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Reproductive Health Matters. 2009 May; 17(33):91-104.This paper examines why progress towards Millennium Development Goal 5 on maternal health appears to have stagnated in much of the global south. We contend that besides the widely recognised existence of weak health systems, including weak services, low staffing levels, managerial weaknesses, and lack of infrastructure and information, this stagnation relates to the inability of most countries to meet two essential conditions: to develop access to publicly funded, comprehensive health care, and to provide the not-for-profit sector with needed political, technical and financial support. This paper offers a critical perspective on the past 15 years of international health policies as a possible cofactor of high maternal mortality, because of their emphasis on disease control in public health services at the expense of access to comprehensive health care, and failures of contracting out and public–private partnerships in health care. Health care delivery cannot be an issue both of trade and of right. Without policies to make health systems in the global south more publicly-oriented and accountable, the current standards of maternal and child health care are likely to remain poor, and maternal deaths will continue to affect women and their families at an intolerably high level.
Lancet. 2007 Oct 27; 370(9597):1471-1474.With the Paul Wolfowitz era behind it and new appointee Robert Zoellick at the helm, it is time for the World Bank to better define its role in an increasingly crowded and complex global health architecture, says Jennifer Prah Ruger, health economist and former World Bank speechwriter. Just 2 years after taking office as president of the World Bank, Paul Wolfowitz resigned amid allegations of favouritism, and is now succeeded by Robert Zoellick. Many shortcomings marked Wolfowitz's presidency, not the least of which were a tumultuous battle over family planning and reproductive health policy, significant reductions in spending and staffing, and poor performance in implementing health, nutrition, and population programmes. Wolfowitz did little to advance the bank's role in the health sector. With the Wolfowitz era behind it and heightened scrutiny in the aftermath, the World Bank needs to better define its role and seize the initiative in health at both the global and country levels. Can the bank have an effect in an increasingly plural and complex global health architecture? What crucial role can the bank play in global health governance in the years ahead? (excerpt)
2004 Nov-Dec; 12(6):847.The Millennium Goals were defined by the United Nations Organization in 2000 and approved by consensus during the Millennium Summit, a meeting that joined 147 heads of State. These goals reflect increasing concerns about the sustainability of the planet and about the serious problems affecting humanity. Constituted by a set of eight goals to be reached by 2015, they refer to the eradication of extreme poverty and hunger, universal access to basic education, gender equality promotion, infant mortality reduction, maternal health improvement, fight against HIV/Aids and other illnesses, guarantee of environmental sustainability and the establishment of a global partnership for development. Sustainability and development are closely linked to health and imply joint actions by States and civil society in the attempt to minimize the influence of the huge gap that exists between countries and persons. Thus, health and particularly nursing professionals' actions are paramount and can lead to local actions with regional, national and international impacts. (excerpt)
Geneva, Switzerland, UNAIDS, 2000 Jul. 47 p. (UNAIDS Best Practice Collection. Key Material; UNAIDS/00.28E)Surveillance is the radar of public health. Nevertheless, its precise contours and justifications remain a matter of contention. Although the World Health Organization (WHO) Epidemiological Surveillance Unit in the Division of Communicable Diseases has defined disease surveillance quite broadly, most public health authorities, such as the United States Centers for Disease Prevention and Control (CDC) and the World Health Assembly, typically identify three key elements of surveillance. Surveillance involves the ongoing, systematic collection of health data, the evaluation and interpretation of these data for the purpose of shaping public health practice and outcomes, and the prompt dissemination of the results to those responsible for disease prevention and control. Surveillance, then, encompasses more than just disease reporting. "The critical challenge in public health surveillance today," conclude two prominent figures who have helped to define surveillance in the United States, "remains the ensurance of its usefulness." Two issues emerge from this understanding of surveillance. The first entails a question of efficacy. The second involves matters of privacy. Although conceptually distinct, the two are nevertheless intimately related. While the necessities of surveillance may justifiably limit some elements of privacy, such limitations are only justifiable to the extent that they in fact benefit the public's health. (excerpt)
Boston, Massachusetts, Harvard School of Public Health, François-Xavier Bagnoud Center for Health and Human Rights, 2000. 10 p.Before human rights, there was altruism and after human rights there is altruism—the unselfish concern for the welfare of others. Altruism has been and remains an integral part of the beliefs, behaviors and practices of public health practitioners. But altruism means different things to different people. What human rights does for public health is to provide an internationally agreed upon framework for setting out the responsibilities of governments under human rights law as these relate to people’s health and welfare. Human rights as they connect to health should be understood, in the first instance, with reference to the description of health set forth in the preamble of the WHO Constitution, and repeated in many subsequent documents and currently adopted by the 191 WHO Member States: Health is a “state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” This definition has important conceptual and practical implications, as it illustrates the indivisibility and interdependence of rights as they relate to health. Rights relating to autonomy, information, education, food and nutrition, association, equality, participation and non-discrimination are integral and indivisible parts of the achievement of the highest attainable standard of health, just as the enjoyment of the right to health is inseparable from other rights, whether categorized as civil and political, economic, social or cultural. Thus, the right to the highest attainable standard of health builds on, but is by no means limited to, Article 12 of the International Covenant on Economic, Social and Cultural Rights. It transcends virtually every single other right. This paper highlights the long evolution that has brought health and human rights together in mutually reinforcing ways. It will summarize key dimensions of public health and of human rights and will suggest a manner in which these dimensions intersect in a framework of analysis and action. It will address these issues against the background of the progress being made by the World Health Organization towards defining its roles and functions from a health and human rights perspective. (excerpt)
International responses to drug abuse among young people: assessing the integration of human rights obligations.
Boston, Massachusetts, Harvard School of Public Health, François-Xavier Bagnoud Center for Health and Human Rights, 2000. 15 p.Drug use and abuse among young people is increasing worldwide. Young people are starting to take drugs at younger ages and report use of a wide variety of drugs including heroin, cocaine and amphetamines. It is estimated that the entire illicit drug industry is worth US$500 billion per year, dwarfing the US$62 billion spent on development assistance per year. The health impacts of drug abuse are evident: dependency, addiction, overdose and sometimes death. The goal of this paper is to highlight the intersection of health and human rights with respect to drug abuse among young people. The paper argues two points. The first is that the failure of governments to respect, protect and fulfill human rights leads to less effective prevention drug abuse as well as to less effective treatment of drug abusers. The second point, which comprises the bulk of this paper, is that the international community, and international drug control bodies in particular, because of their focus on drug supply reduction, are in large part responsible for States’ human rights violations against young people who use and abuse drugs, as well those who are vulnerable to drug abuse. The paper is divided into four sections. The first will discuss why drug abuse is a human rights issue. The second will provide readers with some definitions that are central to this topic. The paper will then explore international responses to drug prevention and abuse among young people and suggest how governmental responses are shaped by international responses. The last section will provide the reader with recommendations for how the international response to drug abuse could be more effective in terms of the integration of human rights principles and obligations. (excerpt)
Paris, France, UNESCO, 2004. 30 p.This paper uses a framework for quality education developed by UNESCO’s Education Sector, Division for the Promotion of Quality Education (ED/PEQ) to show how education systems can and must change in their analysis and conduct in relation to HIV/AIDS. It summarises the 10 dimensions of the framework, considers how HIV/AIDS manifests itself in relation to these quality dimensions and summarises some practical applications of how education has responded and can respond to the pandemic from a quality perspective. A more detailed annex to the paper provides evidence on the manifestations of the pandemic on education systems, and how systems have responded in practical ways. Some general conclusions are drawn and a final section promotes some practical and strategic actions in support of quality education that reflects and responds to HIV/AIDS. The paper was developed for the UNAIDS Inter-Agency Task Team (IATT) on HIV and Education. The IATT is convened by UNESCO and includes as members the UN co-sponsoring agencies of UNAIDS, bi-lateral and private donors, and NGOs. The IATT focuses on mobilising commitment to prevention education, acting as a catalyst for the exchange of information about what is known, what is available, and what still needs to be known about how education can be most effective in mitigating the effects of the HIV/AIDS crisis. It seeks to examine and strengthen existing tools for monitoring and evaluating education systems’ responses to the crisis, identify weaknesses in these responses and overcome these weaknesses, analyse what is known to strengthen information and materials exchange, and stimulate research and evidence-based policy-making. (excerpt)
Lancet. 2005 Mar 19; 365:1004.An impressive fanfare of melodic African gospel music heralded the long-awaited launch last week of the final report of the Commission for Africa. The 17-strong Commission, chaired by UK Prime Minister Tony Blair, set out to take “a fresh look” at Africa’s past and present, and make realistic recommendations for the continent’s survival. The Commission’s report is a laudable achievement: the hefty volume is a pragmatic and decisive review of Africa’s needs. It is, as promised, unfalteringly honest— and health initiatives are not spared criticism. According to the report, the failings of current health efforts are clear: there are too many initiatives and too little coordination. The Commission’s solution focuses on harmonisation of health policy at a national level and integration of donor-led initiatives into governmental plans. As if in preparation for these recommendations, Luís Sambo, head of the WHO’s African Regional Office, last week concluded a tour of the UK and USA by announcing sweeping reforms of WHO/AFRO. He plans to decentralise activities and give more authority to country representatives “to cope with potential increases in resources”. (excerpt)
Issue paper: Review of the human rights content of frameworks to assess the effectiveness of HIV / AIDS programming.
Geneva, Switzerland, UNAIDS, 2004. Prepared for the 4th Meeting of the UNAIDS Global Reference Group on HIV / AIDS and Human Rights, August 23-25, 2004. 7 p.This paper examines approaches used by some of the primary intergovernmental and governmental agencies in assessing the effectiveness of HIV/AIDS programmes, as they have been reviewed by the UNAIDS Monitoring and Evaluation Reference Group (MERG). This is to attempt to begin to shed light on how the effectiveness of HIV/AIDS programs are currently assessed by UNAIDS, its partners, and other major organizations, and to understand the extent and ways in which human rights considerations form parts of these assessments. (excerpt)
Geneva, Switzerland, UNAIDS, 2004. Prepared for the 4th Meeting of the UNAIDS Global Reference Group on HIV / AIDS and Human Rights, August 23-25, 2004. 7 p.This paper explores issues and approaches relevant to the assessment of the application of a rights based approach to the planning and implementation of HIV/AIDS strategies. It builds on the premise that the Reference Group may wish to recommend to UNAIDS a set of practical steps towards integrating human rights in HIV/AIDS policies and programs and monitoring the compliance of HIV/AIDS policies and programs with international human rights principles and guidelines, in particular those that have been explicitly promoted by UNAIDS in its publications and other work. Some suggested key issues are highlighted and, HIV testing strategies will be used as an example to the extent necessary to clarify concepts. (excerpt)
Issue paper: Review and assessment of HIV / AIDS strategies that explicitly include attention to rights. Impact mitigation.
Geneva, Switzerland, UNAIDS, 2004. Prepared for the 4th Meeting of the UNAIDS Global Reference Group on HIV / AIDS and Human Rights, August 23-25, 2004. 4 p.This issue paper examines human rights based approaches explicitly defined as such by organizations addressing impact mitigation policy and programmatic efforts. Given the diversity of definitions of rights based approaches, consideration is given to how rights are conceptualized, and the explicit attention to rights in these policy and program efforts. Commonalities and differences should be considered between the various approaches to determine the evidence that exists of the value of paying attention to rights in these strategies, as well as how rights based approaches to impact mitigation are articulated. While impact mitigation covers a broad range of areas, given the devastating consequences of the epidemic on the lives of children, most of the examples below will focus on children orphaned by AIDS as an example to illustrate how rights based approaches are applied at policy and programmatic levels. (excerpt)
Geneva, Switzerland, UNAIDS, 2003. Prepared for the 2nd Meeting of the UNAIDS Global Reference Group on HIV / AIDS and Human Rights, August 25-27, 2003. 3 p.Over 20 years ago, policy and programmatic approaches to HIV testing emerged in a context of great fear about HIV/AIDS and about how to prevent HIV infected individuals from transmitting the virus. As testing methods were developed, HIV testing assumed an important role in epidemiological surveillance, and as treatment became available, on individual testing for clinical purposes. Yet, as national responses to the emerging epidemics unfolded, numerous States argued that the protection of public health warranted compulsory testing requirements of certain populations considered to be “high risk”, mandatory testing for access to certain goods and services, named reporting of those found to be infected and sometimes contact tracing and mandatory notification of partners, family, employers or community members. The realities of stigma, discrimination and the neglect of human rights protections were recognized to keep people away from prevention and care, and creating fertile ground for people not to get tested and, unaware of their HIV status, to further spread the virus. This recognition lead to a bridge between those concerned with human rights protections and those concerned with public health imperatives. Over time, the components of supportive testing became clearer, the concept of voluntary counseling and testing (VCT) was promulgated and policy direction from GPA/WHO centered on making voluntary counseling and testing an important focus of all national responses to the HIV/AIDS epidemics. This policy, further elaborated by WHO and UNAIDS remains in place today. (excerpt)
Ethics and equity in access to HIV treatment. Issue paper: 3rd Meeting, UNAIDS Global Reference Group on HIV / AIDS and Human Rights, 28-30 January 2004.
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2004. 6 p.The WHO/UNAIDS 3x5 initiative aims to reach those in need of treatment and to identify those who are hard to reach, especially in populations that have not had access to services. There is a global responsibility to support resource-limited countries to scale up ART in the face of a global public health emergency. In addition, a country-level responsibility exists to ensure treatment is made available as enunciated in human rights guidelines for HIV/AIDS. It will not be possible to reach everyone in need as the 3x5 initiative begins, so it is necessary to work progressively towards universal access. Most countries will use a phased approach and this will necessitate making decisions about priorities in allocating resources. Although adherence to human rights provisions is essential, none of the various human rights treaties or declarations provides criteria for setting priorities or choosing among potentially relevant principles of equity. When not all persons in need of HIV treatment can be served, distribution of HIV treatment services should be guided by principles of equity or fair distribution, and considerations of human rights, including the right to freedom from discrimination and the right to the highest attainable state of health. Policy makers will need to make decisions and various ethical principles will guide these decisions in very different ways. (excerpt)
HIV testing of specific populations: recruits of the armed forces. Issue paper: 3rd Meeting, UNAIDS Global Reference Group on HIV / AIDS and Human Rights, 28-30 January 2004.
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2004. 6 p.In 2001, the United Nations Security Council established an Expert Panel to study the issue of whether the UN should institute HIV testing of peacekeeping personnel. This article, based on a 9 July 2002 presentation to the 14th International AIDS Conference, reports on the findings of a paper prepared for the Expert Panel by the Canadian HIV/AIDS Legal Network. The paper examined whether it is permissible for the UN to implement mandatory HIV testing of its peacekeeping personnel, and whether HIV-positive UN peacekeeping personnel should be excluded or restricted from service on the basis of their HIV status or HIV disease progression. The article describes some of the court cases in which these issues have been considered; discusses the importance of analyzing such issues in the context of a human rights–based approach to the pandemic; and formulates a series of key principles for guiding UN decision-making. The article concludes that a policy of mandatory HIV testing for all UN peacekeeping personnel cannot be justified on the basis that it is required in order to assess their physical and mental capacity for service; that HIV-positive peacekeeping personnel cannot be excluded from service based on their HIV status alone, but only on their ability to perform their duties; and that the UN cannot resort to mandatory HIV testing for all UN peacekeeping personnel to protect the health and safety of HIV-negative personnel unless it can demonstrate that alternatives to such a policy would not reduce the risk sufficiently. In the end, the Expert Panel unanimously rejected mandatory testing and instead endorsed voluntary HIV counselling and testing for UN peacekeeping personnel. (excerpt)
BMJ. British Medical Journal. 2003 Nov 8; 327:1101-1103.Over the past 20 years, the public health community has learnt a tremendous amount about the HIV/AIDS epidemic. Yet, despite widespread discussion about the epidemic and some measurable progress, the overall response has been insufficient: globally 42 million people are already infected with HIV, prevalence continues to rise, and less than 5% of those affected have access to lifesaving medicines. In the face of this growing crisis, the World Health Organization has made scaling up treatment a key priority of the new administration. We argue that not only is the HIV/AIDS epidemic an emergency, but its devastating effects on societies may qualify it as one of the most serious disasters to have affected humankind. As such, this crisis warrants a full disaster management response. (excerpt)
In: An agenda for people: the UNFPA through three decades, edited by Nafis Sadik. New York, New York, New York University Press, 2002. 24-46.The solemn commitment that was made in Cairo in 1994 to make reproductive health care universally available was a culmination of efforts made by the United Nations Population Fund (UNFPA) and all those concerned about a people-centred and human rights approach to population issues. The commitment posed important challenges to national governments and the international community, to policy makers, programme planners and service providers, and to the civil society at large. The role of UNFPA in building up the consensus for the reproductive health approach before Cairo had to continue after Cairo if the goals of the International Conference on Population and Development (ICPD) were to be achieved. UNFPA continues to be needed to strengthen the commitment, maintain the momentum, mobilize the required resources, and help national governments and the international community move from word to action, and from rhetoric to reality. Reproductive health, including family planning and sexual health, is now one of three major programme areas for UNFPA. During 1997, reproductive health accounted for over 60 per cent of total programme allocations by the Fund. (excerpt)
AIDS and Society. 1989 Oct; 1(1):5-6.Gerald Desmond, Secretary of the United Nations Standing Committee on AIDS, was interviewed in New York by Richard Rockwell, Associate Editor of the Bulletin. (excerpt)