Overview of PAHO’s work on Health and Human Rights PAHO’s policies on Health and Human Rights

2. Overview of PAHO’s work on Health and Human Rights • PAHO’s policies on Health and Human Rights • Human Rights and access to medicines • Conference PAHO/WCL : March 2012

3. “The use of international human rights principles, treaties and standards is seen in PAHO and WHO not as an optional tool to promote and protect public health, but as an essential strategy to improve the health of the people around the world” Dr. Mirta Roses Georgetown Law Center, October 2006 Director Pan American Health Organization/Regional Office of the World Health Organziation (PAHO/WHO)

4. Links between Health and Human Rights Law • Violations of human rights can affect negatively the physical and mental health of individuals; • Health policies, laws, programs and plans can affect positively or negatively the exercise of the basic human rights and freedoms of the most vulnerable groups; and • Enjoyment of health and the exercise of human rights are both essential requirements to reach well-being and a healthy life

5. Exercise of Basic Human Rights and the Most vulnerable in the Context of Public Health • Persons with disabilities; • Persons living with HIV/AIDS; • Persons with mental disorders; • Older persons; • Indigenous peoples; • Health and related human rights and freedoms of women and children/adolescents in the context of sexual and reproductive health; • Access to essential medicines.

6. SO6 Tobacco Control (Res. CD50.R6) SO7 Indigenous Peoples (Res. CD47/13) SO3 Disabilities (Res. CD47/15) SO 7 Indicator 7.4.1 Ethics and Human Rights Based approaches to health at a national regional and global levels SO4 & SO7 Maternal Mortality and Gender Response (Res. CD49/13) SO3 Oral Health (Res CD49/13) SO3 Mental Health (Res. CD49.11/11) SO4 Older Persons (Res.CD49/8) SO2 HIV/AIDS (Res. CD45.R10) SO4 Adolescents (Res.CD49.12)

7. CONSTITUTION OF WHO “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…”Constitution of WHO (1946)

8. PAHO Resolution CD 50 R.8“Health and Human Rights” Recently adopted (October 2010) by PAHO’s Member States URGES “health authorities to use human rights treaties and standards to REFORM their national health policies, plans, programs and laws ina manner consistent with universal and regional human rights instruments (treaties, standards and technical guidelines)”

9. PAHO’S RESOLUTION • Strengthen health authorities to work with human rights entities; • Strengthen health authorities to provide support for the formulation of health policies and plans consistent with h.r. instruments; • Support PAHO in the formulation/reform of national plans/legislation incorporating h .r. instruments; • Strengthen training programs for health workers; • Adopt measures to disseminate h.r. instruments in the legislative and judicial branches;

10. Disseminate applicable human rights instruments among civil society organizations; • Facilitate PAHO technical cooperation with UN/OAS treaty bodies; • To train PAHO staff and incorporate gradually h.r. Instruments in the work of technical areas; • Stimulate collaboration and research with academic actors, private sector and other social actors; and • Share good practices and experiences among PAHO Member States

11. PAHO Strategic Plan 2008-2012 PAHO Strategic Plan 2008-2012 states that : “Human rights law, as enshrined in international and regional human rights conventions and standards, offers a unifying conceptual and legal framework for these strategies as well as measures by which to evaluate success and clarify the accountability and responsibilities of the different stakeholders involved”. Human Rights is included in PAHO’S Strategic Plan in Regional Expected Result 7.4: “Ethics and human-rights based approaches to health promoted within PAHO/WHO at a national, regional and global levels”

12. Capacity Building/Training Resolution CD50R8 “Health and Human Rights” urge Member States to strengthening technical capacity Formulation/Review National Health Plans And Legislation Resolution CD50R8 “Health and Human Rights" urge Member States to support PAHO's Technical cooperation Tools and Research Guidelines Technical Collaboration with Human Rights Treaties Bodies, Special Rapporteur, Academics Institutions, Collaborating Center And Private Sector

13. International and Regional Human Rights Instruments to advance Access to Medicines

14. “The enjoyment of the highest attainable standard of health…” Constitution of WHO “ …one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition…” International Covenant on Economic and Social Rights protects: “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health” (Article 12) Protocol of San Salvador of the OAS protects: the “right to health” (Article 10)

15. General Comment 14Committee on Economic, Social and Cultural Rights:“the right to the highest attainable standard of health…” The Committee on Economic, Social and Cultural Rights (CESCR) published General Comment No. 14 to address substantive issues arising in the implementation of Article 12 of the ICESCR. The CESCR explained that the right to health is neither the right to be healthy nor the right to health care. Instead, “the right to health embraces a wide range of socio-economic factors that promote conditions in which people can lead a healthy life. “ Elements of the right to health: The right to health is composed of the following essential elements: (a) availability; (b) accessibility; (c) acceptability; and (d) quality. These elements are interrelated and legally enforceable.

16. (d) good quality: (limited accesibility, with administrative, geographical, economical, cultural and social barriers, long waiting lists, no adequate offer of services).

17. INTERNATIONAL COVENANT ON ECONOMIC, SOCIAL AND CULTURAL RIGHTSArticle 12 1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. 2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for: a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child; b) The improvement of all aspects of environmental and industrial hygiene; c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases; and d) The creation of conditions which would assure to all medical service and attention

18. Article 15 1. The States Parties to the present Covenant recognize the right of everyone: ….. (b) To enjoy the benefits of scientific progress and its applications;

19. Protocol of San SalvadorArticle 10 Article 10 Right to Health 1. Everyone shall have the right to health, understood to mean the enjoyment of the highest level of physical, mental and social well-being. 2. In order to ensure the exercise of the right to health, the States Parties agree to recognize health as a public good and, particularly, to adopt the following measures to ensure that right: a. Primary health care, that is, essential health care made available to all individuals and families in the community; b. Extension of the benefits of health services to all individuals subject to the State's jurisdiction; c. Universal immunization against the principal infectious diseases; d. Prevention and treatment of endemic, occupational and other diseases; e. Education of the population on the prevention and treatment of health problems, and f. Satisfaction of the health needs of the highest risk groups and of those whose poverty makes them the most vulnerable.

20. LEGAL OBLIGATIONS OF STATES • Respect: States must respect human rights and can not directly or indirectly violate the human rights and fundamental freedoms of persons living with HIV/AIDS; • Protect: States must take measures to prohibit third parties form violating human rights and fundamental freedoms of persons living with HIV/AIDS; and • Fulfill: States must take Positive Legislative, Budgetary, Administrative and Judicial measures to fulfill human rights

21. LIMITATION OF RIGHTS IN THE CONTEXT OF ACCESS TO MEDICINES • Right to life; • Right to personal integrity (moral, physical and psiquical) • The rights of the child; and • The rights of the family

22. The Siracusa Principles in the context of access to medicines • Restriction in accordance with the law; • Compatible with the ratified international instruments; • Legitimate aim; • Strictly necessary for promoting well-being; • Proportional to the aim

23. Mechanisms of Protection • Country reports (UN treaty bodies); • Individual cases (IACHR, under the American Declaration and the Inter-American Convention on violence against women and Domestic Tribunals/Ombudspersons); • On site observations (IACHR and UN Special Rapporteur on the Right to Health); • Precautionary measures (IACHR, under the American Declaration); • Hearings (NGO’s and speciliazed agencies); and • Formulation of specific standards (mental health)

24. International JurisprudenceAccess to medicines Jorge Odir Miranda v. El Salvador (2001) By failing to provide free of charge antiretroviral drugs essential for the treatment of HIV/AIDS, the State of El Salvador has violated the provisions contained in the American Convention on Human Rights, together with the provisions of article XI of the American Declaration of the Rights and Duties of Man. and Article 10 of the Additional "Protocol of San Salvador". In consequence, it has violated the right to health of Jorge Odir Miranda Cortez and the [other persons] referred to in the instant case.   In the opinion of the IACHR, the response of the Salvadoran State in this case is consistent with progressive development of the right to health.  Therefore, while the Commission has determined violation of article 25 of the American Convention based on the conduct of the judicial authorities, the measures of the administrative authorities have accorded with the international obligations provided at 26 of the aforesaid international instrument.

25. Amicable setlement: the State agreed to: • Authorize the purchase of antirretrovirals; • Measures to prevent HIV transmision • Establish a fund to purchase anti-retroviral treatment • Nowadays around 1,700 receive medication for HIV treatment through the State.

26. Life and HealthConditions- Indigenous Peoples • Poverty and systemic poverty • Low salaries • Unemployment • Migration • School desertion • Illiteracy indexes - female • Lack of land and territory • Epidemiological profile: • Preventive diseases

27. Two important cases in which the Court used an “expansive definition” of Article 4 right to life. 1. Case Yakye Axa v. Paraguay (17 June,2005) 2. Case Sawhoyamaxa v. Paraguay (29 March, 2006) “adequate medicines...vaccines, latrines, or other type of sanitary services adequate for communal settlement”.

28. Evolutionary interpretation of the “right to life” which emphasized a positive obligation to protect the conditions necessary for life. • States must adopt any measures that may be necessary to create an adequate statutory framework to discourage any threat to the right to life to establish an effective system of administration of justice able to investigate, punish and repair any deprivation of lives by state agents, or by individuals; and to protect the right of not being prevented from access to conditions that may guarantee a [dignified life], which entails the adoption of positive measures to prevent the breach of such right”.

29. Colombia – Tutela No. 505/92 –Constitutional Court “Right to due process and the right to health are protected by the Constitution.” “ protecction againts HIV/AIDS immediate application” Ximenes Lopes/Brasil and Alban cornejo v. Ecuador

30. INAUGURAL CONFERENCE The principal aim of the inaugural conference is to underscore the relevance of the collaborative effort to improve equity in health and to identify new leaders for years to come. Based on the PAHO Resolution on Health and Human Rights (CD 50 R.8) approved by the PAHO Directing Council on October

31. The white papers will all have a basic structure: • Overview: situation analysis by region • Comparative framework • Trends • Public health actions needed consistent with international human rights treaties and standards.   • The papers will be ready by the Feb. 15. On-line discussions will start by Feb 16.

32. Example of Targets for Public Health Actions based on Trends in Mental Health • Living Conditions in Psychiatric Institutions and Other Mental Health Facilities • Community-Based Mental Health Services and Living Arrangements • Participation of Consumers/Family Members in Mental Health Decision-making • Participation of Civil Society in Promotion and Protection of Human Rights • Role of he Media in Promoting and Protecting the Rights of Persons • Awareness-raising, Training and Dissemination of International Human Rights Norms and Standards. • Status of National Health Law, Policies, and Plans • Exercise of Civil, Political, Economic, Social and Cultural Rights and Freedoms Fundamental • National Monitoring Mechanism • Policies and Procedures for Admission

33. The human right to the highest attainable standard of healthTHANK YOU!