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International Studies
Brian Orend

INTST 101: Introduction to International Studies Brian Orend Unit 6: Global Public Health Breakdown: 1. Some grim facts 2. Connection between health and other areas of international studies 3. Health and human rights; Health As a Human Right What is Global Public Health? Global Public Health is a new, developing field of research and policy concern which focuses on the health of populations around the world. It considers how health issues are interconnected around the world (with migration of peoples and tourism) as well as how illness and sickness affect issues around the world. There is an increasing sense that this is just as important an issue to international affairs as, say, even war and peace. 1. Some Grim Facts 1 billion people lack the minimal calorie intake needed for their stage of growth 2 billion people lack reliable daily access to drinkable water 2 million people die from the lung disease T.B. in the developing world, even though the cure has been available in the developed world for 60 years. Polio, once thought eradicated completely, is now re-appearing in the developing world. 10 million children die every year from such easily preventable conditions as pneumonia, diarrhea and measles. 1 INTST 101: Introduction to International Studies Brian Orend Between 50,000 and 500,000 women die every year while giving birth. (Note the ELJ▯VZLQJ▯LQ▯WKH▯QXPEHUV▯▯WKHUH¶V▯OLWWOH▯FRQsensus about the exact number, but there is about the range.) 40 million people world-wide have HIV/AIDS, and 55% of them are women. 15 million kids, many in Africa, have lost at least one parent to HIV/AIDS 2. Interconnections Some people believe that sickness and illness cause armed conflict. There is a neat new field of UHVHDUFK▯ FDOOHG▯ ³SHDFH▯WKURXJK▯KHDOWK▯´▯ ,¶P▯QRW▯ VXUH▯RI▯WKLV▯P\VHOI▯▯DV▯VLFN▯SHRSOH▯DOVR▯FDQ¶W▯ILJKW▯▯ and if you look at the main instigators of violence and war, they are often very heDOWK\▯▯MXVW▯³VLFN´▯ in their minds, so to speak. But I suppose it is true to say, for example, that sometimes communities will fight over natural resources which are vital to their life and health. One thinks especially of water in this regard and there are GLUH▯SUHGLFWLRQV▯RI▯³ZDWHU▯ZDUV´▯LQ▯WKH▯IXWXUH▯▯ 6RPH▯HYHQ▯FLWH▯WKH▯'DUIXU▯FRQIOLFW▯DV▯D▯FDVH▯VWXG\▯▯%XW▯ZKDW▯LV▯WUXH▯LQ▯WKH▯³SHDFH▯ WKURXJK▯KHDOWK´▯PRYHPHQW▯LV▯WKDW▯▯LI▯SHRSOH▯DUH▯JHQHUDOO\▯KHDOWK\▯▯WKHQ▯WKDW¶V▯RQH▯ less reason to go to war. Rampant illness and disease clearly hold some countries back, in terms of their GHYHORSPHQW▯▯ 7KH▯ VLFN▯ FDQ¶W▯ EH▯ SURGXFWLYH▯ WKHPVHOYHV▯▯ DQG▯ WKH\▯ DEVRUE▯ KXJH▯ resources just getting treatment. It is widely agreed that widespread illness is a major drag on economic growth and development, especially in Africa. There are also clear connections between health and the environment, as obviously they each impact the other. Polluted environments can make people sick, sick people are less able to clean up polluted environments, and then a nasty cycle of underdevelopment, illness, pollution, lack of economic growth and trade can trap countries and their populations. 2 INTST 101: Introduction to International Studies Brian Orend What I want to do in this lecture is a little bit different. I want to offer here a piece of advocacy, arguing that health ought to be considered a basic human right. As such, this lecture connects with the human rights material from last week. It also, with its discussions of international institutions and costs, stretches back to our discussions of international law and institutions, as well as reaching forward into coming discussions about international trade, DQG▯GHYHORSPHQW▯DQG▯DLG▯LVVXHV▯▯,▯GRQ¶W▯H[SHFW▯DOO▯RI▯\RX▯WR▯ agree with me, but I do wish to provoke further thought along these lines. There are many links about global public health to the side, and I urge you to consult them for more information. The PBS series on global public health is very good, in particular. 3. Health as a Human Right When we turn on the news each day, it seems we are confronted with yet another health crisis: avian virus (bird flu); SARS; HIV/AIDS; mad cow disease; crises of mass starvation, high infant mortality and easily preventable illness in the developing world; and crises of skyrocketing rates of cancer, heart disease, mental illness and obesity in the developed world. And we all know, from our own personal experience, how everything²absolutely everything²takes a back seat to our health when we fall seriously sick. These facts form an interesting question: should we claim health as a KXPDQ▯ULJKW"▯,▯WKLQN▯WKH▯DQVZHU▯LV▯FOHDUO\▯³\HV´▯▯ though this answer leads to further questions whose answers are not clear but, rather, are complex and contested. The idea that we have a human right to health runs up, immediately, against three potent obMHFWLRQV▯▯▯▯▯WKDW▯WKH▯PHDQLQJ▯RI▯³KHDOWK´▯LV▯KRSHOHVVO\▯YDJXH▯DQG▯FRQWURYHUVLDO▯▯▯▯▯WKDW▯ ZH▯GRQ¶W▯VWULFWO\▯KDYH▯KXPDQ▯ULJKWV▯WR▯DQ\▯VRFLR-economic object, like health care; and 3) 3 INTST 101: Introduction to International Studies Brian Orend even if we did, theoretically, have such a right, implementing it in practice would be ruinously costly, especially on a global scale. Here, I wish to refute these objections and re-assert our human right to basic health care²a right which is presently being unfulfilled for literally billions around the world. 3.1 Answering the First Objection on the Meaning of Health Supporters of the idea that we have a human right WR▯KHDOWK▯FDUH▯VRPHWLPHV▯GRQ¶W▯GR▯LW▯DQ\▯IDYRXUV▯▯ Consider that the constitution of the United 1DWLRQV¶▯ :RUOG▯ +HDOWK▯ 2UJDQL]DWLRQ▯ DVVHUWV▯ WKDW▯ KHDOWK▯LV▯³WKH▯HQMR\PHnt of complete physical and social well-EHLQJ▯´▯2U▯FRQVLGHU▯WKDW▯$UWLFOH▯▯▯▯RI▯ International Covenant on Economic, Social and Cultural Rights claims that everyone has the right WR▯ ³WKH▯ HQMR\PHQW▯ RI▯ the highest attainable standard of physical and mental heaOWK▯´▯ :H▯ FDQ▯ VDIHO\▯ FDOO▯ WKLV▯ D▯ ³PD[LPDOLVW´▯ conception of the meaning of health. But we should reject this interpretation. Why? Because its ultra-ambitious language raises red flags about the actual attainability of this goal. Indeed, under this definition²complete well-being²could any one of us be FRQVLGHUHG▯³KHDOWK\´"▯7KLV▯PD[LPDOLVW▯UHDGLQJ▯LV▯XWRSLDQ▯▯H[FHVVLYHO\▯FRVWO\▯DQG▯▯LQGHHG▯▯ perhaps not even applicable to any one of us. 6XSSRVH▯ZH▯WKHUHIRUH▯ZHQW▯LQ▯WKH▯RSSRVLWH▯GLUHFWLRQ▯DQG▯RIIHUHG▯D▯YHU\▯³PLQLPDOLVW´² indeed, purely negative²definition of health as the absence of disease. This is what the OED does²but then it quite un-KHOSIXOO\▯GHILQHV▯GLVHDVH▯DV▯³DQ▯XQKHDOWK\▯FRQGLWLRQ▯RI▯ VLFNQHVV▯▯ LQILUPLW\▯▯ XQVRXQGQHVV▯ RU▯ GLVDELOLW\▯´▯ :KLOH▯ WKLV▯ GHILQLWLRQ▯ is much less ambitious, it too must be given up. Why? First, it features this totally unsatisfying, and even empty, double-negative at its core, wherein health and disease are merely defined as the opposites of each other. Second, it too is unattainable. After all, if health is the absence of disease, and we have the human right to health, then we have the human right to be free of disease! But suffering from some disease, at some point in life, is probably 4 INTST 101: Introduction to International Studies Brian Orend an inescapable feature of the human condition, and VR▯KHUH▯WRR▯ZH▯FDQ¶W▯DFWXDOO\▯GHOLYHU▯ on the promise. Plus, many diseases are only temporary, or can be lived with in a way ZKLFK▯GRHVQ¶W▯SUHYHQW▯D▯QRUPDO▯RU▯VDWLVI\LQJ▯OLIH▯ What we are left with, I believe, is something like what Daniel Callahan says: that health LV▯³WKH▯UHDVRQDEO\▯JRRG▯IXQFWLRQLQJ²physical and mental²of a normal person within a QRUPDO▯OLIH▯VSDQ▯´▯8VLQJ▯³UHDVRQDEO\▯JRRG´▯LV▯DFKLHYDEOH▯DQG▯PRGHVW▯LQ▯D▯ZD\▯LQ▯ZKLFK▯ ³GLVHDVH-IUHH´▯DQG▯³FRPSOHWH▯ZHOO-EHLQJ´▯DUHQ¶W▯▯$QG▯XVLQJ▯DQ▯DYHUDJH▯SHUVRQ¶V▯KHDOWK▯ and medical requirements over a lifetime to serve as a normative benchmark²as is done frequently throughout the law²is neither too high nor too low a standard and it is concrete and achievable. The reference to good functioning, moreover, adds positive content to the idea of health, improving vastly on the empty double-negative in the minimalist conception and the wildly utopian maximalist one. This is not to say this is a perfect definition, vacuum-tight and totally clear. But, then again, neither are such other concepts as liberty, property, equality and justice. This GRHVQ¶W▯SUHYHQW▯XV▯IURP▯PDNLQJ▯JRRG▯XVH▯RI▯WKHP▯▯RU▯HYHQ▯FODLPLQJ▯ULJKWV▯WR▯WKHP▯▯2XU▯ definition lets us see that the aim of a human right to health is not freedom from disease, much less the attainment of physical perfection. It is about having the opportunity to have D▯ERG\▯ZLWK▯UHDVRQDEO\▯JRRG▯IXQFWLRQLQJ▯IRU▯DQ▯DYHUDJH▯OLIH▯VSDQ▯▯1RWH▯³RSSRUWXQLW\▯´▯ We can only promise an opportunity and not guarantee total success, for three reasons. First, some health conditions are natural and cannot be affected by medical intervention. Second, moral hazard: you might be given this health opportunity but then blow it through your own free choices, such as smoking, drinking, narcotics, over-eating, under- exercising, engaging in extreme behaviour, etc. When rights-respecting resources are VFDUFH▯▯ WKH▯ UHVW▯ RI▯ XV▯ GRQ¶W▯ H[LVW▯ WR▯ VDYH▯ \RX▯ IURP▯ \RXU▯ RZQ▯ EDG▯ FKRLFHV▯▯ 7KLUG▯▯ reasonable burdens. As Judy Thomson points out, none of us has the right to have all and DQ\▯RI▯RXU▯YLWDO▯QHHGV▯PHW▯▯DV▯VRPH▯SHRSOH¶V▯YLWDO▯QHHGV²especially their medical ones² can inflict incredible costs and unreasonable burdens. Think, for instance, of those with catastrophic injuries or those requiring round-the-clock nursing care. We only have the right to ask others, and social institutions, to do their fair share in creating a social 5 INTST 101: Introduction to International Studies Brian Orend context which delivers to everyone equal opportunity to have a body with reasonably good functioning for an average life-span. What will such a social context, concretely, offer to everyone as a matter of right? Five things: 1. The basic package of childhood immunizations. 2. Elementary education on the fundamentals of maintaining decent health: nutrition; proper rest and sleep; hydration; hygiene; exercise; and, as Aristotle would say, a balanced life-style. Health experts speak of the massive gains to global public health from just three measures in particular: 1) training people to wash their hands with soap before they eat; 2) providing potable water to drink to the 2 billion people who lack such access today; and 3) providing people with the minimal calorie intake they need for their stage of growth, which one billion people lack today. (Figures from WHO). 3. Life-saving emergency care efforts. 4. Some kind of continuity of care (minimum every seven years) from a qualified health professional for preventive physicals and to provide a concrete locus of UHVSRQVLELOLW\▯LQ▯▯DQG▯DFFHVV▯WR▯▯WKH▯KHDOWK▯FDUH▯V\VWHP▯▯2QH¶V▯KHDOWK▯FDUH▯SURYLGHU▯ is to: 1) restore one to normal functioning if possible; 2) if that is not possible due to chronic, non-lethal illness, to show one how to manage the condition and live with it; and 3) if that is not possible due to fatal illness, at least to provide some pain relief. 5. All serious efforts at realizing those other KXPDQ▯ULJKWV▯ZKLFK▯DOVR▯LPSDFW▯RQH¶V▯ health, such as: the right to physical security; the right not to be tortured; the right to elementary education; and the right to be recognized as a person before the law. I want to stress here the interconnectedness of all human rights, and the interconnected steps which must be taken if any human right is to be genuinely realized. It is, as John Rawls has said, all about how the basic institutional structure in society is set up which determines by and large whether we get our 6 INTST 101: Introduction to International Studies Brian Orend human rights satisfied. For instance, how many health problems are caused by violence, war and a lack of law and order? How many health problems are caused by simple illiteracy, or by extreme poverty? How many health problems are caused by fundamental inequaliti
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