Health-related Rights Research Articles

THE IMPACT OF MALE CONTRACEPTION ON GLOBAL SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS.

The right to health and other health-related human rights are legally binding commitments enshrined in international human rights instruments. While these positions are known and ratified by policy makers, little has been done to actualize men's sexual and reproductive health (SRH) as an integral part of attaining these important global goals. Not addressing men's SRH over and above supporting their female partners sustains the sexual and reproductive risks and burdens that women must bear. Advances in contraceptive technology with several male contraceptive candidates in advanced clinical trials bolsters expectations for a broader contraceptive method mix including greater choice of male contraceptives. This would potentially increase awareness and investments in the men's SRH and promote health systems strengthening and gender equity including shared responsibility for prevention of pregnancy, sexually transmitted infections, and HIV. This paper is a review and synthesis of published literature including research publications, reports, global policies and commitments and technical documents available online and in organizational repositories such as the WHO IRIS on male contraception and men's SRH. We provide insights on the impact of male contraception including novel methods and the spillover effects on global SRH. We call on all stakeholders to invest in men's SRH since the attainment of the SDG target 3.7 on Universal access to SRH cannot be met without addressing this neglected topic.

Laws governing access to sexual health services and information: contents, protections, and restrictions

Access to sexual health services and information is critical to achieving the highest attainable standard of sexual health, and enabling legal environments are key to advancing progress in this area. In determining overall alignment with human rights standards to respect, protect, and fulfil sexual health-related rights without discrimination, there are many aspects of laws, including their specificity and content, which impact which sexual health services and information are availed, which are restricted, and for whom. To understand the nature of existing legal provisions surrounding access to sexual health services and information, we analysed the content of 40 laws in English, French, and Spanish from 18 countries for the specific sexual health services and information to which access is ensured or prohibited, and the non-discrimination provisions within these laws. Overall, there was wide variation across countries in the types of laws covering these services and the types and number of services and information ensured. Some countries covered different services through multiple laws, and most of the laws dedicated specifically to sexual health addressed only a narrow aspect of sexual health and covered a small range of services. The protected characteristics in non-discrimination provisions and the specificity of these provisions with regard to sexual health services also varied. Findings may inform national legal and policy dialogues around sexual health to identify opportunities for positive change, as well as to guide further investigation to understand the relationship between such legal provisions, the implementation of these laws within countries, and relevant sexual health outcomes.

S15: Integrating Human Rights and Mental Health Care and Support for Older Persons

Our world is rapidly aging, with medical and public health advancements extending lifespans without necessarily enhancing the quality of those additional years. Individuals in their later years aspire to preserve dignity, maintain autonomy and independence, foster social inclusion, uphold justice and equality, be respected for their identity, and pursue good health, security, purpose and engagement throughout their lives. Unfortunately, ageism is pervasive and has a significant negative impact on the lives of older individuals. Ageism is the root source of severe violations of the human rights of older persons, incontrovertibly uncovered by the COVID-19 pandemic. Ageism not only damages global health and harms the world’s economy, but also poses a major barrier for older persons everywhere, especially in preventing them from receiving the human rights-based care and support they deserve. This approach to health specifically aims at realizing the right to health and other health-related human rights. These rights translate as social determinants of health and can be integrated into clinical practice. Their implementation is mainly dependent of political will and fair distribution of money, power and resources. Planning health care and support for older persons should be guided by human rights standards and principles with final goal of the empowerment of rights-holders to effectively claim their health rights.Setting the scene: International Human Rights, Mental Health and Older personsWe all are, in principle, covered by the international human rights system. However, the current international human rights framework does neither include explicit guarantee against ageism, nor explicit obligation on States to take active measures to eliminate ageism and its discriminatory consequences. Older persons are very rarely mentioned in human rights treaties. All rights are equally important as set out in the International Bill of Human Rights (Universal Declaration of Human Rights; the International Covenant for Civil and Political Rights; and the International Covenant for Economic, Social, and Cultural Rights) and all international human rights treaties. Everyone, whoever and wherever they are, has an inherent right to the highest attainable standard of health, including the right to available, accessible, acceptable and affordable good quality care; and the right to liberty, independence and inclusion in the community. Unfortunately, older people with mental health conditions or cognitive decline experience a wide range of human rights violations. Coercive practices, social exclusion and discrimination are still too prevalent compounded by the lack of basic rights such as food and adequate housing. This presentation will discuss how the human rights legal framework can be applied to mental health care and support while advocating for better protection of the human rights of older persons through a dedicated UN Convention.

A review and analysis of accountability in global health funding, research collaborations and training: towards conceptual clarity and better practice

IntroductionAccountability is a complex idea to unpack and involves different processes in global health practice. Calls for accountability in global health would be better translated to action through a better...

Limitations of Fundamental Rights in EU Law: Are Human Rights Absolute?

The importance of fundamental rights has been seen especially during the Covid-19 crisis. Although fundamental rights are usually perceived as abstract by individuals, they concretely and directly influence our everyday lives. With this article I want to confirm the thesis that, despite the fact that rights are generally not absolute, their limitation is possible only in exceptional cases. This article will discuss fundamental rights in the EU. It will present the regulation and possibilities of limiting fundamental rights in EU law, in particular in the EU Charter of Fundamental Rights (the Charter). The article will also present the role of the Court of Justice of the EU (CJEU) in the field of fundamental rights. Moreover, it will depict the jurisprudence of the CJEU regarding health care rights. This is particularly important due to the problems of restricting several fundamental rights during the Covid-19 crisis, where health-related rights were at the forefront and accompanied by the search for a fair balance and assessment of proportionality. The article will also present the CJEU case law on the limitation of fundamental rights in the digital society, in the context of which we are also often faced with the search for a fair balance between several rights, especially concerning the protection of personal data on the one hand and other rights on the other hand (e.g. the freedom to conduct a business).

What Healthcare Services Temporary Protection Entitles to Have? Navigating the European Social Charter.

Due to the war against Ukraine, the European Union Temporary Protection Directive, establishing a new migration status of temporary protection, was activated for the first time. The substance of the minimum requirement for providing healthcare services in the Directive appears unclear but is supposed to correspond to human rights standards. This article analyses the standards established in the European Social Charter (revised), recognising several health-related rights. The paper clarifies the material scope of health-related rights and analyses to what extent the Charter applies to persons enjoying temporary protection. The application of health-related rights in the Charter varies depending on citizenship, whether refugee status was additionally sought, and whether a person is seen as a resident or regular worker. The study indicates ambiguity in the position of this group and how the European Social Rights Committee may include it in the scope of protection.

Healthcare Services for Asylum-Seekers: Untangling the European Social Charter.

Asylum-seekers, like any population, need healthcare services, yet national laws sometimes restrict access to such services. The European Social Charter (revised) protects the right to health and medical services. However, the Charter has a complex application, and its scope is limited concerning foreigners. This article analyses to what extent the provisions of the Charter on the right to health and medical assistance apply to adult asylum-seekers. It shows that the Charter may apply to various degrees to asylum-seekers depending on several circumstances, such as the national definition of residence or regular work, grounds for seeking asylum, citizenship or lack thereof. Depending on these factors, some asylum-seekers may receive full healthcare services, whereas others may have only limited rights. The article shows that the migrant statuses created by national and EU law do not fit in the system of statuses in the Charter, which might produce legal hindrances to accessing health-related rights for asylum-seekers. The article also discusses the possible ways for the European Committee of Social Rights to further expand the scope of the Charter's application.

Judicial Power and Influence on Population Health.

Policy Points Since its founding, the Supreme Court has played a major role in defining the parameters of governments' public health powers and the scope of individual health-related rights. Although conservative courts have been less favorable to public health objectives, federal courts have, for the most part, advanced public health interests through consensus and adherence to the rule of law. In establishing the current six-three conservative supermajority, the Trump administration and the Senate shifted the Supreme Court dramatically. A majority of Justices, led by Chief Justice Roberts, did shift the Court in a decidedly conservative direction. It did so incrementally, guided by the Chief's intuition that the Institution itself should be preserved, mindful of maintaining public trust and appearing outside the political fray. That has all changed because Roberts' voice no longer holds sway. Five members of the Court have displayed a willingness to overturn even long-held precedent and dismantle public health policy in favor of the Justices' core ideological tenants-notably the extensive reach of the First and Second Amendments and a parsimonious view of executive and administrative action. Public health is vulnerable to judicial rulings in this new conservative era. This includes classic public health powers in infectious disease control as well as reproductive rights; lesbian, gay, bisexual, trans, queer or questioning, and others (LGBTQ+) rights; firearm safety; immigration; and climate change. Congress has the power to curb the most extreme actions of the Court while still adhering to the vital ideal of a nonpolitical branch. That does not require Congress itself to overreach (such as by "packing" the Supreme Court, as Franklin Delaeno Roosevelt once proposed). Congress could, however, 1) disempower lower federal judges from issuing injunctions that apply nationwide, 2) limit the Supreme Court's so-called shadow docket, 3) alter the way that presidents appoint federal judges, and 4) set reasonable term limits for federal judges and Supreme Court Justices.

Unaccompanied foreign minors and mental health: Implementation and evaluation of the RHS-15 screening procedure for unaccompanied foreign minors

Background and objectiveThe recent notable increase in refugees' flows, with refugee children and adolescents relocating worldwide, posed severe challenges to the different national healthcare systems. Social groups such as refugees fleeing from their countries because of persecution, wars and violence are considered at high risk of developing mental health-related problems. Despite international and national policies legally regulating the reception process and protecting health-related rights, including the mental well-being of refugee migrants, there is a theoretical and applied need for evidence-based instruments and procedures to support mental health within this population. Recent evidence refers to the Refugee Health Screener-15 (RHS-15) as a reliable and valid instrument for the early detection of trauma-related mental health problems. In this scenario, this study aimed to test the RHS screening process within a multidisciplinary first intervention reception context for unaccompanied refugee minors. DesignThe RHS-15 was administered with the support of cultural-linguistic mediators to 81 unaccompanied minor residents in a first intervention facility in Milan, Italy. This study aimed to assess psychometric characteristics, such as reliability, sensitivity and specificity feasibility and its implementation within a first intervention reception process. ResultsThe analysis resulted in the validation of the RHS in its 13-item format. The results highlighted and confirmed an efficient delivery, excellent reliability and a positive predictive and convergent validity of the 13-item version. Further analysis showed an excellent ability to avoid false negatives, although there was a clear tendency to identify false positives. ConclusionsThe early identification of vulnerabilities among refugee minors is recommended to promote their long-term overall well-being. Integrating the screening results with additional observational elements and more specific diagnostic tools is recommended to gain a comprehensive perspective of the minors’ well-being.

Towards a Political Sociology of Social Health Inequalities

In late 2021, in issue 3 of the Revue française des affaires sociales, Jean-Charles Basson, Nadine Haschar-Noé and Marina Honta devoted a dossier to “The Production of Social Health Inequalities” in which they emphasised the social construction of health inequalities, the undermining of the legitimate access to health-related rights and healthcare use, and lastly the political production of health. In light of the Covid-19 pandemic, the authors revisit their questions and launch an international call for the deconstruction of the social production of health discrimination. They are joined by Michelle Kelly-Irving and Cyrille Delpierre, whose work in social epidemiology contributes to the much-needed interdisciplinary understanding of the phenomenon.

Anticipating & assessing adverse consequences of public health interventions - CONSEQUENT framework

Abstract Introduction Despite the best intentions, public health (PH) interventions can have adverse and other unintended consequences (AUCs). AUCs may arise in novel PH interventions, as well as from known and tested PH interventions implemented in a new context. Despite their importance, this topic has been largely overlooked. Therefore, we used a structured value-guided as well as evidence-based approach, to develop a framework to support researchers, practitioners, and policy-makers in anticipating and assessing AUCs of PH interventions. Methods We employed the ‘best-fit’ synthesis approach starting with an a priori framework and iteratively revising this based on systematically identified evidence. The a priori framework was derived from both the WHO-INTEGRATE framework and the Behaviour Change Wheel, to root the framework in global health norms and values, established mechanisms of PH interventions, and a complexity perspective. The a priori framework was advanced based on theoretical and conceptual publications and systematic reviews on the topic of AUCs in PH. Thematic analysis was used to revise the framework and identify new themes. To validate the framework, it was coded against four selected systematic reviews of AUCs of PH interventions. Results The CONSEQUENT framework includes two components: the first focuses on AUCs and serves to categorise them; the second component highlights the mechanisms through which AUCs may arise. The first component comprises eight domains of consequences - health-related, health system, human and fundamental rights, acceptability- and adherence-related, equality- and equity-related, social and institutional, economic and resource-related, and environmental. Conclusions Both over- and underestimation of AUCs of PH intervention poses risks. The CONSEQUENT framework may facilitate classification and conceptualization of AUCs of PH interventions during their development or evaluation to support evidence-informed decision-making. Key messages

Global health governance through the UN Security Council: health security vs. human rights?

ABSTRACT This article examines how the ‘health security’ paradigm positions health-related human rights as subordinate to national security concerns. As a consequence, health is viewed instrumentally, shifting the global health response towards maintaining national security rather than upholding human rights. We trace here how both the World Health Organization (WHO) and the United Nations Security Council have approached global health crises, evolving across infectious disease responses to HIV/AIDS, SARS, Ebola and COVID-19. While the Security Council has come to address human rights in select public health contexts, we see that the securitisation of human rights in times of crisis can pose severe limits on individual rights, failing to develop global health solidarity through a commitment to broader health objectives such as Universal Health Coverage. We conclude that the Security Council and the WHO should collaborate towards a rights-based response to COVID-19 that prioritises individual human rights alongside national security concerns, addressing underlying inequities in the global response to infectious disease.

Transcending the Gender Binary under International Law: Advancing Health-Related Human Rights for Trans* Populations.

Despite a recent wave in global recognition of the rights of transgender and gender-diverse populations, referred to in this text by the umbrella label of trans*, international law continues to presume a cisgender binary definition of gender - dismissing the lived realities of trans* individuals throughout the world. This gap in international legal recognition and protection has fundamental implications for health, where trans* persons have been and continue to be subjected to widespread discrimination in health care, longstanding neglect of health needs, and significant violations of bodily autonomy.

Health sufferings, healthcare seeking behavior, awareness about health insurance, and health related rights of ready made garments workers in Bangladesh: Findings from a cross-sectional study.

ObjectivesThis study aimed at examining health sufferings of readymade garments (RMG) workers, the factors that affect their health sufferings, their healthcare seeking pattern, knowledge about health insurance and health related rights in Bangladesh.MethodsA cross‐sectional study was conducted among 486 RMG workers recruited randomly from eight garments factories located on the periphery of Dhaka, Bangladesh. The prevalence of musculoskeletal pain, headache, fever and abdominal pain was estimated and multivariable logistic regression analysis was performed to examine association between these illnesses of workers and their socio‐demographic characteristics and other work related information. We also explored their healthcare seeking patterns, knowledge about health insurance and health related rights.ResultsThe prevalence of musculoskeletal pain, headache, fever and abdominal pain was found to be 78.1%, 57.9%, 52.2% and 24.6%, respectively, among the RMG workers. Factors that increased the odds of: musculoskeletal pain were working for more than 10 h per day (adjusted odds ratio [AOR]: 2.3, 95% confidence interval [CI]: 1.1–4.7) and being female [AOR: 4.6, 95% CI: 2.0–10.6]; fever was living in slums [AOR: 1.9, 95% CI: 1.1–3.5]; and abdominal pain was being female [AOR: 3.6, 95% CI: 1.4–9.3]. The workers commonly reported visiting drug sellers in local pharmacies for reported illnesses. They also had better knowledge of health related rights but poor knowledge of health insurance.ConclusionIn order to address the overall health and well‐being of the RMG workers, it is imperative to lay out a blueprint for a safe and healthy workplace.

Fundamental Values of the Healthcare and Medical Education System: Evolution of the Iranian-Religious Progress Model.

Iranian culture and religious teachings lead to a unique value-laden model in health and medical educationsystems. This research aimed to determine these fundamental values. To identify the health system values in the religious context of Iran, a mixed critical analysis-synthesis method was conducted. Furthermore, a focus group discussion with experts was conducted. Finally, we determined the fundamental values for the Iranian-religious progress model of health care and medical education. God centeredness, spirituality, divine and religious belief, ethical virtues, health centeredness and promoting all dimensions of human health, justice, protecting the human dignity, protecting health-related rights, social accountability, community centeredness, and scientific authority (excellence) are the values that should be considered to complete the value statement of the Iranian-religious progress model of health care and medical education.

Strengthening Human Rights in Global Health Law: Lessons from the COVID-19 Response

This column addresses the need to strengthen human rights in global health, looking to violations of human rights law in the pandemic response to recommend rights-based reforms in global health law. The column opens by examining the fundamental importance of human rights, recognizing the centrality of human rights in global health governance. Notwithstanding the evolution of health-related human rights under international law, the COVID-19 pandemic response has posed sweeping implications for the realization of human rights, with state responses failing to comply with their domestic and international human rights obligations. Raising an imperative to strengthen human rights in global health law, this column presents recommendations to advance health through the United Nations (UN) human rights system, extend human rights in revisions of the International Health Regulations (IHR), and mainstream human rights in WHO governance.

COVID-19 Raises a Health & Human Rights Imperative to Advance a UN Convention on the Rights of Older Persons

The COVID-19 pandemic has revealed the inequitable health harms and human rights violations faced by older persons, raising a need to support healthy ageing policy as a human rights imperative. However, international human rights law has long neglected the health-related human rights of older persons. Drawing from evolving advocacy efforts to advance the rights of older persons through the United Nations (UN), tentative initial steps have been taken at the regional level, with States in the Americas codifying intersectional rights obligations underlying health through the Inter-American Convention on Protecting the Human Rights of Older Persons. These international and regional efforts provide a foundation to advance the right to health for older persons. Amid an ongoing demographic transition and an inequitable pandemic response, the prospective UN Convention on the Rights of Older Persons provides a crucial opportunity to elaborate and uphold the international legal obligations necessary to facilitate healthy ageing.

Expanding the role of paralegals: supporting realization of the right to health for vulnerable communities

BackgroundAll around the world, the paralegal program prepares members of marginalized communities to face the legal system. Having a common background with their clients and being capable of conducting flexible work, paralegals’ role moves beyond enlarging the beneficiaries of legal aid to addressing intersectional issues around health-related rights. This study assesses the health and other impacts of paralegals recruited by Lembaga Bantuan Hukum Masyarakat (LBHM), a human rights organization which provides legal assistance and operates in Jakarta, Indonesia. The positive results these paralegals can bring in the specific context can contribute to the development of community-based paralegals elsewhere.MethodsThis mixed methods research was carried out in 2016–2018. In 2016, a quantitative survey was administered to LBHM-trained paralegals and a sub-set of paralegals who completed the survey were then also interviewed. Quantitative data were analysed using SPSS, and, for the qualitative data, thematic analysis was conducted.ResultsThe paralegals make important contributions to health-related rights in four distinct ways. Firstly, most of the paralegals checked their clients’ health in all stages of detention, especially regarding their drug dependency status and checking for signs of torture. Secondly, paralegals help clients to be more aware of their health-related rights, especially regarding their rights to obtain health services inside detention. Thirdly, paralegals can ensure that their clients obtain health services by taking medicines directly to the clients or encouraging the law enforcement agencies to refer the clients to health services. Lastly, in drug cases, paralegals help their clients to obtain alternative sentences besides imprisonment.ConclusionsThese four contributions verify the positive impacts paralegals, recruited from marginalized communities, can deliver for community members facing criminal justice processes. The shifting role of paralegals from merely an intermediary between clients and lawyers to champions of the health-related rights of their clients can happen as a result of adequate training, support, and networks with other agents in criminal justice system.

Rights-Based Approaches to Preventing, Detecting, and Responding to Infectious Disease Outbreaks

Human rights offer universal frameworks to advance justice in public health, codifying international standards to frame government obligations. Health-related human rights have evolved dramatically over the past thirty years to offer a normative framework for justice in preventing, detecting, and responding to infectious disease outbreaks. Where human rights were long neglected in international health debates, the advent of the HIV/AIDS pandemic response would operationalise human rights for public health, as advocates looked explicitly to human rights in framing public health efforts. In this period of heightened fear and emerging advocacy, policymakers first sought to implement human rights law in public health law—viewing discrimination as counterproductive to public health goals, abandoning coercive tools of public health, and applying human rights to focus on the individual risk behaviours leading to HIV transmission. By finding a link between public health and human rights, the health and human rights movement could move away from its early focus on the conflicts between public health goals and individual human rights, employing human rights to advance public health. However, infectious disease control efforts continue to challenge the notion that individual rights can best support population health. In the new millennium—from the 2005 revision of the International Health Regulations to the 2014 birth of the Global Health Security Agenda—policymakers have sought to balance infectious disease imperatives for the public’s health with individual dignity protections in human rights. Yet, national public health efforts continue to employ mechanisms that infringe individual rights—from the recent Ebola epidemics in Sub-Saharan Africa to the ongoing COVID-19 pandemic that threatens the world—with public health laws violating individual bodily integrity through vaccination mandates, violating individual medical privacy through surveillance and reporting, and violating individual liberty through quarantine and isolation.

Incorporating a Gender Perspective to Realise the Health and Human Rights of Older Persons

Gender is a social construct, yet it touches nearly every aspect of human life, with sweeping influence on health and human rights. Despite this influence, policy applications of gender in the rights of women, girls, and gender minorities have focused on the needs of youth and those of reproductive age. The gender-related human rights of older persons are often overlooked. Drawing on gender analysis across the life course, this chapter outlines health-related human rights obligations, reviews the history of intersectional advocacy on gender and ageing, and traces how a gender-sensitive approach can inform thinking across the health needs of older persons. This analysis provides a basis for recommendations to mainstream a gender perspective throughout the proposed treaty on the rights of older persons and develop gender-specific health obligations on states parties.