beyond “the highest attainable standard”: analyzing an evolving right to health as a means of...
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Beyond “the highest attainable standard”: Analyzing an Evolving Right to Health as a Means of Protecting Public HealthBenjamin Mason Meier, JD, LLM, MPhilColumbia UniversityAPHA Annual ConferenceNovember 6, 2006
Health Harms in a Health Harms in a Globalized WorldGlobalized World
Shared Health Shared Health DilemmasDilemmas
Weakening of National Health Infrastructures
Degradation of the Built Environment
Rise of the Transnational Corporation
““Double Disease Double Disease Burden”Burden” Infectious Infectious
DiseaseDisease Chronic Chronic
DiseaseDisease
Health Harms in a Health Harms in a Globalized WorldGlobalized World
Shared Health Dilemmas
Weakening of Weakening of National National Health Health InfrastructuresInfrastructures
Degradation of the Built Environment
Rise of the Transnational Corporation
Structural Structural Adjustment Adjustment ProgramsPrograms Weakening of Weakening of
regulations that regulations that protect healthprotect health
Crippling of Crippling of state health state health programsprograms
Health Harms in a Health Harms in a Globalized WorldGlobalized World
Shared Health Dilemmas
Weakening of National Health Infrastructures
Degradation of Degradation of the Built the Built EnvironmentEnvironment
Rise of the Transnational Corporation
Changes in the Built Changes in the Built EnvironmentEnvironment MigrationMigration EmploymentEmployment HousingHousing
IllHealth
Inequitable Poverty
Health Harms in a Health Harms in a Globalized WorldGlobalized World
Shared Health Dilemmas
Weakening of National Health Infrastructures
Degradation of the Built Environment
Rise of the Rise of the Transnational Transnational CorporationCorporation
Exploiting New Exploiting New MarketsMarkets
Subverting Subverting National RegulationNational Regulation
Damaging Damaging Environments, Environments, Local & GlobalLocal & Global
Creating Creating Dangerous Dangerous ProductsProducts
An Evolving Right to Health?An Evolving Right to Health?
Universal Declaration of Universal Declaration of Human Rights (1948)Human Rights (1948)
Art. 25Art. 25 (1) Everyone has (1) Everyone has
the right to the right to a a standard of living standard of living adequate for the adequate for the health health and well-and well-being of himself being of himself and of his family, and of his family, including food, including food, clothing, housing clothing, housing and medical care and medical care ….….
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An Evolving Right to Health?An Evolving Right to Health?International Covenant International Covenant
on Economic, Social on Economic, Social and Cultural Rights and Cultural Rights
(1966)(1966)
Art. 12Art. 121. The States Parties to the
present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right...
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An Evolving Right to Health?An Evolving Right to Health?
Declaration of Alma Ata Declaration of Alma Ata (1978)(1978)
Essential Aspects Essential Aspects of Primary Health of Primary Health CareCare Individual Individual
Medical Care Medical Care
++ Preventive Public Preventive Public
HealthHealth
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An Evolving Right to Health?An Evolving Right to Health?
General Comment 14 General Comment 14 (2000)(2000)
The United Nations The United Nations Committee on Committee on Economic, Social Economic, Social and Cultural Rightsand Cultural Rights
Obligations for Obligations for Public Public Health Health within the within the Individual Individual right to right to healthhealth
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Individual Health = Doctor/PatientIndividual Health = Doctor/Patient Public Health = Underlying Determinants of Public Health = Underlying Determinants of
HealthHealth
Mechanisms ResultSESSES smokingsmoking health statushealth status
statusstatusdietdiet
* * Socioeconomic Status (SES) is a fundamental underlying cause of disease, operating at a societal level and having effects on health status, no matter the disease or the mechanism.
Individual Health Services vs. Public Health Individual Health Services vs. Public Health SystemsSystems
Public Health vs. Individual HealthPublic Health vs. Individual Health
UnderlyingDeterminant
A Right to Public Health?A Right to Public Health?
The Individual Right to Health Is The Individual Right to Health Is Inapplicable to the National Inapplicable to the National Harms of GlobalizationHarms of Globalization
A Collective Right to Public A Collective Right to Public Health Would Compel States to Health Would Compel States to Address Societal Inequities in Address Societal Inequities in Underlying Determinants of Underlying Determinants of Public HealthPublic Health
A Right to Public Health?A Right to Public Health?
Collective Collective RightsRights
Public Health as a Public Health as a Human RightHuman Right TheoreticalTheoretical ProgrammaticProgrammatic
International International ObligationsObligations
Human Rights as Human Rights as Individual RightsIndividual Rights
Origin of Origin of “Solidarity Rights”“Solidarity Rights”
Responding to Responding to Globalization – Globalization – Employing Employing collective rights for collective rights for health promotion health promotion and disease and disease preventionprevention
A Right to Public Health?A Right to Public Health? Collective RightsCollective Rights Public Health Public Health
as a Human as a Human RightRightTheoreticalTheoreticalProgrammaticProgrammatic
International International ObligationsObligations
Theoretical Theoretical ConceptualizationConceptualization
Programmatic Programmatic ComponentsComponents SubstantiveSubstantive ProceduralProcedural
Right to Health
Right to Public Health
Level of Analysis
Individual Collective
Subject of Right
Treatment (Cessation)
Prevention (Advertising)
A Right to Public Health?A Right to Public Health?
Collective RightsCollective Rights Public Health as a Public Health as a
Human RightHuman Right TheoreticalTheoretical ProgrammaticProgrammatic
International International ObligationsObligations
Rights-Based Rights-Based Development Development DiscoursesDiscourses
International International CooperationCooperation
““The The Globalization of Globalization of Public Health” – Public Health” – Role of WHORole of WHO
““The law must remain The law must remain stable, but it cannot stable, but it cannot
stand still.”stand still.”
- Roscoe Pound - Roscoe Pound