Re: Health and Human Rights

[Guest guest]

As usual good stuff thank you. According to Dr. Berwick and the Institute for Healthcare Improvement (The Triple Aim folk) 40% of what keeps us healthy involves individual behavior and lifestyle choices, 30% is accounted for by genetics (don't tell Dr. Chestnut/Bruce Lipton) 15% is due to socio-economic factors and 5% is enviromental factors?? Is this way off by your estimation??

Vern

Health and Human Rights

Vern,

For background, here's a fundamental report on human health and well-being as a function of societal organization as exemplified in the Universal Declaration of Human Rights, from NIH. It views human health (or "wellness") in a macro perspective rather than strictly an empirical reductionist frame-of-reference. An orientation that accepts that the environment in which an individual lives contributes more to that person's health and well-being than medical intervention is realistic and supported by increasing scrutiny. The question as to whether moving a dysfunctional VSC leads to wellness must be viewed in a larger context, just as all other reductionist interventions must be.

Do we believe that expression of full ROM in human joints is life affirming? Or, do we fail to see that lack of human joint motion leads to static life forces? "Movement is life," as Dr. Ida Rolf clearly stated. Do we believe that human immobility leads to human health and wellness? Is activity a critical part of human wellness? Is the VSC at the core of immobility problems?

We fail to see the big picture by only looking at our reductionist data, IMHO.

Health and human rights

Protecting human rights is essentialfor promoting health

When the World Health Organisation redefined health as "a

state of complete physical, mental and social well-being"' it

not only expanded health far beyond medicine, it openly

acknowledged the vast accumulated knowledge about the cen-

tral role of societal determinants of population health. Despite

the public's belief to the contrary, medical care is a relatively

minor, albeit important, contributor to health,2 far outweighed

by societal factors, of which social class has been the most

extensively studied.' 4

In 1988, a seminal report by the United States Institute of

Medicine defined the mission of public health as "ensuring the

conditions in which people can be healthy."4 In turn, this

required those working in public health to consider the societal

nature of these essential conditions in which people could

achieve the highest attainable standard of physical, mental, and

social wellbeing. Paradoxically, the discipline of public health

has generally ignored the societal roots of health in favour of

medical interventions, which operate further downstream. For

example, public health efforts at preventing and controlling

sexually transmitted diseases have focused on diagnosis and

treatment, along with educational programmes, rather than

confronting societal inequality or other societal issues as

"essential conditions" underlying the spread of sexually trans-

mitted diseases. Epidemiological research has contributed to

this narrowed focus,5 because it identifies individual risk

behaviours in isolation from the critical societal context.

Public health's difficulty in addressing the indisputably pre-

dominant societal determinants of health status is exacerbated

by the lack of a coherent conceptual framework for analysing

societal factors that are relevant to health; the social class

approach, while useful, is clearly insufficient.2 3 6 Public health

action based on social class is often simply accusatory, and it

raises, but cannot answer, the question: "what must be done?"

In this sense, "poverty" as a root cause of ill health is both evi-

dent and paralysing to further thought and action. Also, with-

out a consistent approach or vocabulary, we cannot identify

the societal factors common to different health problems (can-

cer, heart disease, injuries, infectious diseases) and to different

countries. Finally, since the way in which a problem is defined

determines what is done about it, the prevailing public health

paradigm is unclear about the direction and nature of societal

change that is needed to promote public health.

Modern human rights, born in the aftermath of the second

world war and crystallised in the Universal Declaration of

Human Rights of 1948, reflect a broader, societal approach to

the complex problem of human wellbeing. The implicit ques-

tion behind the modern human rights movement is: "what are

the societal (and particularly governmental) roles and respon-

sibilities to help promote individual and collective wellbeing?"

This form.of the question leads to a specific list of actions that

governments should not do (discriminate, torture, imprison

under inhumane conditions, interfere with the free flow of

information, invade privacy, prevent associative life in society),

and a basic minimum that governments should ensure for all

(elementary education, housing, food, medical care).While the

word health is mentioned only once in the document, to a

public health professional the declaration is about the societal

preconditions for "physical, mental and social well-being."

The current health and human rights movement is based on

a working hypothesis: that the human rights framework

provides a more useful approach for analysing and responding

to modern public health challenges than any framework thus

far available within the biomedical tradition. The discussion is

complicated by the fact that health professionals are generally

unaware of the key concepts, meaning, and content of modern

human rights.Yet awareness is increasing. Health professionals

924 BMJ voLuME 312 13 APRIL 1996

are learning that promoting and protecting human rights may

be essential for promoting and protecting health. This insight

was already present in the evolving approach to population

and women's health.7 8 It was strongly accelerated in work on

HIV and AIDS, in which discrimination (and other human

rights issues) were found not only to be tragic results of the

pandemic but to be root societal causes of vulnerability to

HIV.9 '° Even the World Bank, not generally involved with

human rights agendas, reached a similar conclusion when it

declared that ensuring girls' rights to education and to

non-discrimination within education represented one of the

most powerful strategies for improving health in the

developing world.11

The world of health and human rights has moved away from

earlier simplistic assumptions about a necessary conflict

between public health goals and human rights norms.12 Public

health professionals increasingly recognise that they must deal

directly with the underlying societal issues that determine, to

the largest extent, who lives and who dies, when, and of what.

For this reason, since 1990, all graduates of the Harvard

School of Public Health receive, along with their diploma, a

copy of the Universal Declaration of Human Rights. The dean

tells them that this will be as important to their future work as

a Hippocratic oath would be for a practising clinician.

Ultimately this approach, linking human rights work with

public health, is both a return to the historical concerns of

public health and the beginning of a new chapter in the

relationship between health and society.

JONATHAN M MANN

Franqois-Xavier Bagnoud professor of health and human rights

Harvard School of Public Health,

Boston, MA 02138,

USA

1 World Health Organisation. Constitution. In: Basic documents. 36th ed. Geneva: WHO, 1986.

2 RG. Introduction. In: RG, Barer ML, Marmor TR, eds. Why are some people

healthy and others notr? Hawthorne, NY: Aldine De Gruyter, 1994:3-26.

3 Adler NE, Boyce T, Chesney MA, Cohen S, Folkman SM, Kahn RL, et al. Socioeconomic sta-

tus and health: the challenge of the gradient. Am Psychol 1994;49:15-24.

4 Institute of Medicine. Future of public health. Washington DC: National Academy Press,

1988:1-7.

5 Krieger N. Epidemiology and the web of causation: has anyone seen the spider? Soc Sci Med

1994;39:887-903.

6 Mann JM, Gostin L, Gruskin S, Brennan T, Lazzarini Z, Fineberg H. Health and human rights.

Health and Human Rights 1994;1:6-23.

7 Correa S, Petchesky R. Reproductive and sexual rights: a feminist perspective. In: Sen G, Ger-

main A, Chen L, eds. Population policies reconsidered: health, empowerment and rights.

Cambridge, MA: Harvard University Press, 1 994:107-23.

8 Cook RJ. Gender, health and human rights. I. 1995; 1:350-66.

9 Mann JM, Tarantola D, Netter T, eds. AIDS in the world. Cambridge, MA: Harvard University

Press, 1992:577-602.

10 Mann JM. AIDS in 1994: the personal and global challenge of renewal. In: ShiokawaY, Kita-

mura T, eds. Global challenge of AIDS: ten years of HIV/AIDS research. Tokyo: Kodansha,

1995:291-7.

11 World Bank. World development report 1993: investing in health. New York: Oxford University

Press, 1993:1-16.

12 International Federation of Red Cross and Red Crescent Societies. AIDS, health and human

rights: an explanatory manual. Geneva: The Societies, 1995.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2350785/pdf/bmj00537-0008.pdf

Sears, DC, IAYT

1218 NW 21st Ave

Portland, Oregon 97209

v: 503-225-0255

f: 503-525-6902

www.docbones.com

[Guest guest]

It seems to me that different perspectives on this elephant of sick-care will be useful at different times in advancing the understanding that health and wellness occur within a larger context than we are currently using. We are mistaken to believe that simply having access to health care (Chiropractic in our case) is the answer to improved outcomes and cost controls. Any data pointing to that reality can be helpful at differing times.We tend to think of the position of health care in relation to the overall burden of disease in a population as a matter of access. While there are class differences in survival rates of those injured in car crashes, those differences are dwarfed when looking at who gets heart disease or cancer (Leon and Wilkinson, 1989). The Whitehall Study of civil servants working in London offices, showed that death rates were, age for age, three times as high among the most junior office workers compared to the most senior workers. ((See updated Whitehall Study II at: http://www.ncbi.nlm.nih.gov/pubmed/1674771 ) In summary, the lower the socioeconomic status of the worker, the greater the risks of chronic disease and early death. To understand the position of medical care in relation to the overall burden of disease in a population, we need to think about it as functioning rather like an army medical corps. As important as good medical treatment is for battle casualties, if we want to know whether the number of battle casualties in a war was large or small, we need to look at the nature of the battle, not at the medical corps. In society at large, the nature of the battle, which would explain overall health standards, is the nature of social and economic life.Just as an individual has a natural propensity for self-healing given the elimination of the barriers to that healing, so also does the collective organism have a natural propensity for self-healing, provided the organism sees it's various elements as inter-dependent and mutually self-serving: as one organism collectively. To improve health outcomes and reduce health care costs, we must see each person as part of this healing or sickening environment.This analysis is from Wilkinson's "The Impact of Inequality." See at:http://books.google.com/books?id=clY7C0F82gsC & printsec=frontcover & dq=richard+wilkinson & source=bl & ots=OU3A3wksex & sig=WJfhoeaaxkw4cfnFPpZcUVwFLGI & hl=en & ei=6_QtTdacM4z0swO99JybBw & sa=X & oi=book_result & ct=result & resnum=16 & ved=0CFcQ6AEwDw#v=onepage & q & f=false See also Wilkinson and Pickett, "The Spirit Level: Why Greater Equality Makes Societies Stronger."

Sears, DC, IAYT1218 NW 21st AvePortland, Oregon 97209v: 503-225-0255f: 503-525-6902www.docbones.comOn Jan 11, 2011, at 7:08 PM, Vern Saboe wrote: As usual good stuff thank you. According to Dr. Berwick and the Institute for Healthcare Improvement (The Triple Aim folk) 40% of what keeps us healthy involves individual behavior and lifestyle choices, 30% is accounted for by genetics (don't tell Dr. Chestnut/Bruce Lipton) 15% is due to socio-economic factors and 5% is enviromental factors?? Is this way off by your estimation?? Vern Health and Human Rights Vern, For background, here's a fundamental report on human health and well-being as a function of societal organization as exemplified in the Universal Declaration of Human Rights, from NIH. It views human health (or "wellness") in a macro perspective rather than strictly an empirical reductionist frame-of-reference. An orientation that accepts that the environment in which an individual lives contributes more to that person's health and well-being than medical intervention is realistic and supported by increasing scrutiny. The question as to whether moving a dysfunctional VSC leads to wellness must be viewed in a larger context, just as all other reductionist interventions must be. Do we believe that expression of full ROM in human joints is life affirming? Or, do we fail to see that lack of human joint motion leads to static life forces? "Movement is life," as Dr. Ida Rolf clearly stated. Do we believe that human immobility leads to human health and wellness? Is activity a critical part of human wellness? Is the VSC at the core of immobility problems? We fail to see the big picture by only looking at our reductionist data, IMHO. Health and human rights Protecting human rights is essentialfor promoting health When the World Health Organisation redefined health as "a state of complete physical, mental and social well-being"' it not only expanded health far beyond medicine, it openly acknowledged the vast accumulated knowledge about the cen- tral role of societal determinants of population health. Despite the public's belief to the contrary, medical care is a relatively minor, albeit important, contributor to health,2 far outweighed by societal factors, of which social class has been the most extensively studied.' 4 In 1988, a seminal report by the United States Institute of Medicine defined the mission of public health as "ensuring the conditions in which people can be healthy."4 In turn, this required those working in public health to consider the societal nature of these essential conditions in which people could achieve the highest attainable standard of physical, mental, and social wellbeing. Paradoxically, the discipline of public health has generally ignored the societal roots of health in favour of medical interventions, which operate further downstream. For example, public health efforts at preventing and controlling sexually transmitted diseases have focused on diagnosis and treatment, along with educational programmes, rather than confronting societal inequality or other societal issues as "essential conditions" underlying the spread of sexually trans- mitted diseases. Epidemiological research has contributed to this narrowed focus,5 because it identifies individual risk behaviours in isolation from the critical societal context. Public health's difficulty in addressing the indisputably pre- dominant societal determinants of health status is exacerbated by the lack of a coherent conceptual framework for analysing societal factors that are relevant to health; the social class approach, while useful, is clearly insufficient.2 3 6 Public health action based on social class is often simply accusatory, and it raises, but cannot answer, the question: "what must be done?" In this sense, "poverty" as a root cause of ill health is both evi- dent and paralysing to further thought and action. Also, with- out a consistent approach or vocabulary, we cannot identify the societal factors common to different health problems (can- cer, heart disease, injuries, infectious diseases) and to different countries. Finally, since the way in which a problem is defined determines what is done about it, the prevailing public health paradigm is unclear about the direction and nature of societal change that is needed to promote public health. Modern human rights, born in the aftermath of the second world war and crystallised in the Universal Declaration of Human Rights of 1948, reflect a broader, societal approach to the complex problem of human wellbeing. The implicit ques- tion behind the modern human rights movement is: "what are the societal (and particularly governmental) roles and respon- sibilities to help promote individual and collective wellbeing?" This form.of the question leads to a specific list of actions that governments should not do (discriminate, torture, imprison under inhumane conditions, interfere with the free flow of information, invade privacy, prevent associative life in society), and a basic minimum that governments should ensure for all (elementary education, housing, food, medical care).While the word health is mentioned only once in the document, to a public health professional the declaration is about the societal preconditions for "physical, mental and social well-being." The current health and human rights movement is based on a working hypothesis: that the human rights framework provides a more useful approach for analysing and responding to modern public health challenges than any framework thus far available within the biomedical tradition. The discussion is complicated by the fact that health professionals are generally unaware of the key concepts, meaning, and content of modern human rights.Yet awareness is increasing. Health professionals 924 BMJ voLuME 312 13 APRIL 1996 are learning that promoting and protecting human rights may be essential for promoting and protecting health. This insight was already present in the evolving approach to population and women's health.7 8 It was strongly accelerated in work on HIV and AIDS, in which discrimination (and other human rights issues) were found not only to be tragic results of the pandemic but to be root societal causes of vulnerability to HIV.9 '° Even the World Bank, not generally involved with human rights agendas, reached a similar conclusion when it declared that ensuring girls' rights to education and to non-discrimination within education represented one of the most powerful strategies for improving health in the developing world.11 The world of health and human rights has moved away from earlier simplistic assumptions about a necessary conflict between public health goals and human rights norms.12 Public health professionals increasingly recognise that they must deal directly with the underlying societal issues that determine, to the largest extent, who lives and who dies, when, and of what. For this reason, since 1990, all graduates of the Harvard School of Public Health receive, along with their diploma, a copy of the Universal Declaration of Human Rights. The dean tells them that this will be as important to their future work as a Hippocratic oath would be for a practising clinician. Ultimately this approach, linking human rights work with public health, is both a return to the historical concerns of public health and the beginning of a new chapter in the relationship between health and society. JONATHAN M MANN Franqois-Xavier Bagnoud professor of health and human rights Harvard School of Public Health, Boston, MA 02138, USA 1 World Health Organisation. Constitution. In: Basic documents. 36th ed. Geneva: WHO, 1986. 2 RG. Introduction. In: RG, Barer ML, Marmor TR, eds. Why are some people healthy and others notr? Hawthorne, NY: Aldine De Gruyter, 1994:3-26. 3 Adler NE, Boyce T, Chesney MA, Cohen S, Folkman SM, Kahn RL, et al. Socioeconomic sta- tus and health: the challenge of the gradient. Am Psychol 1994;49:15-24. 4 Institute of Medicine. Future of public health. Washington DC: National Academy Press, 1988:1-7. 5 Krieger N. Epidemiology and the web of causation: has anyone seen the spider? Soc Sci Med 1994;39:887-903. 6 Mann JM, Gostin L, Gruskin S, Brennan T, Lazzarini Z, Fineberg H. Health and human rights. Health and Human Rights 1994;1:6-23. 7 Correa S, Petchesky R. Reproductive and sexual rights: a feminist perspective. In: Sen G, Ger- main A, Chen L, eds. Population policies reconsidered: health, empowerment and rights. Cambridge, MA: Harvard University Press, 1 994:107-23. 8 Cook RJ. Gender, health and human rights. I. 1995; 1:350-66. 9 Mann JM, Tarantola D, Netter T, eds. AIDS in the world. Cambridge, MA: Harvard University Press, 1992:577-602. 10 Mann JM. AIDS in 1994: the personal and global challenge of renewal. In: ShiokawaY, Kita- mura T, eds. Global challenge of AIDS: ten years of HIV/AIDS research. Tokyo: Kodansha, 1995:291-7. 11 World Bank. World development report 1993: investing in health. New York: Oxford University Press, 1993:1-16. 12 International Federation of Red Cross and Red Crescent Societies. AIDS, health and human rights: an explanatory manual. Geneva: The Societies, 1995. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2350785/pdf/bmj00537-0008.pdf Sears, DC, IAYT 1218 NW 21st Ave Portland, Oregon 97209 v: 503-225-0255 f: 503-525-6902 www.docbones.com