- Email: [email protected]
Water and sanitation become human rights, albeit turbidly
Editorial
Shehzad Noorani/Majority World/Still Pictures
Water and sanitation become human rights, albeit turbidly The printed journal includes an image merely for illustration
For the webcast of the UN General Assembly vote see http://webcast.un.org/ramgen/ ondemand/ga/64/2010/ ga100728am.rm For more on the legal implications of the vote see http://www2.ohchr.org/english/ issues/water/iexpert/docs/AHRC-15-31-AEV.pdf For the 2010 Millennium Development Goal report see http://www.un.org/ millenniumgoals/pdf/MDG%20 Report%202010%20En%20 r15%20-low%20res%20 20100615%20-.pdf
On July 28, the UN General Assembly adopted a nonbinding resolution calling on states and international organisations “to scale up efforts to provide safe, clean, accessible and affordable drinking water and sanitation for all”. Water and sanitation are now enshrined as basic human rights. However, of 163 delegates from member nations who voted on this resolution, 41 abstained and did not fully endorse this right. Why? Some delegates felt the decision to hold the vote was pre-emptive, and all countries could have reached consensus—and thereby avoided the need for a vote— if more time was allowed to interpret legal outcomes of the move for public and private suppliers. Most delegates who abstained, and some who endorsed the resolution, were anticipating a report to be published later this year by an independent expert appointed by the UN Human Rights Council (HRC). The Brazilian delegate, who voted yes, decried the absence of an “appropriate forum” to debate the resolution, and the UK’s delegate, who abstained, said that the resolution was not proposed “with consensus
in mind”. Nevertheless, the justifications given by the 41 countries that abstained, including the USA, Japan, and Canada, were not convincing. Irrespective of politicking at the UN, 884 million people worldwide do not have regular access to clean water, and 2·6 billion do not have access to basic sanitation. The 2010 Millennium Development Goal 7 report states that the target of halving the number of people without access to safe water is on course to be met by 2015, but provision of sanitation is not. The practice of open defecation by 1·1 billion people is not only “an affront to human dignity”, but also the key source of faecal–oral transmitted diseases such as diarrhoea, which causes 1·3 million deaths per year in children younger than 5 years. A little more than 5 years through the UN General Assembly’s Water for Life Decade, adequate supply of water and sanitation is far from universal. When the HRC’s report is published, the hope is that no country obstructs a binding commitment to provide clean water and sanitation for all. ■ The Lancet
DSM-5: diagnosis of mental disorders
Burger/Phanie/Rex Features
The printed journal includes an image merely for illustration
For more on diagnosing mental disorders see J Ment Health 2010, http://informahealthcare.com/ toc/jmh/19/4 For more on draft revisions of DSM-5 see http://www.dsm5. org/Pages/Default.aspx For more on ICD-10 chapter V see http://apps.who.int/ classifications/apps/icd/ icd10online/
390
In the Journal of Mental Health this month, the diagnosis of mental disorders is discussed with focus on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is undergoing draft revisions and is scheduled to be published by the American Psychiatric Association (APA) in May, 2013. Proposed changes to DSM-5 include the addition of autism spectrum disorders, revision to binge-eating disorder, and deletion of some types of schizophrenia. The 11th edition of WHO’s International Classification of Diseases (ICD) is expected to be completed by 2014. DSM is mainly used in the USA and for research purposes, whereas ICD is mainly used in Europe and for clinical diagnoses. Although the publication of these editions of DSM and ICD (chapter V for mental and behavioural disorders) will not coincide, they are intended to harmonise the diagnosis of mental disorders. A concern is that inclusion of more mental disorders in DSM-5 might be of greater benefit to drug
companies than to the patients and their families. Knowledge of the duration, severity, and context in which symptoms arise—eg, bereavement or loss of livelihood—is needed to distinguish normal human reactions to distress from symptoms of real mental disorders and to avoid false-positive diagnoses of mental ill-health. The benefits of a diagnosis for the patient include a prognosis, and perhaps treatment. The disadvantages include the stigma of a mental illness for the patient and the patient’s family; and a diagnosis of a mental disorder in children might mean alienation from peers, or overtreatment with drugs that might have adverse effects. The APA is being open and welcoming feedback for the fifth edition of DSM from mental health professionals and researchers, and from individuals with mental illnesses and their families. This opportunity should not be missed by anyone who might be able to provide input into DSM-5, thereby making a positive difference to people with or at risk of a mental disorder. ■ The Lancet www.thelancet.com Vol 376 August 7, 2010
Shehzad Noorani/Majority World/Still Pictures
Water and sanitation become human rights, albeit turbidly The printed journal includes an image merely for illustration
For the webcast of the UN General Assembly vote see http://webcast.un.org/ramgen/ ondemand/ga/64/2010/ ga100728am.rm For more on the legal implications of the vote see http://www2.ohchr.org/english/ issues/water/iexpert/docs/AHRC-15-31-AEV.pdf For the 2010 Millennium Development Goal report see http://www.un.org/ millenniumgoals/pdf/MDG%20 Report%202010%20En%20 r15%20-low%20res%20 20100615%20-.pdf
On July 28, the UN General Assembly adopted a nonbinding resolution calling on states and international organisations “to scale up efforts to provide safe, clean, accessible and affordable drinking water and sanitation for all”. Water and sanitation are now enshrined as basic human rights. However, of 163 delegates from member nations who voted on this resolution, 41 abstained and did not fully endorse this right. Why? Some delegates felt the decision to hold the vote was pre-emptive, and all countries could have reached consensus—and thereby avoided the need for a vote— if more time was allowed to interpret legal outcomes of the move for public and private suppliers. Most delegates who abstained, and some who endorsed the resolution, were anticipating a report to be published later this year by an independent expert appointed by the UN Human Rights Council (HRC). The Brazilian delegate, who voted yes, decried the absence of an “appropriate forum” to debate the resolution, and the UK’s delegate, who abstained, said that the resolution was not proposed “with consensus
in mind”. Nevertheless, the justifications given by the 41 countries that abstained, including the USA, Japan, and Canada, were not convincing. Irrespective of politicking at the UN, 884 million people worldwide do not have regular access to clean water, and 2·6 billion do not have access to basic sanitation. The 2010 Millennium Development Goal 7 report states that the target of halving the number of people without access to safe water is on course to be met by 2015, but provision of sanitation is not. The practice of open defecation by 1·1 billion people is not only “an affront to human dignity”, but also the key source of faecal–oral transmitted diseases such as diarrhoea, which causes 1·3 million deaths per year in children younger than 5 years. A little more than 5 years through the UN General Assembly’s Water for Life Decade, adequate supply of water and sanitation is far from universal. When the HRC’s report is published, the hope is that no country obstructs a binding commitment to provide clean water and sanitation for all. ■ The Lancet
DSM-5: diagnosis of mental disorders
Burger/Phanie/Rex Features
The printed journal includes an image merely for illustration
For more on diagnosing mental disorders see J Ment Health 2010, http://informahealthcare.com/ toc/jmh/19/4 For more on draft revisions of DSM-5 see http://www.dsm5. org/Pages/Default.aspx For more on ICD-10 chapter V see http://apps.who.int/ classifications/apps/icd/ icd10online/
390
In the Journal of Mental Health this month, the diagnosis of mental disorders is discussed with focus on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is undergoing draft revisions and is scheduled to be published by the American Psychiatric Association (APA) in May, 2013. Proposed changes to DSM-5 include the addition of autism spectrum disorders, revision to binge-eating disorder, and deletion of some types of schizophrenia. The 11th edition of WHO’s International Classification of Diseases (ICD) is expected to be completed by 2014. DSM is mainly used in the USA and for research purposes, whereas ICD is mainly used in Europe and for clinical diagnoses. Although the publication of these editions of DSM and ICD (chapter V for mental and behavioural disorders) will not coincide, they are intended to harmonise the diagnosis of mental disorders. A concern is that inclusion of more mental disorders in DSM-5 might be of greater benefit to drug
companies than to the patients and their families. Knowledge of the duration, severity, and context in which symptoms arise—eg, bereavement or loss of livelihood—is needed to distinguish normal human reactions to distress from symptoms of real mental disorders and to avoid false-positive diagnoses of mental ill-health. The benefits of a diagnosis for the patient include a prognosis, and perhaps treatment. The disadvantages include the stigma of a mental illness for the patient and the patient’s family; and a diagnosis of a mental disorder in children might mean alienation from peers, or overtreatment with drugs that might have adverse effects. The APA is being open and welcoming feedback for the fifth edition of DSM from mental health professionals and researchers, and from individuals with mental illnesses and their families. This opportunity should not be missed by anyone who might be able to provide input into DSM-5, thereby making a positive difference to people with or at risk of a mental disorder. ■ The Lancet www.thelancet.com Vol 376 August 7, 2010