Can human rights discourse improve the health of Indigenous Australians?

OBJECTIVE: Recognition of the poor health outcomes of Indigenous Australians has led to an interest in using human rights discourse as a framework for arguing that the Australian Government has an international obligation to improve Indigenous health. METHOD: This paper explores two potential directions for human rights discourse in this context. The first is the development and elaboration of an asserted 'human right to health'. The second focuses on developing an understanding of the interactions between health and human rights, particularly the underlying social determinants of health, and thereby creating an advocacy framework that could be used to promote the inclusion of human rights considerations into the policy-making agenda. RESULTS: This paper argues that despite the symbolic force of human rights discourse, its capacity to improve the health of Indigenous Australians through international law is limited. This is so irrespective of whether recourse is made to a legal or moral imperative. CONCLUSION AND IMPLICATIONS: The 'human right to health' is limited primarily by several barriers to its implementation, some of which are perpetuated by the current Australian Government itself. Although the potential advocacy capacity of human rights discourse is similarly limited by the hostility of the Government towards the notion of incorporating human rights considerations into its public policy decision making, it does provide a sustainable intellectual framework in which to consider the social and structural determinants of health and maintain these issues on the political agenda.     

A perspective on the history of health and human rights: from the Cold War to the Gold War

Through the end of the Cold War, public health policies were predominantly shaped and implemented by governments and these same governments committed themselves to meet their obligations for health under international and national laws. The post-Cold War era has witnessed the entry of new actors in public health and the sharing of power and influences with non-state actors, in particular the private sector and interest groups. This article examines the emergence of human rights and the rise of health on the international development agenda as the Cold War was ending. It highlights the convergence of health and human rights in academic and public discourse since the end of the Cold War in a context of political and economic shifts linked to the ongoing economic globalization. It describes opportunities and challenges for greater synergy between health and rights and proposes a role for health practitioners.     

Exacerbating Inequalities? Health Policy and the Behavioural Sciences

There have been calls for some time for a new approach to public health in the United Kingdom and beyond. This is consequent on the recognition and acceptance that health problems often have a complex and multi-faceted aetiology. At the same time, policies which utilise insights from research in behavioural economics and psychology (‘behavioural science’) have gained prominence on the political agenda. The relationship between the social determinants of health (SDoH) and behavioural science in health policy has not hitherto been explored. Given the on-going presence of strategies based on findings from behavioural science in policy-making on the political agenda, an examination of this is warranted. This paper begins by looking at the place of the SDoH within public health, before outlining, in brief, the recent drive towards utilising behavioural science to formulate law and public policy. We then examine the relationship between this and the SDoH. We argue that behavioural public health policy is, to a certain extent, blind to the social and other determinants of health. In section three, we examine ways in which such policies may perpetuate and/or exacerbate health inequities and social injustices. We argue that problems in this respect may be compounded by assumptions and practices which are built into some behavioural science methodologies. We also argue that incremental individual gains may not be enough. As such, population-level measures are sometimes necessary. In section four we defend this contention, arguing that an equitable and justifiable public health requires such measures.     

The challenge to public health of the Millenium Development Goals: an approach from political epidemiology

The Millennium Development Goals, and within these the Millennium Targets, constitute a working plan that strives to achieve basic goals within the field of health, eradicate poverty, and ensure compliance with basic human rights. Its scope of action represents a historic breakthrough as a step toward a possible global social policy, in which cooperation between the different sectors is essential for its efficiency. Due to its multidisciplinary nature, public health, as well as political epidemiology, can be used to help increase scientific knowledge in the field of health with respect to the Millennium Development Goals. Despite the opportunity that this international agreement provides, insufficient in-depth study has been carried out on the potential -mainly political- difficulties that could arise during its implementation. Therefore, a conceptual and methodological change is required so that concern does not simply center on social determinants of health but instead takes into consideration the political reasons behind them. To reduce inequality, not only must injustice be classified but effective ways must also be found to encourage institutions with political power to take part in this initiative.     

Social determinants of health: present status, unanswered questions, and future directions.

This article reviews the current status of theory and research concerning the social determinants of health. It provides an overview of current conceptualizations and evidence on the impact of various social determinants of health. The contributions of different disciplines--epidemiology, sociology, political economy, and the human rights perspective--to the field are acknowledged, but profound gaps persist in our understanding of the forces that drive the quality of various social determinants of health and why research is too infrequently translated into action. Many of these gaps in knowledge concern the political, economic, and social forces that make implementation of public policy agendas focused on strengthening the social determinants of health problematic. The author identifies the areas of inquiry needed to help translate knowledge into action.     

A Call for Social Justice and for a Human Rights Approach with Regard to Mental Health in the Occupied Palestinian Territories

This paper examines the process of depoliticization of mental health in the occupied Palestinian territories (oPt) and links it to a critical analysis of post-traumatic stress disorder and the role of international humanitarian aid. It is based on a human rights framework that focuses on the right to health and that is instrumental in connecting human rights violations to demands of social justice. Efforts to weaken justice and reparations are analyzed by looking at the role of mental health professionals and assumptions of psychotherapy as a neutral and nonpolitical sphere. By drawing on models of decoloniality and liberation psychology, we advocate for a shift from a decontextualized and individualistic approach to mental health to acknowledging the structural, social, and political oppression that are the underlying factors for suffering in the oPt. In order to alleviate the social suffering of Palestinians and to prevent their victimization, interventions that acknowledge the political nature of mental health ill-being and promote a human rights approach are needed.     

Australian asylum policies: have they violated the right to health of asylum seekers?

Objectives : Notwithstanding recent migration policy amendments, there is concern that Australian asylum policies have disproportionately burdened the health and wellbeing of onshore asylum seekers. There may be a case to be made that Australian governments have been in violation of the right to health of this population. The objective of this paper is to critically examine these issues and assess the implications for public health practice.
Methods :The author undertook a review of the recent empirical literature on the health effects of post-migration stressors arising from Australian policies of immigration detention, temporary protection and the restriction of Medicare to some asylum seekers. This evidence was examined within the context of Australia's international law obligations.
Results : Findings reveal that Australian asylum policies of detention, temporary protection and the exclusion of some asylum seekers from Medicare rights have been associated with adverse mental health outcomes for this population. This is attributable to the impact of these policies on accessing health care and the underlying determinants of health for aslyum seekers.
Conclusion : It is arguable that Australian Governments have been discriminating against asylum seekers by withholding access on the grounds of their migration status, to health care and to the core determinants of health in this context. In so doing, Australia may have been in violation of its obligation to respect the right to health of this population.
Implications : While the 'right to health' framework has much to offer public health, it is an undervalued and poorly understood discipline. The author argues for more education, research and advocacy around the intersection between heath and human rights.     

Gender Inequality,Health Rights,and HIV/AIDS among Women Prisoners in Zimbabwe

Zimbabwe has successfully reduced its HIV prevalence rate and AIDS-related deaths in recent years, but women, particularly those who are in prison, remain at high risk. Poor prison conditions, discrimination, stigma, and the neglect of the sexual and reproductive health of women prisoners living with HIV result in poor health outcomes for women prisoners. Inadequate and inappropriate health provision in prison is a breach of their human rights and a public health problem. This paper analyzes the political commitment of Zimbabwe to address the underlying determinants of health by incorporating into its health laws and policies measures that promote the health rights of women prisoners living with HIV.     

Developing an evidence base for policies and interventions to address health inequalities: the analysis of "public health regimes"

Systematic reviews have become an important methodology in the United Kingdom by which research informs health policy, and their use now extends beyond evidence-based medicine to evidence-based public health and, particularly, health inequalities policies. This article reviews the limitations of systematic reviews as stand-alone tools for this purpose and suggests a complementary approach to make better use of the evidence. That is, systematic reviews and other sources of evidence should be incorporated into a wider analytical framework, the public health regime (defined here as the specific legislative, social, political, and economic structures that have an impact on both public health and the appropriateness and effectiveness of public health interventions adopted). At the national level this approach would facilitate analysis at all levels of the policy framework, countering the current focus on individual interventions. It could also differentiate at the international level between those policies and interventions that are effective in different contexts and are therefore potentially generalizable and those that depend on particular conditions for success.     

Public nutrition: Why,What, How?

Public Nutrition is a field of professional study and practice that has existed for many years without being named as such. It encompasses the disciplines that deal with factors affecting the food consumption and nutritional outcomes of populations, and goes beyond the definition of Public Health Nutrition by including the study of public policy in areas outside of health and nutrition as traditionally defined, that nonetheless can have profound effects on nutrition. Career paths in Public Nutrition exist at a variety of professional levels, including practitioners and direct service providers; administrators and planners; policy makers; and researchers and educators. The professional preparation of those working in Public Nutrition typically combines education and experience in nutritional science, social science, and sometimes management and planning. The field of Public Nutrition is important in providing a critical link between advances in understanding biomedical determinants of nutrition and the application of such understanding in programs and policies. However, the study of Public Nutrition goes beyond this: it represents an agenda of research and practice in its own right. Public Nutrition includes the study of how specific policies, in varying contexts, affect food consumption and nutrition outcomes; it includes the study of determinants of program effectiveness in improving these outcomes. Specific training programs in Public Nutrition do exist; the elements of a curriculum in Public Nutrition include social science research skills (data collection, management, analysis and interpretation), an understanding of economic, social, political, and behavioral determinants of food consumption, health and nutrition; a grounding in nutritional science. Field experience is an essential part of the preparation of Public Nutrition professionals.     

Reinventing public health: a new perspective on the health of Canadians and its international impact

STUDY OBJECTIVE: To examine the Canadian origins of the Lalonde Report and its impact on British and American health promotion activities. DESIGN: A brief history of the development of key Canadian documents and their use by politicians and public health activists in the United Kingdom and United States. SETTING: This paper focuses on the impact of the Canadian model on Canada, the United Kingdom and United States. MAIN RESULTS: This paper argues that internal political and economic forces are as important as international trends in determining healthcare policy initiatives. CONCLUSIONS: In the 1970s all the English-speaking developed nations were facing deficits as curative costs rose. Adopting health promotion policies permitted them to shift responsibility back to local governments and individuals while limiting their expenditures. Health and community activists, however, used this concept to broaden their focus to include the social, economic and political determinants of health and thus reinvented public health discourse and practice for the 21st century.     

Integrated Approaches to Address the Social Determinants of Health for Reducing Health Inequity

The social and physical environments have long since been recognized as important determinants of health. People in urban settings are exposed to a variety of health hazards that are interconnected with their health effects. The Millennium Development Goals (MDGs) have underlined the multidimensional nature of poverty and the connections between health and social conditions and present an opportunity to move beyond narrow sectoral interventions and to develop comprehensive social responses and participatory processes that address the root causes of health inequity. Considering the complexity and magnitude of health, poverty, and environmental issues in cities, it is clear that improvements in health and health equity demand not only changes in the physical and social environment of cities, but also an integrated approach that takes into account the wider socioeconomic and contextual factors affecting health. Integrated or multilevel approaches should address not only the immediate, but also the underlying and particularly the fundamental causes at societal level of related health issues. The political and legal organization of the policy-making process has been identified as a major determinant of urban and global health, as a result of the role it plays in creating possibilities for participation, empowerment, and its influence on the content of public policies and the distribution of scarce resources. This paper argues that it is essential to adopt a long-term multisectoral approach to address the social determinants of health in urban settings. For comprehensive approaches to address the social determinants of health effectively and at multiple levels, they need explicitly to tackle issues of participation, governance, and the politics of power, decision making, and empowerment.     

Health impact assessment, human rights and global public policy: a critical appraisal

Public policy decisions in both the social and economic spheres have enormous impact on global public health. As a result of this, and of the skewed global distribution of power and resources, health impact assessment (HIA) potentially has a key role to play in foreign policy-making and global public policy-making. Governments, multilateral bodies and transnational corporations need to be held to account for the health impacts of their policies and practices. One route towards achieving this objective involves the inclusion of human rights assessments within HIA. International commitments to human rights instruments and standards can be used as a global auditing tool. Methodological issues may limit the effectiveness of HIA in promoting health equity. These issues include the use of procedures that favour those holding power in the policy process or the use of procedures that fail to apply values of equity and participation. The identification and production of evidence that includes the interests of less powerful groups is a priority for HIA and would be furthered if a human rights-based method of HIA were developed. Because HIA considers all types of policies and examines all potential determinants of health, it can play a part when foreign policy is developed and global decisions are made to treat people as rights holders. Since the human right to health is shaped by the determinants of health, developing links between the right to health assessment (that is, an assessment of the impact of policies on the right to health) and HIA--as recently proposed by the United Nations Special Rapporteur on the right to health--could strengthen the development of foreign policy and global decisions. Such links should be pursued and applied to the development of foreign policy and to the operation of multilateral bodies.     

Shaping public policy and population health in the United States: why is the public health community missing in action?

Renewed international interest in the structural determinants of health manifests itself in a focus on the social determinants of health and the public policy antecedents that shape their quality. This increased international interest in public policy in support of the structural determinants of health has had little traction in the United States. This should be surprising since the United States presents one of the worst population health profiles and public policy environments in support of health among wealthy developed nations. The U.S. position as a health status and policy outlier results from long-term institutional changes that are shaped by political, economic, and social forces. U.S. public health researchers' and workers' neglect of these structural and public policy issues conforms to the dominant ideological discourses that serve to justify these changes. The author presents some means by which public health researchers and workers can challenge these dominant discourses.     

The right to health of prisoners in international human rights law

This paper explores the health rights of prisoners as defined in international law, and the mechanisms that have been used to ensure the rights of persons in detention to realise the highest attainable standard of health. It examines this right as articulated within United Nations and regional human rights treaties, non-binding or so-called soft law instruments from international organisations and the jurisprudence of international human rights bodies. It explores the use of economic, social and cultural rights mechanisms, and those within civil and political rights, as they engage the right to health of prisoners, and identifies the minimum legal obligations of governments in order to remain compliant with human rights norms as defined within the international case law. In addressing these issues, this article adopts a holistic approach to the definition of the highest attainable standard of health. This includes a consideration of adequate standards of general medical care, including preventative health and mental health services. It also examines the question of environmental health, and those poor conditions of detention that may exacerbate health decline, disease transmission, mental illness or death. The paper examines the approach to prison health of the United Nations human rights system and its various monitoring bodies, as well as the regional human rights systems in Europe, Africa and the Americas. Based upon this analysis, the paper draws conclusions on the current fulfilment of the right to health of prisoners on an international scale, and proposes expanded mechanisms under the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment to monitor and promote the health rights of prisoners at the international and domestic levels.     

Human rights,public health and medicinal cannabis use

This paper explores the interplay between the human rights and drug control frameworks and critiques case law on medicinal cannabis use to demonstrate that a bona fide human rights perspective allows for a broader conception of ‘health’. This broad conception, encompassing both medicalised and social constructionist definitions, can inform public health policies relating to medicinal cannabis use. The paper also demonstrates how a human rights lens can alleviate a core tension between the State and the individual within the drug policy field. The leading medicinal cannabis case in the UK highlights the judiciary’s failure to engage with an individual’s human right to health as they adopt an arbitrary, externalist view, focussing on the legality of cannabis to the exclusion of other concerns. Drawing on some international comparisons, the paper considers how a human rights perspective can lead to an approach to medicinal cannabis use which facilitates a holistic understanding of public health.     

Social capital, disorganized communities, and the third way: understanding the retreat from structural inequalities in epidemiology and public health.

The construct of social capital has recently captured the interest of researchers in social epidemiology and public health. The authors review current hypotheses on the social capital and health link, and examine the empirical evidence and its implications for health policy. The construct of social capital employed in the public health literature lacks depth compared with its uses in social science. It presents itself as an alternative to materialist structural inequalities (class, gender, and race) and invokes a romanticized view of communities without social conflict that favors an idealist psychology over a psychology connected to material resources and social structure. The evidence on social capital as a determinant of better health is scant or ambiguous. Even if confirmed, such hypotheses call for attention to social determinants beyond the proximal realm of individualized sociopsychological infrastructure. Social capital is used in public health as an alternative to both state-centered economic redistribution and party politics, and represents a potential privatization of both economics and politics. Such uses of social capital mirror recent "third way" policies in Germany, the United Kingdom, and United States. If third way policies lose support in Europe, the prominence of social capital there might be short lived. In the United States, where the working class is less likely to influence social policy, interest in social capital could be longer lived or could drift into academic limbo like other psychosocial constructs once heralded as the next big idea.     

The economic and political determinants of human (including health) rights

This paper presents an analysis and critique of the U.S. government's current emphasis on human rights; and (a) its limited focus on only some civil and political components of the original U.N. Declaration of Human Rights, and (b) its disregard for economic and social rights such as the rights to work, fair wages, health, education, and social security. The paper discusses the reasons for that limited focus and argues that, contrary to what is widely presented in the media and academe: (1) civil and political rights are highly restricted in the U.S.; (2) those rights are further restricted in the U.S. when analyzed in their social and economic dimensions; (3) civil and political rights are not independent of but rather intrinsically related to and dependent on the existence of socioeconomic rights; (4) the definition of the nature and extension of human rights in their civil, political, social, and economic dimensions is not universal, but rather depends on the pattern of economic and political power relations particular to each society; and (5) the pattern of power relations in the U.S. society and the western system of power, based on the right to individual property and its concomitant class structure and relations, is incompatible with the full realization of human rights in their economic, social, political, and civil dimensions. This paper further indicates that U.S. financial and corporate capital, through its overwhelming influence over the organs of political power in the U.S. and over international bodies and agencies, is primarily responsible for the denial of the human rights of the U.S. population and many populations throughout the world as well.