Dr. Arlan Fuller of the FXB Center for Health and Human Rights at the Harvard School of Public Health is back to explain one of the key pillars of global health, the inexorable link between health and human rights. Just what are human right has been the subject of debate, but Dr. Fuller will present accepted norms codified through the United Nations and explain how the human rights regime has been a powerful fulcrum to effect change. >> My name's Arlan Fuller. I'm the Executive Director of the FXB Center for Health and Human Rights here at Harvard University. So, what are the elements of human rights? Elem, human rights are, are universal. They are they are inherent on the dignity and equality of, of all humans. They are indivisible and interdependent between one and another. And one thing that, that human rights do is, is they actually place a, an obligation or a duty to actually fulfill or to protect the, the freedoms and entitlements that all people have. When, when we actually identify and talk about a right, say, the right to health, there's an individual who is the rights holder. And the question is there is with every rights holder a duty bearer. And most cases, it's the state parties, the, the governments that are required to fulfill these obligations and, and be the, the ones that fulfill these duties that are, that are held by every individual as rights holders. The the international instruments to, to human rights that that basically sets the foundations for what we're talking about really are four different documents that constitute the the International Bill of Rights. That's the, the UN Charter, the Universal Declaration of Human Rights, and the two covenants, the International Covenant for Civil and Political Rights and the International Covenant on Economic, Social, and Cultural Rights. They really form the foundation for, for all that we sort of identify as, as as human rights. Beyond the general concepts of human rights, when we talked about the, the right to health, we, we really need to drill it down specifically to the International Covenant on Economic, Social, and Cultural Rights. Article 12 is, is actually the the piece of the, the treaty body that, that focuses on the right to health. And its specific standard is the enjoyment of the highest attainable standard of health both in the physical and mental sense. I think when we're talking about how each country is attempting to fulfill the rights of, of their citizens as it relates to the right to health, they're expected to, to take three different actions. One is to respect the right to health, and that means to do no harm. So the, there shouldn't be any sort of proactive steps taken by the government to interfere with one's enjoyment to the highest standard of health. The second is, is to protect that right. So, every state needs to take the proactive steps to protect the, the health, right to health for their citizens. And to protect that from third party third party individuals who might interfere with that en, that enjoyment to health. And then the third is actually to fulfill that right. So that's beyond the issue of, of respecting and protecting, they need to move forward and to advance that level of health for all of there citizens. And, and they mean to do that in, in basically four different ways. And it's sort of identified by the, by general comment 14 as AAAQ. Its, availability, accessibility, acceptability, and quality. So availability, what is availability? To provide the right to health in a, in a physical sense and to do that equitably. So to do that in providing services and, and, and medicines in urban areas and in rural areas. And to do that in all areas of, of the country, from one side to the other. Accessibility is really to make sure that there's, that these, that these services and the, the provisions being made are accessible to, to all individuals. And that's being accessible in the sense of it being not discriminatory or that it's, there is accessibility to information so people know their rights, and they know how to, to promote and and see their rights and fulfilled. There's also acceptability. So that these, these services being provided are actually culturally acceptable. They are sensitive to issues of gender or to issues of life cycle. And that they are acceptable to, to all individuals of, of all races and creeds within within a member state. And then finally it's the, the issue of quality, that every state is expected to provide the highest level of quality. Things that are scientifically and approved, things that they're not, medicines that, that are, they're past their due date. And that's the individuals providing these services are, are trained to the, to the highest level and the highest standards that the international community accepts. >> Right. >> I think the, I think the larger problem that we have, and have always had, in fulfilling the right to health is that the member states and the countries that have the greatest burden to fulfill that right, or the greatest challenge to fulfill that right, are most often the ones least capable of, of doing so. And I'm talking about, most specifically, resources. Whether we're talking about the global south, or resource poor areas, the needs to fulfill the right to health is, is an ever present daily issue. But unfortunately it's the world that we live in is so dependent on, on official development assistance, and the United States and Europe being the driver on, on so much financially, in terms of fulfilling that right. That there's a great dependence on the countries that, on a political level, they have a, a duty or an obligation to help. Or have signed one international treaty body or another or political commitments like the Millennium Development Goals to, to work in international cooperation to fulfill the right to health. But the manner in which they, they actually do provide that level of assistance is really spotty, and it's unreliable. And it's ineffectual at times, and it's that challenge that is difficult to be able to, to fulfill the right to health for all individuals. And when you're looking at the member states who have the direct duty to fulfill and to protect and to to really bring forth the right to health for their citizens. They're for too long have been subject to the decisions and strategies of the donor community. And that's created a, a lot of difficulties because the donor community's not always the one who knows what's best for, for a country's citizens and for their, their citizens who are most in need. But unfortunately, whether you're talking about the vertical programs, things that are focusing on HIV AIDS, or things that are focused on TB or vaccinations, the donor community is driving a lot of the strategy involved. And it's only just recently, maybe in the last ten years, that we're looking at country driven strategies. And that we're looking at the country buy-in and leadership and dependent on the decisions that they are making as policymakers to fulfill the right to health. We have to ask ourselves, are these programs and are these services working for the poor or are they working with the poor. And that slight variation actually has, has a large meaning in terms of the philosophy of the programs and the philosophy of the approach that one takes. In my mind working for the poor is charity. You're, you're basically driving the decisions. And that, the recipient of that aid and those services should be thankful that you're providing, providing this assistance. But if you take a rights based approach and you recognize that the rights holder is the one who should be fulfilled in, in their right to health, then you're working with the poor. And you're recognizing that this is an issue of solidarity. And that you are actually, you are actually a you're providing the level of support to help someone fulfill their rights to health. And that's what actually is quite key because you're not talking about charity anymore. You're talking about rights fulfillment, and you're not the decision making, maker anymore. It's the rights holder that's the decisions maker. And that's critical whether you are a policymaker, or whether you work at an international NGO that is making programmatic decisions. I think if someone wants to learn more about human rights and the right to health, they really need to start with the international treaty bodies. And they need to understand what the grounding and the foundation of human rights is. And I think when you are talking about international treaties, they, they seem very high level and unaccessible, but I totally disagree. The, the documents themselves are, are very straightforward, and they're easy to read. And if you really dig into them, I think you will get a very good understanding on, on what, what rights are provided to all individuals. And then I would recommend going to the, the UN sites and looking at the general comments. The International Covenant for Civil and Political Rights, the International Covenant for Economic, Social, and Cultural Rights have many, many general comments. And these general comments are meant to provide greater information to these very, very short articles. So when, but I think if you want more of an academic approach, at the FXB Center, we've been working quite a bit on a Health and Human Rights Resource Guide. So, we have a very, very large document that is broken into, I ten chapters. Everything from how the right to health is affects minorities. How the right to health affects people with disabilities. How the right to health is really employed in issues of HIV/AIDS or tuberculosis. There's a whole host of different topics, chapter by chapter, that the, the Health and Human Rights Resource Guide provides a lot of information for. And I think is, is another great opportunity to, to learn more about the right to health.
