlements (Habitat II), Istanbul (1996):Istanbul Declaration on Human Settlements;World Food Summit, Rome (1996): Rome Declaration on World Food Security<strong>and</strong> World Food Summit Plan of Action, <strong>and</strong> its follow-up, Declaration of the World FoodSummit: Five Years Later, International Alliance Against Hunger (2002);United Nations General Assembly Special Session (UNGASS) on AIDS (2001): Declaration ofCommitment on HIV/AIDS “Global Crisis–Global Action;”World Conference Against Racism, Racial Discrimination Xenophobia<strong>and</strong> Related Intolerance, Durban (2001): Durban Declaration <strong>and</strong> Programme of Action;Second World Assembly on Ageing (2002): Political Declaration <strong>and</strong> Madrid InternationalProgramme of Action on Ageing.33

<strong>25</strong> <strong>Questions</strong> & <strong>Answers</strong> on Health <strong>and</strong> Human RightsAnnex II:United NationsHuman RightsOrganizationalStructureThis chart, which is not exhaustive,describes the functioning of the UnitedNations system in the field of humanrights. Emphasis is given to thosebodies <strong>and</strong> programmes with majorhuman rights responsibilities.The purple areas indicate six principleorgans of the United Nations,whereas the green ones indicate bodiesor programmes serviced by the Officeof the United Nations HighCommissioner for Human Rights. (83)©WHO/PAHOSECURITYCOUNCILTRUSTEESHIPCOUNCILINT. COURTOF JUSTICESecretary GeneralSECRETARIATECONOMIC AND SOCIALCOUNCILOther SubsidiarybodiesCom. on Crime Prevention& Criminal JusticeGENERAL ASSEMBLYTreaty-monitoring bodies(Conventional mechanisms)Commitee on Economic, Social <strong>and</strong> Cultural Rights (CESCR)Human Rights Committee (HRC)Commitee against Torture (CAT)Commitee on the Elimination of Racial Discrimination (CERD)United NationssystemHight Commissionerfor Human RightsCommission on thestatus of WomenCommitee on the Elimination of Discriminationagaints Women (CEDAW)Commitee on the Right of the Child (CRC)Int. CriminalTribunal forex-YugoslaviaInt. CriminalTribunal forRw<strong>and</strong>aHumanitarianTrust FundsTechnicalcooperationHuman RightsField PresencesCommission onHuman RightsSub-Commission onthe Promotion <strong>and</strong> Protectionof Human RightsCountry <strong>and</strong> Thematic Special Rapporteurs…(Extra-Conventional mechanisms)Working GroupsWorking GroupsCopyright 1997(83) This organizationalchart is used courtesy ofthe Office of the HighCommissioner for HumanRights.http://www.unhchr.ch/hrostr.htmOffice of the United NationsHigh Commissioner for Human RightsGeneva, Switzerl<strong>and</strong>Special Committee on Israeli Practices in Occupied Territories34

The enjoyment of the highest attainablest<strong>and</strong>ard of health as a fundamental right ofevery human being was enshrined in WHO’sConstitution over fifty years ago. WHO strives tomake this right a reality for everyone, payingparticular attention to the poorest <strong>and</strong> mostvulnerable.In this context, WHO has launched the Health<strong>and</strong> Human Rights Publication Series to explorethe complex relationship between health <strong>and</strong>human rights regarding various healthchallenges. The first in this series, <strong>25</strong> <strong>Questions</strong><strong>and</strong> <strong>Answers</strong> on Health <strong>and</strong> Human Rights,attempts to answer key questions that come tomind in exploring the linkages between health<strong>and</strong> human rights. It is intended as a practicalguide to generate increased clarity <strong>and</strong>underst<strong>and</strong>ing among WHO staff <strong>and</strong> otherhealth, development <strong>and</strong> human rightspractitioners about the important synergybetween health <strong>and</strong> human rights.Health & Human RightsPublication Series Issue No.1For more information, please contact:Helena Nygren-KrugHealth <strong>and</strong> Human RightsStrategy UnitDirector General’s OfficeWorld Health Organization20, avenue Appia – 1211 Geneva 27 – Switzerl<strong>and</strong>Tel. (41) 22 791<strong>25</strong>23 – Fax: (41) 22 7914726www.who.int/hhr