Stephen P. Marks

The Challenge and Place of International Human Rights in Public Health

Human rights workers and practitioners of public health share common concerns for the well-being of people, the alleviation of suffering and want, and the promotion of social justice. The potential for cooperation between these 2 committed groups has advanced considerably over the past decade or so as scholars, practitioners, administrators, and activists grapple with the differences in disciplinary language and with limited opportunities for contact. It is the intention of the American Public Health Association (APHA) to join others in bridging these differences, so that the combined efforts of these groups can be focused on the shared goal of bettering the human condition around the world. To advance the dialogue among public health and human rights professionals, there is a growing literature, including several books,1–3 a peer-reviewed academic journal (Health and Human Rights. An International Journal, published by the Francois Xavier Bagnoud Center for Health and Human Rights), regular features of this Journal and of The Lancet, and occasional articles in other leading medical journals, such as the Journal of the American Medical Association and the New England Journal of Medicine. A chapter on the topic will appear in the fourth edition of The Oxford Textbook on Public Health.4 The movement has been further advanced through several major conferences, such as those organized by the Francois-Xavier Bagnoud Center for Health and Human Rights in Cambridge, Mass, in 1994 and 1996, and more recently by the University of Iowa5 and Temple University,6 as well as by coalitions and networks such as the Consortium on Health and Human Rights, the International Federation of Health and Human Rights Organizations, and the International Student Association for Health and Human Rights. (For a fairly complete list of organizations and networks involved in the field, see the University of Minnesota Human Rights Library.7) As we confront the issues of public health in the 21st century—including the worldwide spread of HIV/AIDS and other infections, the aging of our populations, and the questions raised by burgeoning health-related technology in the face of gross disparities in access to basic health care—human rights and public health professionals are challenged to forge powerful partnerships to help us attain our mutual aims.

Jonathan Mann's Legacy to the 21st Century: The Human Rights Imperative for Public Health

rofessor Gostin is a leading authority on health law, whose writing and teaching are among the most auP thoritative in the United States, as exemplified by his recent work, Public Health Law: Power, Duty, Restraint.’ Gostin’s article in this issue of theJolourna1 ofLuw, Medicine &Ethics pays homage to Jonathan Mann (1947-1998) by expressing the debt he feels toward this extraordinary doctor and public health official with whom he had collaborated on several projects. As many will remember, Mann held high-level positions at the Centers for Disease Control and worked on AIDS research in Central Africa before setting up the World Health Organization’s Global Programme on AIDS, which he ran from 1986 to 1990. Thanks to his profound commitment and consummate communication skills, he achieved the unprecedented feat of raising the budget within two years to almost

The Evolving Field of Health and Human Rights: Issues and Methods:

100 million from the initial set-up of “himself, a secretary, and one typewriter,” as described by Daniel Tarantola. Everyone concerned with HIV/AIDS and health and human rights in general will remember with horror and grief the deadly crash of Swissair Flight 11 1 on September 2,1998, killing all the passengers and crew, including Jonathan and his wife of two years, Mary Lou Clements, herself a worldrenowned immunologist. Mann’s vision and charisma touched many people, including, of course, Tarantola, who worked with him on AIDS in the World and ADS in the World II and in running the Frangois-Xavier Bagnoud (FXB) Center, and who is now senior policy advisor to Gro Harlem Brundtland, DirectorGeneral of the World Health Organization. During his Geneva years, Mann established long-lasting relations with and cer-

Common Strategies for Health and Human Rights: From Theory to Practice.

he conference on Health, Law and Human Rights: Exploring the Connections held last fall in PhiladelT phia was a telling moment in the complex history of a movement the “health and human rights movement” for want of a better term inaugurated by the pioneering work of Jonathan Mann, whose memory the Conference honored. ’Ihe Fransois-Xavier Bagnoud Center for Health and Human Rights founded by Mann and carrying on his legacy was pleased to co-sponsor the conference. The conference and this symposium issue containing the main papers provide an excellent opportunity to take stock of that movement by means of a commentary based on the papers. This commentary is made from a resolutely human rights perspective, with the aim of engaging the authors in a dialogue on whether and to what extent each article advanmknowledge about the inmnnectednm and mutually reinforcing character of health and human rights, which is the lasting legacy of Jonathan Mann. It surveys the papers through a human rights prism unlike Scott Burris’s introduction, which explains the project as originally conceived and convincingly argues for a social epidemiology of law. My purpose is different, but I hope complementary. I will b e p with the metaphor of the confluence of two streams, both with headwaters in academe, politics, and social mobilization. The mingling of the waters of these two streams has created a rather murky tributary. The contributions to this issue and subsequent efforts to channel the health and human rights movement are clarifying the waters and adding to the flow of the stream. Let us trace these two streams to their respective headwaters and then to their interminghg before considering the analyses and methods that are enriching the ecology of the health and human rights movement as represented by the contributions to this issue.

The Peace-Human Rights-Development Dialectic

M y task is to encourage the participants in this Conference to think about the ways forward, to devise a strategy to move from theory to practice. In offering some thoughts about a common strategy for health and human rights, I am starting from two assumptions. The first assumption is that the health and human rights communities that the Fran~oisXavier Bagnoud Center has brought together at these two Conferences share a growing awareness of a common agenda. There are numerous indicators of this trend. One is the increase in the number of participants from the first Conference to the second. It is truly extraordinary that five hundred people have come to explore a theme that, a few short years ago, might have appeared esoteric and marginal. A second indicator is the spectacular growth in subscriptions to Health and Human Rights, truly remarkable for a scholarly journal. There is something that is capturing the attention of people. A third sign of this shared perception is the extraordinary number of relevant projects under way around the world, about which participants have reported at this Conference. The second assumption behind a strategy for the future is that the problems to which we would apply a common strategy of action are both numerous and urgent. The substantive program of this Conference is an excellent indicator of the quantity and urgency of the issues. The program lists eight or nine different forms of violence and interpretations thereof; it focuses on several emerging and existing diseases and approaches to dealing with them; it deals with a considerable number of health and society issues. Taken together, that list is itself an agenda calling for a common strategy.

Human Rights and the Challenges of Science and Technology

tend to consider that human rights are essentially a matter of protecting the individual against the State. They stress the traditional civil and political rights and favour the possibility of individual petition. Socialist countries are more concerned with economic, social and cultural rights than with civil and political ones and attach importance to collective rights and to the central role of the State as regards implementation. International action in this field should be limited, according to them, to massive and flagrant violations of human rights, individual cases being matters within the exclusive domestic jurisdiction. Third World countries, many of which have only recently gained independence, stress the struggle for self-determination and non-discrimination and the rights of ’peoples’ as, for example, expressed in the Universal Declaration of the Rights of Peoples adopted in Algiers on 4 July 1976. They favour vigorous action against r6gimes which practice racial discrimination and apartheid but are often reluctant to take part in or to establish implementation mechanisms, except against such regimes. These generalizations regarding groups of countries require considerable refinement to take into account variations, exceptions and the complexities of the policies and approaches to be found in the field of human rights. Keeping in mind these variations, exceptions and complexities, the classification into three groups is offered as a working hypothesis. There are, of course, numerous Third World countries which favour strong enforcement machinery and Western and Socialist countries

Development and Human Rights: Some reflections on the study of development, human rights, and peace

Abstract The expansion of the corpus of international human rights to include the right to water and sanitation has implications both for the process of recognizing human rights and for future developments in the relationships between technology, engineering and human rights. Concerns with threats to human rights resulting from developments in science and technology were expressed in the early days of the United Nations (UN), along with the recognition of the ambitious human right of everyone “to enjoy the benefits of scientific progress and its applications.” This comment explores the hypothesis that the emerging concepts most likely to follow recognition of the human right to water primarily involve issues of science and technology, such as access to medicines or clean and healthy environment. Many threats to human rights from advances in science, which were identified in the past as potential, have become real today, such as invasion of privacy from electronic recording, deprivation of health and livelihood as a result of climate change, or control over individual autonomy through advances in genetics and neuroscience. This comment concludes by urging greater engagement of scientists and engineers, in partnership with human rights specialists, in translating normative pronouncements into defining policy and planning interventions.

Human rights-based approach to tobacco control. Invited commentary.

as a third field of investigation where research is conducted along parallel and non-intersecting lines with peace research and human rights. It would be pretentious for a scholar many times more qualified than the present writer to claim to embrace all three fields and draw transdisciplinary conclusions. Nevertheless, some very preliminary remarks on development, peace, and human rights may help motivate research by others along such transdisciplinary lines. The intention of this article is, therefore, to look at development from the perspective of human rights in a way which I hope will be of interest to peace researchers. Thus, without attempting to provide proper scientific demonstration, I shall evoke briefly a few ideas on the

Health, Development, and Human Rights

The fields of health and human rights and of tobacco control (TC) emerged in the early 1990s to focus the attention of academic and policy circles on urgent societal issues calling for new modes of analysis and advocacy. Their emergence coincides to a large extent with the launch of the journals Tobacco Control and Health and Human Rights in 1992 and 1994, respectively. Carolyn Dresler ’s article exemplifies the intersection of these two relatively new fields. The challenge the authors address may be summarised as bridging the gap between two perfectly understandable zones of neglect: the Framework Convention on Tobacco Control briefly alludes to human rights but is essentially a convention for the management of complex public policy relating to the supply and demand of tobacco products without further concern for human rights; TC is notmentioned specifically in the core human rights treaties but emerges briefly in the most recent interpretations of health policy required by the right to health. The article dwells on one means of bridging this gap, namely, the use of non-governmental information to balance government reports on compliance with the obligations under article 12 of the International Covenant on Economic, Social and Cultural Rights (right to health) and stimulate an evidencebased discussion in the treaty-monitoring body on the shortcomings in realising the right to health. The Human Rights and Tobacco Control Network (HRTCN) is currently engaged in the first effort of this type regarding TC. Such ‘shadow reports’ are not the only means of making human rights treaties and the Framework Convention on Tobacco Control mutually reinforcing. Other means include contributing to an interpretative document (‘general comment’) outlining preferred TC policies as part of the right to health, developing alliances among human rights and TC organisations at the national and local levels to lobby for TC, providing evidence for cases brought under regional human rights treaties, and preparing interventions with governments and parliaments using international human rights obligations to reinforce public health arguments for TC. Hopefully, this article will launch an ongoing reflection in this journal on these and similar strategies.

ACCOUNTABILITY FOR THE HEALTH CONSEQUENCES OF HUMAN RIGHTS VIOLATIONS: Methodological Issues in Determining Compensation

The purpose of this chapter is to explore how the three concepts of human rights, health and human development have been defined and linked and what implications these linkages have for the policies and practices of international organizations.