PAHO/WHO Collaborating Center
on Public Health Law and Human Rights

... human rights instruments and standards as effective tool for the promotion and protection of health ...

Dra. Mirta Roses

Chairs the Event:
Dr. Mirta Roses, Director, Pan American Health Organization;
Mr. Alex Aleinikoff, Dean, Georgetown University;
Mr. Lawrence Gostin, Associate Dean, Georgetown University Law Center and Director of the Center for Law and the Public Health;
Dr. Chris Beyrer, Director of Johns Hopkins Center for Public Health and Human Rights.
Washington D.C., October 13, 2006
Georgetown University Law Center


Dr. Mirta Roses Talking Points

This event today, for us, for the PAHO and WHO family is historical. It is the first time that these organizations that formally a center dedicated to the promotion and protection of human rights and fundamental freedoms in the context of health, has been designated to collaborate officially on many different health strategies and initiatives in the Americas and in the rest of the world. However, there is also another important difference this time. The Center for Law and the Public Health at Georgetown and Johns Hopkins Universities in collaboration with PAHO and WHO will use, for the most part, human rights instruments and standards (which are not "health instruments per se" or the "traditional public health approach") that have proved to be another important and effective tool for the promotion and protection of health.

Health is fundamental to human well-being and social and economic development. Some degree of physical and mental health is essential in order to participate in the civil, political, economic and social affairs of civil society. At the same time, the exercise of human right such as personal liberty, privacy, work, and education (among others) are essential to enjoy mental and physical wellbeing. It is in recognition of this fact that the right to the enjoyment of the highest attainable standard of physical and mental health (also known as "the right to health") and other fundamental rights such as the right to life and the right to physical, mental and moral integrity are enshrined in many international treaties, conventions and guidelines. In fact, the Constitution of the World Health Organization which was signed in 1946 by 61 States establishes that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition". I think that it is relevant to go back to our own history, in order to be aware of the fascinating links among health, human rights and public health laws that we have been able to observe in PAHO.

It was back in 1990 when PAHO learned that serious violations of human rights were occurring systematically in many countries of the Americas and in the context of mental health services. As a response, PAHO with the collaboration of the Inter-American Commission on Human Rights convened different mental health organizations, associations, lawyers, mental health professionals, organizations of persons with mental disabilities, law makers and others to the Regional Conference on the Restructuring of Psychiatric Care in Latin America which has held in Caracas, Venezuela. In this conference, on November 14 of 1990, the Declaration of Caracas was adopted and this instrument proposed the restructuring of mental health care consistent with international human rights instruments. For us in PAHO, this is a crucial "seed" that helped us to understand a new approach, a human rights approach to be used in our health interventions. Thus, this Declaration recommended Member States that (quote) "the resources, care and treatment that are made available must safeguard personal dignity and the human rights…and strive to ensure that patients remain in their communities…"

Back in 1990, through the Declaration of Caracas, PAHO was already recommending that countries reviewed and redrafted national mental health legislation to ensure that the (quote) "human and civil rights of the mental patients are safeguarded…" For us, this was the beginning of PAHO's work on human rights. It is important to underline that it was almost 15 years ago that PAHO began to collaborate very closely with regional human rights bodies such as the Inter-American Commission on Human Rights which at the time, 15 years ago, (this collaboration) was rare and sometimes even misunderstood, which is not strange. In fact, we, public health experts and human rights lawyers have to admit that health and wellbeing have not always been at the forefront of human rights discussions and, conversely, public health agencies too infrequently consider the human rights dimensions of their work. However, today, this tendency is changing and the launching of a WHO/PAHO collaborating center on Public Health Law and Human Rights demonstrates that.

II. FROM CARACAS TO WHO STRATEGIES ON HEALTH AND HUMAN RIGHTS

-The use of international human rights principles, treaties and standards are seeing in PAHO and WHO not as an optional tool to promote and protect public health, but an essential strategy to improve the health of people around the world. In the Region of the Americas, the United Nations and the Inter-American Systems of Human Rights provide individuals with effective mechanisms of protection for ensuring the implementation of the human rights obligations that have been voluntarily accepted by WHO Member States. But, what is the major contribution of the human rights instruments in our health strategies, in PAHO's programs and in our work in the field? What possible results the Collaborating Center and PAHO might be able to see in the years to come in this fascinating and changing area of work? I will have to go back to what many experts who have already left us such as Jonathan Mann explored and researched for many years: health and human rights as two distinct but yet inseparable realities.

Certainly some countries of the Americas have started the reform of health services, policies, plans, programs and practices in the light of the human rights norms and standards that have been accepted by our Member States. When this reform happens, then, services, policies and health laws become not only "health" instruments but also instruments that can promote and protect the exercise of basic human rights, specially in the context of the most vulnerable. If PAHO, WHO and its Collaborating Center at Georgetown and Johns Hopkins are able to transform health services, policies, laws, programs and practices consistent with human rights instruments we can be sure that the most vulnerable will be able to reach their physical and mental well being, a healthy life and their status of citizens according to their own Constitutions. For example, and you will have the opportunity of hearing more about PAHO and WHO's interventions later on, PAHO has been able to implement at the country level measures that have been originally taken not by health agencies, but by Regional or International human rights bodies in order to protect the right to life, personal integrity and access to health services and medications of persons living with HIV/AIDS or disabilities or in the context of children who were institutionalized under deplorable conditions. This means that PAHO, WHO and their collaborating centers are in a unique situation as health agencies for collaborating with national, regional and international human rights commissions, councils, rapporteurs and Ombudspersons in order to promote and protect life, health and other civil, political, economic, social, cultural rights and fundamental freedoms of the most vulnerable.

PAHO's initiatives on health and human rights are part of WHO global strategies in this area. We could say that overall integrating human rights norms and standards into policies, laws, practices and programmes of WHO corresponds to the need for the organization as a whole to respond effectively to a complex, multi-dimensional and changing international context. The PAHO and WHO's work on Health and Human Rights is a step toward a more proactive, systematic, and sustainable effort of the entire Organization to enhance health outcomes in WHO's Member States by recognizing the synergy between health and human rights law.

The adoption of this WHO work on Health and Human Rights is also in response to a call addressed to the entire UN system by the UN Secretary-General to integrate human rights in their activities which is stated in his report "A larger freedom". All UN bodies and specialized agencies are required to "periodically assess the impact of their policies and strategies on the enjoyment of human rights", as stressed in the Vienna Declaration and Programme of Action emanating from the UN World Conference on Human Rights in 1993 and the 1998 Economic and Social Council (ECOSOC) session.

The development of a health and human rights approach which is an incremental process, consisting of activities both internal to PAHO and WHO and involving external relations and collaborating centers such as the Center for Law and the Public's Health. Overall, a health and human rights approach may benefit both organizations and particularly our Member States by providing:

- explicit recognition of health as a "human right" in connection with other human rights and freedoms related with physical and mental health;
- application of key health-related human rights, such as freedom from discrimination and rights to education, information, food, privacy, association, autonomy and participation as well as access to scientific progress and its applications;
- an "empowering" strategy for health with vulnerable and marginalized groups engaged as meaningful and active participants;
- normative specificity of human rights framework based on international human rights treaties ratified by Member States, standards, basic principles and customary law; a coherent development framework;
- enhanced governmental capacity and accountability for health and human rights through international and regional human rights bodies such as the Inter-American Commission and Court of Human Rights;
- useful framework, vocabulary and form of guidance for public health efforts to identify, analyze and respond directly to the societal determinants of health;
- greater consistency and coherence in WHO's interaction with international human rights bodies; capacity to keep abreast of developments in the area of health and human rights and to influence and contribute to the international health and human rights discourse and consensus-building process in countries;
- increased policy leverage and credibility at the national level through the reform on national public health laws, policies and programs;
- powerful authoritative basis for implementation and advocacy.

III. A COHERENT AND SOLID EXPANSION

Since 1999 PAHO has expanded the use of human rights instruments from mental health to many other areas of work. For instance, PAHO has conducted technical workshops promoting human rights and fundamental freedoms in the context of HIV/AIDS, disabilities, the health of indigenous peoples, sexual and reproductive health and older persons, among others. As a consequence of PAHO's strategies on the dissemination of human rights norms and standards through training workshops, many countries are in the process of reforming national laws and policies according to international human rights law or have established national monitoring mechanisms with governmental agencies such as the Ombudspersons' offices which are visiting health centers. PAHO is also collaborating with regional human rights bodies such as the Inter-American Commission and Court of Human Rights through participation in technical hearings on health issues, collaboration in formulating human rights guidelines, and formulation of technical opinions to interpret human rights treaties in the context of the right to the enjoyment of the highest attainable standard of health and other related human rights. PAHO's newest initiative in health and human rights is the issue of exposure to second hand tobacco smoke and also in this area international human rights instruments have been an underutilized but powerful mechanism that can help diminish deaths and diseases in the Americas.

After so many years of consistent work in specific areas of health, recently, PAHO and WHO's work on human rights has been recognized by PAHO's Governing Bodies as an important strategy to promote and protect health. Thus, on September 25th, the 35 Member States of PAHO discussed and approved a Resolution entitled "Disability: prevention and rehabilitation in the context of the right to the enjoyment of the highest attainable standard of physical and mental health and other related rights" which urges Members States to use the human rights treaties and standards to reform the disability and rehabilitation services, policies, plans, programs and practices and to collaborate more closely with national, regional and international human rights bodies. This is a significant precedent for our work and for the center's work. There is no doubt that through this resolution the Ministers of Health of the Americas have officially recognized that human rights treaties and standards are an essential tool for restructuring health systems. And moreover, the Ministries of Health underlined that health is a fundamental human right related with other human rights and freedoms.

We already see the work of the Center for Law and the Public's Health as a corner stone in the development of actions, strategies and new approaches in health and human rights and we are sure that our collaborating center here at Georgetown University and at Johns Hopkins will influence, enhance and contribute significantly to the existing work that PAHO and WHO are developing in this area. But overall, we see this collaboration between PAHO and the Center as an innovative synergy which can, among many other things, eliminate the stigma and discrimination associated with the most vulnerable and those who are experiencing health problems, illnesses, epidemics and disability specially with regard to their human right to access health services, facilities, technologies, essential medicines and goods on an equal basis with others. The enjoyment of the right to the highest attainable standard of health is the guarantee that the most vulnerable will be able to enjoy their other basic human rights, reach the status of citizens of their own countries and enjoy the maximum development of their personality.


Read more:
-Center for Law and the Public's Health