Health and Human Rights最新文献

Tanzania is among the countries with high rates of maternal mortality. In 1976, Tanzania ratified the International Covenant on Economic, Social and Cultural Rights, which enshrines the right to health, including maternal health care. This right is further recognized in national law and policy. Despite these commitments, Tanzanian women continue to die from preventable maternal causes. Using a right to health lens, this qualitative study explored the barriers preventing rural underserved women from seeking skilled birth attendance and emergency obstetric care in Ngorongoro, Tanzania, where the use of such services has historically been low. Our study included a document review of maternal health-related laws, policies, and reports issued by governmental and nongovernmental entities, alongside interviews with 32 women of reproductive age. We found that the right to quality maternal health care was constrained by (1) low government budget allocations, (2) a lack of skilled health providers and maternal health care infrastructure and supplies, (3) long distances to health care facilities and a lack of transportation, (4) high cost of transportation and health facility delivery, (5) the tradition of home delivery, and (6) distrust that health care facilities would provide respectful and culturally appropriate care. We then generated key recommendations to overcome such barriers and thereby improve rural maternal health care and reduce maternal mortality.

Dual practice physicians are those who work in both the public and private sectors: for example, in the morning seeing patients in a state-run hospital, and in the afternoon seeing paying customers in a private facility. Dual practice is a legal but morally problematic practice that can lead to dual loyalty. In Serbia, dual practice has contributed to institutional corruption because physicians who work in both sectors siphon patients from public facilities into private ones and have little incentive to protect the public system. This problem is especially acute in the areas of psychiatry and the public mental health care sector. Private health care is unregulated, with no legal framework for psychotherapy, and there is widespread reliance on cheap anti-anxiety drugs in the population. All of this contributes to rising health care costs, poorer care in both the private and public sectors, overworked physicians, and the shortsighted complicity of the guilds. This is an attack on the right to health: the poor will often get insufficient care, while the patients who are financially better off are at risk of overtreatment and overdiagnosis.

Dual loyalty dilemmas are conflicts between health care professionals' obligations toward their patients and third-party interests. These conflicts are more common and starker in custodial settings, such as jails and prisons, military detention facilities, immigration detention centers, and involuntary psychiatric institutions. Despite encountering patients in custody, health care professionals (HCPs) in community settings have limited knowledge and training. In this narrative review, we examined dual loyalty conflicts faced by HCPs working in custodial settings and then applied the identified themes to community-based hospitals where HCPs care for patients in custody. We searched databases for original papers relating to patients in custody and dual loyalties and then abstracted key themes, findings, and characteristics of the conflicts. There are five categories of competing loyalties that give rise to dual loyalty conflicts: institutional and organizational entities, legal and regulatory guidelines, ethical and moral responsibilities, social and public responsibilities, and other individuals. Themes include the inappropriate withholding or delaying of care, the provision of intervention despite patient refusal, the violation of patients' rights to privacy, cruel non-clinical interventions (e.g., torture), and the failure to document or report information accurately. Mitigation strategies in the literature emphasize expanding human rights education, improving patient communication around possible conflicts, and raising clinician awareness of institutional policies. Common in the care of patients in custodial settings worldwide, dual loyalty conflicts can impact patient care. However, pursuing mitigation strategies can lessen their impact.

Maternal death reviews or audits are among several interventions used to reduce maternal mortality. The maternal death surveillance and response (MDSR) system is one such mechanism, combining case identification with analysis of underlying causes to inform corrective action. Although introduced to generate information for accountability in maternal health, the meaning and implications of accountability in this context remain underexamined. A dominant framing of MDSR as an internal quality assurance tool-coupled with a narrow, punitive conception of accountability-appears to limit its potential to help address preventable maternal deaths. This paper draws on the stated objectives and structural design of MDSR to argue that reconceptualizing it as a mechanism of human rights accountability not only aligns with its normative aims but also provides a more robust framework for tackling maternal mortality. It responds to the challenge of achieving accountability without reducing it to blame, examining how MDSR can foster accountability consistent with international human rights standards and what this would entail in practice.

Among the many crimes committed during the Tigray war from 2020 to 2022, the systematic destruction of health care has been extensively documented and contributed to the suffering and death of hundreds of thousands of civilians. Despite the direct harm that Tigray's health care workers experienced and their role in sustaining care under siege, these professionals have been excluded from a transitional justice process that remains performative rather than substantive. We argue that this exclusion represents a violation of international legal obligations and a failure of both the Ethiopian government and the multilateral organizations involved through financing and diplomacy. Despite their marginalization, Tigrayan health workers have continued to exercise agency through sustained grassroots advocacy, documentation, and collective action. In this case study, we amplify the voices of these professionals as they assert their rights, record unacknowledged harms, and demand meaningful participation in the very mechanisms intended to deliver justice. Their experience demonstrates that truly centering victims requires centering health workers as well-addressing their material, legal, and psychological needs as part of any effort to uphold health as a human right.

In Queensland, Australia, adults in custodial facilities do not have discretionary access to over-the-counter (OTC) medications for mild pain relief and management. This study evaluated a trial allowing prisoners in male and female units at a regional Queensland correctional facility to purchase OTC medications from the prison store. The trial aligned with human rights legislation, international obligations, and the requirement for community equivalence of health care for prisoners. Queensland is the first jurisdiction in Australasia to undertake such a trial. We analyze the results from focus groups and surveys, comparing male and female prisoner experiences, by applying a gender impact assessment to examine pain management as a gender and health rights issue. Pain is gendered, and women's pain is often downplayed, not taken seriously, or not treated appropriately. Prisoners reported that being able to manage their pain relief gave them agency and decision-making ability that affirmed their human and health rights while living in a controlling environment. While this initiative has a positive impact on gender equality-because women are better able to self-manage pain-there are continuing opportunities to improve women's health care and address challenges of equivalence and the gender pain gap in prison systems.

Treating obesity with weight-loss medications has redirected clinical attention toward health conditions long stigmatized as personal failings, while potentially benefiting comorbidities such as mental health. Yet this "pharmaceuticalization" is deeply intertwined with the broader financialization of health care, enabling extractive practices by dominant drug makers operating in highly concentrated markets. These dynamics unfold under limited public oversight, ultimately undermining the realization of the right to health and redefining medical progress through corrupted practices of market expansion and control. This paper adopts a moral and political economy perspective to examine the pharmaceuticalization of obesity and its intersections with mental health, revealing its implications for health systems in the United States and low- and middle-income countries.