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Key dates

1 December
World Aids Day

7 April
World Health Day

Background Information on the Global Themes > Health

Health

"Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity."

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Health is a social, economic and political issue as well as an issue concerning human rights. Inequality and poverty lie at the root of ill health, as well as the deaths of poor and marginalised people. The World Health Report classifies sicknesses and causes of death with number codes. The first cause of death around the world, according to the World Health Report, is that corresponding to number 259.5: extreme poverty. It has become a vicious circle: poverty causes illness, which in turn leads to greater poverty.

In recent decades, economic changes worldwide have profoundly affected people's health and their access to health care and social services. World resources are increasingly concentrated in the hands of a few economic players who strive to maximise their private profits. Economic and financial policy is increasingly made by a small group of governments and international bodies, such as the World Bank, the International Monetary Fund and the World Trade Organisation. The policies of these organisations, together with the activities of multinational companies, have severe effects on the lives, livelihoods, health and well-being of people in both the Southern and the Northern hemispheres.

As never before, the figures of deaths and illnesses have the face of injustice and inequality: 75% of the world population live in developing countries and represent only 8% of the world's pharmaceutical market. Furthermore, one third of the world population has no access at all to essential drugs.

Aids and human rights

 

A paradigmatic example is Aids. While in rich countries, people who have HIV/Aids can live better and longer because of anti-retroviral drugs, which are provided by some states for free or at reasonable prices, in southern countries people affected by HIV die because they have no access to treatment. In most cases, the annual per-capita expenses in health amount to about US$10.

The United Nations Commission on Human Rights in a report issued on Aids and human rights has identified the following human rights, among others, as tightly linked to the spread of Aids all over the world31:

  • The right to marry and found a family. A report by the UN Commission on Human Rights states that "it is clear that the right of people living with HIV/Aids is infringed by mandatory pre-marital testing and/or the requirement of "Aids-free certificates" as a precondition for the grant of marriage licences under state laws. Secondly, forced abortions or sterilisation of women living with HIV violates the human right to found a family, as well the right to liberty and integrity of the person."
  • The human rights of children and young people may also be under threat. "Many of these rights, such as freedom from trafficking, prostitution, sexual exploitation and sexual abuse, are relevant to HIV/Aids prevention, care and support for children, since sexual violence against children, among other things, increases their vulnerability to HIV/Aids. The freedom to seek, receive and impart information and ideas of all kinds and the right to education both provide children with the right to give and receive all the HIV-related information they need to avoid infection and to cope with their status if infected."
  • "The right to privacy covers obligations to respect physical privacy, including the obligation to seek informed consent to HIV testing, and also privacy of information, including the need to respect confidentiality of all information relating to a person's HIV status. The individual's interest in his/her privacy is particularly compelling in the context of HIV/Aids, firstly because of the invasive character of a mandatory HIV test, and secondly because of the stigma and discrimination attached to the loss of privacy and confidentiality, if HIV status is disclosed. The community has an interest in maintaining privacy so that people will feel safe and comfortable in using public health measures."
  • The right to education: "This right includes three broad components which apply in the context of HIV/Aids. Firstly, both children and adults have the right to receive HIV-related education, particularly regarding prevention and care. Access to education concerning HIV/Aids is an essential life-saving component of effective prevention and care programmes. It is the state's obligation to ensure, in every cultural and religious tradition, that appropriate means are found so that effective HIV/Aids information is included in educational programmes inside and outside schools. Secondly, states should ensure that both children and adults living with HIV/Aids are not discriminated against by being denied access to education, including access to schools, universities, scholarships and international education or subjected to restrictions because of their HIV status. There is no public health rationale for such measures since there is no risk of transmitting HIV casually in educational settings. Thirdly, states should, through education, promote understanding, respect, tolerance and non-discrimination in relation to persons living with HIV/Aids."
  • "The right to work entails the right of every person to access to employment without any precondition except the necessary occupational qualifications. This right is violated when an applicant or employee is required to undergo mandatory testing for HIV and is refused employment or dismissed or refused access to employee benefits on the grounds of a positive result."

In which way do people in your country who suffer from Aids or are HIV positive see their rights violated? How can it be avoided?

Health and environment in Europe

Some health issues are also linked to environmental problems. In October 2001, a conference was organised to analyse the consequences on health of climate change and ozone depletion. Experts in the field believe that "the potentially damaging impacts of the interaction between climate change and ozone depletion are very significant" and that "urgent action is required to reduce both environmental damage and its impact on health".32

 

Health and youth

In recent years, a worrying trend in many European Member States has been the rise in the consumption of alcohol by young people at increasingly younger ages. The harm they experience as a result is considerable. A comparative risk analysis shows, for instance, that one in four deaths in males aged 15-29 years in the European region is attributable to alcohol. These considerations led to the decision to make "Young people and alcohol" the theme of the WHO Ministerial Conference (Stockholm, 19-21 February 2001), and the overall goal of the conference was to boost implementation of the European Alcohol Action Plan.

The conference adopted a declaration containing the following main elements:

  1. identification of alcohol as an important issue in young people's health;
  2. confirmation of the need to have public health/alcohol policy developed, without any interference from commercial or economic interests;
  3. the opportunity to have young people themselves involved in the policy-making process;
  4. the need to determine targets, at national and local levels, to reduce the impact of alcohol on young people's health.


Several steps were recommended for approval by the Regional Committee for Europe of the World Health Organisation. These included:

  • strengthening international partnerships, especially with the European Commission, the Council of Europe, the United Nations Children's Fund and the European Forum of Medical Associations and World Health Organisation (WHO);
  • maintenance of contact with young people and their organisations throughout the region;
  • the establishment of a system for monitoring the promotion of alcoholic beverages to young people.

Can you make a list of concrete and practical actions that could be developed to help implement these recommendations in your own community and country?

As is emphasised in the above recommendations, young people can and should be strategic partners in activities or programmes that deal with health problems, either through prevention or intervention. There are youth organisations that are active in this field of health, such as the International Federation of Red Cross and Red Crescent Societies, which have youth sections all over the world. The European Network of Health Promoting Schools is a tripartite project launched by the World Health Organisation Regional Office for Europe, the European Commission and the Council of Europe. It emphasises the importance of health promotion in the education system by means of collaboration between health and education professionals and members of the community.

The right to health

The right to health is mentioned in several international human rights instruments such as in Article 12 of the International Covenant on Economic, Social and Cultural Rights, and Article 24 of the Convention on the Rights of the Child. As far as Europe is concerned, Article 13 of the European Social Charter refers to it extensively:

"With a view to ensuring the effective exercise of the right to social and medical assistance, the Contracting Parties undertake:

  1. To ensure that any person who is without adequate resources and who is unable to secure such resources either by his own efforts or from other sources, in particular by benefits under a social security scheme, be granted adequate assistance, and, in case of sickness, the care necessitated by this condition;
  2. To ensure that persons receiving such assistance shall not, for that reason, suffer from a diminution of their political or social rights;
  3. To provide that everyone may receive by appropriate public or private services such advice and personal help as may be required to prevent, to remove, or to alleviate personal or family want;
  4. To apply the provisions referred to in paragraphs 1, 2 and 3 of this Article on an equal footing with their nationals to nationals of other Contracting Parties lawfully within their territories, in accordance with their obligations under the European Convention on Social and Medical Assistance, signed at Paris on 11th, December 1953."

The 1999 World Health Report identified the following four main challenges for national governments, the international community, and civil society:

  1. directing health systems towards delivering a minimum number of interventions, which would have the greatest impact in reducing the excessive disease burden suffered by the poor. This includes a renewed commitment to malaria control, extended efforts to control tuberculosis, a focus on maternal and child health and nutrition, and the revitalisation and extended coverage of immunisation programmes.
  2. enabling health systems to counter proactively the potential threats to health resulting from economic crises, unhealthy environments or risky behaviour. One of the most important threats is tobacco addiction. A global commitment to tobacco control could avert millions of premature deaths. Other priorities include combating the spread of resistance to anti-microbials and mounting an effective response to the threat of emerging diseases. Also critical are the global eradication of polio and the promotion of healthy lifestyles (including cleaner air and water, adequate sanitation, healthy diets and safer transportation).
  3. developing health systems that provide universal access to clinical services with no fees (or only small fees) at the point of delivery. This will require public finance, government-mandated social insurance, or both. However, it is recognised that if services are to be provided for all, then not all services can be provided. The most cost-effective services should be provided first. Even the wealthiest countries cannot provide entire populations with every intervention where the medical value outweighs the risks.
  4. encouraging health systems to invest in expanding the knowledge base that made the twentieth-century revolution in health possible and that will provide the tools for continued gains in the twenty first century. The most critical need is for research and development on infectious diseases that disproportionately affect the poor and the establishment of an information base to help countries develop their own health systems.

References

The World Health Report, World Health Organisation, www.who.int/whr/.

Endnotes

32. Second international consultation on HIV/Aids and human rights. E/CN.4/1997/37, United Nations Commission on Human Rights, 20/01/97.

33. Conference organised by the WHO's European Centre for Environment and Health in collaboration with the Italian Ministry for the Environment and the European Environment Agency, Orvieto, Italy, on 5-6 October 2001. Press release EURO 12/2001, www.who.dk/cpa/backgrounders-2001/pback-2001.htm.

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