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PUBLIC HEALTH: Health, Human Rights, And The War

November 20th, 2006

The American Public Health Association (APHA), the oldest and largest organization of the public health community, chose public health and human rights as the theme of its 13,000 attendee-strong 2006 annual meeting, held earlier this month in Boston. The emphasis this year on human rights, according to APHA executive director Georges Benjamin, was driven in part by the need to make a statement about the Iraq War; war generally; and the often concomitant multigenerational implications, among them erosion of human rights, general societal upheaval, and deterioration of population health indicators (see the full interview with Georges Benjamin). This year’s theme resonates with the public health community’s ongoing exploration of the link between societal conditions and health status, and a desire to connect the goals of social justice and equality with governmental human rights obligations.

In 1997, Jonathan Mann, considered by many the progenitor of the health and human rights movement, published a seminal, call-to-arms piece proposing that fundamental and simultaneous transformation in both the public health and human rights disciplines created the conditions favoring the emergence of a new, hybrid model recognizing the notable role that social determinants [free access article] play in mediating health status. This framework postulated that the human rights model offered a more effective calculus for “identifying, analyzing, and responding directly to critical societal conditions” than either traditional biomedical or public health models. Mann acknowledged the weighty implications. The new construct effectively rousted public health from its historical comfort zone of identifying risk factors contributing to morbidity, mortality, and premature death residing at the individual level, towards relatively uncharted territory whereby an individual’s health status was now viewed as influenced by how society treats her.

After Mann’s untimely death in a 1998 plane crash, Larry Gostin, [2-week free access], George Annas [free access], Sofia Gruskin, and others took up the standard, writing eloquently over the years about the ethical, legal, and policy issues implicated by this melding of health and human rights. Among other things, it fed into debates occurring within and without the public health community on how broadly public health should be defined and what functions and responsibilities should legitimately fall within its purview from a policy and operational perspective.

Consequently, for the rubber-meets-the-road crowd, the conflation of health and human rights provoked rather “animated” ruminations over the size of the budgetary pie to which public health is entitled. It also prompted vigorous consideration of the big, and sometimes “uncomfortable,” questions, including what social justice and equity require of society to achieve conditions in which individuals can be healthy and how far society is willing to go to keep its promises to the individual in this regard.

Fast-forward to the 2006 annual meeting, where APHA — with its long-standing position that health is a fundamental human right — seeks to carry the empirical ball forward by launching a multidisciplinary exploration of “how human rights issues affect us where we work, play and learn.” Keynotes by Helene Gayle of Care USA, discussing the relationship between poverty and health, and Paul Farmer of Partners in Health, emphasizing economic and social equality as human rights, illustrate the vast and potentially unwieldy scope of the dimensions implicated by such an inquiry.

This year’s topic seems a departure from last year’s more pragmatic and politique theme of evidence-based policy and practice. The emphasis on evidence-based public health policy formulation and a call for reinvigorating the heretofore meagerly resourced public health research agenda seemed a timely response to increased pushback from legislators seeking greater accountability for perceived significant increases in federal infrastructure improvement dollars post-9/11 and anthrax. It also felt like the culmination of APHA’s multiyear efforts (1) to ramp up outreach to policymakers in the hopes of better informing public health policy formulation and appropriations discussions, (2) to engage in dialogue with the business community to find areas of mutual cooperation, and (3) to elevate APHA’s public profile as a trusted information clearinghouse and guardian of the public good.

So, is this year’s theme a red-meat correction and a continuation in preaching to the passionate but familiar choir? Benjamin’s expressed desire to advance and strengthen multiprong advocacy efforts might, ultimately, allow APHA to leverage these relatively new lines of communication and relationships to expand the universe of participants in the conversation sussing out the relationship between health and human rights. The new postelection political dynamic may also, of course, serve to increase not only the number of discussants in this “conversation,” but also the size of the choir.

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2 Responses to “PUBLIC HEALTH: Health, Human Rights, And The War”

  1. Leonard Rubenstein Says:

    Thanks for posting the comments of Parmeeth Atwal, George Annas, Larry Gostin, Sofia Gruskin and Georges Benjamin on the theme of human rights at the APHA annual conference. Highlighting the connections between human rights and health is a significant milestone for APHA, but if reduced to a mere theme for one conference, it will not have succeeded. Human rights is a set of values, a means of analysis – including assessments of government adherence to those values – and a powerful motivator and organizing tool to demand compliance with human rights obligations. It should ground our thinking and drive policy in public health, from stopping torture to securing health for all. But as Jonathan Mann said, it is difficult to get to that place, as a belief in human rights represents a conceptual leap, because it means seeing health, education, as well as political freedoms as rights, not as privileges, and as such represents a challenge to status quo. Embracing human rights and taking on that challenge, though, is the surest way to health and well-being in this and every society.

  2. James Colgrove Says:

    Par Atwal reminds us that an effective and ethical public health practice cannot remain detached from political battles against injustice and inequity. The human rights theme of this year’s APHA conference carried striking historical echoes of another “call to arms” by an APHA president amid polarizing debates about the meaning of democracy and citizenship. It was in Philadelphia in 1969, at the height of the Vietnam War, that Paul Cornely, the association’s first African American president, gave his now-legendary address, “The Hidden Enemies of Health.” Cornely urged the APHA to become more politically active, and bluntly accused the organization of being a “mere bystander” to the momentous social issues of the day. He pointed out that the APHA had failed to put forth any plan for national health insurance over the previous decade, even as a groundswell of political support for federal involvement in the health problems of the poor led to the enactment of Medicaid and Medicare. In the years following his 1969 address, as neo-liberal ideologies of limited government were ascendant, the public health profession did not, or could not, rise to Cornely’s challenge—which is why the seminal work of Jonathan Mann and his colleagues represented such a landmark, and such a departure, for the profession. The question now, as Atwal rightly notes, is whether the profession will stay in its “comfort zone” of looking at proximate causes of illness, or whether it will push forward with uncomfortable but necessary questions about how our society organizes itself.

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