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	The Evolution of the Right to Health in the Shadow of COVID-19 by Lisa Forman, Chris Beyrer Harvard FXB: Health and Human Rights Journal   The Evolution of the Right to Health in the Shadow of COVID-19, by Lisa Forman. (Extract)   As I write in early April 2020, extraordinary lockdowns and isolation measures affecting billions of people worldwide are in place to stop the explosive spread of the corona virus. The scale and impact of these measures are such that health and human rights scholars will likely be exploring their legitimacy, necessity, duration, and proportionality for years to come.   Some on social media are suggesting these steps show that for once policy-makers have placed health above the economy. But the rampant global spread of COVID-19 is likely a result of many governments reluctance to take the necessary steps at a far earlier stage, because they did not want to spook markets.   Those steps would have included wide-spread testing, contact tracing, and more adequately preparing health care settings for COVID-19 patients. Health care systems throughout Europe and North America are already struggling to mount adequate public health and clinical responses, with facilities overwhelmed, basic testing and protective gear in short supply, and care triaged to those with the best chance of survival.   These failures are exposing deep vulnerabilities and inequities within universal health care systems in high-income countries, raising tremendous concerns about what this pandemic will mean for health systems in low and middle-income countries and for the roll-out of universal health coverage (UHC).   In many respects, this pandemic is deepening crises of social, economic, and health inequities created by decades of neoliberal economic supremacy.   The neoliberalism which was only nascent 25 years ago now dominates global decision-making, manifesting in reduced health spending for all countries (including under austerity) and the growing deregulation, privatization, and commodification of health care like other social sectors.   These tensions play in relation to interpretations and implementation of UHC, in particular between whether to focus on strengthening comprehensive health systems or support discrete, vertical, selective pro-poor interventions.   Many health and human rights scholars had already been contemplating critiques that a right to health that did not directly address these conflicts risked becoming a 'handmaiden' to a neoliberally-inflected global health policy which reinforced rather than remediated health inequities.   Such tensions are being brought clearly to the surface during this pandemic which is ravaging economies, and exposing the inadequacies of universal health care systems, social safety nets and precarious employment.   Indeed, just as HIV/AIDS did, COVID-19 is exposing the fault-lines and vulnerabilities of the current social and economic system, with infection rates already mapping income gradients in some places.   How policy-makers respond will fundamentally shape key right to health questions, including how we understand government responsibilities towards health and well-being, and the practical meaning of an entitlement to the highest attainable standard of physical and mental health and to living conditions conducive to their health and wellbeing. Government responses are also raising concerning questions about the impact of the pandemic on civil and political rights.   For over 13 years Freedom House has documented a global democratic retreat, marked by rising nationalist populism and civil society crackdowns.   Governments around the world, in response to COVID-19 are now rushing to expand emergency powers of surveillance and detention, and to place restrictions on human rights for political purposes.   There is a risk that regressive responses to COVID-19 could move us even closer to a 21st century defined by 'neo-illiberalism', in which economic neoliberalism combines with political illiberalism and xenophobic nationalism to erode human rights, deepen health inequalities, and undermine the realization of global health policies like UHC.   COVID-19 as a systemic shock that could bring health and human rights to the fore   COVID-19 infections and responses underscore that the indivisibility of health and a range of human rights is not just a theoretical proposition: effective public health measures rely on public trust and the existence of affordable and accessible testing and health care for those who need it.   Now, more than ever, scholars and practitioners of health and human rights must move quickly to assert human rights standards to guide policy and protect those most vulnerable to both infection and neglect. This crisis reinforces the pre-existing challenge for the right to health to evolve to meet the health challenges of our time.   Before COVID-19, I had thought of this evolution in the true Darwinian sense of incremental biological processes of natural selection where organisms must either successfully adapt to shifting external conditions or face extinction.   My concern for some time has been that if the post-World War II project of human rights were not to land (like natural law) on the litter-heap of history, it must transform itself from within and adapt to a vastly changed global environment from that in which the Universal Declaration of Human Rights, the International Covenant on Economic, Social and Cultural Rights, and even General Comment 14 were written.   Yet in the early stages of a global health pandemic which is affecting us where we live and work, and where we are most vulnerable, it seems likely this evolution will be not so much slow and incremental than dramatic and precipitous.   British sociologist Graham Scambler suggests that COVID-19 is functioning as a 'breaching experiment': that disrupting the normal social order allows us to see its rules more clearly.   Already the dark unspoken rules of economic supremacy are becoming visible, including intimations from policy-makers and media that the cure for COVID-19 cannot be worse than the problem itself, and that saving the economy might require sacrificing those must vulnerable, including the elderly.   For those who have long worked in HIV/AIDS, on LGBTQI rights, for the disabled, on racial and indigenous justice, to name a few, this rhetoric is familiar. The global pandemic can help expose such truly disturbing priorities and built-in inequities within our social and political systems.   From a human rights perspective, a 'breaching incident' like COVID-19 could generate tremendous change. Oona Hathaway has suggested that major shifts in human rights practices have often occurred because of [major shocks to the system which provide limited windows of opportunity for effecting large changes in the system.] Indeed, the shock-response impact of crisis is embedded within the genesis of the United Nations and international human rights law, created in response to the atrocities of World War II.   In exposing the shadowy biases of our current economic and health systems and underscoring government responsibilities to assure COVID-related prevention and treatment, COVID-19 may illuminate the value and meaning of the right to health: that inaccessible and unaffordable health care for many desperately ill and dying people is less a misfortune than injustice.   That sacrificing the poor, elderly, ill, and marginalized for the sake of economic growth is wrong. And that in this moment of global crisis, countries should not turn inwards to self-protection at all costs but should also engage in the acts of solidarity, innovation, and urgently needed assistance to meet the grave health and humanitarian needs of this pandemic.   The imperative to evolve human rights also requires our field to engage in some uncomfortable self-inquiry. We need to identify and eradicate the inequities inherent in our essential precepts, and 'de-colonize' global health and human rights.   An illustrative example: when I first read the 1993 Harvard Roundtable discussion, it never occurred to me that of the seventeen participating scholars, only three were women and only two were from outside the United States. That these disparities are so obvious today reflects a significant sea-change in our ability to recognize certain types of inequities, including the startling lack of racial and gender representation in key institutions of public and global health.   As Shklar intimates, we have advanced by being able to recognize that these inequities are not misfortunes of nature but inequities socialized into the fabric of social and political life that drive even well-intentioned global health and human rights institutions.   This pandemic may catalyze responses to pre-existing challenges within health and human rights, changing our understanding of the responsibilities governments have to protect domestic and global health. It may also promote a deeper inquiry into the ways that inequities are reinforced by our institutions, systems, and actors, including within human rights and health.   The challenge for our field is to counter regressive policies that do not meet the human rights standards of non-discrimination, accountability, necessity, and proportionality; to consistently push for accessible, affordable care for those who need it; and to bolster and transform the standards, guidance, and protections that human rights offers when it comes to health writ small and large, especially when it comes to regressive and illiberal social and economic policies.   Now more than ever we need to transform the right to health to meet the challenges of this moment and to push towards a far different understanding of health justice for the many millions of people who will be infected and affected by this pandemic.   * Lisa Forman is an associate professor at the Dalla Lana School of Public Health, University of Toronto, where she holds a Canada Research Chair Tier 2 in Human Rights and Global Health Equity, Canada.   http://www.hhrjournal.org/2020/04/the-evolution-of-the-right-to-health-in-the-shadow-of-covid-19/ http://www.hhrjournal.org/?s=COVID-19   Jan. 2020   Impunity: Undermining the Health and Human Rights Consensus, by Chris Beyrer.   Impunity: exemption from punishment or freedom from the injurious consequences of an action. A noun. (Oxford English Dictionary, 2019)   There has perhaps always been a greater burden of unpunished human rights violations than punished ones. The newest mechanism for accountability for rights abuses, the International Criminal Court, has to date successfully prosecuted only one charge of the most grievous abuse, genocide, that of the case of the Srebrenica massacre of some 8,000 Muslim men and boys in Bosnia in 1995. Yet the post war consensus enshrined in the 1948 Universal Declaration of Human Rights has continued to serve as a basis for health and human rights thinking, advocacy, scholarship, and action.   And impunity for rights violations, including those of the right to health, has been a continued challenge for rights-focused actors, and for those seeking justice and redress. It is now transparently clear, however, that this consensus faces grave threats in the current period of widespread rights violations, toleration for abuses against vulnerable minority groups, and the active denial of health rights by governments and regimes from Myanmar to the United States, Russia, China, and far too many others.   What are the drivers of rising impunity and what can those concerned with health and human rights, including scientists, health professional organizations, and civil society groups, realistically do to address these threats?   One particularly grave set of abuses may help us consider these issues. The Assad regime in Syria has been accused of an extraordinary array of rights abuses in the ongoing Syrian civil war - torture, extra-judicial executions, the use of banned weapons of war including chemical agents on civilian populations, and of widespread violations of international humanitarian laws, including the bombing of health care facilities and other attacks on providers.   Recent reports by the New York Times and others have credibly shown that Assad's allies, notably the Russian military under President Vladimir Putin, have undertaken deliberate bombings of hospitals in civilian areas. Yet it seems highly likely that the Assad regime will prevail in the Syrian conflict and already has regained control of most of the landmass and population of the country. This outcome would serve as a profound threat to the human rights consensus globally.   Imagine Nazi Germany and Japan prevailing in WWII, or the Khmer Rouge being allowed to remain in power after their mass killing of civilians in the 1970s. This is precisely what many would argue is the most likely outcome of the Syrian conflict: impunity for mass atrocities. Impunity for the use of chemical weapons. Impunity for the deliberate bombing of hospitals as a tool of state terror. In such a future, what would restrain governments from these kinds of abuses of state power?   The absence of US leadership at this juncture is deeply concerning, but abrogation of US leadership on human rights, on impunity for abuses, did not, it must be noted, begin with Donald Trump. The retreat from human rights norms and treaty obligations in response to the 9-11 terror attacks began in the early years of the presidency of George W. Bush.   Most egregiously in the 2002 torture memos signed by administration officials including John C. Yoo, Jay S. Bybee and Steven G. Bradbury. The policy laid out in these documents was a clear and direct violation of the Geneva Conventions on the rules of war.   It has been argued, and indeed it is virtually impossible to argue against the notion, that these policies enabled the horrors of Abu Ghraib, the widespread torture of alleged enemy combatants at CIA-run black sites, and the outsourcing of suspects for torture to allied countries, including the Assad regime in Syria.   Early in his first term as president, Barack Obama made clear that his administration would not be pursuing prosecutions against Yoo, and others from the Bush administration, who had engaged in the development of these abusive policies.   Whatever the politics of the moment which compelled this decision, it was a major step in the direction of impunity for rights violations. No one would be held accountable for torture done in the name of US citizens. The director of the CIA black site in Thailand, where suspects were subjected to water boarding and other forms of torture, Gina Haspell, is now the Director of the CIA.   Impunity for rights violations does not only allow abuses to go unpunished and the truth to remain hidden or denied. It has an undermining effect on efforts to redress rights violations.   What hope can victims have for justice when it is made clear that widespread extrajudicial executions will be tolerated, as those conducted against alleged drug users under the Duterte regime in the Philippines have been?   Or when all nine fellow member states of ASEAN, the Association of Southeast Asian Nations, have supported Myanmar in its denial of abuses against the Rohingya minority - despite what the UN High Commissioner for Human Rights called 'a textbook case of ethnic cleansing'.   In one step against impunity, Gambia, on behalf of the Organization of Islamic Cooperation, has successfully brought charges against Myanmar for the Rohingya genocide, in a case that commenced in December 2019 at the UN's International Court of Justice in the Hague. Will it be enough to bring some justice to the Rohingya survivors?   What else can be done to address impunity? First, it seems essential to strengthen and broaden the evidence base for rights abuses, and for the relationships between rights violations or protections and human health.   We have ever more powerful tools, including the explosion of genetic and other forms of biometric data and evidence, to bolster human rights investigations.   This is true on the micro-level of forensic DNA evidence, and on the macro-level, such as the use of satellite imagery, which has helped document the burning and razing of Rohingya villages and undermine the regime's claims that such destruction had not occurred.   Medicine, and science more broadly, has critical roles to play in addressing impunity with more and better methodologic approaches to human rights evidence collection, analysis, and reporting.   Second, it is more critical than ever for professional bodies and organizations to stand against impunity for rights violations, particularly those which involve medical or other health personnel. The denial of basic health rights to detained migrants and asylum seekers in the United States is an example.   The advocacy of the American Academy of Pediatrics on behalf of detained children played a key role in reducing the abusive policy of family separations imposed by the Trump Administration in 2018.   In December 2019, physicians in Texas were arrested for demonstrating in support of influenza immunizations for those held in US immigration detention, spurred, at least in part, by the death from influenza of 16-year-old Carlos Gregorio Hernandez Vasquez, an unaccompanied minor from Guatemala, who was found dead in detention on May 20, 2019.10 He had been diagnosed with influenza a day earlier, given a single oral tablet of Tamiflu, and left without medical supervision overnight.   Third, given that so many of the official bodies charged with protecting rights and addressing impunity, most notably the UN family, have been enormously challenged in this time of nationalism, anti-immigrant sentiment, and rising intolerance, it is all the more critical for civil society to engage in protecting against abuses and demanding accountability.   It will take enormous efforts for grassroots organizations to counter the current trend toward impunity. But we have no choice, impunity must be resisted. Imagine a world where it is not.   * Chris Beyrer, MD,is Desmond M. Tutu Professor in Public Health and Human Rights, at the Johns Hopkins Bloomberg School of Public Health, USA.   http://www.hhrjournal.org/2020/01/impunity-undermining-the-health-and-human-rights-consensus/ http://www.hhrjournal.org/2019/12/war-political-conflict-and-the-right-to-health/ http://www.hhrjournal.org/ http://www.hhrjournal.org/volume-20-issue-2-december-2018/ Visit the related web page
	The greatest burden of climate change will fall on those in poverty by Philip Alston Special Rapporteur on extreme poverty   There is no shortage of alarm bells ringing over climate change, but they seem to have remained largely unheard so far.   In accepting the 2018 Nobel Prize for Economics, William Nordhaus described climate change as a 'Colossus that threatens our world' and the 'ultimate challenge for economics'.   The 2001 winner of the same prize, Joseph Stiglitz, referred to it more recently as World War III. Pope Francis has declared a global climate emergency, and warned that failure to take urgent action would be a brutal act of injustice toward the poor and future generations.   Climate change threatens truly catastrophic consequences across much of the globe and the human rights of vast numbers of people will be among the casualties.   By far the greatest burden will fall on those in poverty, but they will by no means be the only victims.   The last five years have been the hottest in the modern record and global carbon dioxide emissions began rising again in 2017 after three years of levelling off.   World energy consumption is projected to grow 28 percent between 2015 and 2040. The consequences today are attested to by record temperatures, rapidly melting icecaps, unprecedented wildfires, frequent so-called 'thousand year' floods, as well as devastating, more frequent hurricanes.   Millions face malnutrition due to devastating drought, and many more will have to choose between starvation and migration. Rising ocean temperatures are killing marine ecosystems that support food systems for hundreds of millions of people. And climate change is threatening food production and posing dire economic and social threats.   The most widespread scientific benchmark for measuring global warming is the rise in temperature relative to pre-industrial levels, already 1C. The 2015 Paris Agreement aims to ensure no higher than a 2C rise by 2100 and endeavours to limit it to 1.5C. But even those increases would be catastrophic for many people.   A rise of only 1.5C rather than 2C could mean reducing the number of people vulnerable to climate-related risks by up to 457 million; 10 million fewer people exposed to the risk of sea level rise; reducing exposure to floods, droughts, and forest fires; limiting damage to ecosystems and reductions in food and livestock; cutting the number of people exposed to water scarcity by half; and up to 190 million fewer premature deaths over the century.   However, the scale of change required to limit warming to 1.5C is historically unprecedented and could only be achieved through societal transformation and ambitious emissions reduction measures. And even 1.5C of warming - an unrealistic, best-case scenario - will lead to extreme temperatures in many regions and leave disadvantaged populations with food insecurity, lost incomes and livelihoods, and worse health.   In all of these scenarios, the worst affected are the least well-off members of society. Climate change threatens the full enjoyment of a wide range of rights. Rapid action and adaptation can mitigate much of this, but only if done in a way that protects people in poverty from the worst effects.   According to the World Bank, at 2C degrees of warming, 100-400 million more people could be at risk of hunger and 1-2 billion more people may no longer have adequate water.   Climate change could result in global crop yield losses of 30 percent by 2080, even with adaptation measures. Between 2030 and 2050, it is expected to cause approximately 250,000 additional deaths per year from malnutrition, malaria, diarrhea, and heat stress.   With people in poverty largely uninsured, climate change will exacerbate health shocks that already push 100 million into poverty every year.   People in poverty face a very real threat of losing their homes. By 2050, climate change could displace 140 million people in Sub-Saharan Africa, South Asia, and Latin America alone. Flooding and landslides can weaken already degraded infrastructure and housing - especially for people living in unplanned or unserviced settlements.   2017 saw 18.8 million people displaced due to disasters in 135 countries, almost twice the number displaced by conflict.   Since 2000, people in poor countries have died from disasters at rates seven times higher than in wealthy countries. In addition, authorities have a history of prioritizing wealthier areas for protection, further endangering people in poverty.   Climate change is, among other things, an unconscionable assault on the poor.   Climate change will exacerbate existing poverty and inequality. It will have the most severe impact in poor countries and regions, and the places poor people live and work. Developing countries will bear an estimated 75-80 percent of the costs of climate change.   People in poverty tend to live in areas more susceptible to climate change and in housing that is less resistant; lose relatively more when affected; have fewer resources to mitigate the effects; and get less support from social safety nets or the financial system to prevent or recover from the impact. Their livelihoods and assets are more exposed and they are more vulnerable to natural disasters that bring disease, crop failure, spikes in food prices, and death or disability.   Climate change threatens to undo the last fifty years of progress in development, global health, and poverty reduction. Middle-class families, including in developed countries, are also being rendered poor. The World Bank estimates that without immediate action, climate change could push 120 million more people into poverty by 2030, likely an underestimate, and rising in subsequent years. Eight hundred million in South Asia alone live in climate hotspots and will see their living conditions decline sharply by 2050.   Perversely, the richest, who have the greatest capacity to adapt and are responsible for and have benefitted from the vast majority of greenhouse gas emissions, will be the best placed to cope with climate change, while the poorest, who have contributed the least to emissions and have the least capacity to react, will be the most harmed.   The poorest half of the world's population - 3.5 billion people is responsible for just 10 percent of carbon emissions, while the richest 10 percent are responsible for a full half. A person in the wealthiest 1 percent uses 175 times more carbon than one in the bottom 10 percent.   * Access the Climate change & Poverty report: http://bit.ly/2NkMx7X http://bit.ly/2XbHmff http://srpoverty.org/thematic-reports/   Oct. 2019   World stumbling zombie-like into a digital welfare dystopia, warns UN human rights expert   A senior UN human rights expert has expressed concerns about the emergence of the "digital welfare state", saying that all too often the real motives behind such programs are to slash welfare spending, set up intrusive government surveillance systems and generate profits for private corporate interests.   "As humankind moves, perhaps inexorably, towards the digital welfare future it needs to alter course significantly and rapidly to avoid stumbling zombie-like into a digital welfare dystopia," the Special Rapporteur on extreme poverty and human rights, Philip Alston, says in a report to be presented to the General Assembly.   The digital welfare state is commonly presented as an altruistic and noble enterprise designed to ensure that citizens benefit from new technologies, experience more efficient government, and enjoy higher levels of well-being. But, Alston said, the digitization of welfare systems has very often been used to promote deep reductions in the overall welfare budget, a narrowing of the beneficiary pool, the elimination of some services, the introduction of demanding and intrusive forms of conditionality, the pursuit of behavioural modification goals, the imposition of stronger sanctions regimes, and a complete reversal of the traditional notion that the state should be accountable to the individual.   "Digital welfare states thereby risk becoming Trojan Horses for neoliberal hostility towards social protection and regulation," said the UN Special Rapporteur.   "Moreover, empowering governments in countries with significant rule of law deficits by endowing them with the level of control and the potential for abuse provided by these biometric ID systems should send shudders down the spine of anyone even vaguely concerned to ensure that the digital age will be a human rights friendly one".   Alston said governments justified the introduction of expensive and complex biometric digital identity card systems on the grounds that they would improve welfare services and reduce fraud.   "The process is commonly referred to as 'digital transformation' by governments and the tech consultancies that advise them, but this somewhat neutral term should not be permitted to conceal the revolutionary, politically-driven, character of many such innovations," Alston said.   "Systems of social protection and assistance are increasingly driven by digital data and technologies that are used for diverse purposes, including to automate, predict, identify, surveil, detect, target and punish."   The dominant role of the private sector in designing, constructing and even operating significant parts of the digital welfare state is a major reason for concern, according to Alston.   "Most Governments have stopped short of requiring Big Tech companies to abide by human rights standards, and because the companies themselves have steadfastly resisted any such efforts, the companies often operate in a virtually human rights free-zone," said Alston.   The human rights community has thus far done a very poor job of persuading industry, government, or seemingly society at large, of the fact that a technologically-driven future will be disastrous if it is not guided by respect for human rights and grounded in hard law. There is no shortage of analyses warning of the dangers for human rights of various manifestations of digital technology and especially artificial intelligence. "But none has adequately captured the full array of threats represented by the emergence of the digital welfare state," the UN expert said.   The report is based on several country visits as well as a global consultation that drew submissions from more than 30 countries around the world. There is remarkable consistency in the empirical evidence from countries in the high income countries in the north as well as from the Global South.   * Access the report here: http://bit.ly/2WeUnkn   http://srpoverty.org/press-releases/ http://www.hrw.org/news/2019/10/17/un-protect-rights-welfare-systems-tech-overhaul http://www.theguardian.com/technology/2019/oct/14/automating-poverty-algorithms-punish-poor Visit the related web page
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