Author Archives: zhaque1

Let’s tap into the potential of the Human Rights Framework

Dilemmas in decision-making are invariably apart of global health policy. With the variety of international actors, stakeholders, and opinions, it’s easy to see why implementing new global health policies, through ingenious and innovative, are hindered by the stalemate that is governmental bureaucracy and political agendas. However, there potentially exists a framework to navigate around these highlighted challenges – human rights.

health-care-human-right

“The right of everyone to the enjoyment of the highest attainable standard of physical and mental health.”

This statement is echoed in the International Covenant on Economic, Social, and Cultural Rights, a major component of the modern day definition of human rights. The multitude of human right documents establish concepts around the “minimum acceptable standards of health” by which all member countries should abide by in practice. The existing human rights framework provides a reasonable and coordinated framework the international community needs to fully adopt in times of global health responses and dilemmas. In many instances, the norm is to do the opposite however. It is at best questionable whether human rights has a defining impact on governmental practices, as Gostin and Sridhar note in a NEJM May article.

Slow international public health responses are the direct outcome of this, most recently from the Ebola crisis affecting West Africa. Prominent individuals, actors, and organizations have been critical of the WHO’s response to the Ebola epidemic, notably, Peter Piot:

“It’s the regional office in Africa that’s the front line,” “And they didn’t do anything. That office is really not competent.”

The potential of the human rights framework is shown here – a more robust implementation of the human rights framework, and more generally international human rights law, can directly change this. Currently, there are too many barriers which limit the potential human rights can effectively serve the international community – including governmental desire to maintain governance power and weak enforcement practices on behalf of the WHO to ensure international compliance with global health law standards, including human rights.

The significance and influence of the human rights framework is shown in it’s unique link to the health and well-being of individuals in practically all aspects of day-to-day living. From denying individuals the “right to specific information” or the right to live under “just and favorable conditions” (UDHR, Article), a country that fails to uphold human rights will fail to achieve improved health standards. What’s missing is the complete acknowledgement of the international community of this realization and the overall importance of human rights.

What needs to happen is a reevaluation and revamping of administrative mechanisms which the WHO utilizes in reviewing, broadcasting, and implementing human rights to the rest of the international community – maybe this calls for an entirely new enforcement body perhaps? What needs to be ensured is that the potential of the human rights framework to implement change in global health policy must not be wasted – rather it should serve as an impetus to drive forward change in this ever complicated and dynamic field of global health policy.

Polio Elimination in Uttar Pradesh – Individual impact in global health policy

The case of Polio Elimination in the Uttar Pradesh state in India serves to highlight the impact that specific individuals can have in any global health undertaking. Likewise with the smallpox elimination program administered in Africa as well as in India, individual will power serves as a great instigator and spur of driving action in global health policy – in this case of Polio eradication.

The theme of individualized leadership in global public health campaigns is signified through the work of two individuals throughout the course of the Polio Elimination program in Uttar Pradesh – Dr. Kaushik Banerjee and Dr. Jon Andrus.

The efforts of these two individuals quickly made in roads in the Polio fight in Uttar Pradesh. With collaboration with Global Polio Elimination Initiative (GPEI), a coordinated public health program compromising of Rotary International, WHO, the CDC, and UNICEF, Banerjee and Andrus were able to help establish a National Immunization Day (NID). The program helped foster greater immunization rates amongst children, and polio outbreaks in India became more localized. However, coverage gaps still existed amongst the northern portion of India, prompting Banerjee and Andrus to present a case for increased immunization rounds in India to six rounds in the North and four in the south, relying in surveillance data to augment their argument.

What became know as the 4+2 program, the impact was significant on India’s polio outlook – polio cases dropped from 1,126 in 1999 to 265 in 2000; however, a majority of these cases, over 200, were concentrated in the Utter Pradesh state, for a multitude of reasons – climate, public health conditions, etc. Ultimately, the success of the program was hinged on the arguments and persistence of Banerjee and Andrus.

When the pair left their respective posts within the Polio Elimination campaign in the summer of 2002, the Indian government decided to scale down it’s polio response within the northern region, using just two national and regional immunization days – which was against the recommendations of Banerjee and Andrus. In 2002, India Suffered a polio outbreak, and 1,600 Children came down with paralytic polio, including over 1,200 cases in the Uttar Pradesh region alone. This incidence found that past immunization campaigns were not robust enough in their strategies, leaving a “pool” of unvaccinated children contributing to the outbreak.

The main talking point here revolves around the significance and displays of influence Banerjee and Andrus held towards the Polio elimination campaign in Uttar Pradesh and India overall. Once their opinions, perspectives, and arguments were no longer voiced, the Indian government immediately took retroactive steps in the Polio elimination campaign. Likewise to an extent to the smallpox global eradication program, although many international and national organizations and institutions were behind this public health campaign, the realization of the elimination of Polio in Uttar Predesh is fundamentally tied to the efforts and insights of a few particular individuals. I feel it’s quite interesting to find such a relation – that problems so inherently tied to the well-being of millions individuals can rest on the capabilities of just a few individuals in global health policy.