Health and Human Rights最新文献

Self-managed abortion holds particular promise for revolutionizing people's access to quality reproductive care in Africa, where the burden of abortion-related mortality is the highest globally and where abortion remains criminalized, in violation of various internationally and regionally recognized human rights. Increasingly safe and effective, self-managed medication abortion is still subject to many restrictions, including criminal laws, across the continent. Drawing on recent evidence and human rights developments around self-managed abortion, this paper explores whether and to what extent Africa's regional legal framework builds a normative basis for the decriminalization of self-managed abortion. We conclude that the region's articulation of the rights to dignity, to freedom from cruel, inhuman, and degrading treatment, and to nondiscrimination, among others, provides strong grounds for decriminalization, both concerning individuals who need abortions and concerning the constellation of actors who enable self-management.

Extended life expectancies and shifting dynamics in chronic disease have changed the landscape of public health interventions worldwide, with an increasing emphasis on chronic care. As a result, transition from pediatric to adult care for medically complex adolescents and young adults is a growing area of intervention. Transition medicine is a nascent field whose current emphasis is on middle- and high-income countries, and thus far its methods and discourse have reflected those origins. Through several case-based examples, this paper aims to highlight the possibilities of an analytic approach grounded in structural competency for transforming transition medicine through a human rights-based framework, with an emphasis on imagining a more global framework for transition medicine. Our cases highlight the disparities between patients navigating pediatric to adult-based care, illuminating social stigma, stratification between public and private insurances, engagement in risk-taking behaviors, family conflict, and challenges with transition readiness. To reimagine transition medicine so that it is based on human rights, we must prioritize structural solutions that embrace multisectoral integration and holistic mental health support rather than oppress and marginalize these critical systemic adaptations. We aim to reconfigure this scaffolding to center structures that integrate holistic well-being and imagine alternate realities to healing. Our work contributes to the literature bringing structural competency to new spaces of clinical practice, contextualizing new frontiers for the exploration of chronic diseases across diverse clinical contexts worldwide.

Improving the protection of the right to health of ethnic Roma people is one of the most pressing public health challenges in contemporary Europe, as their life expectancy and health status remain significantly lower than their non-Roma counterparts.¹ This paper analyzes Roma-led accountability initiatives that embrace social accountability and legal empowerment approaches to advocate for equitable fulfillment of the right to health. While these initiatives have led to the elimination of some harmful health practices (such as illegal cash bribes and violent and abusive treatment by medical professionals) and to improvements in health care, and some Roma communities have become driving forces for local and national health system reforms for advancing the fulfillment of health rights, the health inequalities affecting Roma communities remain significant. This issue also remains largely overlooked by European health research and policy experts, who are mostly reluctant to incorporate analyses of ethnicity and racialization into their research on health inequalities in Europe. The COVID-19 pandemic has further exacerbated these health inequalities.

After considerable progress in recent decades, maternal mortality and morbidity (MMM) either stagnated or worsened in most regions of the globe between 2016 and 2020. The world should be outraged given that we have known the key interventions necessary for preventing MMM for over three-quarters of a century. Since the 1990s, human rights advocacy on MMM has gained crucial ground, demonstrating that entitlements related to maternal health are judicially enforceable and delineating rights-based approaches to health in the context of MMM. Nonetheless, evident retrogressions, coupled with ballooning social inequalities, redoubled austerity post-pandemic, and a conservative populist backlash against reproductive rights, underscore the steep challenges we face. This paper offers five lessons gleaned from what we have achieved during the past 30 years of human rights advocacy on maternal health, and where we have fallen short: (1) maternal health is not a technical challenge alone and is inseparable from reproductive justice; (2) reproductive justice requires strengthening health system infrastructures; (3) we must center the political economy of global health in our advocacy, not just national policies; (4) litigation is part of a larger advocacy toolkit, not a go-it-alone strategy; and (5) we must use metrics that tell us why women are dying and what to do.

The Araucanía region of Chile is characterized by a significant rural Indigenous population-the Mapuche people-who preserve their cultural beliefs about the world around them. This region is also distinguished by the conflict between the Mapuche people and the Chilean government. The Chilean state has supported the development of extractive projects such as industrial plantations, hydroelectric plants, and aquaculture, using nature to generate profits. This has collided with the Mapuche's inextricable relationship with nature and territory, which they value as a spiritual and historical space. Our qualitative study, conducted between 2016 and 2019 in three Araucanía territories with large Mapuche populations, sought to explore Mapuche perceptions of nature, their right to health, Indigenous rights generally, and Indigenous communities' relationship with the state. The results show an overall perception among Mapuche communities of an extractive mentality at the heart of the Chilean state, regardless of the administration in power, as well as a belief that the industrial occupation of their territories represents a process of colonialism and the transgression of ancestral rights. This extractivist approach by the state has caused Mapuche communities to witness enormous changes to their ecosystem, with negative impacts on their well-being.

Traditionally, teaching in psychiatry has had a passing focus on human rights. Against this backdrop, the aim of this study was to construct a theory of the learning value of a service user-led human rights-focused teaching program for final-year medical students. We used descriptive qualitative analysis based on constructivist grounded theory to examine final-year medical students' understandings of human rights following a formal teaching program. The overarching theory that emerged focuses on an awareness of the need for change within student learning. This involves both a need for understanding the mental health care system and a need for self-reflection. These two processes appear to interact, promoting learning about the value of a human rights focus. While acknowledging the difficulties in securing such a change, students felt that doing so would be valuable to the practice of mental health. This service user-led human rights teaching program produced new awareness in medical students, both in terms of their understanding of their own biases and in terms of understanding the influence of systemic and structural elements of the psychiatric system on the protection of service users' human rights. Teaching human rights in psychiatry is likely to enrich their future self-reflective practice.

Food insecurity can be understood as a manifestation of health inequality and thus a deprivation of the right to health. This paper explores the strategies followed in primary health care centers in Spain to care for people struggling to regularly access healthy, safe, and sufficient food. Ethnographically based, our study analyzes, on the one hand, the resources available to primary health care teams to assess the social determinants of health and, on the other, the importance that professionals give to food in the diagnosis, treatment, and prevention of diseases related to inequality. Given that our study was carried out during the recent economic and health crises, the results show the difficulties faced by these centers in responding to constantly changing social needs. Budget cuts, a lack of specific or structural actions, and the invisibilization of particular expressions of inequality have proven challenging to the aim of providing integrated care capable of recognizing the environmental factors that condition patient health. In the case of food insecurity, our study found that there are no instruments in primary care centers to identify and therefore address this insecurity. We explore whether this is due mainly to the growing lack of means or more to the fact that the relationship between material living conditions, food, and health has been downplayed-and the responsibility of the health system in guaranteeing the right to food correspondingly diluted.