The Right to Health and the Climate Crisis: The Vital Role of Civic Space

Under the United Nations Framework Convention on Climate Change and its protocols, states have legal obligations to address the climate crisis. The principle of participation is increasingly acknowledged as central to the protection and promotion of human rights, including the right to health. This paper explores states’ obligations to address the climate crisis—and concomitant health crises—from a right to health perspective. The right to health lens provides a valuable opportunity for engaging diverse civil society constituencies in the response to the climate crisis. However, civic space must be protected if these actors are to participate meaningfully. The climate crisis discourse has lacked an explicit recognition of the interconnected nature of the right to health, environmental degradation and climate change, and civic space. There is also concern that restrictions on civic space will continue after the COVID-19 pandemic. While the public health community is an important constituency in the design and implementation of laws, policies, and programs to address climate change, the human rights literacy of this community remains to be strengthened. This paper addresses these lacunae within the context of the right to health as enshrined in United Nations human rights treaties and related international law.     

Multilateral agencies and world population growth. Introductory statement: the need for United Nations leadership

There is a widespread interest by United Nations agencies in family planning programs; this is evidenced by large scale financial aid that is offered. The UN has some advantages in providing support in national efforts to include population planning in their development plans: a) since the issue is highly political, the existence of an institution such as the UN where the whole world is represented helps operate the family planning field; b)as this is an international operation, it is possible to make use of international talent and experience; and c) because practically the whole world has shown some interest in the issue and is undertaking official programs, it is good that a highly select staff is acting as a guiding hand. The author urges that the forthcoming World Population Conference establish a new UN unit situated above the existing organization, for this purpose.     

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.     

Development of a globally harmonized system for hazard communication

As a result of an international mandate adopted in 1992 at the United Nations Conference on the Environment and Development (UNCED), a globally harmonized system (GHS) for hazard communication has been developed. The work has involved significant contributions from numerous countries and international organizations. The GHS is designed to be a common and coherent approach to defining and classifying hazards of chemicals, and communicating information on labels and substance data sheets. The target audiences for the information include workers, consumers, transport workers, and emergency responders. The GHS can provide an informational infrastructure for countries establishing national, comprehensive programs for the sound management of chemicals. Adoption of the GHS by the United Nations is expected in December 2002, and it will be available for countries to adopt in 2003. The purpose of this discussion is to describe the work to develop the system, the primary components of the GHS, and efforts to promote implementation.     

医院维和医疗分队派遣工作的组织与准备

派遣医疗分队参加国际维和行动的卫勤保障,是我国越来越多地参与国际事务,国际地位日益提高的重要标志。医院作为派遣维和医疗分队的主体,依据联合国所赋予的各项任务,在派遣工作的组织和准备上,需要有明确的目标和周密的计划。担负派遣任务的军队医院还必须在人员选拔和抽组、各种技能的培训、物资装备的筹措、分队的组织与管理、卫勤任务的评估等方面进行充分准备,确保所派遣的医疗分队能顺利地完成联合国赋予的维和卫勤保障任务。     

Do national drug control laws ensure the availability of opioids for medical and scientific purposes?

Objective

To determine whether national drug control laws ensure that opioid drugs are available for medical and scientific purposes, as intended by the 1972 Protocol amendment to the 1961 Single Convention on Narcotic Drugs.

Methods

The authors examined whether the text of a convenience sample of drug laws from 15 countries: (i) acknowledged that opioid drugs are indispensable for the relief of pain and suffering; (ii) recognized that government was responsible for ensuring the adequate provision of such drugs for medical and scientific purposes; (iii) designated an administrative body for implementing international drug control conventions; and (iv) acknowledged a government’s intention to implement international conventions, including the Single Convention.

Findings

Most national laws were found not to contain measures that ensured adequate provision of opioid drugs for medical and scientific purposes. Moreover, the model legislation provided by the United Nations Office on Drugs and Crime did not establish an obligation on national governments to ensure the availability of these drugs for medical use.

Conclusion

To achieve consistency with the Single Convention, as well as with associated resolutions and recommendations of international bodies, national drug control laws and model policies should be updated to include measures that ensure drug availability to balance the restrictions imposed by the existing drug control measures needed to prevent the diversion and nonmedical use of such drugs.     

Return to Galileo? The Inquisition of the International Narcotic Control Board

Nearly 400 years after Galileo Galilei of Florence was arraigned and convicted of suspected heresy by the ten member Congregation of the Holy Office (Inquisition), the International Narcotic Control Board (INCB) is similarly inserting itself into matters pertaining to innovations in healthcare and the public health response to addiction throughout the world. Like that earlier Inquisition of 1633 that convicted Galileo of heresy for holding that the sun is the centre of the universe with the earth revolving around it (in contradiction to church doctrine of the time) the INCB and its thirteen-member panel, now rails against any evidence out of sync with the established doctrine of the war on drugs – particularly those innovations in public health called harm reduction.     

WHO Expert Committee on Specifications for Pharmaceutical Preparations. Forty-first report

This report presents the recommendations of an international group of experts convened by the World Health Organization to consider matters concerning the quality assurance of pharmaceuticals and specifications for drug substances and dosage forms. The report is complemented by a number of annexes. These include: guidance notes on related substances tests concerning the dosage form monographs of The International Pharmacopoeia; a list of available International Chemical Reference Substances and International Infrared Reference Spectra; a revision of the general guidelines for the establishment, maintenance and distribution of chemical reference substances; the procedure for assessing the acceptability, in principle, of pharmaceutical products for purchase by United Nations agencies; the procedure for assessing the acceptability, in principle, of quality control laboratories for use by United Nations agencies; and guidance on variations to a prequalified product dossier.     

The Role of Major Donors in Health Aid to the Democratic People's Republic of Korea

We investigated the major trends in health aid financing in the Democratic People''s Republic of Korea (DPRK) by identifying the primary donor organizations and examining several data sources to track overall health aid trends. We collected gross disbursements from bilateral donor countries and international organizations toward the DPRK according to specific health sectors by using the Organization for Economic Cooperation and Development creditor reporting system database and the United Nations Office for the Coordination of Humanitarian Affairs financial tracking service database. We analyzed sources of health aid to the DPRK from the Republic of Korea (ROK) using the official records from the ROK''s Ministry of Unification. We identified the ROK, United Nations Children''s Fund (UNICEF), World Health Organization (WHO), United Nations Population Fund (UNFPA), and The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) as the major donor entities not only according to their level of health aid expenditures but also their growing roles within the health sector of the DPRK. We found that health aid from the ROK is comprised of funding from the Inter-Korean Cooperation Fund, private organizations, local governments, and South Korean branches of international organizations such as WHO and UNICEF. We also distinguished medical equipment aid from developmental aid to show that the majority of health aid from the ROK was developmental aid. This study highlights the valuable role of the ROK in the flow of health aid to the DPRK, especially in light of the DPRK''s precarious international status. Although global health aid from many international organizations has decreased, organizations such as GFATM and UNFPA continue to maintain their focus on reproductive health and infectious diseases.     

Global frameworks,local strategies: Women's rights,health, and the tobacco control movement in Argentina

ABSTRACT

The article examines how civil society organisations in Argentina used the United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) to frame the country's failure to enact strong national tobacco control legislation as a violation of women's rights in the late 2000s. We analyze this case study through the politics of scale, namely the social processes that produce, reproduce, and contest the boundaries of policies and socio-economic relations. This approach understands how multiple scales overlap and connect to obstruct or enhance the right to health in Latin America. In Argentina, the global organisation of tobacco companies, the reach of international financial institutions and the national dynamics of economic austerity and export-orientation promoted the local production and use of tobacco (leaf and cigarettes) and reproduced health inequalities in the country throughout the 1990s and the early 2000s. Yet, the visible legacy of local and national human rights struggles in the adoption of international human rights treaties into Argentina's national constitution allowed the tobacco control movement to link the scale of women's bodies to the right to health through the use of CEDAW to change national legislation, tackling the social determinants of the tobacco epidemic.     

Nuclear Arms Control,Nonproliferation, and Counterterrorism: Impacts on Public Health

Reducing the risks of nuclear war, limiting the spread of nuclear weapons, and reducing global nuclear weapons stockpiles are key national and international security goals. They are pursued through a variety of international arms control, nonproliferation, and counterterrorism treaties and agreements.These legally binding and political commitments, together with the institutional infrastructure that supports them, work to establish global norms of behavior and have limited the spread of weapons of mass destruction.Beyond the primary security objectives, reducing the likelihood of the use of nuclear weapons, preventing environmental releases of radioactive material, increasing the availability of safe and secure nuclear technology for peaceful purposes, and providing scientific data relevant to predicting and managing the consequences of natural or human-caused disasters worldwide provide significant benefits to global public health.For more than a century, there have been efforts to outlaw weapons of mass destruction and terror, starting with the first Hague Peace Conference in 1899 and the 1925 Geneva Protocol to prohibit the use of chemical and biological weapons. These efforts were extended to nuclear weapons, the most devastating weapons of all, in the immediate aftermath of World War II. In November 1945, the United States, the United Kingdom, and Canada proposed the establishment of a United Nations (UN) Atomic Energy Commission for “entirely eliminating the use of atomic energy for destructive purposes.”1 This was followed by a call from the General Assembly of the UN for the elimination of atomic weapons and other major weapons adaptable to mass destruction in January 1946. Stopping short of elimination, the Baruch Plan, suggested by the United States in 1946, proposed placing all nuclear weapons and energy under international ownership and control.None of these initiatives came to fruition, however, and by the 1950s both the United Kingdom and the Soviet Union had tested their own nuclear weapons, with China and France following suit in the 1960s. Because of the existence of nuclear weapons, controlling their spread and use became urgent international goals. A wide-ranging set of activities has evolved over the decades to pursue these goals, including nuclear arms control, nonproliferation, and counterterrorism measures. International institutions, such as the International Atomic Energy Agency (IAEA) and the UN 1540 Committee, have grown to support their implementation.A broad range of motivations underlies the almost universal support for efforts to control the spread and use of nuclear weapons. These include increasing security for all states, maintaining a balance of power, and a moral imperative to eliminate nuclear weapons altogether. Although states may have different reasons for wanting to control nuclear weapons, there is widespread agreement on the need to do so, and most believe that these treaties and agreements make the world a safer place. However, these activities have other, less recognized benefits as well. Indeed, we argue that the public health benefits are significant both in avoiding events that would have major public health impacts and in supporting the transfer of beneficial technology to the less-developed world.In cases where countries are deemed out of compliance with their nonproliferation commitments, political and economic actions can have deleterious impacts on elements of the population. Analysis of the relative impact of such sanctions on public health,2 as compared with other public health benefits discussed in this article, is beyond the scope of this article.In the following sections we briefly summarize selected international arms control, nonproliferation, and counterterrorism efforts, as well as their institutional infrastructure. (Evaluation of the effectiveness of these treaties and agreements is beyond the scope of this article.) We consider the public health benefits resulting from reducing the likelihood of use of nuclear weapons, preventing environmental releases of radioactive material, providing access to nuclear technology for peaceful purposes, and providing scientific data relevant to predicting and managing the consequences of natural or human-caused disasters worldwide. We hope that this discussion will stimulate thought about how to include public health as an explicit factor in constructing provisions for future treaties and agreements.     

Transition of chemical management in Japan – Shift to self-regulation and measures for small businesses –

Increased variety and use of chemicals and the number of chemical disasters have changed chemical management. Europe and the United States have adopted self-regulation in chemical management; furthermore, countries worldwide must comply with the relevant United Nations recommendations and international standards for chemical management. Japan has experienced numerous pollution incidents and occupational disasters, resulting in the development of laws and regulations on chemical management; however, these policies are inconsistent with international trends. In particular, the shift from a compliance approach to self-regulation and measures for small businesses remain as challenges. This paper discusses the current situation and issues in chemical management in Japan, focusing on international trends.     

Addressing culture and context in humanitarian response: preparing desk reviews to inform mental health and psychosocial support

Delivery of effective mental health and psychosocial support programs requires knowledge of existing health systems and socio-cultural context. To respond rapidly to humanitarian emergencies, international organizations often seek to design programs according to international guidelines and mobilize external human resources to manage and deliver programs. Familiarizing international humanitarian practitioners with local culture and contextualizing programs is essential to minimize risk of harm, maximize benefit, and optimize efficient use of resources. Timely literature reviews on traditional health practices, cultural beliefs and attitudes toward mental health and illness, local health care systems and previous experiences with humanitarian interventions can provide international practitioners with crucial background information to improve their capacity to work efficiently and with maximum benefit. In this paper, we draw on experience implementing desk review guidance from the World Health Organization (WHO) and UNHCR, the United Nations Refugee Agency (2012) in four diverse humanitarian crises (earthquakes in Haiti and Nepal; forced displacement among Syrians and Congolese). We discuss critical parameters for the design and implementation of desk reviews, and discuss current challenges and future directions to improve mental health care and psychosocial support in humanitarian emergencies.     

Challenges in understanding disparities in drug use and its consequences

Racial/ethnic disparities in health have long been documented in a broad range of medical conditions in the United States. For example, Blacks have higher HIV incidence and AIDS-related mortality than do Whites., This article summarizes racial/ethnic differences in drug use and its consequences in the United States and proposes three key challenges to the study of disparities in drug use and its consequences. These are (a) patterns of drug use and misuse are complex, with different patterns of use of different drugs in different racia,/ethnic groups; (b) racial/ethnic differnces in use of drugs are not always associated with comparable differences in the consequences of drug use; and (c) the consequences of drug use are associated with drug use itself and other social/economic circumstances. Each of these challenges is discussed, and suggestions offered for future research that may help overcome them.     

Introduction of the Republic of Korea–the United States of America's Joint Exercise Against Biothreats in 2013: Able Response 13

The Republic of Korea (ROK) and the the United States of America (USA) has held joint exercises to respond to biothreats in the Korean Peninsula since 2011. The exercise was called Able Response (AR) and it aims to coordinate interministerial procedures inside Korea and international procedures in requesting the medical resources urgently between ROK and USA, and among ROK and the United Nations, and nongovernmental organizations. AR13 was a functional exercise with a scenario that presumed a series of attack by terrorists, dispersing Bacillus anthracis in Seoul. The participants conducted exercises with action cells and using point-to-point communication system. It was followed by Senior Leadership Seminar participated by high-ranking officials in ROK and USA to discuss possible collaboration in advance. AR and its following actions will fortify collaboration between ROK and USA and enhance the capability of countermeasures against biothreats in Korea.     

Vietnam moves forward with harm reduction: An assessment of progress

Abstract

Historically, the response of the Vietnamese government to illicit drug use and HIV has been slow and ineffective. However, 2006 saw the government formally endorse harm reduction interventions. This paper examines the views of senior key informants inside Vietnam on the development of an advocacy strategy for harm reduction. Twenty-nine informants were interviewed across public health, public security, social affairs and other international bodies, including United Nations agencies and international non-governmental organisations. Challenges and barriers identified for harm reduction progress included: promoting a nationwide understanding and acceptance of harm reduction and the HIV Law; lack of skilled resources, training programmes and technical capacity; poor coverage of interventions; and gaps in the sharing of information. There is currently a government-led shift in Vietnam in the response to the prevailing HIV epidemic among drug users, but ensuring that the HIV Law can operate unhindered is critical. The implementation of a response to illicit drug use and HIV remains an enormous challenge. With appropriate technical education and training, ongoing advocacy, and a cohesive, coordinated multi-sectoral effort, the capacity of the government and community to adopt, support and promote measures to reduce HIV and other drug-related harms will be markedly strengthened.     

Report of the commission on health research for development and the countries of the south.

Of late, governments of affluent countries have become more brazen in using United Nations organizations and other global commissions as tools to serve their political and economic interests. WHO and UNICEF have been used by these governments to impose technocentric and dependence-promoting programs on countries of the South. The report of the Commission on Health Research for Development is yet another effort in that direction. It advocates international cooperation in health research. It merely adds to the bulk of documents on international health research. It is ahistorical. It does not analyze why WHO and UNICEF and the governments of affluent countries imposed global programs on immunization and diarrheal and respiratory diseases without bothering to gather even the most elementary data about them. There is a method in the brashness. Worse still, it ignores the rich heritage of health research of the past half a century in countries such as India, Indonesia, and Thailand. It is yet another effort to obscure the message of self-reliance contained in the Alma-Ata Declaration on Primary Health Care.     

Attitudes and practices regarding the use of methadone in US State and federal prisons

In the United States, vigorous enforcement of drug laws and stricter sentencing guidelines over the past 20 years have contributed to an expanded incarcerted population with a high rate of drug use. One in five state prisoners reports a history of injection drug use, and many are opiate dependent. For over 35 years, methadone maintenance therapy has been an effective treatment for opiate dependence; however, its use among opiate-dependent inmates in the United States is limited. In June 2003, we conducted a survey of the medical directors of all 50 US states and the federal prison system to describe their attitudes and practices regarding methadone. Of the 40 respondents, having jurisdiction over 88% (n=1,266,759) of US prisoners, 48% use methadone, predominately for pregnant inmates or for short-term detoxification. Only 8% of respondents refer opiate-dependent inmates to methadone programs upon release. The results highlight the need to destigmatize the use of methadone in the incarcerated setting, expand access to methadone during incarceration, and to improve linkage to methadone treatment for opiate-dependent offenders who return to the community.     

Radiation safety standards and their application: international policies and current issues

This paper briefly describes the current policies of the United Nations Scientific Committee on the Effects of Atomic Radiation and the International Commission on Radiological Protection and how these policies are converted into international radiation safety standards by the International Atomic Energy Agency, which is the only global organization-within the United Nations family of international agencies-with a statutory mandate not only to establish such standards but also to provide for their application. It also summarizes the current status of the established corpus of such international standards, and of it foreseeable evolution, as well as of legally binding undertakings by countries around the world that are linked to these standards. Moreover, this paper also reviews some major current global issues related to the application of international standards, including the following: strengthening of national infrastructures for radiation safety, including technical cooperation programs for assisting developing countries; occupational radiation safety challenges, including the protection of pregnant workers and their unborn children, dealing with working environments with high natural radiation levels, and occupational attributability of health effects (probability of occupational causation); restricting discharges of radioactive substances into the environment: reviewing current international policies vis-a-vis the growing concern on the radiation protection of the "environment;" radiological protection of patients undergoing radiodiagnostic and radiotherapeutic procedures: the current International Action Plan; safety and security of radiation sources: post-11 September developments; preparedness and response to radiation emergencies: enhancing the international network; safe transport of radioactive materials: new apprehensions; safety of radioactive waste management: concerns and connections with radiation protection; and radioactive residues remaining after the termination of activities: radiation protection response to the forthcoming wave of decommissioning of installations with radioactive materials. The ultimate aim of this paper is to encourage information exchange, cooperation, and collaboration within the radiation protection professional community. In particular, the paper tries to facilitate consolidation of the growing international regime on radiation safety, including the expansion of legally binding undertakings by countries, the strengthening of the current corpus of international radiation safety standards, and the development of international provisions for ensuring the proper worldwide application of these standards, such as a system of international appraisals by peer review.