Spotlights on Health and Rights

Key topics in the Heilbrunn Department of Population and Family Health

Human Rights

Human Rights and Health

The figure below depicts some relationships between health and human rights that highlight the importance of understanding human rights.

  1. The impact of human rights violations on health. The impact of some human rights violations on health is obvious; for example, a person who is tortured will experience health problems as a result. The health consequences of rape and other gender-based violence are clear. Others may be less obvious. When people with drug addictions are arrested and detained without due process, as they frequently are in some countries, they can be at high risk of HIV and hepatitis C because they may inject drugs unsafely. Denial of access to accurate information about HIV/AIDS is a human rights violation with serious health implications, as is denial of information about contraception and HIV/AIDS prevention methods like condoms.
  2. Promotion or violation of human rights through health programs and policies. This connection between health and human rights can take several forms:
    • States may fail to take measures to assure that the right to privacy is upheld and that confidentiality is maintained in the provision of health services.
    • States are allowed to limit rights in the name of protecting the public's health from epidemic disease. Many countries have law or jurisprudence that gives the government the right to detain a person with active tuberculosis for quarantine, for example.
    • Governments may treat drug addiction with incarceration or with scientifically unproven and sometimes cruel and inhuman forms of compulsory "rehabilitation" rather than with proven medical interventions.
    • Health services may exacerbate subordination of women by requiring that they have permission from their husbands for certain medical procedures.
    • Women with HIV may be berated by health service providers for becoming pregnant or may be coerced into sterilization.
  3. Reducing vulnerability to poor health outcomes through human rights. A focus on the underlying conditions that create health and well-being reveals that many of these conditions are human rights issues. The most profound underlying condition is social and economic status. Lower socioeconomic status has been repeatedly linked to poorer health. Racial and gender discrimination are also underlying conditions that can negatively affect health.

EXAMPLE: In many countries, particularly in Africa and South Asia, married women are at high risk of contracting HIV. Although they may have information on HIV and have access to condoms, they are unable to protect themselves because they cannot refuse sex, negotiate condom use, or affect their husbands' sexual practices. Married women's vulnerability to HIV is linked to their poverty and low social status, which are in turn linked to gender-based discrimination and subordination. For example, laws or customary practices that discriminate against women in their ability to own or inherit property or complete their education make women subordinate to their husbands and unable to insist on safer sex.

Question for Thought

Which link(s) between health and human rights are illustrated by this example?

A note on limiting human rights

It is mentioned above that in the case of an outbreak of tuberculosis or another highly contagious disease, countries may need to abrogate rights of some people to preserve the rights of others. In addition to an objective such as containing an epidemic, countries have often also invoked national security of public safety emergencies to restrict rights. In 1984, a distinguished group of legal experts met in Siracusa, Italy, to discuss the legitimate circumstances under which rights of some might be limited in the case of an emergency "threatening the life of the nation" and ways in which governments should and should not cause such restrictions. Among the so-called "Siracusa Principles" that they drew up, which have been endorsed by the United Nations, are that limitations of rights (such as quarantine) must:

  • respond to a pressing public or social need;
  • pursue a legitimate aim and be proportionate to that aim;
  • not be arbitrary or unreasonable;
  • be consistent with national law;
  • constitute the least restrictive means possible for the achievement of the purpose of the limitation;
  • include adequate safeguards and remedies; and
  • not interfere with the democratic functioning of society.

In addition, the Siracusa Principles enjoin countries to "make an official proclamation of the existence of a public emergency" - that is, all people should know why rights are being restricted. The Principles also note that the onus is on the government to justify rights-restricting measures according to these principles.

For example, in the face of a growing epidemic of drug-resistant tuberculosis in New York City in the late 1980s and early 1990s, the city's Department of Health announced that people diagnosed with drug-resistant TB who did not comply with the prescribed regimen of medications could be detained involuntarily in a special facility on Roosevelt Island. Several hundred persons were so detained. The detentions were covered in the newspapers, and people in the special hospital had access to lawyers and could see a judge if they wanted to challenge their detention. The detentions were judged by the courts to be within the scope of the city's existing emergency health laws.