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Need of the hour

by Professor Ravindra Fernando

(Excerpts from a speech delivered by Professor Ravindra Fernando, Director, Centre for the Study of Human Rights, University of Colombo and the Immediate Past President of the Sri Lanka Medical Association (SLMA), who was the Chief Guest at the Foundation Sessions of the Association held recently).

It is a myth to believe that human rights is a western concept as fundamental principles of human rights are found in all major religions that originated in Asia and Middle East. Buddhism, Hinduism, Christianity and Islam have principles of human rights in their teachings.

After the horrifying, inhuman acts and experiences of the Second World War, The United Nations adopted the Universal Declaration of Human Rights (UDHR) in 1948.

The UDHR was drafted by the Human Rights Committee of the United Nations, headed by the wife of US President Eleanor Roosevelt. The committee also had members from countries in Asia, Middle East and South America.

Therefore, the UDHR is not a document prepared by the West.

Concerns for Human Rights and Health share the common goals of alleviating suffering and promoting the well-being of all people. When we commemorate the fiftyseventh anniversary of the UDHR, it is an occasion for us to explore and embrace strong links between Human Rights and Health.

Health professionals can explore the connections between Health and Human Rights by examining the UDHR and the declarations, conventions and laws that it helped to generate.

Three aspects of the right to health have been enshrined in the international instruments on Human Rights. Firstly, the declaration of the right to health as a basic human right, secondly, the prescription of standards aimed at meeting the health needs of specific groups of persons, and thirdly, the prescription of ways and means for implementing the right to health.

The preamble of the Universal Declaration of Human Rights (UDHR) says that human beings shall enjoy freedom of speech and belief, and freedom from fear and want, which has been proclaimed as the highest aspiration of the common people.

Articles 1 and 2 of the UDHR state that all people are born equal in dignity and rights, and these rights are guaranteed to everyone. Yet in the provision of medical services and public health, dignity and equal rights may be neglected or unevenly protected.

Article 19 of the UDHR guarantees freedom of opinion and expression.

Promoting and protecting the right to free expression is fundamental to promoting and protecting health. Nations that suppress independence of the health professions and the voices of medical and public health officials compromise their ability to contain the spread of disease, sustain immunization programmes, raise alarms about the environmental threats to health and put into place effective health policy and programmes, that reach all members of the affected population.

Professional associations such as the Sri Lanka Medical Association and Colleges of Medicine have maintained a constant dialogue with the Ministry of Health and therefore, at least in that area the voice of the medical profession has not been suppressed in Sri Lanka.

Article 23 of the UDHR guarantees the right to work, and just and favourable conditions to work. Inhuman labour practices compromise the health of people. In some countries men, women and children toil under brutalising, unsanitary and hazardous conditions, or work for wages insufficient to support their family's basic needs.

In Sri Lanka domestic labour of children is affecting their health.

Article 25 of the UDHR guarantees the right to a standard of living adequate for the health and well - being of all people and their families including food, clothing, housing, medical care and necessary social services. One fifth of the world's population live in absolute poverty.

In Sri Lanka also poverty that leads to ill health has been a major problem. Despite various poverty alleviation programmes implemented since independence, about 7% are poor according to the lower poverty line, i.e. the income of US$ 1 per day. About 45% are poor according to the high poverty line, i.e. US$ 2 per day.

Poverty in the rural areas accounts for 31.3% of people, that is more than 3 times of that in the urban areas, which is 8.6%. We have to remember that 90% of our population lives in rural areas.

Article 26 of the UDHR guarantees the right to education. Although education is one of the strongest predictors of health status and an intrinsic quality of well -being, more than 900 million adults world over are illiterate, two thirds of whom are women. Fortunately, Sri Lanka has a high literacy rate, but a significant number of children under 14 years still do not go to school.

The preamble of the 1948 Constitution of the World Health Organisation states that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social conditions.

The Constitution declare that, in conformity with the Charter of the United Nations, the following principles are basic to the happiness, harmonious relations and security of all peoples:

a) Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

b) The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.

c) The health of all peoples is fundamental to the attainment of peace and security, and is dependent upon the fullest co-operation of individuals and States.

d) The achievement of any State in the promotion and protection of health is of value to all.

e) Unequal development in different countries in the promotion of health and control of disease, especially communicable disease, is a common danger.

f) Healthy development of the child is of basic importance; the ability to live harmoniously in a changing environment is essential to such development.

g) The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health.

h) Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people.

i) Governments have a responsibility for the health of their peoples, which can be fulfilled only by the provision of adequate health and social measures.

On 16th December 1966, The United Nations adopted the International Covenant on Economic, Social and Cultural Rights. Article 12 states that the State Parties to the Covenant recognise the right of everyone to enjoy the highest attainable standard of physical and mental health.

The steps to be taken by the States Parties to the present Covenant to achieve the full realisation of this right shall include, those necessary for the provision for the reduction of the stillbirth-rate and of infant mortality, and for the healthy development of the child, the improvement of all aspects of environmental and industrial hygiene, the prevention, treatment and control of epidemic, endemic, occupational and other diseases and the creation of conditions, which would assure to all medical service and medical attention in the event of sickness.

To be continued next week

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