Income Inequality and Health

In this guest post, Ronald Labonté moves from describing the impact of income inequality on health to the implications of this relationship for both the Canadian and global context. He presents two sets of policy reforms necessary for acting on these contexts and illustrates the scope for Canadian engagement with both national and global policy options. Labonté holds a Canada Research Chair in Globalization and Health Equity at the Institute of Population Health, and is Professor in the Faculty of Medicine, University of Ottawa; and in the Faculty of Health Sciences, Flinders University of South Australia.

Acting to reduce health inequity: How much evidence is enough?

It is often asserted that more evidence is needed to take action on the social determinants of health. In this guest post Ted Schrecker identifies such claims as a key obstacle to achieving health equity. He argues that to overcome this obstacle, we must recognize that decisions about how much evidence is enough are irrevocably bound together with important ethical and political choices. Ted is a Professor of Global Health Policy at Durham University.

Paul Krugman: America’s Greatest Public Health Champion?

Last week the New York Times reported on a study which documents a reversing trend in life expectancy for the least educated whites in the US. The study shows that since 1990, life expectancy for white Americans without a high school diploma has fallen by five years for women and three years for men. Reading […]

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Human Rights and Reproductive Health: A primer

In this guest post Maria Pawlowska presents the story and ideals behind the use of a human rights framework in health.  Maria establishes the importance of using a human rights framework to guide reproductive health policies by tracing its implications from the global to the individual level.

In the early 1990s the late Jonathan Mann and Daniel Tarantola left the WHO Global Program on AIDS. They helped establish the unit just a few years before, however they now felt they disagreed with the way the program was run and the philosophy that motivated its actions. Tarantola and Mann found academic “refuge” at Harvard and began thinking about the most effective framework for dealing with the AIDS epidemic. The epidemic is now known as the one “that changed public health forever”. One of factors behind this dramatic sea change was the framework Mann and Tarantola developed.  Although they were both qualified physicians, it didn’t take long for them to realize that HIV/AIDS needs to be treated with new drugs, but equally importantly the patients need to be guaranteed respectful treatment and honoured of their dignity as human beings.  After some trial and error Mann and Tarantola decided that the Universal Declaration of Human Rights (UDHR) is the best theoretical basis for an effective fight against AIDS forward.

And so the discipline of health and human rights was born. Today it is a thriving area of research and clinical as well as legal practice with increasing numbers of institutions and countries incorporating a rights-based approach to health.

The core idea behind health and human rights is that the best public health programs respect the human rights of the population involved. Unfortunately, I do not have the space here to go into too many details, but the WHO provides a good introduction for those who may want to know more.  In just a few words, incorporating a rights-based approach to health means treating patients with the dignity they deserve and respect for their choices and decisions. I’ll take a closer look at this now, with the example of a rights-based approach to reproductive rights and health.

It is important to realize that these concepts are not just subjects of academic discussion and taglines from WHO leaflets. They are the forces driving policies and ultimately the healthcare we are delivered in the doctor’s office. This may be hard to believe: probably the first things that come to mind when discussing human rights violations in the context of reproductive rights are coercive reproductive policies such as China’s one-child rule.  Governments which force citizens into unwanted abortions are obviously violating a number of human rights. Similarly, it is clear to most of us that countries which delegalize homosexuality or criminalize it are also guilty of human rights violations. But the situation really isn’t always that obvious. What about governments which delegalize abortion (e.g. Malta)? And governments which do not provide access to evidence-based sexual education (e.g. Poland but also the US)? Governments which force mandatory HIV/AIDS status tests on sex workers (discussed in a number of countries and regions)? What about doctors who do not want to prescribe contraceptives to under-18s (again, many places around the world)? Or on a more personal level, has any doctor ever performed an examination – including (for those readers who have given birth) a vaginal examination during delivery – without your explicit informed consent?  All these are in fact human rights violations according to a number of binding human rights instruments (the UDHR is not the only basic human rights document, although it is the only one with the term ‘human rights’ explicitly embedded in it – a full list of the important international documents can be found here).

We tend to imagine that breaking human rights involves wars, refugee camps, power-obsessed dictators and lunatic warlords. In fact, human rights violations may be happening in your oby/gyn office or at the GPs. For example, The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), adopted in 1979 by the UN General Assembly, clearly states that access to evidence-based sexual education and contraception is a basic human right. CEDAW should be informing policy-makers around the world. However, as is too often the case we lag far behind the ideal. I’ve recently written about the pretty bad condition Polish citizens’ reproductive rights are in. But we needn’t look to emerging post-communist countries to find examples of human rights violations in regards to reproductive health. For example, the U.S. Department of Health and Human Services announced only last month that insurance will now have to cover several women’s preventive services, including birth control and voluntary sterilization. Prior to that contraceptives required a considerable co-pay, which barred many lower income women from accessing them. Moreover, according to the leading reproductive health research body The Guttmacher Institute: A total of 36 states require that sex education include abstinence, while only thirteen states require that the information presented in sex education classes be medically accurate and factual. And just a reminder: access to contraception and evidence-based information about sex is considered a human right according to CEDAW!

In this (very brief) outline I hope to have communicated that human rights really aren’t a bunch of idealistic phrases written down for the benefit of victims of violent conflicts. Human rights come into every aspect of our lives and definitely with regards to health – particularly an issue as intimate and politically charged as reproductive health. The take-home message really is this: the human rights framework guarantees that we should be the ones making choices, and they should be informed ones. The role of the state is to aid us in this and not encroach on our decisions about our sexuality and reproductive activity.

Health Inequalities

Why Occupying Wall Street can make the U.S. Healthier

Growing commentary has covered much ground on the causes, faults, and promise of the Occupy Wall St. movement. However, a stone that has yet to be overturned is the one that should have public health professionals, as well as anyone who cares about the health of their community, taking to the streets.


From the Social to the Ultimate Determinants of Health

The notion that health is influenced by society, and the politics governing it, has been around for generations. The contemporary uptake of this idea can be found in the increasingly popular concept of ‘social determinants of health’. But should all social determinants be treated with equal concern? Or are certain determinants more important than others in influencing the health of populations?


WHO Reform: Background notes, Broader context, Directions for advocacy

In this guest post, David Legge directs us to his work at the WHO Watch where he provides insightful background into the upcoming WHO reform talks, set to take place this November. Advanced is an analysis of global health governance which positions the social determinants of health, and health system development, within a dynamic interplay of policy paradigms, donor practices and corporate power.

Community Participation

Reasons For and Benefits From Community Participation in Public Health

In this guest post, Lauri Andress continues her series on community participation and public health. In order to bring more clarity to the concept of community participation, Lauri provides a framework that
attempts to discern a range of benefits that stem from community participation. She argues that some justifications for community participation are more likely to benefit the community than others. Also outlined are various mechanisms through which these benefits impact population health.


Poland vs. Malta – or a beginner’s guide to strict anti-abortion policies

In this post, guest blogger Maria Pawlowska discusses anti-abortion policies in Malta, drawing comparisons to her previous post on Poland and relating the harmful repercussions of these policies to the influence of the Catholic Church, social conservatism, and gender inequality.

Health Inequalities

Tackling Health Inequalities: restructured into a luxury?

In this guest post, Kate Thomson discusses the elimination of a national taskforce proven to reduce health inequalities in England. She asks whether the shift of responsibility to local authorities will render health equity concerns into unaffordable luxuries. Kate is a Senior Lecturer in the Department of Public Health at Birmingham City University and is currently researching health reforms in the Russian Federation.


Social Determinants of Health: Resuscitating the Agenda in Rio

In this guest post, Ted Schrecker offers a commentary on how the 2011 World Conference on Social Determinants of Health might restore an otherwise ailing SDOH agenda. Ted is an associate Professor in the University of Ottawa’s Department of Epidemiology and Community Medicine, and a principal scientist at the University’s Institute of Population Health.

Community Participation

Community Participatory Methods : Positive, Negative or Negligible Benefits for the Community

This guest post is the first in a series of posts which will critique the use of community participatory methods in public health. The author of this series, Lauri Andress, is a public health policy analyst at Andress & Associates where she advises US public health departments on policies, programs, and competencies related to health inequities. In this introductory piece, Lauri introduces the idea of community involvement and demonstrates its alignment with a social determinants of health perspective.


The Price of Democracy in Illegal Abortions

In this guest post, Maria Pawlowska looks at how the transition from socialism to democracy has impacted reproductive health in Poland. In the absence of both evidence-based sex education and access to safe and affordable contraceptives, Maria illustrates that the transition has effectively delegalized abortions, shifted the discourse surrounding reproductive rights to mirror the sentiments of the extreme political right, and ultimately placed the lives of Polish women hugely at risk. Maria is a healthcare analyst with a passion for reproductive health and gender issues in health care provision. Maria has a PhD from Cambridge, where she was a Gates scholar, and has worked with the Global Poverty Project and RESULTS UK.

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