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An overview of the international legal framework for human rights with emphasis on the right to health and the rights based approach to development. This presentation was featured as part of the June 21 2014 EMERGENCY USA Volunteer Conference.
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• Human rights:
• are primarily about the relationship between the individual and the state
• are universal, interrelated and indivisible
• imposes on governments the obligation to respect, protect and fulfill human rights
• International human rights law:
• defines what governments can do to us, cannot do to us, and should do for us
• is meant to be equally applicable to everyone, everywhere in the world, across all borders and across all cultures and religions
• consists of the obligations that governments have agreed they have in order to be effective in promoting and protecting our rights
Defining Terms: Human Rights
Defining Terms: Health
• Health as an aspira7onal goal: “Health is a state of complete physical, mental and social
well-‐being and not merely the absence of disease” Cons=tu=on of the World Health Organiza=on, adopted by the Interna=onal Health Conference, New York, 19 June-‐22 July 1946
• Health as an instrumental goal: “Ensuring the condi=ons in which people can be
healthy” Ins=tute of Medicine, Future of Public Health, Summary and Recommenda=ons, Washington, DC: Na=onal Academy Press, 1988 US Ins=tute of Medicine
• Interna7onal Health: “Tradi=onally defined by the rela=ons between states”
Lee K. Lancet World health: shaping the future of global health coopera=on: where can we go from here?, Lancet, vol. 351, no. 9106, pp. 899-‐902
• Global Health: “Relates to health issues that transcend na=onal borders, class, race,
ethnicity and culture. The term stresses the commonality of health issues and requires a collec=ve (partnership-‐based) ac=on” Global Health Educa=on Consor=um, ‘Global vs. Interna=onal,’ hfp://globalhealthedu.org/Pages/GlobalvsInt.aspx
• Health as a right: “The right of everyone to the enjoyment of the highest afainable
standard of physical and mental health” UN. Ar=cle 12, Interna=onal Covenant on Economic, Social and Cultural Rights, adopted and opened for signature, ra=fica=on and accession by United Na=ons General Assembly Resolu=on 2200 A(XXI). New York: United Na=ons, 1966
• Customary law – Consistent practice with a sense of legal
obligation – General Assembly Resolutions like the Universal
Declaration of Human Rights (UDHR) are evidence of customary law – they are not legally binding
• International agreements (treaties, conventions, covenants) – Can serve as codification of international
customary law or be valid international law even if no custom precedes it
– Legally binding for countries who sign on to them
Sources and Evidence of International Law
• In 1945, human rights was set out as one of the purposes and principles of the UN
• Took human rights out of national concern and placed squarely into international law – spoke only of promotion, not protection
• The Universal Declaration of Human rights (UDHR) is a declaration, not a treaty. It has a special place in international law and may have risen to the level of proof of customary law
• The 2 Covenants further elaborate the rights set out in the UDHR: International Covenant on Civil and Political Rights (CCPR); International Covenant on Economic, Social and Cultural Rights (CESCR)
• The UN Charter, UDHR and 2 Covenants are often called the International Bill of Human Rights
• Over 25 other international human rights treaties exist that further elaborate the concepts set out in the International Bill of Human Rights
Modern Human Rights Law
Fundamental Values Underpinning Human Rights
• Respect for the physical and mental integrity of the person
• Respect for individual autonomy, including personal and group self-determination
• Guarantees of the material conditions of existence necessary to lead a productive and fulfilling life
• Equality and non-discrimination
Interna=onal Human Rights Documents Relevant to Health
1948: Universal Declara=on of Human Rights (UDHR) Trea&es: Legally binding on na0ons that have ra0fied 1965: Interna=onal Conven=on on the Elimina=on of All Forms of Racial
Discrimina=on 1966: Interna=onal Covenant on Economic, Social, and Cultural Rights 1966: Interna=onal Covenant on Civil and Poli=cal Rights 1979: Interna=onal Conven=on on the Elimina=on of All Forms of
Discrimina=on Against Women 1985: Conven=on Against Torture 1990: Conven=on on the Rights of the Child 2000: Conven=on on the Protec=on of Migrant Workers and their Families (2006) Conven=on on the Rights of Persons with Disabili=es (2006) Interna=onal Conven=on for the Protec=on of All Persons
Against Enforced Disappearances
Human Rights Relevant to Health
• The right to life, survival, and development
• The right to equality and non-discrimination
• The right to travel • The right to bodily integrity
and security of the person • The right to an identity • The right to privacy • The right to seek, receive
and impart information
• The right to food • The right to housing • The right to social security • The right to be free from
torture • The right to association • The right to the benefits of
scientific progress • The right to education • The right to health
In Red are items directly relevant to the programs and ini=a=ves EMERGENCY USA supports
Further Defining The Right to Health
• As stated by the UN Committee on Economic, Social, and Cultural Rights, bringing human rights into health programming includes ensuring the – availability, – accessibility, – acceptability and – quality of health services; and – ensuring attention to the underlying determinants of health, such
as access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, and healthy occupational and environmental conditions
• Human rights, such as the right to the highest attainable standard of health, are understood to be progressively implemented by the state to the “maximum of its available resources.”
• States must “take steps, individually and through international assistance and cooperation, especially economic and technical, to the maximum of its available resources, with a view to achieving progressively the full realization of the rights recognized in the [Economic, Social, and Cultural Rights] covenant by all appropriate means, including particularly the adoption of legislative measures.” ICESCR, Art 2 (1)
Progressive Realization
• credibility stems from “impartial application of universal norms”
• methods of work relevant to health include: – research – legal representation – publicity – training – investigation – provision of direct assistance – intervention at national and international level – lobbying
Human Rights NGOs
UN Mechanisms Overseeing Health-Related Human Rights UNITED NATIONS HUMAN RIGHTS MECHANISMS
Charter-‐based bodies Treaty bodies
General Assembly
Human Rights Council
Special Rapporteurs/Working groups
Country specific
The UN Special Rapporteur on the right to health
Sub-Commission on Protection and
Promotion of Human Rights
Human Rights Committee (HRC)
Committee on Economic, Social and Cultural Rights (CESCR)
Committee on the Elimination of Discrimination Against Women (CEDAW)
Committee of the Rights of the Child (CRC)
Committee on the Elimination of Racial Discrimination (CERD)
Committee Against Torture (CAT)
Committee on Migrant Workers (CMW)
Thematic: e.g.
Accountability
• What do we mean by it? • Who ensures it?
- National level courts -International reporting mechanisms (including treaty monitoring bodies)
- Media - NGOs - World Bank Inspection Panels etc..
The Genesis of (H)RBAs
• Rights-based approach to child growth and development (UNICEF 1990s)
• RBAs in health and development programs (International
Organizations, NGOs…)
• Human-rights based approach to development programming (UNDP 1998)
UN Secretary General Kofi Annan’s Definition of a RBA (1997)
“A rights-based approach to development describes situations not simply in terms of human needs, or of developmental requirements, but in terms of society's obligations to respond to the inalienable rights of individuals, empowers people to demand justice as a right, not as charity, and gives communities a moral basis from which to claim international assistance when needed.”
UN Statement of Common Understanding of the Human Rights-Based Approach to Development
(1) 1. All programmes of development co-operation, policies and
technical assistance should further the realisation of human rights as laid down in the Universal Declaration of Human Rights and other international human rights instruments.
2. Human rights standards contained in, and principles derived from the Universal Declaration of Human Rights and other international human rights instruments guide all development cooperation and programming in all sectors and in all phases of the programming process.
• Human rights standards include the minimum level of programmatic and/or policy-level activity necessary to be able to affirm that a right is being fulfilled. For example, one of the minimum core obligations of the right to health is that health facilities, goods, and services are available, accessible, acceptable, and of high quality (3AQ).
UN Statement of Common Understanding (2) 3. Human rights principles are:
• Universality and inalienability • Indivisibility • Inter-dependence and Inter-relatedness • Equality and Non-discrimination • Participation and Inclusion • Accountability and Rule of Law
4. Development cooperation contributes to the development of the capacities of ‘duty-bearers’ to meet their obligations and/or of ‘rights-holders’ to claim their rights.
• Every individual is a rights-holder • Duty-bearers are primarily State actors and institutions at
various levels of government, and certain non-state actors who have responsibilities to carry out in response to other actors exercising their rights
In General, a HRBA…
• Emphasises the process as well as the outcome of programming
• Draws attention to the most marginalized populations • Works towards equitable service delivery • Extends and deepens participation • Ensures local ownership of development processes • Strengthens the accountability of all actors
A Human Rights-Based Approach to Health and Development
• Intrinsic rationale: A HRBA is the right thing to do, morally and legally.
• Instrumental Rationale: A HRBA can lead to better and more sustainable outcomes because it: – Has a special focus on groups subjected to discrimination
and suffering from disadvantage and exclusion; – Emphasizes participation; – Counts on the accountability of the State and its institutions; – Gives attention to the capacities and needs of both rights-
holders and duty-bearers, and thus fosters a lasting sense of shared ownership in efforts to improve the community’s well-being, and prepares the actors to work together in other ways to address new challenges arising in the future.
EMERGENCY: a Rights Based Approach:
Manifesto for a Human Rights Based Medicine
After the International Workshop “Building Medicine in Africa. Principles and Strategies” hosted at San Servolo Island, Venice, Italy, on May 14 -15, 2008
and in accordance with the spirit and the principles of the Universal Declaration of Human Rights, stating that
“All human beings are born free and equal in dignity and rights” (art.1) “Everyone has the right... to medical care” (art.25)
“The recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom,
justice and peace in the world” (Preamble)
WE HEREBY DECLARE the “Right to be Treated” as a basic and inalienable right belonging to each
and every member of the human community.
WE THEREFORE ADVOCATE the implementation of health systems and projects solely devoted to
preserve, extend and improve the life of the people in need and based on the following principles:
Equality Every human being has the right to be cured regardless his
economic and social condition, gender, race, language, religion and opinions. Standards of health care, set by the progress of
medical knowledge, must be delivered equally and without discrimination to all patients.
Quality
High quality health systems must be based on community’s needs, up to date with the achievements of medical science, and not oriented, shaped or determined by lobbies and corporations
involved in the health industry.
Social Responsibility Governments must have the health and well being of their citizens
as their priority, and allocate adequate human and financial resources. The services provided by health systems and
humanitarian projects in the health sector must be accessible to and free of charge for all.
As Health Authori=es and Humanitarian Organiza=ons
WE RECOGNIZE EQS (Equality, Quality, Social responsibility) based health systems and projects as respecmul of human rights, appropriate to develop medical science and effec=ve
in promo=ng health by strengthening and genera=ng human, scien=fic and material resources.
WE COMMIT
To plan and develop EQS based policies, health systems and projects. To cooperate among us to iden=fy common needs in the health sector and design
joint programs.
WE APPEAL To other Health Authori=es and Humanitarian Organisa=ons to sign this
Manifesto and to join in promo=ng an EQS based medicine. To donors and to the interna=onal aid community to support, fund and par=cipate in designing and
implemen=ng EQS based programs.
Afghanistan: Status of Ra=fica=on • Afghanistan has ra=fied the following:
– CERD: Conven=on on the Elimina=on of all forms of Racial Discrimina=on – CCPR: Covenant on Civil and Poli=cal Rights – CESCR: Covenant on Economic, Social and Cultural Rights – CAT: Conven=on Against Torture – CEDAW: Conven=on on the Elimina=on of All Forms of Discrimina=on
against Women – CRC: Conven=on on the Rights of Children – CRPD: Conven=on on the Rights of Persons with Disabili=es
Not ra=fied: – CMW: Conven=on on the Protec=on of the Rights of All Migrant Workers and
Members of their Families – CPPED: Conven=on for the Protec=on of All Persons from Enforced
Disappearance
IRAQ: Status of Ra=fica=on • Iraq has ra=fied the following:
– CERD: Conven=on on the Elimina=on of all forms of Racial Discrimina=on – CCPR: Covenant on Civil and Poli=cal Rights – CESCR: Covenant on Economic, Social and Cultural Rights – CAT: Conven=on Against Torture – CEDAW: Conven=on on the Elimina=on of All Forms of Discrimina=on
against Women – CRC: Conven=on on the Rights of Children – CPPED: Conven=on for the Protec=on of All Persons from Enforced
Disappearance
Not ra=fied: – CRPD: Conven=on on the Rights of Persons with Disabili=es – CMW: Conven=on on the Protec=on of the Rights of All Migrant Workers and
Members of their Families
Central African Republic: Status of Ra=fica=on
• CAR has ra=fied the following: – CERD: Conven=on on the Elimina=on of all forms of Racial Discrimina=on – CCPR: Covenant on Civil and Poli=cal Rights – CESCR: Covenant on Economic, Social and Cultural Rights – CEDAW: Conven=on on the Elimina=on of All Forms of Discrimina=on
against Women – CRC: Conven=on on the Rights of Children
Not ra=fied: – CAT: Conven=on Against Torture – CRPD: Conven=on on the Rights of Persons with Disabili=es – CMW: Conven=on on the Protec=on of the Rights of All Migrant Workers
and Members of their Families – CPPED: Conven=on for the Protec=on of All Persons from Enforced
Disappearance
Sudan: Status of Ra=fica=on • Sudan has ra=fied the following:
– CERD: Conven=on on the Elimina=on of all forms of Racial Discrimina=on – CCPR: Covenant on Civil and Poli=cal Rights – CESCR: Covenant on Economic, Social and Cultural Rights – CAT: Conven=on Against Torture – CEDAW: Conven=on on the Elimina=on of All Forms of Discrimina=on
against Women – CRC: Conven=on on the Rights of Children – CRPD: Conven=on on the Rights of Persons with Disabili=es
Not ra=fied: – CMW: Conven=on on the Protec=on of the Rights of All Migrant Workers
and Members of their Families – CPPED: Conven=on for the Protec=on of All Persons from Enforced
Disappearance
Sierra Leone: Status of Ra=fica=on • Sierra Leone has ra=fied the following:
– CERD: Conven=on on the Elimina=on of all forms of Racial Discrimina=on – CCPR: Covenant on Civil and Poli=cal Rights – CESCR: Covenant on Economic, Social and Cultural Rights – CAT: Conven=on Against Torture – CEDAW: Conven=on on the Elimina=on of All Forms of Discrimina=on
against Women – CRC: Conven=on on the Rights of Children – CRPD: Conven=on on the Rights of Persons with Disabili=es
Not ra=fied: – CMW: Conven=on on the Protec=on of the Rights of All Migrant Workers
and Members of their Families – CPPED: Conven=on for the Protec=on of All Persons from Enforced
Disappearance
United States: Status of Ra=fica=on • The U.S. has ra=fied the following:
– CERD: Conven=on on the Elimina=on of all forms of Racial Discrimina=on – CCPR: Covenant on Civil and Poli=cal Rights – CAT: Conven=on Against Torture – CRPD: Conven=on on the Rights of Persons with Disabili=es
Not ra=fied: – CESCR: Covenant on Economic, Social and Cultural Rights – CEDAW: Conven=on on the Elimina=on of All Forms of Discrimina=on
against Women – CRC: Conven=on on the Rights of Children (the U.S. has signed the
Op=onal Protocols CRC:OPSC and CRC:OPAC) – CMW: Conven=on on the Protec=on of the Rights of All Migrant Workers
and Members of their Families – CPPED: Conven=on for the Protec=on of All Persons from Enforced
Disappearance