The Connection With Health

Article 12 of the International Covenant on Economic, Social and Cultural Rights affirms “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” The meaning of this right was further spelled out in the Alma Ata Declaration that emerged out of the International Conference on Primary Health Care in 1978. This international conference was sponsored by Who and UNICEF. It defined health as “a state of complete physical, mental, and social well-being.” Furthermore, the declaration affirmed the principle that “ The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.” Sadly, as David Werner points out in his article Alma Ata and the Institutionalization of Primary Health Care, a variety of economic and ideological factors have largely defeated efforts to implement this right in the real world. Human rights is not one issue among others, but is rather the linchpin with regard to everything that must be put in place if we are to create a healthy future for our children. The various rights that are addressed on this page are all seen as necessary, or supportive to our central concern, the right to health.

Key Issues

“Positive” and “Negative” Human Rights

The tenets laid down in the Universal Declaration of Human Rights of the United Nations seem self evident and non-controversial. Who is going to argue that the basic human rights to life, liberty, freedom of thought and speech, education, health and welfare should not be supported by every government? Yet the declaration was controversial – so much so that it was not able to muster the unequivocal international support that would enable it to become a binding treaty. The reasons for this difficulty are instructive.


If one examines the Declaration, one can see that there are two kinds of rights that are discussed. Although any right can be stated in either negative or positive terms, it still make some sense to refer to these two types of rights as negative and positive. The negative rights basically have to do with the right to be left alone by the government. The idea here is that so long as I am not infringing on the rights of others, what I do or say is not the government’s business. The negative rights are put in place to protect individuals from the unwarranted intrusion of the government.

Positive rights, on the other hand, have to do with what the government is expected to provide to the citizens under its jurisdiction. The right to at least an elementary education is perhaps the most universally agreed upon positive right. But many people feel that people have a right to health, to a clean environment and to all the physical necessities for a tolerable life.

That all human beings have a right to health is a core belief of the Politics of Health web page, and of its parent organization, HealthWrights. Therefore we naturally support the UN in its various affirmations of this positive right.

It was around the issue of positive and negative rights that the controversy about the Declaration emerged. In general, capitalist nations favored the negative rights, and were skeptical about the positive ones. Many of the leaders in capitalist countries, and especially in the Uniter States, felt that one could easily go too far in guaranteeing positive rights. They felt that too much emphasis on positive rights could lead to the creation of welfare states – which they opposed, largely on ideological grounds.

The socialist countries, on the other hand, did want to emphasize the positive rights. Their leaders felt that the right to free speech and to do as one wished was fairly meaningless to a person who did not have enough to eat or who was plagued by chronic pain and ill health. In some cases Socialist leaders seemed willing to sacrifice civil liberties (negative rights) in order to protect a system of government that recognized people’s rights for health and welfare.

In order to resolve this controversy between negative and positive rights, two international conventions were created. One, the International Covenant on Civil and Political Rights, emphasized the negative rights, and the other one, the International Covenant on Economic, Social, and Cultural Rights, highlighted the positive rights. These documents established treaties that were considered binding on the nations that ratified them. In this way the legal basis for an international political order, based on the principle of inalienable rights, was established.

Negative and the positive rights are like two wheels on a bicycle. Both are equally needed. Both the UN covenants are equally important.

While it remains a difficult task to implement these principles in practice, a great step forward was taken with the establishment of an international consensus that the protection of human rights should be the cornerstone of all international treaties and the guiding principle in all the affairs within and between nations. The “two wheels” of the UN Bill of Rights are elegant and inspiring documents, as are the additional covenants that were added in time that addressed children’s rights, women’s rights, racial discrimination, genocide and other issues. Yet, there are concerns that require further reflection. One of these has to do with the question of children’s rights.

Children’s Rights

The International Covenant on Children’s Rights states that “the child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth.”

In so far as the principle of “special safeguards” provides a basis for assuring that a child’s “positive” rights for food, health, education and the like are adequately provided for, it is clearly a positive assertion. However, without significant institutional changes with regard to the delivery and availablity of health and wellfare services, for many people these will just be paper rights.

As one looks through the rights that are to be guaranteed to the child, it appears weak with regard to the negative rights – the right to be left alone, to have one’s own thoughts, to select one’s own religion, and to select one’s own educational program and have a real voice in shaping the one that is chosen – these kinds of rights are not emphasized.

In Article 12, section 1, the Covenant states that “States Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child.” In Article 13, part 1, we read that “The child shall have the right to freedom of expression; this right shall include freedom to seek, receive and impart information and ideas of all kinds, regardless of frontiers, either orally, in writing or in print, in the form of art, or through any other media of the child’s choice.”

These articles express good, progressive sentiments and are certainly laudable. Yet a few sentences farther down in Article 13 we find that “the exercise of this right may be subject to certain restrictions.” A number of restrictions are mentioned but the central one is that the signers of the covenant “shall respect the rights and duties of the parents and, when applicable, legal guardians, to provide direction to the child in the exercise of his or her right in a manner consistent with the evolving capacities of the child.”

“A “child” it must be remembered, is defined as anyone under 18 years of age, unless it is otherwise designated by any specific country. So parents and other authorities are able to determine when, and to what degree, a child is ready for the exercise of his or her rights. Children have, in other words, only those negative rights (or civil liberties) that are delegated to them by the authorities who have jurisdiction over them – which in practice means almost no rights at all.

Undoubtedly the covenant went as far as politically practical in affirming the civil liberties of children. Yet if the goal is to raise individuals who will be able to participate meaningfully in democratic life, it would not seem that raising them up to the age of 18 with virtually no civil liberties guaranteed to them would be the best way to go about this. Children know what they need from birth. One does not see healthy infants turning away from an offered breast, for example. And they know who they love and who they feel loved by, and hence, they know with whom it is best for them to live. They know what interests them and what they like to do. They naturally seek out information and guidance from adults when they feel the need for it.

Perhaps children should be granted civil liberties that are essentially commensurate with those of adults. The one legitimate qualification on children’s civil liberties might be that they should be prevented from behaviors that are clearly and demonstrably dangerous to their physical well being. They might be required to take vaccinations when they saw no need of doing so, and be prohibited from swimming in dangerous waters. But the burden of proof for showing that something actually was dangerous would always be with those wanting to limit the choices of the child.

Even if our practice lags behind our theory, we have gone a long way in affirming the rights of all people regardless of sex, color, religion, national origin and disability. But children still live with almost no civil liberties. Perhaps in our quest for a truly liberated and free society, this is the next frontier that needs to be explored.

Rights and Morality

Whether dealing with children or adults, all of the the UN rights covenants support the idea that there are circumstances when most, but not all, human rights might be set aside. The general nature of these circumstances is defined in a noteworthy recurring phrase. This or that right “may be subject only to such limitations as are prescribed by law and are necessary to protect public safety, order, health or morals, or the fundamental rights and freedoms of others.”

Certainly some limitations must be imposed upon people so that they do not infringe on the rights and freedoms of others. But the inclusion of the word “morals” in this list is curious. On the face of it, it would seem difficult to argue against the inclusion of this word. Who, after all, wants to support immorality? But suppose the religious and secular authorities consider it immoral for a child to masturbate, or for a woman to show her face uncovered in public, or for a person of low cast to come into contact with a person of high cast, or for someone to smoke marijuana, or for two men to get married. In none of these cases is an individual infringing on the rights or freedoms of someone else. Yet in the name of a morality that designates no victim with regard to these “immoral acts,” they have all been proscribed by law in various societies. Does it not suffice that society should act to protect the tangible rights and freedoms of others? Beyond that should not personal morality be a matter for the individual to choose for him or herself?

Inalienable Rights

An interesting feature of the various UN rights documents is that they distinguish between rights that can be set aside under certain prescribed circumstances and those that are non-alienable even in extreme circumstances. Among those rights that are considered to be inalienable in all situations are the right to be free from genocide or torture, the right to not be discriminated against on the basis of religion, sex, color etc., the right to not be killed in a genocidal attack on one’s people, and the right to have one’s own opinions. To have this principle of inalienable rights clearly stated in binding international treaties represents an important step in the evolution of human society.


While the United States has always been lukewarm in affirming the positive rights of its citizens, historically it has been, at least in principle, if not in fact, a strong advocate for the negative rights. For this nation to now endorse torture as an acceptable part of its foreign policy is an unprecedented admission of barbarism. As the article, The US has used torture for decades, makes clear, all that is really new is the open acknowledgment that torture has long been condoned by government officials from the very top. Perhaps now that Americans can no longer pretend to themselves that torture is contrary to the real American values, some soul searching may take place, and the government may actually be forced to stop the practice.


One of the most important of the United Nations Human Rights Agreements is the Convention Against Genocide. One would like to think that genocide is so unthinkable that such an agreement would be unnecessary. But the many examples of genocide in the 20th century make it clear that this is not the case. Unfortunately the practice of genocide is continuing into the new century, as we see in the Darfur region of Sudan. Some have also labeled the US destruction of Falluja a an example of genocide.

The health impact of active forms of genocide are pretty much self-evident. Not only are there the deaths and injuries from the actual attacks, but one also finds that health issues are created from the destruction of infrastructures and from the creation of refugee groups.

A second form of genocide may be responsible for creating health problems that are even greater in scope that the active attacks one usually thinks of as genocide. This is when the countries in the world who are in position to prevent diseases, poverty or genocide stand by and do nothing. This could be called “passive genocide.” The inadequate response to the AIDS problem in Sub-Saharan Africa, the refusal to allow desperately poor countries the debt relief they need in order to address their health and welfare problems, preventing war torn countries from re-creating their infrastructure as in Iraq during the last decade of the last century, and the refusal to deal with the genocide in Sudan in an aggressive manner would be examples.

The causes of either active or passive genocide are varied and specific to each situation. One possible causative factor that may be frequently overlooked has to do with the attitude of the wealthy nations toward the Third World. With the carrying capacity of the earth already strained, many wealthy people and countries could well see events that thin out the population in underdeveloped regions as a boon, in much the same way as the Puritans who settled the North America saw the hand of God in the diseases that decimated the Native American populations.


It would almost seem that a society cannot survive without selecting a scapegoat as a means of maintaining unity in the face of diverse and sometimes conflicting groups. Targeting a scapegoat is a way of saying “we may disagree about this or that, but at least we are all in agreement that these people are scum.” The negativity that might threaten the fabric of society can then be re-directed to the scapegoat. One hopes that a more civilized means for attaining a reasonable degree of harmony in a culturally diverse society will be found. For a more complete discussion of the “benefits” of scapegoating see the article “A Tough Weed to Uproot”. The main scapegoat in the United States for a couple of decades now has been the “sex offender,” or more specifically the “pedophile.” The article “Sexual Fascism in Progresive America” is an eye-opener for people who feel that the mainstream press has been presenting an objective and balance picture of this issue.

Connections With Other Issues

From a logical point of view, the entire POH page could be organized as sub-topics of Human Rights. Every topic could be framed as a rights issue. Here we simply point out some of the more obvious connections:Access to

Access to resources and Services

If health for all, the ultimate goal affirmed in the Alma Ata Declaration is to become a reality, then access to needed health and welfare services must be treated as t right – not as privilege.


As the Alma Ata declaration made clear, people not only have the right to health, but the right to participate in the planning and implementation of the health care system. This is an important aspect of the larger right to participate meaningfully in all the decision making patterns of ones social groups.


The simple right to be different, whether by choice, by birth, or by accident, without being discriminated against by society has to be diligently defended in democracies as well as in authoritarian states.


Not only is the health of individuals obviously connected with the right to a clean environment, the health of the whole biosphere depends on it.


The right to an appropriate education is one that few would deny in principle. However, the right to participate actively in the development of one’s own educational plan as well as in the planning and implementation of the educational system as a whole is not generally recognized. It remains difficult for adults to see children as people who also have rights.

Free Speech and the Media

The right to express one’s own opinions and to hear the opinions of others, is a critical factor for a democratic society in which people can participate meaningfully and effectively in the planning and implementation of health services.

Global Economics

The right to a livelihood – on that pays a living wage – is crucial for the health of both adults and their children.

What Can Be Done?

We naturally feel somewhat overwhelmed with the immensity of the Human Rights problems that face us today. This feeling of being overwhelmed can easily lead to paralysis. But there are things that can be done.

Perhaps the first two things that are needed to energize ourselves for the task that lays ahead of us have to do with shifts in our our perceptions more than with action in the world.

First, it is important to realize that despite all the ongoing egregious examples of human rights violations, a great deal of progress has been made. There is a general consensus in the world today on a number of points. Slavery is not OK. One nation does not have a right to rule other nations for its own advantage. Children have a right to education, to the basic physical needs for survival, and for health. All human beings have a right to due process before the law. These and many other rights are taken for granted in most political discussions. This was not always the case.

Furthermore the basic rights of humanity have been expressed in eloquent language in treaties that are binding on all nations.

The evolution of human society is not an automatic process; it requires the dedication and hard work of many people who are able to envision a freer, more equitable and more caring way of being together in the future. Experience tells us that progress occurs at a slower rate and at a greater cost than any of us would like to believe. Even so, progress is not only possible, but it is a reality. If we look back over a period of a century or two, we can see that huge gains have been made. With hard work, perseverance, creative thinking and well considered non-violent strategies, it can be expected that equal gains will be possible in the future.

A second attitudinal shift that might help motivate us for the hard work that lays ahead has to do with our perception of the issue of human rights. We not only want to survive as a human race, but we want to survive with a way of life that is worth living that is available to everybody.

Anarchists have pointed out that with very few, and for the most part transient, exceptions, governments have always supported the special needs of the elite few at the expense of the majority. The solution they prescribe is, therefore, the abolition of government itself. One has to have sympathy for their vision of a free and equitable society, and acknowledge the justice of their observations about the history of governments. But their prescription would seem to be both naive about human nature, and unrealistic with regard to the complex needs of modern society.

Experience suggests to us that without effective limits being placed on some individuals, those who are able to make the most plausible threat of violence tend to move into positions of power and control. We need governments that are able to curb those who might violate the freedom and the rights of others. But we must not be naive about government itself.

Governments easily become instruments of oppression. Therefore we need governments on all levels – local, national and international – that are firmly grounded in an unshakable commitment to Human Rights.

When we see that human rights is not one issue among others, but is rather the linchpin with regard to everything that must be put in place if we are to create a worthwhile future for our children, we become energized for the task.

But of course, a shift in attitude will not by itself change the world. Action is required. Perhaps the most important action is to insist upon an in depth discussion of the issues on all levels of society. We need to become informed ourselves, through reading, and then initiate dialog wherever possible. Dialog may be provoked by a wide range of activities –discussions with friends, letters to the editor, communications to our representatives making them aware of our concerns, or even writing articles or books.

Then, perhaps, we might choose a specific rights issue that seems especially cogent, or for some reason is of special interest to us, and take the trouble to become informed in depth about that issue as a preparation for more extensive political action. The Wikipedia article on Human Rights ends with a list of human rights organizations. After reading that article one might wish to select an organization that focuses on an issue of particular interest, and support that organization in whatever ways might be possible. Most human rights organizations provide very concrete suggestions as to how a person might help out. The fact that I cannot do everything should not be a reason for my doing nothing.