Panel Theme:
Our Human Environment
Paper Title:
Pandemics, Disease, and Human Rights
Author:
Gearóid Ó Cuinn
The human ecology of the 21st century has brought new challenges for human rights law.
The emergence of new diseases, and resurgence of old ones like tuberculosis and
cholera, reflects a change in the delicate balance between humans and microbes.
Globalisation of travel and trade has made borders and sovereignty impotent, making
outbreaks of viruses, such as Avian Influenza, a global threat that demands a global
solution. Based on genetic evidence and historical experience, experts agree that another
influenza pandemic is inevitable. These outbreaks are increasingly perceived as nontraditional threats to Western stability fomenting the securitization of such diseases.
Concern with these developments prompted the recent revision of the International
Health Regulations which were unanimously adopted by the World Health Assembly of
the WHO, entering into force in June 2007. The regulations represent binding standards
that aim to harmonise an international response to diseases not just at borders, but also
in an increasingly interconnected human environment. Although the regulations explicitly
mention respect for human rights when combating infectious diseases, they are silent on
the legal standards and processes necessary for disease control. The nexus between
public health, infectious diseases and human rights remains surprisingly undeveloped for
a variety of reasons, including the misplaced faith of policy makers in the antibiotic
revolution. The threat of an influenza pandemic brings multi-faceted challenges including
the need to balance individual freedom with the common good, economic losses against
the need to control the disease, health workers’ duty to provide care and self interest,
and the allocation of scarce resources. Thus acute infectious diseases highlight the
apparent conflict of interests between the values of public health and those of human
rights.
Evolving approaches to public health, however, increasingly recognise the mutual
interdependence of human rights and public health, as society is best served by full
realisation of both goals. Progress involving public health problems requires
improvements in the respect for human rights and dignity. Similarly, improvements in
respect and realisation of human rights undoubtedly contribute to the health of an
individual and the conditions of the surrounding community. The essence of the health
and human rights linkage derives from the deep complementarity between the goals of
public health (to ensure the conditions in which people can be healthy), and the ability of
human rights in identifying, promoting, and protecting the social determinants of human
well-being.1
The groundbreaking contribution to realising this complementarity lies in the recognition
of the applicability of international law to HIV/AIDS issues. 2 The human rights based
approach taken by Western governments after the onset of the HIV pandemic illustrated
a consistent pattern through which discrimination, marginalisation, stigmatisation and a
general lack of respect for human rights by states had heightened vulnerability of
individuals or groups to exposure to the virus. Arguably, the failure to acknowledge or
address inequalities in the social determinants of health as a pandemic amplifier is one of
the WHO’s greatest oversights in its recommendations for influenza pandemic planning.
Epidemiological models indicate that a pandemic would have the greatest impact on the
poorest countries, as a result of limited surveillance and healthcare resources, as well as
Mann J, ‘Medicine and Public Health, Ethics and Human Rights’ Health and Human Rights: A Reader Mann
J.M., Gruskin S., Grodin G.A., Annas G.J., (eds) (Routledge: London, 1999) p447.
2
Mann, J.M., Gostin, L., Gruskin, S., Brennan, T., Lazzarini, Z., Fineberg, H. ‘Health and human rights.’ 1994
Health and Human Rights 1(1) 6-23.
1
Author: Gearóid Ó Cuinn
University: University of Nottingham
Programme: School of Law / Institute for Science and Society
the general poor health and nutritional status of the population. 3 As stated in Art. 12.2
(c) of the ICESCR, a proper response requires “the establishment of prevention and
education programmes for behaviour-related health concerns … and the promotion of
social determinants of good health, such as environmental safety, education, economic
development and gender equity”. An overly individualistic, or medicalised approach to
health masks the actual processes that shape our microbial environment and promotes a
pharmacological solution, an approach hampered by global inequalities. Although
adaptive genetic dynamics of infectious diseases play an important role in generating
disease burdens, factors under human control play an even larger role in heightening the
risk of disease outbreaks.4 Diseases evolve when humans intensively interact with the
natural environment, urbanisation generates overcrowding and invariably a reduction in
environmental health. In the developing world this is compounded by human induced
movements of poultry. Unsanitary conditions and close quarter live animal markets
facilitate millions of potential cross-infections for respiratory diseases. To prevent or
mitigate the impact of respiratory disease outbreaks, this ecosystem should considered
as part of the environmental front, complementing the human medical and research
response. It is proposed that a more socialised and environmentally informed view of
human rights is required to recognise the determinants of health relevant to outbreaks of
acute diseases, such as Avian Influenza and to properly guide states as a global ethical
framework for pandemic policy.
WHO 2004: Informal consultation on influenza pandemic preparedness in countries with limited resources.
Kuala Lumpur, Malaysia 23.25 June 2004. Department of Communicable Disease Surveillance and Response.
http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2004_1/en/index.html.
4
Nicastri E, Girardi E, Ippolito G. ‘Determinants of emerging and re-emerging infectious diseases.’ 2001 J Biol
Regul Homeost Agents. 15(3) 212-7; Urbanization for example brings with it the problems of housing,
sanitation, pollution, drinking water, and health care facilities. Increasing population densities and urban
poverty encourage the spread of viruses.
3
Author: Gearóid Ó Cuinn
University: University of Nottingham
Programme: School of Law / Institute for Science and Society