Public Health & Human Rights: Evidence-Based Approaches

  • Published
Public Health & Human Rights: Evidence-Based Approaches edited by Chris Beyrer and H. F. Pizer. Johns Hopkins University Press, 2007, 512 pp.

Administrative woes associated with public health delivery, combined with human rights violations, are unfortunate, complex components of society, both in the past and today. The enormous barriers of poverty, marginalization, and discrimination can create insurmountable hurdles to affording aid. Additionally, inaccurate perceptions and errors in reflective thought combine to give faulty views of hopeless futures. Public Health & Human Rights: Evidence-Based Approaches tackles the undoing of learned association and faulty perspectives and examines the impact of economic, cultural, and social ineptitudes in the conduit between public health ethics and human rights violations.

This essential volume includes a foreword by a world leader in the battle for human rights—Leonard S. Rubenstein, JD, executive director, Physicians for Human Rights. Rubenstein applauds the book for chronicling the efforts of such organizations as Human Rights Watch, International Aids Society, Office of High Commissioner for Human Rights, and the US Committee for Human Rights. The commitment documented by these and many other aid organizations is superbly laid out in this volume to provide a glimpse of the synergy that can be achieved between public health practice and human rights work.

To open a door that houses shocking issues of monumental importance to humankind takes courage. I ask that you not open this book if you do not want to be privy to the monsters of the world, described in sometimes-frightening details. Those who venture in will find the editors do a convincing job of relegating these monsters to tamable elements through hope of developing within the possibilities—possibilities that emerge when morality and ethics are considered within public health and the legalities surrounding human rights. Just enough information is given to inspire curiosity and the removal of blindfolds; additionally, the book tenders the “good news that there do appear to be powerful synergies between human rights work and public health practice.” Jointly sponsored by the Johns Hopkins Fogarty AIDS International Training and Research Program, the Open Society Institute, and the Institute for Asian democracy, this book is a work of literary advocacy beseeching praxis.

Public Health & Human Rights is social and intellectual commentary at its finest. Editors Beyrer and Pizer take an in-depth look into the complexities of joining public health and human rights with ethical proprietorship—a way of making the whole a part of the pieces. Cases, contexts, and consequences; evidence-based methodologies; and dynamic and strategic policies are explicitly juxtaposed with present major public health challenges as polar methods of transformation from oppression. As noted in Rubenstein’s foreword, “this volume is a pioneering effort at showing where we are in meeting these challenges, and it is full of ideas, insights and learning. It deepens our understanding of the ‘doing’ of public health and human rights and demonstrates in concrete ways how that work can help us move toward a more just world.”

This valuable resource draws on a multidisciplinary team of healthcare professionals, health care consultants, health writers, evidence- and rights-based researchers, scientists, sociologists, and international advocates who provide descriptive frameworks, contexts, methods, and policies from the frontline. The book is bursting with possibilities—new tools, strategies, and alliances for the advancement of inclusive public health and human rights respect. Wide-range coverage and insight is delivered in three parts: cases and concepts, methods, and policy. Public Health & Human Rights takes a global, probing look at the marginalized and oppressed individuals and communities in stress while scaling the mountains of war crimes, torturous activities, political repression, and unjust imprisonment. Included are the pandemic of human immunodeficiency virus (HIV) infection and acquired immune-deficiency syndrome (AIDS); human trafficking, tackled through original research; gender-specific abuses; and other pandemic diseases seemingly innate to marginalized societies.

Contemporary global concerns are addressed while scrutinizing the systematically exploitive governments and agencies that effect human rights violations and segregate public health access. Many of the articles bring a firsthand perspective that makes the tragedy of human rights violation more real and personal for those who have not felt (or are not aware of feeling) oppressed. As a black woman, I feel I understand a certain sense of marginalization and oppression, yet none to the degree of that found within these pages. This book examines decadence in our dialogical relationships, especially dialogue that has led to dehumanization and degradation of human beings: the pedagogy of silence.

The economic, social, and cultural rights accompanying membership in the human race is studied using evidence-based approaches coupled with rights-based research to offer a knowledge framework that allows for the reflection and paradigm shift necessary to conquer the ethical monsters.

The evidence-based approach utilized here begs the urgent need for “development, articulation and use” of strategic thinking about contexts, analysis, and practical solutions to the ethical intersection of public health and human rights. This book speaks to the current state of action, preferences, and research to determine expertise integration of practical and evidentiary issues that will maximize the flow of knowledge, information, and assistance. It tackles four questions for the reader:

  • What roles do human rights approaches play in the ethical delivery of inclusive public health?
  • How do you dissect the connective tissue between human rights and public health to provide compassionate health care to the global community?
  • What preventive/intervention effectiveness do evidence-based and human rights-based research approaches bring to the table for future public health and human rights issues?
  • With the current state and circumstances, what are we willing to try?

Part I, “Cases and Contexts,” establishes the interactivity of human rights and public health through five powerful cases. The evidence presented promotes education campaigns, risk reduction programs, elimination of policies that promote victimization, and rescinding of inept policies and laws that dismiss partnership of the violated with public health freedom. The content is presented not only in the context of medical conditions but also the conditions of social, economic, and political magnitude—exploring the contradictions inherent to delivering public health care in upturned environments.

Internally, within borders and ethnicities, groups such as Backpack Health Workers aid displaced persons—a mobile medical team practicing under the radar to counter human rights violations in public health availability. Drs. Lee, Mullany, and Richards, along with several Backpack Health Workers, strategically examine the outcomes of displacement due to military activity. Their research in civil conflict zones (specifically Burma), weathered by the internal displacement of ethnic groups/communities—demonstrates the reach-back capabilities awaiting development by the introduction of stronger allies. Additionally, Part I addresses the health and human rights violations uncovered from the blanket of drug wars where essential health services are buried by the government in an effort to control drugs; where personal control is overlooked.

Readers may find themselves captured by the unfolding of organizations that are formed to speak to the human rights of drug users: organizations that provide voice “to a highly marginalized population with few opportunities to speak for itself.” Workers are concerned with rights that are often negated by the hunt—the hunt that drives those needing prevention, intervention, and treatment underground and out of reach of public health and human rights arms.

A strong case for reducing harm is made in Part I—“harm reduction is a general term used to describe strategies for minimizing the adverse effects of unhealthy behaviors that individuals persist in.” Protect and educate. The case study on China demonstrates the precursor to the fundamental violations of suppression of information that gave birth to the Severe Acute Respiratory Syndrome (SARS) information debacle. The case highlights how censorship by provincial governments led to the jeopardy of public health (and in effect, the human rights of others). Closer to home is the reduction of harm in US prisons. The writers remind us that confinement does not eliminate the right to health and human rights; inadequacy in prison health and safety is not determined by inadequacy of the prisoner to meet societal rules and regulations. Substandard health provisions in prisons increase risk of spread of disease to society upon release.

Part II, “Methods,” highlights contemporary methods and approaches associated with rights-based public health research. It addresses the development and refinement of current methodologies acquainted with human trafficking, genocide, and spread of disease in conflicted communities. Micro and macro views of trafficking in women and children and sexual violations are magnified through the inherent complexities of qualitative and quantitative research on subjects that challenge standard methodologies. The reader is provided future directions for intervention and examination across borders.

The book looks at the events leading to Darfur and other acts of genocide that have given birth to “an international responsibility to protect civilian populations from sweeping assault by rapacious authorities.” The reader will find 18 pages of heart-wrenching details to further awareness and promote human outcry to the inhumane effect of genocide on humankind.

Part III, “Putting Policy into Practice,” delves into the ethical linchpin between public health and human rights. It solemnly reminds the reader that ethical outcomes are not based on legality but on humanity. The scrutiny of several current policy approaches for improving human lives is highlighted by not only the burdens but the benefits—the successes found in policies globally. Public health policies responding to the HIV/AIDS pandemics, illicit drug policies, and gender and sexual health rights are placed under the umbrella of strategic advocacy and affirmation of the right for each human to dwell equally in the sphere of public health, fueled by human rights.

The content of Part III is presented as a historical account of policies in political and social context—the behavioral effects of prevention and treatment efforts to-date—and maps the contradictions of methods and policies interjected through time. Good policy practices are followed by unique analyses and assessments in reference to the widening gap between public health and human rights, while strategic empowerment, the inclusion of marginalized stakeholders intent on reducing human rights violations, and strategic partnerships are offered as answers. Competition, theory, and practice are highlighted through the lens of causality from individuals, regional organizations, and the United Nations.

This book is a critical appraisal of public health and human rights data, proposing the best scientific evidence available for integration into future policy decision making. As hopeful inspiration to a generation of liberators, the editors feature articles which speak to educational empowerment, humanization, policy change, and ethical awareness. An important theme throughout the 17 articles is the development of partnerships that leverage resources, the expansion of programs, and informed advocacy. Ethical delivery through distributive justice of human rights is posited as a powerful tool for developing effective and deliberate programs, procedures, and policies beneficial to the advancement of public (global) health. Coverage is not limited to violations and violators, but to insights on the use of evidence-based approaches to public health issues.

If exposure and shame are key tools to human rights achievement, should we not use it on all aspects to include economics? Are the pharmaceutical firms doing their part? Are US strategic leaders taking careful note of the implications of the war on terrorism to communities affected by the current conflict? Is anyone gathering forensic evidence of the impact of conflict on the public health and human rights of the people of Iraq? What fingerprints will be left behind on the ethical mirrors of the Iraqi people? Condom provision works—are we trading one right for two wrongs; is this advocating legalization of the sex industry? In many global communities have we not “put the cart before the horse”—sending false hope through funding to impoverished, underdeveloped countries, which although needy are ill-equipped to implement systems of delivery? What role do we have as the most powerful country in the world to mandate a beneficial union of public health and human rights worldwide? These are but a few of the questions I was left pondering—to me, the sign of a great book—leave them thinking, desiring, and doing.

Having read this book and before I mindlessly grab my designer drink to aid in swallowing my pills for hypertension, diabetes, and all the other ailments of my aging body, I stop to think in what small way may I aid in the progression of these sometimes elusive, imperative freedoms. This is definitely no romance novel, but it does speak to the courtship of the political, economic, and social possibilities with the moral imperative. This book holds essential information for anyone involved in living—a global challenge. Highly recommended!

Patricia R. Maggard, PhD

Squadron OfficerCollege

"The views expressed are those of the author(s) and do not reflect the official policy or position of the US government or the Department of Defense."