Advocating for Human Rights – Role of the Provider
By Kawika MKI Liu, MD, PhD, JD
For all concerned about health equity, a human rights based approach to health (HRBA) provides a set of metrics by which to measure the progress of individuals and populations towards health equity. For those unfamiliar with the human right to health, it is the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.[1] States party to the International Covenant on Economic, Social and Cultural Rights, including the United States, have agreed to take steps including the reduction of infant mortality and for the healthy development of the child; the improvement of all aspects of environmental and industrial hygiene; the prevention, treatment and control of epidemic, endemic, occupational and other diseases; the creation of conditions which would assure to all medical service and medical attention in the event of sickness. Particularly important, this right, perhaps the most inclusive human right, is dependent on other fundamental rights, such as the rights to housing, education, food, an adequate source of income, privacy and access to information.[2] The obligation to actualize these rights are not instantaneous, but subject to progressive realization.1 States are, however, under obligations to continue to take steps to realize the rights.1
If the highest attainable standard of health is the goal, the indicators of the achievement of this goal can be both quantitative and qualitative, and measure structure, process and outcome.[3] Structural indicators determine whether a particular government’s laws are in compliance with its international obligations. Process indicators determine if a state’s institutions and policies fulfill its obligations under international law. Finally, outcomes indicators measure the actual result of the implementation of a state’s laws and policies, and thus whether the conditions which people face on a daily basis are in compliance with its international obligations. States thus have the most control over structure and process, whereas other factors (for example, international events or disasters) could influence outcomes indicators.
One area that individual practitioners can play a role in is accountability.[4] Particularly in the United States, systemic accountability monitors for the human right to health are either extremely weak or non-existent; thus, non-governmental organizations and concerned individuals can play a part in maintaining the accountability of actors in the human right to health to its realization. Health care providers are not only intimately knowledgeable about the realization of the human right to health, but are often given a privileged position from which to speak about health. Thus, health care providers can speak about the determinants of health and their role in the attainment of the highest standard of health. They can speak about how these determinants are improving or deteriorating for the populations whom they serve. They can advocate at local, state and national levels for knowledge about the human right to health, its related human rights, and the prerequisites for the fulfillment of those rights. Most importantly, they can speak of how attaining social justice, through realizing the human right to health, is essential to attaining health equity.
(Dr. David Liu (“Kawika”) is a physician and lawyer committed to health and human rights. Recently appointed to the APHA Science Board, he lives in Hawaii)
[1] International Covenant on Economic, Social and Cultural Rights, adopted 16 Dec. 1966, G.A. Res. 2200 (XXI), U.N. GAOR, 21st Sess., U.N. Doc. A/6316 (1966), 993 U.N.T.S. 3 (entered into force 3 Jan. 1976). Available at www.ohchr.org. Accessed June 3, 2010.
[2] International Covenant on Economic, Social and Cultural Rights,
1966 (art.12, General Comment 14). www.ohchr.org.
[3] Kalantry S, Getgen JE, Koh SA. Enhancing Enforcement of Economic, Social and Cultural Rights Using Indicators: A Focus on the Right to Education in the ICESCR. Human Rights Quarterly. 2010;32:253-310.
[4] Report of the Special Rapporteur on the Right of Everyone to the Enjoyment of the HighestAttainable Standard of Physical and Mental Health, Paul Hunt, U.N. ESCOR, Comm’n on Hum. Rts., 62d Sess., U.N. Doc. E/CN.4/2006/48 (2006).
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