Public Health & Human Rights

Love: The foundation for human rights

I was listening to a DVD given to me by my brother-in-law (thanks Ben) in which the speaker was talking briefly about human rights and the fact that rights, on their own, are relatively empty.  That without a solid underpinning, they become rather subjective. 

As I was thinking more about the point, I came across a relatively recent (2005) book by Thomas WIlliams on the topic of human rights from a faith perspective.  As a book I had not see before, I perused it and found it very insightful.  I also found a nice summary of the book in the journal FIrst Things from the year 2005.

What I like about the author is that he makes human rights, sometimes an elusive concept, relatively easy to grasp (although the 300+ page book is, at times, rather academic).  The author agrees with Pope John Paul II when he stated, "a person's rightful due is to be treated as an object of love."  The author writes that a right, considerably different than defined by Websters Dictionary, is "the moral capacity to claim from another what one deserves."  And what one deserves is love. 

As the author points out, Jesus stated that one of the two greatest commandments is to "love your neighbor as yourself."  So, as the reviewer in First Things states, "we must will for our neighbors things that are truly good for our neighbor's own sake."  The commandment to love one's neighbor shows the inherent dignity of all people and their "intrinsic lovableness."  So, Williams argues, this Biblical love is the most basic human right, the very basis of human rights.  Without this foundation, the concept of rights, Williams argues, falls apart and becomes simply subjective. 

Thomas Williams' book, "Who is my neighbor?" is a solid read both providing the Biblical perspective and some insight into the language of human rights.  I have not yet read the entire book, but I plan to.

 

Moving beyond a "headless heart"

I've been intrigued by a new book entitled, The Bottom Billion, ever since I first heard about it several weeks ago. There are many positive reviews of the book, which is written by Paul Collier, currently a professor at Oxford and formerly the Director of development research at the World Bank.

The book appears to be one worth getting, but until that time I have managed to skim sections of it in a local bookstore. The book is about the poorest billion people in the world, people who live in economies that are not growing and are in need of new and more complex solutions than many would have us think. It is a well-researched and well-written book, and the words sound as if they come from a man who has spent a lot of time with these poorest billion (he has). The author provides a nice balance in his views. There is talk of globalization, aid, war, etc yet all with a care to not run into what he calls "the headless heart" problem.

One of the central themes that runs through the book, beginning in the introduction, is this idea of the "headless heart." Collier describes that too often people become passionate about helping the poorest and move first with their heart without intelligently thinking through the options or consequences. He spends a little time citing a specific example of a Christian relief organization with good intentions that probably did more harm than good in Africa because of their stance on the poor and their subsequent actions.

I don't doubt that there are faith-based organizations that run with their heart more than with their head, but it most certainly is not a problem of only faith-based organizations (and he argues the same). More generally, having a headless heart is a problem in many public health/human rights activities (although that is increasingly changing). One of the most well-documented such problems is with aid that is provided after a major disaster. Whether a hurricane in Central America, a tsunami off the coast of Sumatra, or flooding in the Gulf Coast states of the U.S., it is well-documented that much of the aid that pours in is wasted or not well managed, in large part because the donors gave with good hearts, but with little critical thinking about what really was needed or how it was needed.

I highly recommend Collier's book, and it is about much more than this "headless heart" syndrome. But, it is a central theme, and one I wanted to pick up on briefly here. I'm sure that I could use less of that headless heart in my own life and work. Collier, it seems, helps us think again about the poor and how to move our actions beyond the popular Hollywood rhetoric.

(I first heard about The Bottom Billion in a discussion of it in the journal First Things. I have found First Things to be an excellent source for academic and well-thought articles about public health and human rights from a Christian perspective. If you know of other good sources, I'd be very interested. For an excellent discussion on the topics raised in The Bottom Billion, visit First Things (http://www.firstthings.com/) and look at the October, November, and December issues--the section titled, "The Public Square.")

Fundamentals of health

We each have various roles in society, and what we do with our roles has profound effects on the autonomy of those around us and their ability to engage socially. Autonomy (a person's ability to have control over their daily life) and engagement with society are not merely nice things to have. These are such fundamental needs that health suffers markedly if they are not fulfilled.

The above is a paraphrase of Michael Marmot's conclusion in his book titled, "The Status Syndrome." This is a powerful, compelling, and well-researched book by a man known world-wide for his research about inequalities in health (Michael Marmot is a professor of epidemiology and public health at University College in London and also serves as an advisor to the WHO).

Jonathan Mann was a world leader in both public health and human rights and is widely regarded as the one who brought the two fields together and best articulated their connections. In the context of AIDS, he one time described the link between public health and rights in this way: "...we have learned that the HIV pandemic flourishes where individual capacity to learn and to respond is constrained...this capacity is constrained by belonging to a group that is discriminated against, marginalized, or stigmatized." The same could be said of nearly every other health issue--where freedom and participation in society are reduced, health is impacted.

The Institute of Medicine has defined the mission of public health as "assuring the conditions in which people can be healthy," and, as illustrated by Mann's quote above and Marmot's conclusions, it turns out that assuring these conditions has a lot to do with societal issues.

In fact, Marmot states in his book that it is autonomy and social participation that are critical for health. Here are a few other jarring, and well-researched, sentences from his book:

“The way we organize society leads to inequality in the lives people are able to lead.”

“Health inequalities are not confined to the poor and the nonpoor, but affect us all.”

“Where you stand in the social hierarchy is intimately related to your chances of getting ill, and your length of life.”

From Sweden to Russia to England to Hungary to Japan to the United States to Kerala, the circumstances in which you and I live and work are critical to health.

And why should we care? Because whether you work specifically in the field of health or rights or whether your role is of another kind, you have the ability every day to impact the health of the people around you. In your roles, as you allow autonomy and as you encourage others to more actively engage in their society, their health improves.

This is that inextricable link between health and rights. More than access to health care and more than correcting bad habits, health is intimately linked to control over one's life and the ability to participate in one's society--issues defined by human rights.

Health and Inequity

"Progress is more plausibly judged by the reduction of deprivation than by the further enrichment of the opulent. We cannot really have an adequate understanding of the future without some view about how well the lives of the poor can be expected to go. Is there, then, any hope for the poor?" -Amartya Sen, "Will There Be Any Hope for the Poor" as cited in Paul Farmer's book titled, "Pathologies of Power: Health, Human Rights, and the New War on the Poor."

Paul Farmer's book, "Pathologies of Power," is a compelling read about health inequities and "structural violence"--inequities caused by the systems in which people find themselves. I find the above quote, like most of the book, thought provoking. How frequently we measure progress by looking at the "have's" rather than the "have-not's." The author argues that in improving the lives of the poor, we need to focus not on interventions that are guided by "cost-effectiveness" or "sustainability," (terms that pervade the field of public health today) but rather on those that strive for excellence and equity.

A focus on "excellence" and "equity" in health, which ultimately comes from a focus on health as a human right rather than the more popular notion of market-driven health, will require a new way of thinking about health. A poem by Bertolt Brecht begins with these lines, "The more there are sufferings, then, the more natural their sufferings appear. Who wants to prevent the fishes in the sea from getting wet?"

That, in part, is our challenge.