Health and Human Dignity: an Inseparable PAIR

A few years ago, a homosexual man contracted AIDS in San Francisco. Instead, he decided to forgo the city's excellent health care system and support network to return home to Georgia and live his last days peacefully with his family.

But the family treated him as if he were a public embarrassment. Homosexuality and AIDS were taboo in the town in which they lived, and the family took pains to ensure that the community knew nothing of his existence.

Early each morning, the mother would drive her son to a secluded spot in the woods. She would then walk back home, leaving the sick man languishing in the car for the entire day.

Only at night would she return to drive her son back home, where he was locked in his room with the shades drawn and no phone to communicate with the outside world.

The human rights violations suffered by this man exacerbated his illness, condemning him to an early death.

This was just one of the real life scenarios discussed by academics, government officials, community health workers and human rights activists from all over the world at the first International Conference on Health and Human Rights, held Thursday to Saturday in Cambridge.

The conference, attended by 350 people from more than 25 countries, was sponsored by the Francois-Xavier Bagnoud Center for Health and Human Rights, part of the School of Public Health.

The Bagnoud center, founded in January 1993, is the first of its kind devoted to the field of health and human rights. It was funded by a $20 million donation, the largest ever given to the School of Public Health.

Dr. Jonathan M. Mann, director of the center, said the conference's objectives were to exchange information, educate the participants and build solidarity.

Conference participants discussed such human rights violations as discrimination against intravenous drug users, the removal of organs without full consent and genocide in war-torn countries including Bosnia.

Representatives from several organizations, including Amnesty International, Physicians for Human Rights and the Red Cross also reflected on how attitudes such as homophobia and racism negatively impact general health.

Mann said the field of health and human rights is relatively new and not well-understood by the general public.

The major challenge of the conference, he said, was building a bridge between two fields which traditionally have had so little interaction.

"The conference brings together what have largely been different communities of interest, in the human rights field and in the health field, and opens up lines of communication and opportunities for further relations and developments for the future," said Harvey V. Fineberg '67, dean of the school of public health.

Conference Discussions

Roundtable discussions, speeches, a networking session and classes on health and human rights were held at various locations in Cambridge, including the Carpenter Center for the Visual Arts, Lamont Library and the American Repertory Theater.

"People who are not capable of being tolerant are not healthy. People who are filled with hate are more sick than anybody else," said Slobodan Lang, a professor of public health from the University of Zagreb, addressing one of the plenary sessions.

Kenneth Roth, executive director of Human Rights Watch, talked about how his organization uses shame and publicity to stigmatize human rights violators.

Mann, who is also the first Bagnoud professor of health and human rights, said the energy of the participants was "incredible, up to the very last meeting on Saturday morning."

As evidence of their commitment, Mann pointed to the high attendance at the various conference sessions on Friday despite the torrential rain.

The Link

"Most people in this country are illiterate about human rights," said Mann, who teaches a course on the subject at the School of Public Health.

Adopted by the United Nations in 1942, the Universal Declaration of Human Rights is the central document of the modern human rights movement, Mann said. Though it only mentions the word health once, Mann argued that the entire document can be seen as referring to health.

"The mission of public health is to ensure the conditions in which people can be healthy," Mann said. "Our analysis is that people whose rights and dignity are respected are thereby assured of the conditions in which they can be healthy."

"The promotion and protection of health is inextricably linked to the promotion and protection of human rights and the respect of human dignity," he added.

For example, Mann feels the low status of women in most societies has numerous negative effects on their health. Forced prostitution in Burma and female genital mutilation in Africa are but two examples.

"[Women] don't have equal access to care or education, and their dignity is impugned," he said in an interview yesterday. "It's clear that male-dominated societies are a threat to public health.

Mann said that the medical care given by doctors is a "relatively small piece of the health picture."

"In the United States, about one-sixth of the increase in life expectancy since the beginning of this century is due to medical care," said Mann. "The rest is due to the underlying conditions that are actually societal and environmental."

Mann said such societal issues as education, income and jobs were important factors in determining health, as evidenced by the poor generally having shorter lives than the rich.

Social practices--such as alcohol and drug abuse, smoking, reckless driving and lack of seatbelt use--are the "things that account for the major problems of health in this country," Mann said.

A New Approach

Mann says the profound relationship between health and human rights is "revolutionary;" the beginning of a new approach to public health.

"The current approach to public health tends to limit itself to medical type applications--health education, clinics, distributing condoms, immunizations," Mann said. "But if we really want to get to the root problem, we have go beyond that to the central question of rights and dignity."

Four years ago, the School of Public Health became the first institution in the nation to give a copy of the Universal Declaration of Human Rights to their graduates in addition to their diplomas.

Participants' Thoughts

Most of the conference participants said they enjoyed interacting with members of many different professions--lawyers, demographers, social workers and physicians.

"It's different than any other conference I've ever attended," said Dr. Eva E. Metalios, a primary care physician from New York who works in a clinic for immigrants seeking political asylum.

"Most of the conferences that I've been to in my training have been much more medically oriented," she said, during a break between sessions. "This is far more conceptual, far more theoretical, a bit less concrete perhaps than I expected, but I'm really enjoying it and learning a lot."

"I'm very pleased. It has demystified the conservative image of Harvard," said Dr. Cheka Cosmas, a representative of the German Corporation of Technical Assistance in Cameroon.

"This conference has facilitated the coming together of several different disciplines that contribute to making public health what it ought to be," Cosmas said. "Our hope is that in the long run this can be transformed into fact, not only here in the advanced world, but in developing countries."

But Cosmas did have one criticism of the conference.

"The only weakness is that perhaps enough thought was not put into seeing the institutional aspects of real life that make it impossible for certain people to accede to human rights the way they are conceived and understood in the West," he said.

Cosmas feels that dictatorial governments in developing countries have institutionalized poverty, so an "enabling environment" for the enforcement of human rights does not exist.

Mann said that the "sense that you're not alone" in thinking there's an important relationship between health and human rights is probably the most important outcome for the participants.

The next conference is tentatively slated for 1996, Mann said.

"The basic challenge is to see that enough activity is carried out until then, so that the meeting really moves us forward. We're not interested in meeting for meeting's sake," he said.

But for the people out there whose health is affected by human rights violations, the awareness raised by meetings like this may provide valuable support.

Consider the case of an American on vacation in Greece, who fell ill and was diagnosed with AIDS. The major hospitals in Athens refused to accept him into their main wards, and instead shut him in an abandoned old hospital that hadn't been cleaned or used in twenty years. He was quarantined in a single room with just a hole in the floor as a toilet, as doctors waited for him to die, it took the powerful connections of a U.S. senator to convince Greece to allow him to fly back home for proper treatment.

The Bagnoud center may be academic in its approach, but the issue it focuses on is anything but academic.