University of Alberta Visiting Lectureship in Human Rights
April 7th 2008
Although it is recognized in the Universal Declaration and enshrined in legally binding international human rights treaties, the right to health still does not carry the same currency as the right to freedom of expression or the right to be free from torture. I can tell you that for millions of people around the world, health is perhaps the most valuable of all human rights. It is inseparable from the right to life and security. And it is women, children and marginalized populations that continue to suffer by far the worst deal.
Mary Robinson, April 2nd, 2008
Mary Robinson
Ladies and Gentlemen, It is an honour for me to take part in this visiting lectureship series in Edmonton. I would like to thank Chancellor Eric Newell, the Stollery family and all of our hosts at the University of Alberta. I first visited this city in 1998, when I was UN High Commissioner for Human Rights, and had the pleasure of speaking at a conference hosted by the Canadian Human Rights Foundation and the University of Alberta, together with Archbishop Desmond Tutu and the late Supreme Court Chief Justice Antonio Lamer. I also had the pleasure of visiting the First Nations communities at Hobbema, at the invitation of Willie Littlechild, who many of you will have heard deliver last year’s visiting lectureship in human rights. I am pleased to be back here today as one of the Elders. We came together as a group last year under the inspiration of Nelson Mandela and Graça Machel, and with Archbishop Desmond Tutu’s chairmanship, to speak freely on global issues and respond to conflict situations, working publicly and behind the scenes on whatever actions need to be taken. Archbishop Tutu delivered the first annual visiting lectureship here in Edmonton ten years ago, during the 50th anniversary of the Universal Declaration of Human Rights. It is fitting for us to reflect today, as we approach the 60th anniversary, on the enduring relevance of the values and principles that underpin the Universal Declaration. These are the values and principles that we, as Elders, are convinced must guide us through major global challenges towards equitable solutions. We see the 60th anniversary of the Universal Declaration as an opportunity to encourage a global conversation on human rights – to try to inspire new visions and actions, building on the best traditions of the past. We hope to encourage individuals and communities, not just governments, to sign the Declaration and live by its principles. This is why we launched the Every Human Has Rights campaign last December, in partnership with a diverse group of global organizations and businesses. Each month throughout the year, we highlight a specific area of the rights contained in Universal Declaration. You can find out more about the campaign at www.everyhumanhasrights.org. It is our hope that the 60th anniversary will help to give the spirit of the Universal Declaration new energy and make it a living document for everyone.
As the University celebrates its 100th anniversary, I have no doubt that he would be impressed with the way in which his vision has been carried forward. My remarks this evening will focus on the enduring significance of the full spectrum of rights reflected in the Universal Declaration, and in particular on the importance of economic, social and cultural rights - rights that, in my view, continue to be severely neglected. Now, some of you might wonder about the relevance of the Universal Declaration to today’s reality. I would encourage you to read the text: you may be struck by how it resonates with the issues we face today, nearly six decades after its adoption. The full implementation of the human rights reflected in the Declaration remains a serious challenge. Looking back to 1947 when the Declaration was drafted, the world was reeling from the unprecedented suffering brought about by a devastating war, the first use of nuclear weapons and the horrors of the Holocaust. Fifty-five million people had lost their lives and many more lives were altered forever. And yet the horror of that war provided the impetus for a new era in international human rights, as people were searching for common threads that would bind nations together and increase human security for all. The newly constituted UN Commission on Human Rights set to work in preparing a declaration which would be the foundation of an international bill of rights. Eleanor Roosevelt and other members of the Commission worked closely with Canadian John Humphrey, the Director of the Human Rights Division at the UN Secretariat, to produce a draft, which Roosevelt hoped would become an international Magna Carta. In December 1948, the United Nations General Assembly adopted the Universal Declaration of Human Rights “as a common standard of achievement for all peoples and all nations”. The adoption of the Declaration is testimony to the resilience of the human spirit and the strength of the ideals that underpin human rights. Today, the world remains marked by divisions and gripped by fear. The real and perceived threat of terrorism continues to preoccupy governments, communities and households around the world. Civilians, including relief workers and journalists, increasingly are the target of violent attacks during conflict, with the rise in suicide attacks a particularly alarming manifestation of this. Some 35 million people caught up in armed conflict have been displaced from their homes and communities. We need only to consider the conflict in the Democratic Republic of Congo, which alone has claimed more lives than any conflict since the end of World War II. An estimated five million people have died in the DRC since 1996, many by starvation or preventable diseases. Women, in particular, have suffered indescribable violence and indignity. Gender-based and sexual violence has become a routine weapon of war, and the statistics stagger the imagination: according to the UN, in 2006 more than 27,000 cases of rape and sexual violence were registered in the province of South Kivu alone. It is difficult to comprehend the impact of this horrific violence on the lives of the women and girls affected, and destruction it wreaks on the social fabric of their communities. In Darfur, the conflict that started five years ago continues to rage and has spread to neighbouring Chad, as hundreds of thousands of refugees struggle to escape unspeakable brutality. I visited the camps in Eastern Chad last September as part of a group of women leaders from Africa, Europe and the United States. We met refugees from across the border in Darfur, as well as local Chadians who had been forced from their homes by the spiraling violence. I heard stories of unimaginable suffering from the women there that still haunt me. The absolute priority of everyone we met was security, for themselves and their families. These brutal realities, and the changing, more interconnected world we live in, are what make respect for the rule of law and human rights so crucial today. They also underscore the intrinsic link between civil, political, economic, social and cultural rights, for it is often systematic discrimination and inequality in access to land, water or food, health care, or housing, for example, which lie at the root of social tensions and conflict. Standing up for human rights and the systems which have been built to uphold them, requires, I believe, not only holding fast to long-standing national and international obligations but also thinking in new ways about what human rights implies at home and for people around the world. It also requires an appreciation of security which is grounded in a holistic understanding of human rights, one which adheres to the vision set out in the Universal Declaration for “the advent of a world in which human beings shall enjoy freedom of speech and belief and freedom from fear and want” as our highest common aspiration. This means protecting people from the threat of violence, alleviating the suffering of those who find themselves in the midst of brutal conflict, and holding those responsible to account for abuses. It also means addressing the massive inequities related to poverty, which is itself the source of great insecurity for one-fifth of the world’s population, the majority of whom are women. Millions of people living in poverty are denied access to even the most basic health services, adequate housing and food. Over a billion have no access to clean water and sanitation. Every day 6,000 girls and boys die from diseases linked to unsafe water, inadequate health and poor hygiene. In many places, climate change is compounding these socio-economic challenges and further impeding the fulfillment of human rights for the poor. Last November I co-hosted the International Women’s Leaders Global Security Summit, where Sheila Watt-Cloutier presented very passionately the reality of climate change for the Inuit population across the Arctic. These all are challenges to human security, development and well-being. They are human rights crises which require our urgent attention. While its drafters could not have predicted the challenges we would face in this globalized world, the Universal Declaration provides a framework for addressing them by recognizing that the “inherent dignity of all members of the human family is the foundation of freedom, justice and peace in the world”. It affirms that fundamental rights and freedoms are inalienable and inherent to all human beings and, significantly, captures the full range of human rights, from the right to life, liberty and security of person, to the right to an adequate standard of living, including food, health and housing. Since its adoption, the Declaration has become the touchstone for international human rights law, its universal significance reaffirmed on countless occasions. It has provided the framework for a series of international human rights treaties and the inspiration for regional human rights treaties and national bills of human rights, including the Canadian Charter of Rights and Freedoms. Today Alberta is celebrating the tenth anniversary of the Canadian Supreme Court’s decision in the Delwin Vriend case, a landmark judgment which resulted in changes to Alberta’s human rights legislation to include protection against discrimination on the basis of sexual orientation. Social justice victories such as the Vriend decision would not have been possible, I would argue, without the foundation laid by Eleanor Roosevelt, John Humphrey and the other champions of the Universal Declaration sixty years ago. Yet in spite of the widespread acceptance of the Universal Declaration, the rights it encompasses have not always been given equal recognition in practice. In the years following the adoption of the Declaration, Cold War political realities and ideological differences led to an awkward categorization of civil and political rights, on the one hand – rights which tended to be favoured by Western societies – and economic, social and cultural rights on the other. These differences eventually led to the adoption in 1966 of two separate treaties – the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights - rather than of a single treaty guaranteeing all human rights. Many considered economic, social and cultural rights to be lofty aspirations rather than the source of any legal entitlement. Some believed that civil and political rights required fewer resources and were more easily implemented, or that the fulfillment of economic, social and cultural rights was unattainable or, at least, somehow a less pressing objective. Today we have moved well beyond these categorizations. The indivisible and inter-dependent nature of human rights is as widely recognized as the links between security, development and human rights. Economic, social and cultural rights are enshrined in legally binding international and regional treaties, and in domestic constitutions and laws, alongside civil and political rights. There is a greater understanding of the principle of progressive realization, which has helped to dispel some of the misconceptions around the way in which economic, social and cultural rights are to be implemented. This principle recognizes that, particularly in resource-poor countries, human rights related to education, health, food and housing may only be achieved over time. Nonetheless states have an obligation to undertake all appropriate means towards the implementation of these rights, within the maximum extent of their available resources - including through international cooperation and assistance. This week in Geneva, governments are negotiating an optional protocol to the International Covenant on Economic, Social and Cultural Rights, which will make it possible for individual, groups or organizations acting on their behalf to seek justice at the international level for violations of economic, social and cultural rights. A similar complaints mechanism to the International Covenant on Civil and Political Rights was adopted in 1966, and complaints brought through this procedure have resulted in important policy changes in countries around the world, including Canada. The adoption of a comprehensive optional protocol would help correct the historic imbalance and contribute to the greater recognition of economic, social and cultural rights in domestic law and before courts. There are also other, equally important ways to promote the full spectrum of rights reflected in the Universal Declaration. I founded my own organization, Realizing Rights, in 2002 as an initiative that would help illuminate the ways in which governments, the private sector and others could promote human rights - particularly economic, social and cultural rights - to better address pressing global issues. It was particularly important to do this in response to the concern that many individuals, communities, and even whole countries, were losing out in processes of globalization. We wanted to give particular attention to Africa – the region that has been most excluded from the potential benefits of increased connections between societies. One of our priorities has been to work with others to help redress the glaring inequalities in health. Our efforts have been given new impetus this month as The Elders have decided to focus the month of April on the right to health as part of the Every Human Has Rights campaign. Now some may not think of health as a human rights issue. Although it is recognized in the Universal Declaration and enshrined in legally binding international human rights treaties, the right to health still does not carry the same currency as the right to freedom of expression or the right to be free from torture. I can tell you that for millions of people around the world, health is perhaps the most valuable of all human rights. It is inseparable from the right to life and security. And it is women, children and marginalized populations that continue to suffer by far the worst deal. There are valuable lessons to be learned from early efforts to address HIV/AIDS as a human rights issue. One of those key insights is the importance, in very practical terms, of recognizing health is a human right; a right possessed in equal measure by the world’s wealthiest and its poorest, by its most advantaged and its most marginalized and dispossessed. A human rights analysis has informed and strengthened public health responses by highlighting the discrimination and inequalities that fuel the spread of HIV. The recognition of access to life-saving treatment as a right has played a key role in scaling up access to antiretrovirals – and about 2.5 million people are now accessing ARVs, up from around 100,000 in 2001. We know now that addressing HIV requires an understanding and honest discussion of its social and cultural dimensions, including issues of sexuality and reproductive rights, gender inequalities, and sexual violence. The crucial link between health and human rights is clear as we consider other global health challenges. Reproductive health problems are the leading cause of death for women of reproductive age in developing countries. Yet it is socioeconomic inequities – not a lack of medical solutions -- that determine which women live and which ones die. For example, the number of women who die from pregnancy-related causes each year is over 500,000, while globally more than 300 million women live with illnesses due to pregnancy or childbirth. 99 percent of maternal deaths occur in developing countries. The differences between rich and poor countries are startling. Consider that the lifetime risk of death from pregnancy-related causes in Canada is around one in 11,000, while in Afghanistan and Sierra Leone the number is one in eight. Even within wealthy countries, the inequities are revealing. According to the Society of Obstetricians and Gynecologists, Canada's average maternal mortality masks big regional variations and the reality for women in some rural and remote areas, particularly aboriginal communities, is disturbing. When we break the figures down, it is clear that survival rates for pregnant women depend largely upon the distance and time a woman must travel to reach skilled emergency medical care. According to the United Nations, the factors that increase the risk of maternal death relate to delays in seeking care, for example when a women must get permission from male family members to travel; delays in reaching an emergency care facility due to lack of affordable and available transportation; and delays in receiving care from providers, when facilities lack sufficient staff and equipment, or care is unaffordable. Maternal mortality rates could be drastically reduced by improving women’s access to comprehensive reproductive health services and promoting sexual and reproductive health education. The statistics reflect gross inequities between rich and poor. For the women affected, they also represent a serious infringement of basic human rights, including the right to the highest attainable standard of health. But they mask a much wider societal impact. More than a million children are left motherless every year. Newborns whose mothers die preventable deaths are three to ten times more likely to die before the age of two than those whose mothers survive. Girls who are orphaned often are pulled out of school to fill the role of caregiver to other family members. This is why UNICEF refers to the ‘double dividend’ of gender equality, one that benefits women and children both – and, indeed, society at large. These ongoing global health challenges are even more daunting when we consider the health systems and human resources available to meet them. Imagine living in a country like Malawi, in which you share your doctor with 50,000 others. According to the WHO, people in 36 countries in Africa live a similarly grim reality. Africa faces a shortage of 800,000 doctors and nurses, and currently trains only between 10 and 30% of the skilled health workers required to meet ongoing need. With ageing populations, industrialized countries too are suffering a shortfall while the demand for health services is on the rise, a trend which is driving up demand for trained hospital and clinic staff. Africa loses 20,000 trained health professionals every year to migration - this in a continent that already manages 25% of the global burden of disease with only 3% of the global health workforce. Many health professionals trained in low-income countries leave their home in search of better working conditions, often driven by political instability and conflict. They move from poor rural regions to urban centres and from there, migrate to higher-income countries like Canada. The result is that wealthy countries reap a benefit while poorer countries that provided financing for education and professional training lose a return on their investment. But there are deeper societal impacts in many countries, where the net loss of health workers can result in the near-collapse of already fragile health systems. Without a strong and effective human infrastructure, health systems will never be able to tackle crippling diseases or achieve national and global health goals. At the beginning of this century all governments pledged through the UN Millennium Declaration to reduce child mortality, improve maternal health, combat HIV and AIDS, malaria and other diseases, and develop a global partnership for development. More than half way toward a 2015 target date for the Millennium Development Goals, many countries are nowhere near meeting these goals. According to the WHO, 4.3 million more health workers are required globally to achieve the health-related MDGs. This week my organization, Realizing Rights, together with the World Health Organization and the Global Health Workforce Alliance, launched a worldwide virtual discussion on the challenges raised by health worker migration. For the next three weeks, participants in countries from around the world can contribute to a global dialogue on:
There are other concerted efforts being made at global and national levels to address health systems weaknesses and support the development of equitable, integrated health systems. Donor and recipient countries have committed to enhancing development cooperation and ensuring that solutions are country-driven, aligned with national plans and strategies, and results-oriented. Global partnerships such as the GAVI Alliance, of which I am a Board member, have generated critical opportunities for addressing health system weaknesses in countries where support is most desperately needed. GAVI support is helping developing countries to address health system weaknesses such as coordination and management, logistics, transport, health information systems and human resource issues - including basic and continuous education, salaries, infrastructure and cold chain supplies - through long-term and predictable financing. Uptake for this support has far exceeded expectations, and is increasing. Canada also has shown leadership by partnering with UNICEF and others through the International Catalytic Initiative to Save a Million Lives, which will help build the capacity of national health systems to deliver essential primary health care services for children and pregnant women to combat preventable childhood diseases, and support community-based education initiatives. A great deal more needs to be done towards the realization of the right to health, including new policy efforts to craft mutually responsible health-worker migration policies between sending and receiving countries which involve processes for the ethical recruitment of migrant health workers, reduced dependency on migrant health workers in industrialized countries, and improved conditions for health workers. Let me be clear: I am not suggesting that human rights will provide the solution to these massive and complex challenges. But human rights can, and must, be the compass that provides the moral, ethical and legal guidance to effective responses at every level. By placing individuals and communities at the centre of health systems, focusing attention on marginalized and vulnerable populations, and holding governments and other actors to account, human rights provide a powerful standard by which to ensure the development and implementation of equitable health policies, strategies and systems. Although the problems are daunting, the elements of a human rights response are straightforward and the potential for positive change is enormous. The challenge lies in galvanizing the resources and political will to ensure that the principles that underpin the right to health are met in practice. Here, I will highlight just a few. Participation and empowerment are central to the right to health. Individuals and communities must be engaged and involved in health policy decisions that affect them. This can be directly or through elected representatives and civil society organisations, particularly movements and organisations representing marginalised groups. Tanzania is one example of where such engagement is happening. Health sector donors have initiated a joint support mechanism for a network of health NGOs to allow them to examine the extent to which increases in resources for the heath sector are benefiting marginalised groups. This has allowed the network to undertake research, gather evidence and carry out analysis to support their policy positions on the health service needs of the poorest and most vulnerable. Their evidence-based contributions to policy dialogue have an increased value and legitimacy. A second element involves priorities: there must be a profound shift in the priorities that shape policies and resource allocations globally, nationally and locally. For example, health systems must be sufficiently resourced to respond to the health needs of women and girls through long-term, sustained investment. Support for the research, development and equitable distribution of technologies that will benefit women’s health must be prioritized. Cervical cancer is just one example. Although we have the tools to prevent this terrible disease, it affects an estimated 500,000 women each year and leads to more than 250,000 deaths – the vast majority in developing countries. Most women affected do not have access to local health systems or routine gynecological care, including regular HPV screening which plays a critical role in preventing cancer in industrialized countries. The availability of HPV vaccines has created a unique opportunity for a new, life-saving vaccine to be introduced simultaneously in the North and the South. Much more should be done to encourage the international support necessary to make these new life-saving tools available as soon as possible to the girls and women who need them most, and to ensure that robust health systems are in place to support their delivery. Third, human rights are about accountability, not charity. Individuals should expect that their governments will be accountable for policy decisions that have an impact on human rights, including the right to the highest attainable standard of health. This means that States must adopt and implement laws and policies that strengthen health systems, foster gender equality and improve women’s health. And finally, human rights are everyone’s responsibility. The Universal Declaration states that "every individual and organ of society ... shall strive ... to promote respect for these rights ... and by progressive measures ... secure their universal and effective recognition and observance". While human rights are primarily the responsibility of government, their fulfillment also depends upon the actions of individuals and communities, the private sector, international organizations and religious leaders. There are countless examples of the difference individuals are making in communities around the world, and we are profiling their initiatives as part of the Every Human Has Rights campaign. They are people like Sakena Yacoobi who, after receiving a master’s degree in public health in the United States, returned home to bring quality educational opportunities and basic health services to women and children in Afghanistan. Her organization, the Afghan Institute of Learning, was the first to offer human rights and leadership training to Afghan women, the first to open women’s learning centers, and the supporter of 80 underground schools for 3,000 girls when the Taliban closed girls’ schools in the 1990s. The group serves 350,000 women and children in Afghanistan and Pakistan. Yacoobi travels internationally to focus attention on the need for women’s rights to education and healthcare in Afghanistan. Afghan women, Yacoobi says, “come into our programs with nothing and they leave with, not only an education and income-generating skills to help provide for their families, they leave with hope in their hearts and a healing in their souls”. As we approach World Health Day on April 7th, let us call on all countries to help move us towards a future where basic access to health care, with a robust health workforce as its anchor, is a human right enjoyed by all women, men and children. And throughout the year, as we celebrate the Universal Declaration’s sixtieth anniversary, let’s embrace its values and goals, challenge ourselves to give its spirit new energy and make the Declaration a living document for everyone. As Elders, we hope that 2008 can be the year that individuals, not just governments, sign the Declaration put its principles into practice. We’re hoping for one billion signatures from across the world. I hope yours will be among them. Thank you. Related Links:
|
The tenth annual University of Alberta Visiting Lectureship in Human Rights was delivered by Mary Robinson, on April 2nd, 2008. The Visiting Lectureship in Human Rights was inaugurated in 1998 by Archbishop Desmond Tutu to provide a means to further learn about and discuss human rights issues.
Tenth annual University of Alberta
