Introduction: The Human Right to Health Dilemma
1. Amartya Sen, foreword to Paul Farmer, Pathologies of Power (Berkeley: University of California Press, 2005).
2. World Bank, Investing in Health: The World Development Report for 1993 (Oxford: Oxford University Press, 1993), 200. Available online at: http://files.dcp2.org/pdf/WorldDevelopmentReport1993.pdf.
3. Lawyers have argued that there is another serious difficulty: that the right is not “justiciable,” or, in other words, capable of being used in legal actions. For an important rebuttal of this criticism, by looking in detail at how the human right to health has in fact been used in courts in five different countries, see Varun Gauri and Dan Brinks, eds., Courting Social Justice (Cambridge: Cambridge University Press, 2008).
Chapter 1: The Universal Declaration of Human Rights
1. This is not to say that the weather never gives rise to questions about human rights. Consider, for example, climate change caused by human action.
2. The account of Moleen Mudimu is told in Stephanie Nolen, 28 Stories of AIDS in Africa (London: Portobello Books, 2007), 321–31 and 375–76.
3. Farmer, Pathologies of Power.
4. United Nations, International Covenant on Economic, Social and Cultural Rights (1966). Available online at: http://www2.ohchr.org/english/law/cescr.htm.
5. United Nations, Universal Declaration of Human Rights (1948). Available online at: http://www.un.org/en/documents/udhr/.
6. The origin and drafting of the UDHR is a fascinating story, beautifully told in two highly contrasting books on which I rely here: Mary Ann Glendon’s A World Made New: Eleanor Roosevelt and the Universal Declaration of Human Rights (New York: Random House, 2001) and Johannes Morsink’s The Universal Declaration of Human Rights: Origins, Drafting and Intent (Philadelphia: University of Pennsylvania Press, 1999). Glendon blends together the drafting and development of the Declaration with biographical accounts especially of Eleanor Roosevelt, but also other key figures such as Charles Malik, René Cassin, Peng-chun Chang, and John Humphrey. These people also feature heavily in Morsink’s scholarly work, yet his task is to explain, by painstaking reference, especially to committee minutes, how more or less every phrase, almost every word, in the declaration came to earn its place. The patience, tenacity, and legal and philosophical talent of the key group of drafters was remarkable. The process gives the lie to a common criticism made of the Declaration—that it was poorly or hastily drafted. Of course there are unclarities, but for a document drafted by a series of committees it is hugely impressive.
7. The four freedoms are memorably illustrated by Norman Rockwell.
8. Glendon, A World Made New, 170.
9. World Health Organization, Chronicle of the World Health Organization (1947). Available online at: http://whqlibdoc.who.int/hist/chronicles/chronicle_1947.pdf.
10. Ibid., 8.
11. Ibid., 11.
12. World Health Organization, Constitution (1946/2006). Available online at: http://www.who.int/governance/eb/who_constitution_en.pdf.
13. United Nations, UDHR.
14. There are some significant omissions, including China, Cuba, Burma, Saudi Arabia, and Singapore.
15. United Nations, ICESCR.
16. International Conference on Primary Health Care, Declaration of Alma-Ata (1978). Available online at: http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf.
17. Indeed, some years later, the WHO formulation of the right was recognized in the UN Convention on the Rights of the Child, adopted in 1989, and coming into force very soon afterward, in 1990. Article 24(1) reads: “States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.” United Nations, Convention on the Rights of the Child (1989). Available online at: http://www2.ohchr.org/english/law/crc.htm. Although, as we noted, ICESCR has not been universally adopted, the position is much more encouraging for the Convention on the Rights of the Child. According to UNICEF, it has been ratified by all countries of the world except Somalia, with no effective government, and the USA, which is always very slow to ratify human rights conventions. (UNICEF, Convention on the Rights of the Child: Frequently Asked Questions (2006). Available online at: http://www.unicef.org/crc/index_30229.html.) In consequence, virtually all countries in the world have accepted the right to the highest attainable standard of health for children, and many have accepted it for all their citizens.
18. United Nations, ICESCR Article 2(1). See also Kristin Hessler and Allen Buchanan “Specifying the Content of the Human Right to Health Care,” in Medicine and Social Justice: Essays on the Distribution of Health Care, ed. R. Rhodes, M. Pabst Battin and A. Silvers (Oxford: Oxford University Press, 2002).
19. United Nations, General Comment 14 (2000). Available online at: http://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.En.
20. United Nations, General Comment 3 (1990). Available online at: http://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.En.
21. Other important developments include the appointment in 2002 of Professor Paul Hunt, from the University of Essex in the UK, as first Special Rapporteur on the right to health, to help promote, protect, and advocate for the human right to health, with the obligation to undertake country-based missions and to produce reports. At the end of his term in 2008, Anand Grover, a human rights lawyer specializing in HIV/AIDS litigation, was appointed as second Special Rapporteur. It is also worth mentioning the optional protocol on ICESCR which was adopted by the General Assembly of the United Nations in 2008 (United Nations, United Nations Treaty Collection (2011). Available online at: http://treaties.un.org/Pages/ViewDetails.aspx? src=TREATY&mtdsg_no=IV-3-a&chapter=4&lang=en). The point of the protocol is to allow individuals to bring their claims to the Committee on Economic, Social, and Cultural Rights for a hearing. At present there is no centralized international forum to which people may make their complaints, although individuals have in some cases had access to domestic courts and to regional courts such as the European Court of Human Rights. However, the committee will only have jurisdiction over those countries that have ratified the protocol, and it will not come into force until ratified by ten states parties. At the time of writing (July 2011) it has been ratified by only three: Ecuador, Mongolia, and Spain. And so it will probably be some considerable time before it enters into force, if it ever does. However, the fact that a new optional protocol has been produced, to fill a clear gap in the existing institutions, shows that human rights law in this area is still evolving, especially under the perception of its own inadequacies. Progress will be slow, but improvements seem possible.
Chapter 2: The Human Right to Health and Its Critics
1. Henry Shue, Basic Rights, 2nd ed. (Princeton: Princeton University Press, 1996).
2. It is also sometimes assumed that all first-generation rights are more important than all second-generation rights. Yet this claim has been seriously questioned for decades. As Henry Shue argues, without particular second-generation rights, such as the right to subsistence, many other rights cannot be enjoyed (for one would be dead). Both first- and second-generation rights can be “basic rights” in Shue’s terminology (see Shue, Basic Rights).
3. Jack Donnelly, “Human Rights and Asian Values: A Defence of ‘Western’ Universalism,” in The East Asian Challenge For Human Rights, ed. Joanne R. Bauer and Daniel A. Bell (Cambridge: Cambridge University Press, 1999), 61.
4. Or, for a better documented example, the impressively detailed and thoughtful Namibian development plan Vision 2030 includes the aspiration to move from a country that receives development aid to one that disperses aid to other countries by the year 2030. National Planning Commission of Namibia, Namibia Vision 2030 (2004). Available online at: http://www.npc.gov.na/vision/vision_2030bgd.htm.
5. For example, it is sometimes said that when Zimbabwe achieved independence the British government assumed that Bishop Abel Muzorewa would be elected prime minister and continue to respect British interests. In fact, his party received very little support from the electorate and the much more radical Robert Mugabe was elected instead.
6. Cited in Glendon, A World Made New, 164. It may be hard to understand why the state would be prepared to open itself up to external scrutiny, and we have seen and will see again that many states are very nervous of doing so. However, in the aftermath of the Second World War, when it was becoming clear what Nazi Germany had done to so many of its own citizens, it was hard to argue for the principle of complete internal sovereignty of the state. As philosopher Charles Beitz puts it, human rights exist as an attempt to correct a defect in the way political history has led to the development of the world as a “society of states,” each with a concentration of power over its citizens. Human rights doctrine attempts to provide a much-needed counterweight. Charles Beitz, The Idea of Human Rights (Oxford: Oxford University Press, 2009), 128–30.
7. Anne-Emanuelle Birn, “Health and Human Rights: Historical Perspectives and Political Challenges,” Journal of Public Health Policy 29 (2008): 34.
8. For a trenchant presentation of a skeptical position see Bernard Baumrin, “Why There is No Right to Health Care,” in Medicine and Social Justice: Essays on the Distribution of Health Care, ed. R. Rhodes, M. Pabst Battin, and A. Silvers (Oxford: Oxford University Press, 2002).
9. John Locke, Two Treatises of Government, 1689 (Cambridge: Cambridge University Press, 1988).
10. Jeremy Bentham, “Anarchical Fallacies” and “Supply Without Burden,” 1796, in Nonsense Upon Stilts, ed. Jeremy Waldron (London: Methuen, 1987), 53.
11. Bentham, Nonsense Upon Stilts, 72–73. More recently, philosopher Alasdair MacIntyre has twisted the anti-human rights knife: “The best reason for asserting so bluntly that there are no [natural or human] rights is precisely the same type as the best reason we possess for asserting there are no witches [or] unicorns: every attempt to give good reasons for believing that there are such rights has failed . . . In the United Nations declaration of 1948 what has since become the normal U.N. practice of not giving good reasons for any assertions whatsoever is followed with great rigour.” Alasdair MacIntyre, After Virtue (London: Duckworth, 1981), 67.
12. Jacques Maritain, Man and the State (Chicago: University of Chicago Press, 1951), 77.
13. John Rawls, Political Liberalism (New York: Columbia University Press, 1993/1996), 135–72.
14. Hessler and Buchanan, “Content of Human Right.” Such a proposal fits well with the account of human rights provided by Joseph Raz in “Human Rights Without Foundations,” in The Philosophy of International Law, ed. J. Tasioulas and S. Besson (Oxford: Oxford University Press, 2010). See also Beitz, The Idea of Human Rights. In summary, Raz believes that human rights should now be seen as a branch of international law, and, luckily, a branch of law in reasonably good order. This is essential, Raz argues, if the discussions of philosophers are to engage with the concerns of human rights practice. Seeing matters this way allows us to draw an analogy with other branches of law such as family law or property law. In such cases, the broad contours of the law can be seen as being based on any one of a number of moral reasons, setting limits to what can reasonably be part of the law. So, for example, any reasonable view would wish to give parents duties of care toward their children. Yet it would be unrealistic to think that precise details of maintenance payments for children in case of divorce can be given a philosophical foundation or be the object of a similar consensus. Such issues will be worked out in the practical context of politics and legal casework. The same is possible for the details of human rights. While the overall framework can be justified from a range of philosophical positions, it is not necessary or realistic to think that each particular human right needs a single philosophical justification, or even that the details of its determinate content needs to be acceptable from all points of view.
15. Karl Marx, “On The Jewish Question,” 1843, in Karl Marx: Early Writings, ed. L. Colletti (Harmondsworth: Penguin, 1975).
16. Onora O’Neill, “The Dark Side of Human Rights,” International Affairs 81 (2005): 427–39.
17. American Anthropological Association, The Executive Board, “Statement on Human Rights,” American Anthropologist 49 (1947): 539–40.
18. American Anthropological Association, Committee for Human Rights, Declaration on Anthropology and Human Rights (1999). Available online at: http://www.aaanet.org/stmts/humanrts.htm.
19. The drafting committee for the Universal Declaration itself was extremely concerned about the possibility that drawing up a declaration would privilege Western values over others. As the drafters began their business, UNESCO commissioned an investigation into this very topic. A “philosophers’ committee,” chaired by University of Cambridge historian E. H. Carr, was set up. Questionnaires were sent to leading intellectuals around the world, including Mohandas Gandhi and several other Indian thinkers, and Chinese Confucian philosopher Chung-Shu Lo, as well as Western figures such as Italian philosopher Benedetto Croce and British novelist Aldous Huxley. The questionnaire sought the respondents’ views on human rights from a very broad perspective of religious, cultural, and philosophical traditions. The results of the consultation, as Mary Ann Glendon puts it, “were encouraging: they indicated that the principles underlying the draft Declaration were present in many cultural and religious traditions, though not always expressed in terms of rights.” Glendon, A World Made New, 76.
20. See Donnelly, “Human Rights and Asian Values.”
21. In response, it has often been rather smugly pointed out in that it is not clear that Asia is universally hostile to all Western values. After all, several Asian, and indeed African, countries have been enthusiastic champions of another strain of Western values: Marxist communism. However, there remains a prima facie case to answer.
22. Bangkok Declaration (1993). Available online at: http://law.hku.hk/lawgovtsociety/Bangkok%20Declaration.htm.
23. Amartya Sen, Human Rights and Asian Values (New York: Carnegie Council on Ethics and International Affairs, 1977), 9, citing W. S. Wong, “The Real World of Human Rights” (mimeographed, 1993).
24. Sen, Human Rights and Asian Values, 9–10.
25. We should recall that English philosopher John Locke found himself having to argue against the feudal tradition of the divine right of kings, and as Sen notes it is hard to argue that Plato and Augustine were less authoritarian in sympathy than Confucius. Sen, Human Rights and Asian Values, 17.
26. The drafters of the UDHR were well aware of this line of attack—that a statement of states’ rights should also be included—frequently raised by the Soviets. In a speech, in his capacity as ambassador of Lebanon, to the US Chamber of Commerce in 1949, Charles Malik eloquently discussed why the Declaration had no place for the rights of states: “The problem of human rights arose in recent years precisely because society and the state trespassed upon man, to the extent, in totalitarian states, of choking him altogether. In our formulation we are therefore called upon to correct the excesses precisely of statism and socialism. The right amount of anarchism and individualism is exactly what statism and socialism need. It is not that we find ourselves at present in a lawless jungle with every man brutally seeking his own individual advantage without any organized lines of relation and authority; and as a result we are called upon, so to speak, to restore order and authority by reminding men of their duties and obligations: It is rather that we find ourselves today in a situation, all the world over, in which man’s simple, essential humanity—his power to laugh and love and think and change his mind, in freedom—is in mortal danger of extinction by reason of endless pressures from every side.” Charles Malik, “Talk on Human Rights” (1949), available online at: http://www.udhr.org/history/talkon.htm.
27. Shue, Basic Rights.
28. United States Government, Response to Request (not dated). Available online at: http://www.globalgovernancewatch.org/docLib/20080213_US_Hunt_Response.pdf.
29. Gunilla Backman et al., “Health Systems and the Right to Health: An Assessment of 194 Countries,” The Lancet 372 (2008): 2047–85.
30. It is unclear that incorporating the right to health in the constitution correlates in any significant manner with better health performance in other respects. Few European countries recognize the right to health in domestic law.
31. The authors resist the temptation to present a ranking or league table of countries’ performance. In this respect they have probably learned the lesson of the World Health Organization’s notorious World Health Report of 2000, Health Systems: Improving Performance, which included a “statistical annex” setting out a very controversial ranking of countries, in which France, Italy, San Marino, Andorra, Malta, Singapore, Spain, and Oman occupied the top eight places, with the UK eighteenth, Switzerland twentieth, Sweden twenty-third, Germany twenty-fifth, and the USA thirty-seventh, sandwiched between Costa Rica and Slovenia. Naturally the ranking was used to cast doubt on the methodology, and the exercise, which led to acrimonious dispute within the WHO, has never been repeated, even though the report itself suggests it will be the first of an annual exercise. World Health Organization, World Health Report: Health Systems: Improving Performance (WHO: Geneva, 2000). Available online at: http://www.who.int/whr/2000/en/whr00_annex_en.pdf.
32. William Easterly, “Human Rights Are the Wrong Basis for Health Care,” Financial Times, October 12, 2009. Available online at: http://www.ft.com/cms/s/0/89bbbda2-b763-11de-9812-00144feab49a.html.
33. See, for example, William Easterly, The White Man’s Burden (Oxford: Oxford University Press, 2006).
34. See also S. R. Benatar, “Human Rights in the Biotechnology Era 1,” BMC International Health and Human Rights 2002: 2: 3.
35. Markus Haacker, “The Macroeconomics of HIV/AIDS,” in Southern Africa: 2020 Vision, ed. M. Hannam and J. Wolff (London: e9 Publishing, 2010).
36. Anne-Emanuelle Birn, “Health and Human Rights,” 32–41.
37. Gilbert Burnham, Riyadh Lafta, Shannon Doocy, and Les Roberts, “Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey,” The Lancet 368 (2006): 1421–28.
38. Octavio Ferraz, “The Right To Health In The Courts Of Brazil: Worsening Health Inequities?” Health and Human Rights 11 (2009) 33–45.
Chapter 3: HIV/AIDS and the Human Right to Health
1. Jonathan M. Mann, “Human Rights and AIDS: The Future of the Pandemic,” in Health and Human Rights, ed. Jonathan M. Mann, Sofia Gruskin, Michael A. Grodin, and George J. Annas (London: Routledge, 1999), 216.
2. South Africa.Info, “My Son Died of AIDS: Mandela,” January 12, 2005, available online at: http://www.southafrica.info/mandela/mandela-son.htm.
3. AVERT “World AIDS Day” 2010, available online at: http://www.avert.org/world-aids-day.htm.
4. Mann, “Human Rights and AIDS,” 223. See also George J. Annas, “Human Rights and Health: the Universal Declaration of Human Rights at 50,” New England Journal of Medicine 339 (1998): 1778–81.
5. Robert C. Gallo, “A Reflection on HIV/AIDS. Research after 25 Years,” Retrovirology 3 (2006): 72.
6. Peter Baldwin, Disease and Democracy (Berkeley: University of California Press, 2005), 27.
7. Paul Farmer, Aids and Accusation (Berkeley: University of California Press, 1992).
8. Jonathan M. Mann et al., “Health and Human Rights,” in Health and Human Rights, ed. Mann et al.
9. David Lush, “Medical Totalitarianism and My Part in Its Downfall,” in Southern Africa, ed. Hannam and Wolff.
10. Unity Dow and Max Essex, Saturday is for Funerals (Cambridge, MA: Harvard University Press, 2008), 216.
11. Baldwin, Disease and Democracy.
12. Ibid., 53.
13. Ibid., 52–55.
14. European Court of Human Rights, Enhorn v. Sweden (Application no. 56529/00), January 25, 2005.
15. Baldwin, Disease and Democracy, 96.
16. Peter Piot, Susan Timberlake, and Jason Sigurdson, “Governance and the Response to AIDS: Lessons for Development and Human Rights,” in Realizing the Right to Health, ed. Andrew Clapham and Mary Robinson (Zurich: Rüffer & Rub, 2009).
17. Baldwin, Disease and Democracy, 191.
18. Ibid., 97.
19. NAPWA, “The Denver Principles 1983 and Today,” 2011, available online at: http://www.napwa.org/content/denver-principles-1983-and-today.
20. Baldwin, Disease and Democracy, 156.
21. UNAIDS, The Greater Involvement of People Living With HIV (GIPA) 2007, available online at: http://data.unaids.org/pub/BriefingNote/2007/jc1299_policy_brief_gipa.pdf.
22. Michael Kirby, “The New AIDS Virus—Ineffective and Unjust Laws,” Journal of Acquired Immune Deficiency Syndromes 1 (1988): 305.
23. Baldwin, Disease and Democracy, 61–62.
24. Mary Crewe, “The HIV/AIDS Epidemic and Human Rights Responses,” in Realizing the Right to Health, ed. Clapham and Robinson, 278. For an excellent, detailed examination of the ethical dilemmas regarding public health and infection, see Margaret P. Battin, Leslie P. Francis, Jay A. Jacobson, and Charles B. Smith, The Patient as Victim and Vector: Ethics and Infectious Disease (Oxford: Oxford University Press, 2009).
25. Mann, “Health and Human Rights,” 217.
26. Farmer, AIDS and Accusation.
27. Baldwin, Disease and Democracy.
28. It is, of course, possible and necessary to treat secondary infections and other conditions, but this does nothing to address the underlying condition.
29. Margaret A. Fischl et al., and the AZT Collaborative Working Group, “The Efficacy of Azidothymidine (AZT) in the Treatment of Patients with AIDS and AIDS-Related Complex,” New England Journal of Medicine 317 (1987): 185–91.
30. Douglas D. Richman et al., and the AZT Collaborative Working Group, “The Toxicity of Azidothymidine (AZT) in the Treatment of Patients with AIDS and AIDS-Related Complex,” New England Journal of Medicine 317 (1987): 192–97.
31. E. Dournon et al., “Effects Of Zidovudine In 365 Consecutive Patients With Aids Or Aids-Related Complex,” The Lancet 332 (1988): 1297–302.
32. Baldwin, Disease and Democracy, 223.
33. Ryan White and Ann Marie Cunningham, My Own Story (New York: Penguin, 1991).
34. P. W. Eggers, “Medicare’s End Stage Renal Disease Program,” Health Care Financing Review 22 (2000): 55–60.
35. Baldwin, Disease and Democracy, 120.
36. Dow and Essex, Saturday, 12.
37. AVERT, “HIV and AIDS Treatment in the UK” (2011). Available online at: http://www.avert.org/hiv-treatment-uk.htm.
38. Farmer, AIDS and Accusation, 15.
39. Ibid., 2.
40. C. L. R. James, The Black Jacobins, 1938 (London: Penguin, 2001).
41. Farmer, AIDS and Accusation, 7.
42. Ibid., xii.
43. M. Thomas et al., “The emergence of HIV/AIDS in the Americas and beyond,” Proceedings of the National Academy of Science 104 (2007): 18566–70.
44. Farmer, AIDS and Accusation, 209.
45. Ibid., 216.
46. Ibid., 216.
47. Paul Farmer, Pathologies of Power (Berkeley: University of California Press, 2005), 55.
48. George J. Annas, “Detention of HIV-Positive Haitians at Guantánamo,” New England Journal of Medicine 329 (1993): 592.
49. Quoted in Farmer, Pathologies, 66.
50. B. S. Weeks and I. E. Alcamo, AIDS The Biological Basis, 5th ed. (Sudbury, MA: Jones and Bartlett, 2010), 13.
51. Zenda Woodman and Carolyn Williamson, “HIV Molecular Epidemiology: Transmission and Adaptation to Human Populations,” Current Opinion in HIV and AIDS 2009, 4 (2009): 247–52.
52. Gallo, “Reflection on HIV/AIDS Research.”
53. Woodman and Williamson, “HIV Molecular Epidemiology.”
54. D. Huminer, J. B. Rosenfeld, and S. D. Pitlik, “AIDS in the pre-AIDS era,” Review of Infectious Diseases 9 (1987): 1102–08.
55. S. S. Frøland et al., “HIV-1 Infection in Norwegian Family before 1970,” The Lancet 331 (1988): 1344–45.
56. Weeks and Alcoma, AIDS: The Biological Basis, 12.
57. Amnesty International, Uganda: Antihomosexuality Bill Is Inherently Discriminatory And Threatens Broader Human Rights (London: Amnesty International, 2010).
58. Weeks and Alcoma, AIDS, 12.
59. Ibid., xi.
60. L. O. Kallings, “The First Postmodern Pandemic: 25 Years of HIV/AIDS (Review),” Journal of International Medicine 263 (2008): 221.
61. Kallings, “The First Postmodern Pandemic,” 221; see also Nolen, 28 Stories.
62. William E. Forbath, “Cultural Transformation, Deep Institutional Reform, and ESR Practice,” in Stones of Hope: African Lawyers Use Human Rights to Challenge Global Poverty, ed. Jeremy Perelman and Lucie White (Stanford, CA: Stanford University Press, 2011), 51.
63. Daryl Collins, Jonathan Morduch, Stuart Rutherford and Orlanda Ruthven, Portfolios of the Poor: How the World’s Poor Live on $2 a Day (Princeton: Princeton University Press, 2009), and Dow and Essex, Saturday.
64. Rachel Hammonds and Gorik Ooms, “World Bank Policies and the Obligation of its Members to Respect, Protect and Fulfill the Right To Health,” Health and Human Rights 8 (2004): 26–60.
65. Piot et al., “Governance and the Response to AIDS,” 335.
66. Nolen, 28 Stories, 108.
67. Ibid., 109–11.
68. Kallings, “The First Postmodern Pandemic,” 224.
69. United Nations, Political Declaration on HIV/AIDS, 2006. Available online at: http://data.unaids.org/pub/Report/2006/20060615_hlm_politicaldeclaration_ares60262_en.pdf.
70. Kallings, “The First Postmodern Pandemic,” 234.
71. TASO Mission Statement, 2011. Available online at: http://www.tasouganda.org/index.php?option=com_content&view=article&id=44:brief-background&catid=34.
72. John Maddox, “Does Duesberg Have A Right to Reply?” Nature 363 (1993): 109.
73. Samantha Power, “The Aids Rebel,” New Yorker, May 19, 2003, 54–67.
74. A counter-orthodoxy that HIV does not cause AIDS is still to be found fairly prominently on the Internet and in parts of Africa, even among the educated elite. The current effectiveness of HAART treatment has done much to confirm the HIV theory and therefore counter the denialists, yet Duesberg himself has not conceded. See Pride Chigwedere and Max Essex, “AIDS Denialism and Public Health Practice,” AIDS and Behavior 14 (2010): 23–47.
75. N. E. Groce and R. Trasi, “Rape of Individuals with Disability: AIDS and the Folk Belief of Virgin Cleansing,” The Lancet 363 (2004): 1663–64.
76. G. J. Pitcher and D. M. G. Bowley, “Infant rape in South Africa,” The Lancet 359 (2002): 274–75.
77. Groce and Trasi, “Rape of Individuals with Disability.”
78. Rachel Jewkes, Jonathan Levin, Nolwazi Mbananga, and Debbie Bradshaw, “Rape of Girls in South Africa,” The Lancet 359 (2002): 319–20; Rachel Jewkes, Lorna Martin, and Loveday Penn-Kekena, “The Virgin Cleansing Myth Cases of Child Rape are Not Exotic,” The Lancet 359 (2002): 711.
79. Kallings, “The First Postmodern Pandemic,” 223–24.
80. Nolen, 28 Stories.
81. Power, “The AIDS Rebel,” 56.
82. Sarah Joseph, “Trade and the Right to Health,” in Realizing the Right to Health, ed. Clapham and Robinson.
83. Forbath, “Cultural Transformation.”
84. Anthony Brink, “Criminal Complaint Of Genocide Against Abdurrazack ‘Zackie’ Achmat,” 2007. Available online at: http://www.whale.to/b/brink3.html. For further discussion of the circumstance of this charge see Ben Goldacre, Bad Science, rev. ed. (London: Harper Perennial, 2009). Make sure that you read the revised edition as the relevant chapter, “The Doctor Will Sue You Now,” was omitted from the first printing because of a suit for libel from Matthias Rath, a vitamin pill entrepreneur, described by Goldacre as a colleague and employer of Brink. The chapter has also been made available by Goldacre and his publishers at: http://www.badscience.net/files/The-Doctor-Will-Sue-You-Now.pdf.
85. Republic of South Africa Constitution, 1996. Available online at: http://www.info.gov.za/documents/constitution/1996/96cons2.htm.
86. KwaZulu Natal, CCT32/97 (1997) ZACC 17: 1998 (1) SA 765 (CC). Available online at: http://www.saflii.org/za/cases/ZACC/1997/17.html.
87. Mark Heywood, “South Africa’s Treatment Action Campaign: Combining Law and Social Mobilization to Realize the Right to Health,” Journal of Human Rights Practice 1 (2009): 14–36.
88. Heywood, “South Africa’s Treatment Action Campaign.”
89. Forbath, “Cultural Transformation.”
90. Heywood, “South Africa’s Treatment Action Campaign,” 17.
91. Ibid.; Forbath, “Cultural Transformations.”
92. Kallings, “The First Postmodern Pandemic.”
93. Dow and Essex, Saturday, ix.
94. Ibid., 61–66, 181–87.
95. Chigwedere and Essex, “Denialism,” 243.
96. AVERT, “HIV and AIDS in Swaziland,” 2011. Available online at: http://www.avert.org/aids-swaziland.htm#contentTable4.
97. Kallings, “The First Postmodern Pandemic,” 226.
98. Nolen, 28 Stories, 32.
99. There is at least one more promising, lower-tech, approach. Three randomized clinical trials, in Uganda, Kenya, and South Africa, show that male circumcision reduces the risk of female-to-male HIV transmission. B. Auvert et al., “Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial,” PLoS Med 2 (2005): e298; R. C. Bailey et al., “Male Circumcision for HIV Prevention in Young Men in Kisumu, Kenya: a Randomized Controlled Trial,” The Lancet 369 (2007): 643–56; R. H. Gray et al., “Male Circumcision for HIV Prevention in Men in Rakai, Uganda: A Randomised Trial,” The Lancet 369 (2007): 657–66. There is, unfortunately, no evidence of direct reduction of male-to-female transmission, although it would seem to make sense that if fewer men are infected there will be less transmission to women. However, if men think they are less at risk for HIV, they may then engage in riskier behavior. This is a general point about behavior in relation to risk. It has been argued that, for example, if you think you are driving a safe car you may well drive it at higher speed. John Adams, Risk (London: UCL Press, 1995). It is an empirical claim, but brings home the point that those undergoing circumcision should be made aware that reducing risk is not the same as eliminating it. Furthermore, until the surgical wounds are healed, those circumcised are very much more vulnerable to infection than they otherwise would be, and so once again a belief that one is safe can be very dangerous.
100. Nolen, 28 Stories, 113.
101. Lush, Medical Totalitarianism, 58.
102. Nolen, 28 Stories.
103. Joseph S. Fulda, “The Mathematical Pull of Temptation,” Mind 101 (1992): 305–07.
Chapter 4: Problems and Prospects
1. Joseph Stiglitz, Globalization and Its Discontents (New York: Norton, 2002).
2. Jennifer P. Ruger, “The Changing Role of the World Bank in Global Health,” American Journal of Public Health 95 (2004): 60–70.
3. Stiglitz, Globalization, 11–20.
4. K. Abbasi, “The World Bank and World Health: Under Fire,” British Medical Journal 318 (1999): 1003–06.
5. Lynn P. Freedman, “Drilling Down: Strengthening Local Health Systems to Address Global Health Crises,” in Realizing the Right to Health, ed. Clapham and Robinson, 411.
6. Abbasi, “World Bank.”
7. Hammonds and Ooms, “World Bank Policies,” 36.
8. Ruger, “Changing Role,” 68.
9. World Bank, Investing in Health: The World Development Report for 1993 (Oxford: Oxford University Press, 1993), iii. Available online at: http://files.dcp2.org/pdf/WorldDevelopmentReport1993.pdf.
10. S. Anand and K. Hansen, “DALYs: Efficiency versus equity,” World Development 26 (1998): 307–10. Opponents were especially critical of the application of the recently introduced and highly controversial DALY (disability-adjusted life-year) as a way of measuring health and assessing cost-effectiveness. The DALY provides a measure of how much each health condition contributes to the “global burden of disease” and encourages health policy-makers to allocate funds to achieve the greatest reduction in the burden of disease for their health budget. This may seem entirely reasonable, but it has the consequence that attending to those with severe diseases that are very expensive to treat may yield less DALY reduction than alternative ways of spending the money, such as on common, less severe conditions that are relatively cheap to deal with.
11. World Bank, Investing in Health, iii.
12. Anne-Emanuelle Birn and Klaudia Dmitrienko, “The World Bank: Global Health Or Global Harm?” American Journal of Public Health 95 (2005): 1091.
13. Paul Collier, The Bottom Billion (Oxford: Oxford University Press, 2007).
14. Hammonds and Ooms, “World Bank Policies.”
15. Ibid.
16. Fatma E. Marouf, “Holding The World Bank Accountable For Leakage Of Funds From Africa’s Health Sector,” Health and Human Rights 12 (2010): 95–107.
17. World Bank, Improving Effectiveness and Outcomes for the Poor in Health, Nutrition, and Population (2009), xi. Available online at: http://siteresources.worldbank.org/EXTWBASSHEANUTPOP/Resources/hnp_full_eval.pdf.
18. Ibid., 68.
19. Sarah Joseph, “Trade and the Right to Health.”
20. Jane Galvao, “Brazil and Access to HIV/AIDS Drugs: A Question of Human Rights and Public Health,” American Journal of Public Health 95 (2005): 1110–16.
21. Roy Porter, The Greatest Benefit to Mankind (London: HarperCollins, 1997), 23.
22. Ibid., 401.
23. Ibid., 427.
24. Ibid., 457–58.
25. World Health Organization, Multidrug And Extensively Drug-Resistant TB (M/XDR-TB) 2010 Global Report On Surveillance And Response, 2010, available online at: http://whqlibdoc.who.int/publications/2010/9789241599191_eng.pdf.
26. Farmer, Pathologies of Power, 123.
27. Ibid., 131.
28. Joseph, “Trade and the Right to Health.”
29. Thomas Pogge, “The Health Impact Fund: How to Make New Medicines Accessible to All,” in Global Health Ethics, ed. Solomon Benatar and Gillian Brock (Cambridge: Cambridge University Press, 2011).
30. WHO, Multidrug Resistant TB, 2.
31. Ibid., 3.
32. Olusoji Adeyi and Rifat Atun, “Universal Access to Malaria Medicines: Innovation in Financing and Delivery,” The Lancet 376 (2010): 1869–71.
33. Nuffield Council on Bioethics, The Ethics of Research Related to Healthcare in Developing Countries (London: Nuffield Council on Bioethics, 2002), 31.
34. World Health Organization, Working Together for Health (2006). Available online at: http://www.who.int/whr/2006/whr06_en.pdf.
35. Amy Hagopian et al.,”The migration of physicians from sub-Saharan Africa to the United States of America: measures of the African brain drain,” Human Resources for Health 2 (2004): 17.
36. Marvellous Mhloyi, “Health And Human Rights: An International Crusade,” Health and Human Rights 1 (1994): 125–27.
37. King’s Fund, London Calling: The International Recruitment of Health Workers to the Capital (London: King’s Fund, 2004).
38. Hagopian, “Migration of Physicians.”
39. Mary Robinson and Peggy Clark, “Forging Solutions to Health Worker Migration,” The Lancet 371 (2008): 691–93.
40. World Health Organization, Migration of Health Workers (Fact Sheet No. 301), 2010. Available online at: http://www.who.int/mediacentre/factsheets/fs301/en/index.html.
41. Devesh Kapur and John McHale, Give Us Your Best and Brightest: The Global Hunt for Talent and Its Impact on the Developing World (Washington DC: Center for Global Development, 2005); and Gillian Brock, “Health in Developing Countries and Our Global Responsibilities,” in The Philosophy of Public Health, ed. Angus Dawson (Farnham: Ashgate, 2009), 73–83.
42. Nigel Crisp, Turning the World Upside Down (London: Royal Society of Medicine Press, 2010), 73.
43. Ibid.
44. World Health Organization, Global Code of Practice on the International Recruitment of Health Personnel, 2010. Available online at: http://www.who.int/hrh/migration/code/code_en.pdf.
45. World Health Organization, Primary Health Care (Now More Than Ever), 2008. Available online at: http://www.who.int/whr/2008/en/index.html.
46. Anne Mills, “Mass Campaigns Versus General Health Services. What Have We Learnt in 40 Years about Vertical and Horizontal Approaches?” Bulletin of the World Health Organization 83 (2005): 315–16.
47. World Health Organization, Primary Health Care, 13.
48. World Health Organization, Positive Synergies, 2009. Available online at: http://www.who.int/healthsystems/GHIsynergies/en/index.html.
49. Global Forum on Health Research, 10/90 Gap, 2011. Available online at: http://www.globalforumhealth.org/About/10-90-gap.
50. Nuffield Council on Bioethics, Research in Developing Countries, 15.
51. Paul Farmer and Nicole Gastineau Campos, “New Malaise: Bioethics and Human Rights in the Global Era,” Journal of Law, Medicine and Ethics 32 (2004): 243.
52. Janice Hopkins Tanne, “President’s commission considers how to protect human rights after Guatemala experiment,” British Medical Journal 342 (2011): d3232. Full details are available at: http://www.hhs.gov/1946inoculationstudy/.
53. Marcia Angell, “The Ethics of Clinical Research in the Third World,” New England Journal of Medicine 337 (1997): 847–49.
54. Robert L. Berger, “Nazi Science: The Dachau Hypothermia Experiments,” New England Journal of Medicine 322 (1990): 1435–40.
55. World Medical Organization, “Declaration of Helsinki,” British Medical Journal 313 (1996): 1448–49.
56. Nuffield Council on Bioethics, Research in Developing Countries.
57. Peter Lurie and Sidney M. Wolfe, “Unethical Trials of Interventions to Reduce Perinatal Transmission of the Human Immunodeficiency Virus in Developing Countries,” New England Journal of Medicine 337 (1997): 855.
58. Angell, “Ethics of Clinical Research”; Farmer and Gastineau Campos, “New Malaise.”
59. Nuffield Council on Bioethics, Research in Developing Countries, 92–95.
60. S. R. Benatar, “Imperialism, Research Ethics and Global Health,” Journal of Medical Ethics 24 (1998): 221.
61. Nuffield Council on Bioethics, Research in Developing Countries, 115.
62. The current version, of 2008, qualifies this demand considerably, stating in its place: “At the conclusion of the study, patients entered into the study are entitled to be informed about the outcome of the study and to share any benefits that result from it, for example, access to interventions identified as beneficial in the study or to other appropriate care or benefits.” World Medical Association, Declaration of Helsinki, 2008 revision, available online at: http://www.wma.net/en/30publications/10policies/b3/index.html.
63. Ibid., 123.
64. Joseph Millum, “Post-Trial Access to Antiretrovirals: Who Owes What To Whom?” Bioethics 25 (2011): 145–54.
65. Leonard H. Glantz et al., “Research in Developing Countries: Taking ‘Benefit’ Seriously,” The Hastings Center Report 28 (1998): 38–42.
66. Nuffield Council on Bioethics, Research in Developing Countries, 124.
67. Ibid., 203.
68. World Health Organization, UNICEF, UNFPA, and World Bank, Joint Statement on Maternal Mortality and Newborn Health, 2008. Available online at: http://www.unfpa.org/webdav/site/global/shared/safemotherhood/docs/jointstatement_mnh.pdf.
69. A. E. Yamin and D. P. Maine, “Maternal Mortality as a Human Rights Issue: Measuring Compliance with International Treaty Obligations,” Human Rights Quarterly 21 (1999): 563–64.
70. United Nations, Maternal Mortality Joint Statement, 2009. Available online at:http://righttomaternalhealth.org/sites/iimmhr.civicactions.net/files/statement.pdf.
71. Amnesty International, Demand Dignity, 2010. Available online at: http://www.amnesty.org/en/campaigns/demand-dignity/issues/maternal-mortality/background.
72. Yamin and Maine, “Maternal Mortality”; United Nations, Report of the Office of the United Nations High Commissioner for Human Rights on preventable maternal mortality and morbidity and human rights, 2010. Available online at: http://www2.ohchr.org/english/bodies/hrcouncil/docs/14session/A.HRC.14.39.pdf.
73. World Health Organization Global Health Observatory, Child Mortality, 2011. Available online at: http://www.who.int/gho/mdg/child_mortality/situation_trends_child_mortality/en/index.html.
74. Yamin and Maine, “Maternal Mortality.”
75. IIMMH, Combating Maternal Mortality, Why Bring Human Rights into the Picture?, 2009. Available online at: http://righttomaternalhealth.org/resource/HRC-panel-2009.
Chapter 5: Where Next?
1. Djély K. Samoura, “African Commission of Health and Human Rights Promoters,” Health and Human Rights 2 (1995): 145–50; see also Cécile Marotte and Hervé Rakoto Razafimbahiny, “Haiti 1991–1994: The International Civilian Mission’s Medical Unit,” Health and Human Rights 2 (1995): 117–26.
2. David McCoy et al., “The Bill & Melinda Gates Foundation’s Grant-making Programme for Global Health,” The Lancet 373 (2009): 1645–53.
3. Elizabeth Pisani, “An End to Polio?” Prospect, March 2011, 72–74.
4. Richard Horton, “Stopping Malaria: The Wrong Road,” review of Bill Shore, The Imaginations of Unreasonable Men: Inspiration, Vision, and Purpose in the Quest to End Malaria, New York Review of Books, February 24, 2011.
5. Farmer, Pathologies of Power, ix.
6. People’s Health Movement, “About The People’s Health Movement,” 2011. Available online at: http://www.phmovement.org/en/about.