Health and Human Rights最新文献

Existing evidence shows that mental health policies and services are especially vulnerable to ineffective and corrupt practices. Systemic obstacles, such as the overuse of the biomedical model, power asymmetries, and selective evidence, undermine both the realization of the right to health and the rights-based implementation of policies in practice. This paper draws on the personal experience of the authors alongside global insights to examine the relationship between institutional corruption and the right to mental health, with a focus on Central and Eastern Europe as a bellwether. Following the societal transitions of the 1990s and beyond, prolonged psychosocial stress contributed to widespread self-destructive behavior and high mortality rates, particularly among rural, middle-aged men. In response, foreign consultants frequently advised governments to prioritize diagnosing clinical depression and prescribing new-generation psychiatric medications as the principal strategy. We argue that this narrow biomedical focus, reinforced by biased evidence, represents a form of institutional corruption: it distorts problem framing, entrenches biomedical dominance, sidelines community and social responses, and ultimately compromises the right to health. Recognizing and addressing these dynamics is essential to align mental health policy with rights-based, context-responsive care.

Through an exploration of the impacts of institutional corruption in global mental health, we argue here that deploying human rights-based approaches to health must go beyond rhetoric regarding equity in access to treatment to address power structures that systematically perpetuate harm against diverse people in specific contexts. First, applying human rights to mental health in transformative ways requires upending the biomedical paradigm that both locates mental health within people's brains and imbues psychiatric expertise as an unchallengeable authority in defining mental health conditions. Second, such change in approaches to mental health has proved challenging due in significant measure to institutional corruption, defined as a systemic, legal influence that diverts the institution from its purpose. We focus on institutional corruption driven by financial influences of the pharmaceutical industry in combination with the guild interests of the psychiatric profession. Third, we sketch the relation between institutional corruption and the spread of neoliberal policy imperatives on the financing and organization of mental health services in lower-middle and middle-income countries. Finally, we question the metrics deployed in global health that reaffirm existing presumptions in mental health systems, such as coverage, which can foster institutionalized corruption. We conclude that focusing on institutional corruption allows us to understand the need for new forms of health governance aligned with transformative human rights praxis.

The discourse around health as a human rights issue usually focuses on access to medical treatment. However, the "right to health" begins with the right to informed consent about the merits of a treatment, which has been lacking as a US-constructed "disease" model of psychiatric care has been exported around the globe. The narrative that supported the adoption of the disease model told of how major psychiatric disorders were due to chemical imbalances in the brain, which could be treated by a second generation of psychiatric drugs that fixed those imbalances, much like "insulin for diabetes." Randomized clinical trials had proven that antidepressants, antipsychotics, and other psychiatric drugs were safe and effective. However, missing from this narrative of medical progress were three key facts: that investigations failed to validate the chemical-imbalance theory of mental disorders; that studies of long-term outcomes regularly failed to show a benefit for the medicated patients; and that this model of care has led to poor public health outcomes in the United States and other developed countries. The principle of informed consent in medicine can be expanded to include the obligation of a medical specialty to be a reliable narrator of its own research, which provides a framework for understanding the violation of human rights that occurred with the exporting of a disease model of care to a global population.

This paper examines how people-centered accountability initiatives are operating to enforce the right to health amid Israel's genocide in Gaza. Drawing on a critical case study of Doctors Against Genocide, Healthcare Workers Watch, and the Freedom Flotilla Coalition, we situate these actors' work within international human rights law, social accountability scholarship, and decolonial and abolitionist critiques. We show how these actors are able to combine clinical documentation, survivor testimony, and direct action to monitor human rights violations, generate medically literate records of the harm inflicted, and press for remedies that state-centered mechanisms have failed to deliver despite findings of war crimes and genocide by United Nations bodies and human rights groups. Across these cases, we identify some common practices and tensions surrounding coalition-building, risks to documentation, navigating a media environment of mis/disinformation, and engaging strategically with institutions that often reproduce health harms or are directly complicit. We argue that these movements treat people-centered accountability as part of their professional duty and act on a mandate to prevent mass atrocity crimes rather than being silent. We conclude by outlining some practical implications for clinicians, professional associations, and health systems seeking to align their global health practice with a people-centered approach to accountability.

Peru's mental health system remains marked by chronic underinvestment, fragmentation, and weak regulation, leaving many without adequate access to care. In this context, private pharmacy chains have become central actors in the provision of mental health services, functioning as de facto points of access for psychotropic medications. Drawing on the concept of institutional corruption and a rights-based analysis, this paper examines how their dominance has transformed access to psychotropic medication into a market-controlled process in which commercial interests shape treatment pathways, reinforcing inequality and overmedicalization and undermining the right to health.

In the last 15 years, coalitions of individuals and institutions worldwide have been calling for global policies to close the treatment gap for people living with mental disorders. This paper seeks to contribute to the literature on the effects of the diffusion of these global mental health polices by exploring their implementation and impact in Peru. Aligned with the Movement for Global Mental Health, Peru has carried out a mental health reform aimed at scaling up mental health care in public facilities. Using the human rights-based framework of availability, accessibility, acceptability, and quality, this paper examines the reform's effects on a population prioritized by global and Peruvian policies: adolescents. The analysis, based on qualitative research, illustrates how the reform's overemphasis on scaling up access to pharmaceutical treatment neglects critical issues such as health system capacity, the availability of trained human resources, the need for intercultural approaches tailored to adolescents, and information systems that adequately monitor policy impact. The analysis also highlights how a reform that promotes pharmacological treatment creates risks of abuse by private actors involved in the marketing of psychiatric medications.

Through a one-country case study, this essay analyzes nongovernmental organizations' (NGOs) institutional work, ranging from legal to grassroots actions, to enforce adolescents' sexual and reproductive health rights in Kenya. Within the rapidly shifting landscape in international aid and despite the difficulties of achieving internationally agreed rights and Sustainable Development Goals, NGOs continue to position themselves as key advocates for adolescents' rights. NGOs' multilevel institutional work has three main roles: legal advocacy and litigation, evidence generation and policy monitoring, and rights awareness-raising. This Kenyan analysis highlights NGOs' actions, successes, and challenges in advocating for adolescents' sexual and reproductive rights, providing valuable insights for similar settings within the region.

Accountability is central to human rights, yet it has varied interpretations across contexts. Conventionally, accountability denotes blame and punishment or emphasizes hierarchical relationships between claim holders and duty bearers. However, accountability cannot be an episodic event. In health governance, continuous and iterative improvements are required to reflect changing social, economic, and political circumstances. Accordingly, we define "temporal accountability" as an institutional design that incorporates time-bound obligations for implementing corrective actions and remedial measures. Through a case study of Taiwan's Constitutional Court decision on expatriate residents' financial contributions, we analyze temporal accountability in action and draw broader lessons for human rights accountability, proposing measurable indicators and guiding principles of temporal accountability.