Health and Human Rights最新文献

Discriminatory laws and punitive policing practices have long been known to impede access to HIV and other health services. While the 2021-2026 Global AIDS Strategy calls for decriminalizing laws targeting key and vulnerable populations, progress toward this goal has largely stalled. To better understand the potential for working with police to ensure access to HIV services, we conducted a scoping review of peer-reviewed and gray literature examining outcomes of police training published between January 2000 and August 2024. Following a review of 639 articles and reports meeting our search criteria, we found 11 peer-reviewed articles and six reports that included outcomes of police training. Our review found that well-designed police training can benefit both law enforcement and communities. It can be a cost-effective public health investment. Best practices for police training included addressing police occupational safety concerns; using trainings as opportunities to build stronger relationships between law enforcement and communities; fostering support from police leadership; and embedding training in a broader effort to change policing. While changing police is complex, our review found a body of literature describing positive outcomes from training, including increasing recognition by police of their role to protect the right to health for key and vulnerable populations.

The 2030 Agenda for Sustainable Development promotes multi-stakeholder partnerships (MSPs) to achieve sustainable development, including global health-related goals. MSPs typically involve three or more types of actors, including states, corporations, philanthropic organizations, civil society, and multilateral institutions. While MSPs often operate in sectors that are crucial for the realization of health-related rights, they are seldom analyzed through a human rights lens. This paper will advance knowledge in this field through an exploration of the Access to COVID-19 Tools Accelerator (ACT-A), launched in 2020. In doing so, the paper sheds light on the direct accountability of MSPs to rights holders, as well as the state obligations to respect and protect human rights in the context of MSPs. The paper outlines a human rights accountability framework to investigate the ACT-A's accountability structure. The analysis confirms three systemic accountability problems: diffused responsibility in terms of the applicable normative and legal frameworks; limited answerability to rights holders; and weak enforceability in terms of remedies. This, in turn, limits the possibility of health rights accountability, including review, monitoring, and remedial action. The conclusions highlight three solutions: that MSPs themselves should at least have the duty to respect human rights, as do other corporate entities; that an independent, people-centered mechanism to hold MSPs accountable should be established; and that multilateral governance solutions, including seats at the table for less powerful actors, should be prioritized over multi-stakeholder approaches.

Sexual and reproductive health and rights (SRHR) during conflicts and disasters are protected under multiple legal and policy frameworks; however, weak accountability mechanisms often prevent these rights from being realized. Drawing on case studies from Uganda, Bangladesh, and Nepal, this paper examines rights-based approaches for strengthening accountability for access to health services at the local level. The case studies adopt a "circle of accountability" as both a conceptual framework and implementation strategy to monitor, review, and prompt remedial action when reproductive rights are not respected. We argue that four interrelated strategies offer a promising approach to advance accountability for SRHR in displacement contexts marked by weakened governance, overlapping duty bearers, and power imbalances within humanitarian systems: (1) strategic legal and policy advocacy to promote alignment with human rights standards; (2) multi-sectoral partnerships and human rights champions to facilitate commitments among humanitarian actors; (3) equitable participation in humanitarian platforms to shape decision-making and remedial action; and (4) reimagined rights-based evaluation methods to promote people-centered accountability. Ultimately, we offer a road map for practitioners working in other humanitarian and disaster contexts to shift accountability for reproductive rights beyond performative checklists toward addressing both the immediate needs of displaced communities and systemic remedial action.

As South Africa moves toward implementing the National Health Insurance scheme, the promise of universal health coverage remains constrained by material and legal obstacles to land access. Mobile clinics, vital for underserved communities, are undermined by tenure insecurity, fragmented land governance, and exclusionary property regimes. These obstacles expose an accountability gap: the state's failure to use available constitutional tools to dismantle entrenched spatial inequalities. This paper conceptualizes accountability through three interlinked features-monitoring, review against human rights standards, and remedial action-and uses this framework to examine the case of South Africa. We argue that equitable health care delivery requires transforming the property relations that structure spatial access. At the heart of this claim is the recognition that property is a social institution whose legitimacy depends on serving broad societal goals. Reframed in this way and coupled with expropriation as a constitutionally sanctioned remedial tool, land acquisition for health care infrastructure becomes a decisive test of accountability. Doing so repositions expropriation not as an exception but as a necessary instrument of social repair and redistributive justice, particularly where historical dispossession and spatial apartheid have left deep scars in access to health care.

The story of United Nations (UN) efforts to create an independent mechanism to foster greater accountability across global health is one of high hopes, missed opportunities and, ultimately, planned project failure. The creation of the UN Secretary-General's Independent Accountability Panel on Women's, Children's and Adolescents' Health (IAP) in 2016 was born out of the idea that accountability was the missing link to achieve progress on the Sustainable Development Goals related to women's, children's, and adolescents' health. The IAP produced four reports before it was dissolved in 2020. Subsequently, other independent accountability mechanisms have been proposed, such as for antimicrobial resistance. In this paper, I draw on my experience as a member of the IAP to examine the context for the creation of the IAP and share four lessons as to why meaningful accountability has been so elusive in global health and how future efforts might benefit from these insights. These lessons relate to the need for (1) normative grounding; (2) institutional legitimacy; (3) genuine independence; and (4) conceptual clarity with respect to the meaning of accountability. I conclude by arguing that the deeply neoliberal and colonial architecture of global governance for health constrains possibilities for transformative accountability. In telling this story, I do not pretend to represent the views of other IAP members, who may have very different reflections.

The international legal landscape governing global health is characterized by regime complexity and legal fragmentation, with overlapping and sometimes conflicting legal norms. This fragmentation can blur lines of accountability, particularly in the context of access to medicines, where responsibility is dispersed across multiple stakeholders. Traditional frameworks of accountability in human rights law emphasize a vertical relationship between states as duty bearers and individuals as rights holders- failing to capture the multifaceted reality of global pharmaceutical governance, where access to medicines is shaped not only by the relevant state but also by a range of nonstate actors. Among these, pharmaceutical corporations play a pivotal role in shaping a state's capabilities to ensure access to medicines for its population. In this context, we argue that the development and deployment of a pharmaceutical accountability scorecard offers an innovative tool to address some of the existing accountability gaps. This paper presents the Fair Pharma Scorecard - Cancer Edition, developed by the Dutch nonprofit Pharmaceutical Accountability Foundation, as an innovative tool to address some of the existing gaps. Grounded in a normative framework that draws on various international legal and health- related instruments, this scorecard evaluates the extent to which multinational pharmaceutical companies fulfill or neglect their responsibilities to ensure equitable access to medicines.

In mid-2015, the Gauteng Department of Health in South Africa canceled a contract with Life Esidimeni, a subsidiary of a large hospital group that ran four facilities housing almost 2,000 people with mental illnesses. The termination of the contract and the chaotic transfers of people that followed resulted in enormous suffering and 144 deaths. Mental health care users died in conditions of neglect-emaciated, dehydrated, unmedicated, and with bedsores and gangrene. Their rights to health care services, to dignity, and to life were violated. The Life Esidimeni disaster occurred within the context of institutional corruption: a systemic and strategic influence that undermines an institution's effectiveness by weakening both its ability to achieve its purpose and the public's trust in it. Considering the institutional corruption that was the context for the Life Esidimeni disaster-including the overlap of political and administrative functions and the drive to save money, disguised as a desire for deinstitutionalization-this paper examines the public and legal processes undertaken to expose the disaster, to secure accountability, and to begin to deconstruct the conditions that allowed one of South Africa's most shameful human rights violations of the democratic era.