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Health and human rights education: time to act
Correspondence
Health and human rights education: time to act
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The violations of medical neutrality described by Leonard Rubenstein and Melanie Bittle (Jan 23, p 329)1 are shocking in their inhumanity and pervasiveness. Yet doctors are not only victims in relation to international law— they have responsibilities too. The Magna Carta of health rights is Article 12 of the UN International Covenant on Economic, Social and Cultural Rights, which, as amplified in 2000 by a 65-paragraph explication known as General Comment 14, exhaustively defines states’ obligations, health entitlements, and their ethical implementation by use of human rights principles. Yet, as the former UN Special Rapporteur on the right to the highest attainable standard of health explained to the UN Human Rights Council, “most health professionals whom the Special Rapporteur meets have not even heard of the right to health. If they have heard of it, they usually have no idea what it means, either conceptually or operationally”.2 Doctors for Human Rights recommended that the UK General Medical Council (GMC) require medical students to be taught human rights, citing the Government’s response to scandalous health-care for people with intellectual disabilities.3 In the end, the GMC only alluded to binding human rights law by recommending doctors “Recognise the rights and the equal value of all people and how opportunities for some people may be restricted by others’ perceptions”.4 34 years on from the adoption of the Covenant, and 17 years on from the World Conference in Vienna that recognised the importance of special education in human rights for health professionals, doctors remain shockingly ignorant of the right to the highest attainable standard of health.5 I played a part in the development of General Comment 14 of the International Covenant on Economic, Social, and Cultural Rights.
894
Peter Hall [email protected] Doctors for Human Rights, Abbots Langley, Watford WD5 0BE, UK 1
2
3
4
5
Rubenstein LS, Bittle MD. Responsibility for protection of medical workers and facilities in armed conflict. Lancet 2010; 375: 329–40. Hunt P. Report on progress and obstacles to the health and human rights movement (A/HRC/4/28). http://www2.ohchr.org/ english/issues/health/right/issues.htm (accessed Feb 24, 2010). Department of Health. Valuing people now: a new three-year strategy for people with learning disabilities. London: The Stationery Office, 2009. http://www.dh.gov.uk/en/ Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_093377 (accessed Feb 24, 2010). General Medical Council. Tomorrow’s doctors: outcomes and standards for undergraduate medical education. London: General Medical Council, 2009. http://www. gmc-uk.org/education/undergraduate/ tomorrows_doctors_2009.asp (accessed Feb 24, 2010). United Nations. Vienna Declaration and Programme of Action (A/CONF.157/23). http:// www.unhchr.ch/huridocda/huridoca.nsf/ (symbol)/A.CONF.157.23.En?OpenDocument (accessed Feb 24, 2010).
The right to health encompasses more than just access to health care. It also includes health-related freedoms, obligations, and entitlements, with the underlying determinants of health—ie, safe water and nutrition, adequate housing, education, and the environment—all having a substantial role.1 Ensuring non-discrimination, gender equality, availability, accessibility, acceptability, and quality in health care are central to the realisation of the right to health. There needs to be a deeper understanding from the health sector of what the right to health is and to see its practical added value. As was shown in the UK, systematic application of a human rights approach can have a positive effect on the provision of health care.2,3 If such depth of understanding is to be achieved among the health-care workers of the future, there needs to be a major change in the development of their respective curricula, as seen in the UK and elsewhere in Europe with the incorporation of formal medical ethics and law training.4 UN member states
have an obligation to provide training in human rights if human rights are to be realised. Health-care professionals are also educators themselves and a beacon for those in need; they are able to report when injustices occur, from places where human rights professionals are unable to access. Educating health-care workers in human rights and the practical applications of the right to health is not only imperative for social justice, it is a morally powerful approach capable of transcending borders and directing health systems for the improvement of health.5 We declare that we have no conflicts of interest.
Gunilla Backman, *Joseph R Fitchett joseph.fi[email protected] Swedish International Development Cooperation Agency, Stockholm, Sweden (GB); and London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK (JRF) 1
2 3
4
5
Hunt P. The human right to the highest attainable standard of health: new opportunities and challenges. Trans R Soc Trop Med Hyg 2006; 100: 603–07. Singh JA, Govender M, Mills EJ. Do human rights matter to health? Lancet 2007; 372: 521–27. Department of Health. Human rights in healthcare evaluation: final evaluation report 2008. London: The Stationery Office, 2008. http://www.dh.gov.uk/en/Publicationsand statistics/Publications/PublicationsPolicyAnd Guidance/DH_088979 (accessed Feb 24, 2010). General Medical Council. Tomorrow’s doctors: outcomes and standards for undergraduate medical students. London: GMC, 2009. http:// www.gmc-uk.org/education/undergraduate/ tomorrows_doctors_2009.asp (accessed Feb 24, 2010). Backman G, Hunt P, Khosla R, et al. Health systems and the right to health: an assessment of 194 countries. Lancet 2008; 372: 2047–85.
Department of Error Chow RT, Johnson MI, Lopes-Martins RAB, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or activetreatment controlled trials. Lancet 2009; 374: 1897–908—In this Article (Dec 5), there was an error in figure 4. The mean pain intensity score in the laser therapy group of Chow et al 2004 should have been 21 mm. Consequently, the weighted mean difference should have been 14·00 (95% CI –1·32 to 29·32) for that trial and 19·41 (95% CI 9·67 to 29·15) overall.
www.thelancet.com Vol 375 March 13, 2010
Health and human rights education: time to act
Getty Images
The violations of medical neutrality described by Leonard Rubenstein and Melanie Bittle (Jan 23, p 329)1 are shocking in their inhumanity and pervasiveness. Yet doctors are not only victims in relation to international law— they have responsibilities too. The Magna Carta of health rights is Article 12 of the UN International Covenant on Economic, Social and Cultural Rights, which, as amplified in 2000 by a 65-paragraph explication known as General Comment 14, exhaustively defines states’ obligations, health entitlements, and their ethical implementation by use of human rights principles. Yet, as the former UN Special Rapporteur on the right to the highest attainable standard of health explained to the UN Human Rights Council, “most health professionals whom the Special Rapporteur meets have not even heard of the right to health. If they have heard of it, they usually have no idea what it means, either conceptually or operationally”.2 Doctors for Human Rights recommended that the UK General Medical Council (GMC) require medical students to be taught human rights, citing the Government’s response to scandalous health-care for people with intellectual disabilities.3 In the end, the GMC only alluded to binding human rights law by recommending doctors “Recognise the rights and the equal value of all people and how opportunities for some people may be restricted by others’ perceptions”.4 34 years on from the adoption of the Covenant, and 17 years on from the World Conference in Vienna that recognised the importance of special education in human rights for health professionals, doctors remain shockingly ignorant of the right to the highest attainable standard of health.5 I played a part in the development of General Comment 14 of the International Covenant on Economic, Social, and Cultural Rights.
894
Peter Hall [email protected] Doctors for Human Rights, Abbots Langley, Watford WD5 0BE, UK 1
2
3
4
5
Rubenstein LS, Bittle MD. Responsibility for protection of medical workers and facilities in armed conflict. Lancet 2010; 375: 329–40. Hunt P. Report on progress and obstacles to the health and human rights movement (A/HRC/4/28). http://www2.ohchr.org/ english/issues/health/right/issues.htm (accessed Feb 24, 2010). Department of Health. Valuing people now: a new three-year strategy for people with learning disabilities. London: The Stationery Office, 2009. http://www.dh.gov.uk/en/ Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_093377 (accessed Feb 24, 2010). General Medical Council. Tomorrow’s doctors: outcomes and standards for undergraduate medical education. London: General Medical Council, 2009. http://www. gmc-uk.org/education/undergraduate/ tomorrows_doctors_2009.asp (accessed Feb 24, 2010). United Nations. Vienna Declaration and Programme of Action (A/CONF.157/23). http:// www.unhchr.ch/huridocda/huridoca.nsf/ (symbol)/A.CONF.157.23.En?OpenDocument (accessed Feb 24, 2010).
The right to health encompasses more than just access to health care. It also includes health-related freedoms, obligations, and entitlements, with the underlying determinants of health—ie, safe water and nutrition, adequate housing, education, and the environment—all having a substantial role.1 Ensuring non-discrimination, gender equality, availability, accessibility, acceptability, and quality in health care are central to the realisation of the right to health. There needs to be a deeper understanding from the health sector of what the right to health is and to see its practical added value. As was shown in the UK, systematic application of a human rights approach can have a positive effect on the provision of health care.2,3 If such depth of understanding is to be achieved among the health-care workers of the future, there needs to be a major change in the development of their respective curricula, as seen in the UK and elsewhere in Europe with the incorporation of formal medical ethics and law training.4 UN member states
have an obligation to provide training in human rights if human rights are to be realised. Health-care professionals are also educators themselves and a beacon for those in need; they are able to report when injustices occur, from places where human rights professionals are unable to access. Educating health-care workers in human rights and the practical applications of the right to health is not only imperative for social justice, it is a morally powerful approach capable of transcending borders and directing health systems for the improvement of health.5 We declare that we have no conflicts of interest.
Gunilla Backman, *Joseph R Fitchett joseph.fi[email protected] Swedish International Development Cooperation Agency, Stockholm, Sweden (GB); and London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK (JRF) 1
2 3
4
5
Hunt P. The human right to the highest attainable standard of health: new opportunities and challenges. Trans R Soc Trop Med Hyg 2006; 100: 603–07. Singh JA, Govender M, Mills EJ. Do human rights matter to health? Lancet 2007; 372: 521–27. Department of Health. Human rights in healthcare evaluation: final evaluation report 2008. London: The Stationery Office, 2008. http://www.dh.gov.uk/en/Publicationsand statistics/Publications/PublicationsPolicyAnd Guidance/DH_088979 (accessed Feb 24, 2010). General Medical Council. Tomorrow’s doctors: outcomes and standards for undergraduate medical students. London: GMC, 2009. http:// www.gmc-uk.org/education/undergraduate/ tomorrows_doctors_2009.asp (accessed Feb 24, 2010). Backman G, Hunt P, Khosla R, et al. Health systems and the right to health: an assessment of 194 countries. Lancet 2008; 372: 2047–85.
Department of Error Chow RT, Johnson MI, Lopes-Martins RAB, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or activetreatment controlled trials. Lancet 2009; 374: 1897–908—In this Article (Dec 5), there was an error in figure 4. The mean pain intensity score in the laser therapy group of Chow et al 2004 should have been 21 mm. Consequently, the weighted mean difference should have been 14·00 (95% CI –1·32 to 29·32) for that trial and 19·41 (95% CI 9·67 to 29·15) overall.
www.thelancet.com Vol 375 March 13, 2010