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Public Health and Human Rights

Public Health and Human Rights To the Editor Dr Galea and Mr Annas called for greater priority to be given to public health vs more individualized methods to improve population health.1 We agree with the authors’ recommendation for a multisectorial approach to public health that engages academia, industry, and the not-for-profit sector. We wish to highlight, however, the authors’ proposal that the Universal Declaration of Human Rights (UDHR) should be formally adopted as the code of public health ethics. Although we endorse the public health role of human rights,2 an exclusively rights-based approach generates 2 serious challenges that the authors did not address. First, it is widely assumed that human rights, including canonical instruments such as the UDHR, apply exclusively to states. This assumption seems to be shared by the authors when they wrote that human rights are appropriate to public health because “much of public health is still directed by governments.” But their focus on “governmental obligations” is in tension with their recommendation for a multisectorial strategy. Mobilizing human rights for public health needs to reflect the fact that human rights obligations extend beyond the state, encompassing many kinds of nongovernmental actors. A recent example of this is the United Nation’s Guiding Principles on Business and Human Rights,3 which directly impose on corporations a responsibility to respect all human rights, including the right to health. Second, the authors did not address the potential tension that exists between human rights and public health. Human rights are individualistic in focus, being concerned with claims that individuals can make to the provision of certain benefits. By contrast, public health is geared toward aggregate health goods delivered to populations as a whole. Therefore there is a serious question to what extent a code of human rights alone can be a comprehensive ethical basis for public health.4 For example, a common good such as widespread participation in physical activity is vital to population health, but not something that can be completely guaranteed by upholding human rights. Examples such as this suggest that considerations of the common good in addition to human rights will be needed when seeking an ethical basis for public health.5 Human rights are important to public health, and their importance extends beyond governments, but the ethics of public health need more than human rights. Section Editor: Jody W. Zylke, MD, Deputy Editor. Back to top Article Information Corresponding Author: John Tasioulas, DPhil, King's College London, Yeoh Tiong Lay Centre for Politics, Philosophy, and Law, Dickson Poon School of Law, Somerset House East Wing, London, United Kingdom WC2R 2LS (john.tasioulas@kcl.ac.uk). Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. References 1. Galea S, Annas GJ. Aspirations and strategies for public health. JAMA. 2016;315(7):655-656.PubMedGoogle ScholarCrossref 2. Gostin LO. Global Health Law. Cambridge: MA Harvard University Press; 2014. 3. United Nations Human Rights Office of the High Commissioner. Guiding Principles on Business and Human Rights. New York, NY and Geneva: United Nations; 2011. 4. Childress JF, Faden RR, Gaare RD, et al. Public health ethics. J Law Med Ethics. 2002;30(2):170-178.PubMedGoogle ScholarCrossref 5. Tasioulas J, Vayena E. Getting human rights right in global health policy. Lancet. 2015;385(9978):e42-e44.PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Public Health and Human Rights

JAMA , Volume 316 (1) – Jul 5, 2016

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Publisher
American Medical Association
Copyright
Copyright © 2016 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2016.5244
Publisher site
See Article on Publisher Site

Abstract

To the Editor Dr Galea and Mr Annas called for greater priority to be given to public health vs more individualized methods to improve population health.1 We agree with the authors’ recommendation for a multisectorial approach to public health that engages academia, industry, and the not-for-profit sector. We wish to highlight, however, the authors’ proposal that the Universal Declaration of Human Rights (UDHR) should be formally adopted as the code of public health ethics. Although we endorse the public health role of human rights,2 an exclusively rights-based approach generates 2 serious challenges that the authors did not address. First, it is widely assumed that human rights, including canonical instruments such as the UDHR, apply exclusively to states. This assumption seems to be shared by the authors when they wrote that human rights are appropriate to public health because “much of public health is still directed by governments.” But their focus on “governmental obligations” is in tension with their recommendation for a multisectorial strategy. Mobilizing human rights for public health needs to reflect the fact that human rights obligations extend beyond the state, encompassing many kinds of nongovernmental actors. A recent example of this is the United Nation’s Guiding Principles on Business and Human Rights,3 which directly impose on corporations a responsibility to respect all human rights, including the right to health. Second, the authors did not address the potential tension that exists between human rights and public health. Human rights are individualistic in focus, being concerned with claims that individuals can make to the provision of certain benefits. By contrast, public health is geared toward aggregate health goods delivered to populations as a whole. Therefore there is a serious question to what extent a code of human rights alone can be a comprehensive ethical basis for public health.4 For example, a common good such as widespread participation in physical activity is vital to population health, but not something that can be completely guaranteed by upholding human rights. Examples such as this suggest that considerations of the common good in addition to human rights will be needed when seeking an ethical basis for public health.5 Human rights are important to public health, and their importance extends beyond governments, but the ethics of public health need more than human rights. Section Editor: Jody W. Zylke, MD, Deputy Editor. Back to top Article Information Corresponding Author: John Tasioulas, DPhil, King's College London, Yeoh Tiong Lay Centre for Politics, Philosophy, and Law, Dickson Poon School of Law, Somerset House East Wing, London, United Kingdom WC2R 2LS (john.tasioulas@kcl.ac.uk). Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. References 1. Galea S, Annas GJ. Aspirations and strategies for public health. JAMA. 2016;315(7):655-656.PubMedGoogle ScholarCrossref 2. Gostin LO. Global Health Law. Cambridge: MA Harvard University Press; 2014. 3. United Nations Human Rights Office of the High Commissioner. Guiding Principles on Business and Human Rights. New York, NY and Geneva: United Nations; 2011. 4. Childress JF, Faden RR, Gaare RD, et al. Public health ethics. J Law Med Ethics. 2002;30(2):170-178.PubMedGoogle ScholarCrossref 5. Tasioulas J, Vayena E. Getting human rights right in global health policy. Lancet. 2015;385(9978):e42-e44.PubMedGoogle ScholarCrossref

Journal

JAMAAmerican Medical Association

Published: Jul 5, 2016

References