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Health is a fundamental human right

Human rights day 2017.

“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”.

Almost 70 years after these words were adopted in the  Constitution of the World Health Organization , they are more powerful and relevant than ever.

Since day one, the right to health has been central to WHO’s identity and mandate. It is at the heart of my top priority: universal health coverage.

The right to health for all people means that everyone should have access to the health services they need, when and where they need them, without suffering financial hardship.

No one should get sick and die just because they are poor, or because they cannot access the health services they need.

Good health is also clearly determined by other basic human rights including access to safe drinking water and sanitation, nutritious foods, adequate housing, education and safe working conditions.

The right to health also means that everyone should be entitled to control their own health and body, including having access to sexual and reproductive information and services, free from violence and discrimination.

Everyone has the right to privacy and to be treated with respect and dignity. Nobody should be subjected to medical experimentation, forced medical examination, or given treatment without informed consent.

That’s why WHO promotes the idea of people-centred care; it is the embodiment of human rights in the practice of care.

When people are marginalized or face stigma or discrimination, their physical and mental health suffers. Discrimination in health care is unacceptable and is a major barrier to development.

But when people are given the opportunity to be active participants in their own care, instead of passive recipients, their human rights respected, the outcomes are better and health systems become more efficient.

We have a long way to go until everyone – no matter who they are, where they live, or how much money they have – has access to these basic human rights.

The central principle of the  2030 Agenda for Sustainable Development  is to ensure that no one is left behind.

I call on all countries to respect and protect human rights in health – in their laws, their health policies and programmes. We must all work together to combat inequalities and discriminatory practices so that everyone can enjoy the benefits of good health, no matter their age, sex, race, religion, health status, disability, sexual orientation, gender identity or migration status.

Dr Tedros Adhanom Ghebreyesus

WHO Director-General World Health Organization

• Open access
• Published: 20 December 2017

Human rights in patient care and public health—a common ground

• Maya Peled-Raz   ORCID: orcid.org/0000-0003-0893-8709 1  

Public Health Reviews volume  38 , Article number:  29 ( 2017 ) Cite this article

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Medical law and public health law have both served extensively as instruments of health protection and promotion—yet both are limited in their effect and scope and do not sufficiently cover nor supply a remedy to systematic, rather than anecdotal, mistreatments in the health care system.

A possible solution to this deficiency may be found in the human rights in patient care legal approach. The concept of human rights in patient care is a reframing of international human rights law, as well as constitutional thought and tools, into a coherent approach aimed at the protection and furthering of both personal and communal health. It applies human rights discourse and human rights law onto the patient care setting while moving away from the narrow consumeristic view of health care delivery.

By applying human rights in patient care approach, both national and international courts may and should serve as policy influencing instruments, protecting the rights of the most vulnerable and prejudiced against groups, which are want of a remedy through traditional patients’ rights legal schemes.

The concept of human rights in patient care (HRPC) is rooted in the health and human rights framework and builds on the last 2 decades of work by the health and human rights movement [ 1 ].

It is a reframing of international human rights law, as well as constitutional thought and tools, into a coherent approach aimed at the protection and furthering of both personal and communal health. It attempts through the theoretical and practical application of general human rights principles to the patient care context, particularly to interactions between patients and providers ([ 2 ] at p. 7).

HRPC is viewed as a principled alternative to the growing discourse of “patients’ rights” that has evolved in response to widespread and severe human rights violations in health settings ([ 2 ] at p. 13–15).

In this paper, I would like to contend that HRPC is a conceptual link between medical law Footnote 1 and its patients’ rights subpart and public health law.

While an in-depth discussion into the similarities and differences between HRPC and patients’ rights discourse is due (and has been done elsewhere) [ 2 ], this paper will focus on the correlation between HRPC and the public health legal framework, while limiting the discussion of the former topic to only central short observations.

What are human rights?

Ethicists use the term “human rights” to describe unchallengeable, fundamental rights to which a person is inherently entitled simply because she or he is a human being. They are commonly seen as based on natural law, which is a norm that exists independently, regardless of the law enacted by people under a certain regime, society, or country. The existence of such rights derives from philosophical reasoning and argumentation, deducing binding rules of moral behavior, via the use of reason, to analyze both social and personal human nature [ 3 ].

Human rights, through the lens of natural law theory, are aspirational in nature and are commonly (though contestable) thought to be universal and timeless.

Legal scholars, on the other hand, use the concept of human rights to refer to a body of international law that originated in response to jarring offenses against human dignity committed during World War II [ 4 ]—as well as to its derivatives and complimenting arrangements on the regional and national levels. The concept of human rights, in this context, relies on texts and precedents and is enforced through treaty obligations, as well as constitutional ones.

The main international source of human rights law is the International Bill of Human Rights, comprising the United Nations Charter, the Universal Declaration of Human Rights, and two international human rights conventions—the International Covenant on Civil and Political Rights (ICCPR) and the International Covenant on Economic, Social and Cultural Rights (ICESCR) (both adopted in 1966 and entered into force in 1976).

In its preamble, the United Nations Charter articulates the international community’s determination “to reaffirm faith in fundamental human rights, [and] in the dignity and worth of the human person.” The Charter, as a binding treaty, pledges member states to promote universal respect for, and observance of, human rights and fundamental freedoms for all, without distinction as to race, sex, language, or religion [ 4 ].

Over the years, states have created an extensive array of international conventions, declarations, and organizational frameworks to protect human rights. These conventions reflect the human rights norms that the signatory states undertake to meet and guarantee. In America, Footnote 2 Europe, Footnote 3 and Africa Footnote 4 states established separate regional systems to promote and protect human rights, which include enforcement mechanisms.

In order to fulfill their treaty obligations, as well as independently of that, many states have incorporated a human rights protection scheme into their national constitutional and regulatory frameworks—articulating their tailored commitment to the furthering and protection of human rights within their borders.

Laying the ground: medical law and public health law

Patient care and public health are two complementary and interrelated approaches for promoting and protecting health. Yet, patient care and public health can and also must be differentiated because in several important ways, they are not the same [ 5 ].

Patient care refers to the prevention, treatment, and management of illness and the preservation of physical and mental well-being through services offered by health professionals (or non-professionals under their supervision) [ 6 ]. Conversely, public health, as per the Institute of Medicine, “is what we, as a society, do collectively to assure the conditions for people to be healthy.” [ 7 ]. The fundamental difference involves the population emphasis of public health, which contrasts with the essentially individual focus of medical care. Public health identifies and measures threats to the health of populations, develops governmental policies in response to these concerns, and seeks to assure certain health and related services. In contrast, patient care focuses on individuals—diagnosis, treatment, relief of suffering, and rehabilitation [ 5 ].

Medical law (along with its patients’ rights subpart) and public health law have both long been used to protect and further human rights: the first through attempting to regulate professional conduct in patient care and the second by attempting to regulate public health engagements.

The patients’ rights legal approach

The medical law governs professional conduct in the patient care sphere primarily through civil law—torts law mainly. It zeros on the interaction between patients and caretakers in the patient care setting—and specifically sets its focus on the obligations of the caretaker in that relationship. It is relevant and applicable in cases where the individual—receiving or seeking treatment—suffers direct harm, due to a breach of his right to good care. Good care has been viewed to consist of not only competent and skilled practices but also of respect of patients’ rights—their ability to lead treatment decisions instead of being led through them, to maintain control of the information divulged to them and to others, to receive equal care in a non-discriminatory fashion, and to leave the health care facility when desiring so and so on.

While these rights stem directly from the fiduciary attributes of the doctor-patient relationship [ 8 ], they have gradually taken on a consumeristic form [ 9 ]. Policy analysts began to think about the potential role of patients as customers in the 1930s, in response to the rapidly rising costs of medical care ([ 8 ] at p. 586). In the 1960s, consumerist ethos has been warmly embraced by medical law as an aspect of the patients’ rights movement that challenged physician paternalism [ 10 ] and has gained additional force in the 1980s in light of the desire to shield patients from harm due to the rising need to rationalize medical expenditures [ 11 ].

Within this consumeristic framework, patients’ rights are seen as placing what resembles contractual obligations on the shoulders of health professionals—therein viewed as service providers. These obligations, when not fulfilled, may be grounds for a civil lawsuit, demanding compensation for damages—caused due to the direct violation of the right itself and/or due to physical damage that may have been caused by the said violation.

In the last 50 years, specific aspects of what good care is—and thus what a patient has a right to expect when entering the health care system—have been codified in key national and regional instruments ([ 2 ] at p. 13). These codes, along with court decisions awarding damages for breaches of patients’ rights, have gone a long way in furthering patients’ rights to good care. With that being said, key limitations must be noted to the scope of the protection rendered to human rights under the patients’ rights doctrine.

First, the patients’ rights doctrine leaves out the rights of other stakeholders in health care delivery, focusing exclusively on patients ([ 2 ] at p. 14). It does not, for example, regard caretakers’ right to safe working conditions, their freedom from (professional) coercion, nor their right to freedom of association. Second, as a paradigm that only looks at what happens inside of the patient-provider (whether a human provider or an institutional one) relationship, it is unsuitable to instances in which the cause of the infringement on human rights rests with elements which are external to the said relationship. When the (health care) system is designed—deliberately or not—in a way that is set to infringe on human rights, the patients’ rights doctrine will provide no assistance. A patient cannot claim an infringement on his right as a patient when he is not receiving equal care, due to the lack of a nationally funded health plan, nor can he protest his patient’s rights breached when a state law requires the physician to notify the authorities of his medical condition.

• Public health law

Public health professional conduct, in contrast to the previously described patient care sphere, has long been governed by public law—through its public health law subdomain—focusing on the interaction between the state and its citizens regarding their health.

Public health law regulates the state’s authority and duty to identify and lessen community health risks as well as to promote the health of the community. At the same time, it contemplates the limits on the state’s authority to constrain the personal rights of its inhabitants—in the name of furthering the population’s health [ 12 ]. The core legal components of the public health law are the administrative, statutory, and constitutional provisions that empower or mandate a government to act for the health of the community, as well as those that bridle the state’s power to do so [ 12 ].

In many cases, human rights are intertwined with the public health law, serving both as the reasoning behind public health governmental interventions and actions, as well as a limitation on the state’s power, as it attempts to further public health goals.

WHO’s constitution states that health is the “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. Footnote 5 Human rights are the basis for such conditions—headed by the right to health care, but definitely not concluding at it. People will be healthier when they get better excess to health care and when health care itself is better, but also when they themselves are better educated, when their bodily integrity is not threatened by external preventable harms, when they have a right to use pregnancy prevention and planned-parenthood tools, and so on. Governments are therefore responsible for enabling their populations to achieve better health through respecting, protecting, and fulfilling rights, i.e., not violating rights, preventing rights violations, and creating policies, structures, and resources that promote and enforce rights [ 13 , 14 ].

At the same time, actions taken to further health-supporting rights may also infringe on the rights of some individuals, and should thus be scrutinized in accordance with human rights law and its application in public health law. Attempts to minimize the use of tobacco products may infringe on the smoking individual’s right to autonomy and free choice; immunization programs may harm individuals’ right to bodily integrity; and tuberculosis curtailment measures may limit individuals’ right to freedom of movement; these potential human rights violations must be weighed against the sought-after public health goals, using the balancing scheme incorporated through human rights into public health law—to be later explored.

Defining HRPC and situating it in the legal landscape

For many years, the two approaches to health promotion—patient care, governed by medical law, and patient’s rights and public health, governed by public health law—were viewed as somewhat dichotomous—the one only interested with the quality of care delivered by the specific care-taker, while the other looking only at the power-play between the state and its citizens.

In this section, I will assert that HRPC is a gap-bridging approach to the promotion of both individual and community health—applying human rights discourse and human rights law onto the patient care setting while moving away from the narrow consumeristic view of health care delivery.

The HRPC approach relies on human rights law in the same way public health law often does, yet it is applicable to the patient care setting the way that patient’s rights law was thought to exclusively be. By doing so, HRPC makes it possible to coherently look at the actions and interests of all the relevant players involved in the health delivery and promotion interplay—including, but not limited to, specific patients, patient groups, health care providers, policymakers, and the community at large.

HRPC functions as a health promotion and protection tool by looking for systematic, rather than anecdotal, mistreatments by health care providers, which constitute either direct or indirect (through the violation of other rights) breaches of the right to quality care and to freedom from injury and bodily integrity.

An example of a direct systematic breach of the rights to health and bodily integrity may be found in state laws that allow for the forced feeding of prisoners [ 15 ]. An indirect systematic harm to health may be exemplified by notification laws, requiring health personnel to notify authorities about the treatment of illegal immigrants (i.e., infringement of their right to privacy and confidentiality)—causing them to avoid seeking health care.

Systematic mistreatments are the product of either an active policy decision, as in the two above examples, or of an undesirable common practice, which the state has been neglecting to attend to. Such neglect may, for example, be found in cases where the state does not intervene in order to curtail discriminatory and sub-par health care delivery to HIV-positive patients.

Systematic problems must be systemically addressed by the state, by amending policies or regulations, ensuring appropriate training, creating monitoring services, establishing opportunities for complaint and redress, and taking disciplinary measures when warranted ([ 2 ] at p. 7). Under human rights law, governments are obliged to respect, protect, and fulfill the rights contained in its signed treaties [ 16 ]. When the state neglects to act or refrains from using the tools in its possession to abolish human rights violations, not to mention when it actively puts the harmful policy into place, HRPC calls for the use of both international and national human rights law, in order to oblige the state to conform with its obligations to the protection and advancement of health. Footnote 6

As not all mistreatments in patient care amount to a violation of human rights, the HRPC approach may be viewed as narrower in its application than patients’ rights law; yet as it is mainly based in international law, HRPC is applicable also in countries that do not have national patient’s rights laws, thus allowing for the protection of rights in patient care settings in countries where the protection of patients’ rights does not present a high priority for the policymakers.

More markedly, unlike patients’ rights law, which regards the rights of individual patients as intrinsically paramount (as consumer protection laws tend to do), HRPC recognizes that rights of no single patient are absolute. While as concerned with informed consent, confidentiality and the right to information—just to name a few central patients’ rights’ fundamental concepts—HRPC automatically recognizes the need to place limitations on rights in the health context for the sake of other interests, both communal and private. It does so by balancing the protection of such elements of good care, against the state’s obligation and choice to further the rights and interests of others—including the rights and interests of health care providers, which are finally given a voice, via HRPC.

Balancing the rights to health and bodily integrity against other rights and interests

Both the International Covenant on Civil and Political Rights and the International Covenant on Economic, social and cultural rights state that rights protected thereof may be justifiably limited under certain conditions, except for the rights to life (art. 6); the right to freedom from torture and from cruel, inhuman, or degrading treatment or punishment (art. 7); the right to recognition as a person before the law (art.16); and the right to freedom of thought, conscience, and religion (art.18)—which the Covenant on Civil and Political Rights has proscribed any derogation of—all other rights may be limited as determined by law “only in so far as this may be compatible with the nature of these rights and solely for the purpose of promoting the general welfare in a democratic society” [ICESCR (art. 4)].

Correspondingly, almost every national constitutional guarantee of certain rights attaches limitations to the breadth of those rights in an effort to balance the interests of the individual with those of the community when certain conditions arise.

There are two types of limitation vehicles, the first of which is called a “derogation clause.” Derogation clauses allow states to breach obligations to uphold certain rights, for reasons related to war or a public emergency, while establishing the conditions under which the state may argue that such a state of affairs exists.

The second limitation vehicle, which is central to our discussion, is called a “limitation clause” (or “clawback” clause). This legal tool allows for the suspension or restriction of guaranteed rights to which they apply, under specific conditions.

These conditions form a balancing scheme allowing for the weighing of states’ powers and discretions against individuals’ human rights and for a critical look at the way states use (or do not use) their powers and discretion. This balancing scheme is inherent to both public health law and the HRPC approach. Yet, while under public health law, the question at play is whether a state may infringe upon human rights; in order to further and protect the public’s health, HRPC is employing the same legal scheme in order to explore the legitimacy of the state’s use of its powers when the aforementioned use (or lack thereof) infringes upon individuals’ health-related rights.

When ruled upon by either a national or an international court, a breach of this balancing scheme would (a) allow (and even require) the state to use its powers for the sake of furthering the health of the community, despite foreseeable harms to individual’s rights—under the public health doctrine—or (b) require the state to use (or cease from using) its powers, in order to protect individual’s health rights—under the HRPC approach.

Although the wording of the conditions that form the balancing scheme may differ from country to country, and from state to state, it is agreed upon Footnote 7 that the following conditions are central to all limitation clauses:

All limitation clauses shall be interpreted strictly and in favor of the individual rights at issue;

No limitation on human rights shall be applied in an arbitrary manner;

Every limitation imposed shall be subject to the possibility of challenge to and remedy against its abusive application;

No limitation on individual rights shall be discriminatory in nature;

For a limitation on individual rights to be deemed legitimate, it must

Respond to a pressing public or social need—assessed based on objective considerations;

Pursue a legitimate aim;

Be proportionate to that aim.

In applying a limitation, a state shall use no more restrictive means that are required for the achievement of the purpose of the limitation.

The application of the balancing scheme in the HRPC approach—a case study

In order to exemplify the use of the HRPC approach and the balancing scheme in its center, let us look at the following example: After falling off of the roof he was working on, a non-registered immigrant worker is rushed to the ER. He is treated for broken bones, and the physicians fear that he may suffer from a hemorrhage in his skull, and would like to hospitalize him for farther examination and surveillance. Regretfully, so the physician tells the patient, he will have to notify the authorities about the presence of an illegal immigrant in the hospital. The patient refuses hospitalization as well as divulging his identity to the staff and leaves the premise without proper treatment.

Statutory notification requirements, such as the one described here, are beyond a doubt a breach of patients’ right to privacy—which consequently infringe on the right to health care, of both patients and those who refrain from approaching the health system to begin with and do not acquire a “patient” status. Yet, as it is a state-mandated breach, patients, such as the one described above, can find no remedy for the sub-par health care they receive, via medical law and patients’ rights discourse.

Such a remedy could and should be sought, though, through HRPC tools. A petition can be brought forth in front of the national or international courts, claiming that the state is over-reaching its authorities and unduly infringing on individuals’ rights to privacy and health.

The relevant court would then be required to consider the following questions:

Is the notification requirement pursuing a legitimate aim?

It appears that notification requirements, regarding the illegal stay of immigrants, mainly aim to protect the rule of law and to prevent the violation of immigration laws. Indirectly, they aim to prevent “harms” which illegal immigration may cause to the community.

Is it responding to a pressing public or social need?

This question should be answered based on the data relevant to each country and each era. Relevant data should include the extant of illegal immigration experienced by the state, as well as the types and scope of harms caused by it to the community. These should be described in specifics, and not merely generally speculated upon.

Is the harm to individual rights in this case proportionate to that aim?

The more prominent the nature and the scope of the burden caused by illegal immigration, the more likely it is that the courts would see the infringement on individual rights as proportionate. Yet, as the harm to individual rights here is grave, only extreme burden should be deems proportional, and in any case, where it resolved that illegal immigration in of itself is not a real issue of concern and that the aim is mainly to protect the rule of law; it is likely that such a requirement would be struck down.

Are there less restrictive means that may still reasonably achieve the legitimate aim?

This, I believe, would serve as the main argument in favor of the abolition of this notification requirement. In order for the requirement to pass the courts’ scrutiny, evidence would have to be presented, showing that (1) it plays an integral part in the minimization of law-violations, in general, and illegal immigration in particular; (2) that, if abolished, all together or specifically inside the health system, these aims will greatly suffer; and (3) that there are no other less damaging legal tools, that may take their place in furthering the worthy goal of legal obedience.

In this author’s opinion, there are good chances that such a requirement would be struck down, or at least limited to non-health care venues—even in view of the current global immigration situation— dimmed un-proportional and overly intrusive.

HRPC is a gap-bridging approach to the promotion of both individual and community health—applying human rights discourse and human rights law onto the patient care setting while moving away from the narrow consumeristic view of health care delivery. It functions as a health promotion and protection tool by looking for systematic, rather than anecdotal, mistreatments by health care providers—mistreatments which are the product of either an active policy decision or of an undesirable common practice—which the state has been neglecting to attend to.

By applying a HRPC approach, both national and international courts may and should serve as policy influencing instruments, protecting the rights of the most vulnerable and prejudiced against groups, which are want of a remedy through traditional patients’ rights legal schemes.

Though several definitions have been suggested, medical law is referred to in this paper as “essentially concerned with the relationship between health care professionals and patients” (Kennedy I. and Grubb A. Medical Law 2000: 5).

American Convention on Human Rights (adopted 1969, entered into force 1978).

European Convention on Human Rights (adopted 1950, entered into force 1953).

The African Charter on Human and Peoples’ Rights (adopted 1981, entered into force 1986).

WHO, Constitution of the World Health Organization, adopted by the International Health Conference, New York, June 19 to July 22, 1946, and signed on 22 July 1946 by the representatives of 61 states. World Health Organization, 1946.

The notion of “enforcement” of treaty obligations under international law is a complex one. Both international and national courts may be petitioned and asked to rule as to a state’s violation of human rights—the right to health included. Yet, the enforced consequences of such a ruling are ambiguous and varied. Also, in many cases, the sought-after relief may be achieved just by the mere existence of international debate regarding the infringement, with no actual need for a formal court intervention. On this, see Cassel D. Does International Human Rights Law Make a Difference? International Human Rights Law in Practice, Chicago Journal of International Law 2001; 2: 121, and Koh H. H. How Is International Human Rights Law Enforced, Indiana Law Journal 1998;74(1): 1397.

See UN Commission on Human Rights, The Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights, 28 September 1984, E/CN.4/1985/4.

Abbreviations

• Human rights in patient care

International Covenant on Economic, Social and Cultural Rights

World health organization

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Acknowledgements

The author would like to thank Tamar Ezer, JD, and Judy overall, JD for their comments and support of this paper.

About the authors

Dr. Peled-Raz (LLB, MPH, PhD) is a jurist and bio-ethicist. She is a lecturer at the University of Haifa School of Public Health, where she acts as the chair of the faculty’s ERB, she serves as a clinical ethicist and chairs several ethics committees.

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Peled-Raz, M. Human rights in patient care and public health—a common ground. Public Health Rev 38 , 29 (2017). https://doi.org/10.1186/s40985-017-0075-2

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Alexandra Phelan

Johns Hopkins University - Bloomberg School of Public Health; Johns Hopkins Center for Health Security

Rocío Quintero Martinez

Ravi m. ram, madhira institute, ian seiderman, sharifah sekalala.

University of Warwick

Magdalena Sepulveda Carmona

United Nations

Brigit Toebes

University of Groningen - Faculty of Law; University of Groningen

Matiangai V. S. Sirleaf

University of Maryland Francis King Carey School of Law; University of Maryland School of Medicine

Allyn Taylor

University of Washington - School of Law

Pedro A Villarreal

Max Planck Institute for Comparative Public Law and International Law

Nerima Were

Kenya legal and ethical issues network, alicia ely yamin.

Harvard University - Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics; Harvard University - Harvard Law School; Partners in Health; Chr. Michelsen Institute (CMI) - Center on Law and Social Transformation; Harvard TH Chan School of Public Health

Physicians for Human Rights

Date Written: May 21, 2023

The COVID-19 pandemic posed a grave threat to health systems worldwide and brought to light the precarious state of human rights in times of public health emergency. The rapid spread of the novel coronavirus exposed deep-seated inequalities within and between societies and magnified the suffering of those already marginalized, including women, girls and disadvantaged communities. Despite urgent and persistent calls to foreground human rights in COVID-19 responses from international organisations, human rights advocates and civil society organizations, human rights were too often neglected or violated in public health prevention, preparedness and response in nearly every country in the world. In the face of the unprecedented challenges posed by COVID-19, a diverse group of expert jurists, scholars, and practitioners of public health and human rights united to clarify the principles and obligations of human rights in the context of public health emergencies. Recognizing the critical need for guidance on the matter, these experts engaged in three years of intensive collaboration and deliberation, culminating in the development of the Principles and Guidelines on Human Rights and Public Health Emergencies (the ‘Principles’). This wide-ranging and authoritative text represents an international consensus-based expert opinion on the most pressing human rights issues related to public health emergencies. It reflects the wisdom of a broad range of perspectives and experiences, and it provides a critical framework for governments, civil society, and other stakeholders to prioritize human rights considerations in the prevention of, preparedness for, and response to public health emergencies, and in the recovery of health systems in the aftermath of public health emergencies.

Note: Funding Information: This research was funded by the Open Society Foundations, the Social Sciences and Humanities Research Council of Canada (SSHRC), the United Kingdom Research Institute’s (UKRI) Economic and Social Research Council, and the Brocher Foundation. Conflict of Interests: The authors have no competing interests to declare.

Keywords: global health law, public health law, human rights, public international law, public health emergency

Suggested Citation: Suggested Citation

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• v.8(12); 2007 Dec

The continuing tensions between individual rights and public health. Talking Point on public health versus civil liberties

Ronald bayer.

1 Ronald Bayer is Professor of Sociomedical Sciences at the Center for the History and Ethics of Public Health at Columbia Universitys Mailman School of Public Health in New York, NY, USA. ude.aibmuloc@8br

To what extent can a state legitimately restrict the liberties of its citizens in order to serve the common good? Furthermore, to what extent has the protection of the public's welfare been a pretext for governments to curtail or erode fundamental rights? These questions have formed the foundation of controversies and long-running debates about public health in the USA; conflicts that have been animated by a deep-rooted mistrust of overreaching authorities, concerns about arbitrary exercises of power, and by the anti-authoritarian ethos that is a historically prominent feature of US politics and civic culture.

The first tensions over the scope of public health and the acceptability of its measures arose during the fight against infectious disease in the nineteenth and early twentieth centuries. They resurfaced in the last decades of the twentieth century in the wake of efforts to address chronic conditions that began to inform the pattern of morbidity and mortality in industrial societies. They reveal an enduring tension between public health and individual rights—a tension that we ignore at our own peril.

Scientific advances in Europe during the nineteenth century, notably in the laboratories of Louis Pasteur (1822–1895) and Robert Koch (1843–1910), identified the causative agents of many infectious diseases. This ‘bacteriological revolution' transformed our understanding of how disease spreads and laid the foundations for a new public health ethos ( Baldwin, 1999 ). In this regard, it is worth noting that the discoveries of infectious bacteria by Pasteur and Koch provoked sharp resistance in those nations that were concerned about whether and how the imposition of quarantines would interrupt the free movement of goods and people ( Ackerknect, 1948 ).

Early advocates of public health in the USA, such as Mitchell Prudden (1849–1924) and Hermann Biggs (1859–1923), who was general medical officer of the city of New York's (NY, USA) Department of Health in the late nineteenth and early twentieth centuries, were unabashed as they defended the legitimacy of coercion in the face of public health threats. “[E]verything”, said Biggs when talking about efforts to curtail tuberculosis, “which is detrimental to health or dangerous to life, under the freest interpretation, is regarded as coming within the province of the Health Department. So broad is the construction of the law that everything which improperly or unnecessarily interferes with the comfort or enjoyment of life, as well as those things which are, strictly speaking, detrimental to health or dangerous to life, may become the subject of action on the part of the Board of Health.” Looking back almost a century later, Laurie Garrett commented in her book, Betrayal of Trust: The Collapse of Global Public Health , that, “[i]t was a declaration of war, not just against tuberculosis but against any group or individual who stood in the way of Public Health or the sanitarians' Hygeia” ( Garrett, 2000 ).

…the often abysmal health situations in the rapidly growing cities of the USA and Europe required drastic measures, and public health officials were given the freedom to meet the problems…

Biggs was but the most articulate of the new cadre of public health officials who endorsed authoritarian attitudes in the name of public health; the often abysmal health situations in the rapidly growing cities of the USA and Europe required drastic measures, and public health officials were given the freedom to meet the problems with what, at times, were heavy-handed approaches. In turn, these provoked resistance to mandatory vaccination programmes, quarantines and surveillance. Efforts to control smallpox, which involved compulsory vaccination, acted as a rallying point for groups and individuals motivated both by anti-government ideology and concrete fears of the physical harm that sometimes resulted from the procedure. Anti-vaccine organizations throughout the USA were driven, among other things, by opponents of germ theory and groups generally opposed to government interference in their claims to privacy. In Milwaukee (WI, USA), for example, forceful application of the State's mandatory vaccination law sparked riots among the city's large German immigrant population in the 1890s. Health officers who went into neighbourhoods to vaccinate residents and remove sick individuals to quarantine hospitals were greeted by angry mobs throwing rocks ( Colgrove, 2006 ).

In the state of Massachusetts (USA), a smallpox epidemic during the winter of 1901 provided the occasion for a legal challenge to the state's compulsory vaccination law. This led to a landmark ruling by the US Supreme Court in the case of Jacobson versus Commonwealth of Massachusetts, which established the government's right to use its ‘police powers' in order to control epidemic disease. In its seven-to-two decision, the Court affirmed the right of the people, through their elected representatives, to enact “health laws of every description to protect the common good” ( Colgrove & Bayer, 2005 ).

Efforts to impose quarantines on those viewed as a threat to public health has involved the use of measures that look excessive and profoundly unfair from the perspective of less troubled times. On several occasions, the outbreak of diseases among disfavoured minority groups has led to harsh measures being used against them. As Howard Markel noted in his book, Quarantine! , “[i]mmigrants arriving in New York City in 1892, for example, could be isolated and kept in squalid conditions to prevent the spread of cholera and typhus. At a time of massive immigration and concomitant nativist sentiment, health officials faced little popular opposition to their efforts” ( Markel, 1997 ).

US courts have almost always deferred to public health authorities that have deprived individuals of their liberty in the name of public health

A central strategy of the emergent public health regime in the nineteenth and early twentieth centuries involved the mandatory reporting of patients' names to public health registries. Physicians attending patients in private practices often opposed such requirements as impinging on their autonomy and as a violation of the doctor–patient relationship. Biggs, when reflecting on the controversies that had greeted his efforts to mandate the reporting of tuberculosis cases—as he moved forward to begin the surveillance of sexually transmitted diseases in the early twentieth century—remarked that, “[t]he ten year long opposition to the reporting of tuberculosis will doubtless appear a mild breeze compared with the stormy protest against the sanitary surveillance of the venereal diseases” ( Biggs, 1913 ). Despite the existence of much opposition, the reporting of cases by name to local and state health departments and to special confidential registries ultimately became part of the tradition and practice of public health.

US courts almost always deferred to public health authorities that have deprived individuals of their liberty in the name of public health. One US state high court declared at the beginning of the twentieth century that, “[i]t is unquestionable that the legislature can confer police powers upon public officers for the protection of the public health. The maxim Salus populi suprema lex is the law of all courts in all countries. The individual right sinks in the necessity to provide for the public good” ( Parmet, 1985 ). Even more remarkably, a plenary grant of authority was still found to be constitutional in the 1960s. In upholding the detention of a person with tuberculosis pursuant to a statute that provided virtually no procedural protections, a California appellate court declared in 1966 that, “[h]ealth regulations enacted by the state under its police power and providing even drastic measures for the elimination of disease...in a general way are not affected by constitutional provisions, either of the state or national government.”

The breadth of powers that public health authorities had enjoyed remained virtually unchallenged through most of the twentieth century, but finally came under increasing scrutiny during the last decades of that era. The development of a robust jurisprudence of privacy, and the “due process revolution”, which extended rights to prisoners, mental patients and others under the authority of the state, ultimately questioned the long-held assumptions that had protected public health from constitutional scrutiny. The groundwork for this profound change was laid in the transformations that occurred in American politics, law and culture during the 1960s and 1970s. But it was the HIV/AIDS epidemic that forced a fundamental rethinking of the dominant ideology of public health. The methods of mandatory screening and examination, reporting the names of those who were sick or infected to public health registries and the imposition of quarantine once again became the subject of controversy and dispute ( Bayer, 1989 ).

The debates that raged during the 1980s when HIV/AIDS emerged in the USA revealed the profound influence that political and historical contexts had had on the enforcement of public health. In the early years of the epidemic, a broad coalition of gay rights' activists and advocates of civil liberties were largely successful in their efforts to put the protection of privacy and individual rights at the forefront of the public health agenda. Fierce battles ensued when proposals were made to mandate the reporting of people infected with HIV to public health registries, and it was not until many years later that such reporting became universal. Intense controversy also surrounded the efforts to preserve the right of individuals to determine whether they would be tested for HIV infection. Newly adopted policies required exacting and specific informed consent for testing, and it was not until the 1990s that significant support among physicians emerged to help relax these standards. Finally, every attempt to use the power of quarantine to control those whose behaviour might place their sexual partners at risk provoked extensive debate about the counterproductive impact of recourse to coercion.

The HIV/AIDS epidemic provided the occasion to articulate a new paradigm of public health

The HIV/AIDS epidemic provided the occasion to articulate a new paradigm of public health. Given the biological, epidemiological and political factors that shaped the public policy discussion, proponents and defenders of civil liberties were able to assert that no tension existed between public health and civil liberties, that policies that protected the latter would foster the former and that policies that intruded on rights would subvert public health. What was true for HIV/AIDS was also true for public health generally. Indeed, the experience of dealing with HIV/AIDS provided the opportunity to rethink the very foundations of public health and to re-examine the legacy of compulsory state powers. Even when some elements of the privacy- and rights-based approaches to HIV/AIDS were modified in the 1990s as the epidemic ‘normalized', the core values of privacy and civil liberties that had taken hold retained their influence.

But is it true that there is no tension between public health and civil liberties? Public health surveillance for both infectious and non-infectious diseases is crucial in order to understand the patterns of diseases, and for the planning and execution of remedial action. This is true for tuberculosis, as it is true for cancer ( Fairchild et al , 2007 ). Surveillance, to be effective, necessitates that either physicians or laboratories comply with public health mandates that clearly intrude on privacy. Only if we acknowledge this fact can we determine whether the public health benefits of surveillance justify this price.

Mandatory immunization of school children clearly intrudes on or burdens parental autonomy. Yet, both the protection of children from infectious disease and the ensuing ‘herd immunity' by high-level vaccination coverage, which protects those who cannot be vaccinated, depend on such mandates. Various outbreaks of measles and pertussis (whooping cough) underscore the toll that we have to pay when we privilege parental choice; it might be a cost worth bearing but we will only know if we are forced to acknowledge the trade-offs involved.

Another central tenet of public health is the requirement that people with certain diseases undergo treatment—as in the case of tuberculosis—or that people with highly infectious diseases be isolated or quarantined. Such measures always require that we address questions of whether the health threats, their severity and transmissibility all justify depriving individuals of their liberty. These questions cannot be answered without confronting the tension between the interests of the individual and those of the collective. If SARS (severe acute respiratory syndrome) taught us anything, it was how difficult it is to make such decisions in the face of uncertainty. It might turn out in retrospect that the quarantines we impose when faced with a potential epidemic are more extensive than necessary. But in the face of an evolving threat, public health officials have no choice but to weigh personal liberty against potential grave threats ( Gostin et al , 2003 ).

To this point I have focused on infectious diseases, which compel us to address the powers of public health when there is a direct risk or a potential risk to third parties. But the scope of public health in industrial and post-industrial societies extends to chronic diseases ( Knowles, 1977 ). Many such conditions involve lifestyle choices; patterns of behaviour which, in the first instance, harm oneself. What is the legitimate role of the state in modifying, discouraging, burdening or even prohibiting behaviours that increase both morbidity and mortality?

At stake here is the question of paternalism. Is it appropriate for the State to impose restrictions on competent adults in order to protect them from harming themselves? Those who are inspired by the tradition of John Stuart Mill answer with a resounding ‘No'. They claim that public health officials can educate and warn, but not compel. As these ideas have gained wide influence, advocates of public health often need to assert that they intervene because the social consequences or negative externalities of certain behaviours warrant intervention; thus, self-regarding harms are transformed into other-regarding harms. In any event, the state seeks to use its authority to change individual behaviour.

Two examples will illustrate this point. It has long been known that wearing helmets drastically decreases a motorcyclist's risk of death or severe injury in the case of an accident. During the 1970s, pressure by the federal government in the USA led virtually all states to mandate the use of motorcycle helmets ( Jones & Bayer, 2007 ). These statutes provoked the wrath of motorcyclists who asserted that the state deprived them of the right to cycle in the way that was most pleasurable and exciting, and that failure to use helmets posed no threat to others. In short, these laws were, they asserted, an example of overreaching state intrusion, of gross paternalism. Nevertheless, when the courts reviewed these statutes, they were almost never overturned as unconstitutional. A court in Massachusetts noted, “From the moment of the injury, society picks the person up off the highway; delivers him to a municipal hospital and municipal doctors; provides him with unemployment compensation if, after recovery, he cannot replace his lost job; and if the injury causes permanent disability many assure the responsibility for his and his family's continued sustenance. We do not understand a state of mind that permits a plaintiff to think that only he himself is concerned” ( Cronin, 1980 ).

What is the legitimate role of the state in modifying, discouraging, burdening or even prohibiting behaviours that increase both morbidity and mortality?

Although efforts to justify the regulation of behaviour in non-paternalistic terms might be effective in the short term, they are almost always transparent subterfuges. It would be more honest—and in the long term more protective of public health—to acknowledge that intervention is sometimes necessary to protect individuals from their own foolish or dangerous behaviour because such efforts can have a broad and enormous impact at a population level. An explicit acknowledgement would also help to understand the trade-offs involved. Ironically, the use of the social impact argument can, in the end, be more subversive of rights than the explicit embrace of paternalism. After all, everything can be shown to have a social impact.

The failure to make a strong case for paternalistic restrictions with regard to motorcycle helmets set the stage for repeals of compulsory helmet laws for adults; now, only half the states have such statutes. The consequences were predictable: in 2004, approximately 4,000 cyclists died, the seventh year to show an increase in fatalities. The triumph of individual rights has transformed a public health success story into a public health defeat. Recognizing the right to ride a motorcycle without a helmet might be a right we want to protect—but there should be no confusion about the price we pay.

The case of tobacco control gives more reason for optimism ( Feldman & Bayer, 2004 ), but here too, recent history underscores that achievements in public health often carry a price in individual freedom. It would be convenient to think about tobacco as similar to other environmental toxins, which we simply ban when we find that they cause morbidity and mortality; however, tobacco is different. Millions consume it because of addiction, habit, desire or social convention. It is therefore impossible to consider public policy without addressing the extent to which the state might exert pressure and impose limits in the name of health. The answer to this question will determine whether we will be able to save the lives of smokers both now and in the future.

It is striking that in most economically advanced democracies, the first decades of tobacco control were marked by a distinct reluctance to embrace measures that bore the taint of paternalism—especially in the USA. Pressure from the tobacco industry and its allies partly accounted for this phenomenon, but they do not provide a sufficient explanation. Here, as in the case of motorcycle helmets, there was considerable uncertainty about how far the state could go. As a consequence, much of public health policy focused on children and innocent bystanders.

When limits were proposed on tobacco advertising—a unique problem in the USA, where the Supreme Court has extended the protections of the First Amendment to commercial speech—they were commonly justified by the need to protect children from the seductions of tobacco. When arguments were made for radically increasing taxes on cigarettes, thus burdening consumption—especially for those with less disposable income—it was asserted that such levies were vital because of the social costs created by tobacco-associated morbidity and mortality. Finally, when increasingly restrictive measures were imposed on smoking in public settings, the central justification was that passive smoking was pathogenic and responsible for deaths associated with cancer and heart disease. It was almost never asserted that limits on advertising, increases in taxes and restrictions on public smoking were necessary to protect those who might begin to smoke or those who were smokers.

Clearly the public health—measured collectively in terms of the lives of individuals and on a population basis—requires intervention that involves restrictions of choice

As a result of changing social norms and public policies, the prevalence of smoking by adults in advanced democracies has declined markedly in the past 40 years. A steep social gradient has also emerged: those better educated smoke less; those with poorer education comprise an ever-greater proportion of smokers. Under these social conditions, it has become increasingly possible to assert that the aim of restrictive public health policy is to pressure, even cajole, smokers to give up their behaviour. Tobacco advertising must, where permissible, be banned. Taxes must make the price of cigarettes increasingly prohibitive. Limits on public smoking are necessary to make it more difficult for smokers to find a place where they can light up.

Given the human toll caused by tobacco consumption, who then but the most hidebound of libertarians would oppose measures to radically reduce, even end, the scourge associated with cigarette smoking? Clearly the public health—measured collectively in terms of the lives of individuals and on a population basis—requires intervention that involves restrictions of choice.

Across the spectrum of threats to the public health—from infectious diseases to chronic disorders—are inherent tensions between the good of the collective and the individual. To acknowledge this tension is not to foreordain the answer to the question ‘How far should the state go?'; rather, it is to insist that we are fully cognizant of difficult trade-offs when we make policy determinations.

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Deserted: The U.S. Military's Sexual Assault Crisis as a Cost of War

Over the past decade, the U.S. military has implemented policies to promote gender equality, notably lifting the ban on women in combat roles in 2013 and opening all military jobs to women by 2016. Yet, even as U.S. military policy reforms during the “War on Terror” appear to reflect greater equality, violent patterns of abuse and misogyny continued within military workplaces.

This author of this report found that sexual assault prevalence in the military is likely two to four times higher than official government estimations. Based on a comparison of available data collected by the U.S. Department of Defense to independent data, the research estimates there were 75,569 cases of sexual assault in 2021 and 73,695 cases in 2023. On average, over the course of the war in Afghanistan, 24 percent of active-duty women and 1.9 percent of active-duty men experienced sexual assault. The report highlights how experiences of gender inequality are most pronounced for women of color, who experience intersecting forms of racism and sexism and are one of the fastest-growing populations within the military. Independent data also confirm queer and trans service members’ disproportionately greater risk for sexual assault.

The report notes that during the post-9/11 wars, the prioritization of force readiness above all else allowed the problem of sexual assault to fester, papering over internal violence and gender inequalities within military institutions.

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17th Session Of The Conference Of States Parties To The CRPD (COSP17)

Theme and sub-themes of the Conference

Overarching theme : Rethinking disability inclusion in the current international juncture and ahead of the Summit of the Future

Sub theme 1 : International cooperation to promote technology innovations and transfer for an inclusive future, co-chaired by:  Sri Lanka Vice President of the bureau and a civil society representative Sub theme 2 : Persons with disabilities in situations of risk and humanitarian emergencies,  co-chaired by: Georgia Vice President of the bureau and a civil society representative Sub theme 3 : Promoting the rights of persons with disabilities to decent work and sustainable livelihood,  co-chaired by:  Greece Vice President of the bureau and a civil society representative

COSP17 Multimedia

📺 Videos of the main meetings

Opening Session

Roundtable 1: International cooperation to promote technology innovations and transfer for an inclusive future

Roundtable 2: Persons with disabilities in situations of risk and humanitarian emergencies

Roundtable 3: Promoting the rights of persons with disabilities to decent work and sustainable livelihood

Interactive Dialogue among States Parties, the United Nations system, other stakeholders and Closing Session

Statements 

• H.E Mr. Tarek Ladeb, President of Conference
• Ms. Amina J. Mohammed, Deputy Secretary-General of the United Nations
• H.E. Mr. Dennis Francis, President of the General Assembly (video message)
• Ms. Gertrude Oforiwa Fefoame, Chairperson, Committee on the Rights of Persons with Disabilities
• Ms. Heba Hagrass, Special Rapporteur on the Rights of Persons with Disabilities
• Ms. Sanja Tarcazy, Civil Society Representative/ World Federation of the Deafblind
• Ms. Khadija Jallouli, Youth Representative, Tunisia

Roundtable One "International cooperation to promote technology innovations and transfer for an inclusive future"

• Mr. Constantinos Stephanidis, Hellenic National Accessibility Authority, Greece
• Mr. Mamadou lamine Faty, Office for the Protection of the Promotion and Protection of the Rights of Persons with Disabilities (DPPPH), Senegal
• Ms. Maria Jose Carranza, San Carlos de Guatemala University, Guatemala
• Ms. Hjördís Anna Haraldsdóttir, World Federation of the Deaf, Iceland

Roundtable Two "Persons with disabilities in situations of risk and humanitarian emergencies"

• Ms. Gunta Anča, Latvian Umbrella Body for Disability Organisations (SUSTENTO), Latvia
• Mr. Anderson Henao Orozco, National Disability Council, Colombia
• Ms. Virginia Gamba, Office of the UN Special Representative of the Secretary-General for Children and Armed Conflict, Argentina
• Mr. Waqar Puri, Transforming Communities for Inclusion of Persons with Disabilities-Global, Pakistan

Roundtable Three "Promoting the rights of persons with disabilities to decent work and sustainable livelihood"

• Ms. Cynthia Samuel-Olonjuwon, ILO Special Representative to the UN
• Mr. Josh Tseng, Digital Accessibility Services at Etch Empathy, Singapore
• Mr. Michael Cox, Down Syndrome Australia
• Ms. Mariana Lozano Medina, Human Rights Watch, Colombia

President (Africa):  Tunisia Vice-presidents: Sri Lanka (APG) Georgia (EEG) Panama (GRULAC) Greece (WEOG)

General Debate and List of Speakers Registration

The General Debate will be organized and will begin on the first day of the conference. All States Parties and Observer States that wish to be inscribed on the list of speakers are requested to inscribe through the e-Speakers module of the e-Delegate portal between 20 May (Monday) and 3 June (Monday) . Further information will be announced in due course through the UN Journal and regional group representatives in the bureau.

Considering the time constraints, a statement will be limited to three minutes for each speaker duly and in-timely inscribed to the list and the time-limit policy will be enforced effectively (i.e. cutting off the microphone). Individual reasonable accommodation will be granted for persons with disabilities, and in this regard, needs must be communicated directly to the Secretariat via emailing to [email protected] in advance no later than 15 May 2024.

All States Parties and Signatories to the CRPD are requested to inscribe their speaker through the  e-Delegate/e-Speakers portal link .

United Nations entities, intergovernmental organizations (IGOs), national human rights institutions (NHRIs), and non-governmental organizations (NGOs) are kindly asked to sign up here for the speakers list by providing their speaker details and all required information by 6:00 pm on 3 June (New York time). 

Guidance Note on the General Debate

UN Guidelines for Pre-recorded Video Statements

Informal Briefing to States Parties and Civil Society

An informal briefing was held on Monday, May 13, 2024, at 10am in Conference Room 11 at the UN Headquarters in New York. The briefing, organized for States Parties and stakeholders, was co-hosted by the Permanent Mission of Tunisia and the United Nations Department of Economic and Social Affairs (UN DESA).

Election of the Members of the Committee on the Rights of Persons with Disabilities

“In accordance with article 34, paragraph 7, an election will be conducted during the 17 th session of the Conference of States Parties to elect nine members of the Committee on the Rights of Persons with disabilities whose term will expire on 31 December 2024. More details about the election including a list of received Names of Candidates and their biodata, among others, are made available and will be updated by OHCHR in the website of the Committee on the Rights of Persons with Disabilities.

Note Verbale

Credentials

The United Nations Department of Economic and Social Affairs (UNDESA) has sent a   Note Verbale  (DESA-23/02786, dated 20 December 2023) by which the secretariat is pleased to: (1) Notify States Parties and Observers of the convening of the 17th session in New York from 11 to 13 June; (2) The e-Credentials/e-Delegate services will be available to delegations starting from 1 March 2024 . Delegations can submit a scanned copy of their credentials for the 17th session of the Conference of States Parties. The original copy of the credentials should be submitted to the secretariat at DISD/UNDESA, located on the 25th floor of the Secretariat Building, before the opening of the Conference, specifically before 11 June 2024. (3) States are kindly requested to inform their delegates of any specific accessibility requirements and forward this information via email to  [email protected]  as soon as possible by 1   May 2024  in order to help ensure accessibility for all participants.

Download the step-by-step Guidance on how to submit credentials to the General Assembly meetings via the e-Credentials portal.

If delegations experience any technical issues using the e-DELEGATE portal for submitting their Credentials, please direct inquiries to the Secretariat:  [email protected] .

Seating Charts

General Assembly Hall  11 June, AM-PM

Conference Room 4 , 12-13 June, AM-PM

Accessibility Requirements

The United Nations is committed to promoting accessibility and inclusion for persons with disabilities at its Headquarters and beyond. All necessary efforts and accommodations, such as seating adjustments, will be made to best meet the needs of participants with disabilities who have provided advance notice of their specific accessibility requirements.

All States Parties are kindly requested to notify the secretariat if their delegates have specific accessibility requirements via [email protected].  no later than 1 May 2024 , in order to ensure accessibility for all participants.

Please send the following details:

• Specific accessibility needs such as wheelchair access, hearing loops usage, documentation in Braille, large print, or sign language usage
• The name of the delegation and individual delegate especially when the delegate will expect speak on behalf of the delegation in a meeting. 

Delegations are requested to also include specific accessibility needs details of their speaker, if applicable, when inscribing to the List of Speakers for the General Debate.

Ground Passes for Delegations of States Parties

Delegations shall obtain a valid United Nations grounds pass for all national delegation members whose names are reflected in their credentials that should be duly submitted to secretariat via eCREDENTIALS /e-DELEGATE portal for attending the COSP17 meetings, in order to gain access to the United Nations headquarters.

Delegations shall be aware, when designating representatives and alternates to the forthcoming COSP17 meetings, there is a seating capacity limitation for each delegation at a particular meeting, and specifically, each delegation will have 1+5 seats in the General Assembly Hall and 1+1 seats in the Conference Room 4 during the 17th session. No secondary passes will be issued for official national delegations.

Practical Information for COSP Participants 

• Monday 10 June | 8:30am to 3pm
• Tuesday 11 June | 8:30am to 1pm
• Wednesday 12 June | 9am to 1pm
• Thursday 13 June | 9:30am to 1pm  
• The Conference will be held  as an in-person meeting at the United Nations Headquarters in New York from 11 to 13 June 2024 in the GA Hall and CR.4 . In the general debate and roundtable discussions, speakers from the audience are required to send a copy of their intervention in MS WORD and PDF format via emailing to  [email protected]  no later than 3 hours before the respective meeting but preferable earlier for accessibility.   
• The United Nations Accessibility Centre  offers assistive information and communications technology to support those with auditory, visual or physical impairments. The assistive devices are available on-site or as a loan to participants with disabilities. The Accessibility Centre is located in the Conference Building (first basement level, by the Secretariat Building escalators). Please contact  [email protected]  for enquiries regarding available assistive tools and other accessibility accommodations related requests. For more information, please visit  https://www.un.org/dgacm/en/content/accessibility  
• The Meetings Support Section also offers print-on-demand service for meeting participants requiring braille copies of official documents. Please send braille requests to  [email protected]  at least 24hrs in advance of the meeting date for processing. The printouts can be collected at the Accessibility Centre located on the first basement of the Secretariat building at Office number S-1B032. For further enquiries please contact +1 212 963 7348 / 9 or by email  [email protected] .

Download the Information Note for Participants

Accessibility Centre Maps

National Human Rights Institutions (NHRIs) Participation

National Human Rights Institutions (NHRIs) interested in attending the COSP17  must complete this online application form . The deadline for receiving this application form is   now CLOSED.  

The online application is only open to NHRIs with "A"  Status. If you have any questions, please contact us by email at  [email protected]  with the subject "COSP17 NHRIs".

Civil Society Forum

The Civil Society Coordination Mechanism (CSCM) , which is facilitated by the International Disability Alliance , hosts a Civil Society Forum (CSF), as an addition to the COSP, to leverage the opportunity to amplify the voice and facilitate adequate and active participation of persons with disabilities. This year, the CSF will be held on Monday 10 June.  The Civil Society Forum will follow a format of a “People’s Assembly” or a Townhall meeting. Following a brief opening, three substantive sessions will be held. The sessions will be focused on specific pre-determined topics. They will be a mirror of the three COSP Themes, as above, and focused on the civil society perspectives and issues CSOs deem most appropriate under each theme. Read the background papers before making your submission to ensure compliance! Each session will start off in a chat show style with the moderator and one invited guest very briefly laying out the outline of the topic. There will be no panel. Once the brief introduction is done, the moderator will invite organizations that have already been shortlisted. Organizations will be allotted 3 mins, and are invited to deliver a statement, presentation or call to action on the topic in hand. Interventions will be made from the main floor (no podium).

Agenda of the Civil Society Forum

Key messages from the Civil Society Forum

Civil Society Participation

1. Watch a short video:  How can I register for COSP17 on Indico? 2. Watch a short video:  How to designate yourself as the Conference Focal Point for #COSP17? 3. Watch a short video:  How to approve your representatives and yourself as a Conference Focal Point in Indico?

Registration for NGOs with ECOSOC status and NGOs Accredited to the Conference of State Parties : The deadline is now CLOSED . For questions related to your indico registration, please contact us by email at  [email protected] .

• Please note that only NGOs with ECOSOC Status and Accredited NGOs to the Conference of State Parties (COSP) may register via indico for the COSP17.
• Please be advised it is the responsibility of your organization to approve your registration. Upon registering, please contact your organization for approval. Your organization's designated conference focal point may select the menu item on the left to access the approval area. 
• Due to space constraints, the numbers of attendees to the COSP16 should be kept to a minimum and should not exceed 10 representatives per organization. 

Application for New NGO accreditation:  Please consult the  Information Note .The deadline is  now CLOSED.  For questions related to your application, please contact us by email at  [email protected] .

Only NGOs accredited by the Conference of States Parties can participate in the sessions of the Conference of States Parties. NGOs that have consultative status with the Economic and Social Council (ECOSOC) or were accredited to the Ad Hoc Committee on the Convention are already accredited to the Conference of States Parties.

• All other NGOs wishing to participate in the Conference of States Parties must apply for accreditation to the Conference.
• Accreditation is a one-time process  by which non-governmental organizations that have not previously been accredited become eligible to participate as observers in the Conference of States Parties (including in future sessions). Accreditation is granted to organizations and not to individuals.
• How to apply for UN ECOSOC Status
• ECOSOC Resolution 1996/31

Side Events

Draft List of Side Events (as of 10 June 2024)

All questions on side events should be directed to  [email protected]  with the subject "COSP17 Side Events"

• List of suggested Cart Services Providers
• List of suggested International Sign Language Interpreters
• Speaker Guidance on accessibility for people with intellectual disabilities  by IDA

LIVE BLOG TAKEOVER AT COSP17

Welcome to the first ever  UN News  live blog takeover by a guest editor with a disability. People from around the world are gathering at UN Headquarters to take part in the largest global meeting on issues that affect people with disabilities.

Activist, actor and talk show host Nick Herd will be leading the  UN News  team for the opening day of the 17th session of the Conference of States Parties (COSP17) to the game-changing Convention on the Rights of Persons with Disabilities, taking place from 11 to 13 June 2024. 

Part of his mission is to amplify voices and drive change, so join in as Nick offers invaluable insights into the ongoing dialogue surrounding disability rights and inclusive communities and meets change makers from around the world to find out how best to boost inclusivity in tech, jobs and aid efforts in times of war and climate disasters.

Join us live on 11 June at 8am (New York time). Stay tuned and follow #COSP17 on social media.

Spread the Word!

• Follow us on Twitter @UN_Enable ,  @UNDESASocial,   @UNDESA
• Use  #COSP17  as the main hashtag
• Other hashtags:  #COSP #GlobalGoals  and  #EveryoneIncluded
• Planning a special event for #COSP17? We want to know! Tweet or email us at  [email protected] .

Armenia  - Video

Bahmair (Arabic)

Belarus (Russian)

Belgium (French)  - Video

Burkina Faso (French)

Colombia (Spanish)

Commonwealth

Costa Rica (Spanish)  - Video

Cyprus  - Video

Democratic People’s Republic of Korea (DPRK)

Denmark (LGTB Group)

Egypt  - Video

El Salvador (Spanish)

France (French)

Germany  - Video

Guatemala (Spanish)

Honduras (Spanish)

Iceland  - Video

Iraq (Arabic)

Kazahstan (Russian)  - Video

Kuwait (Arabic)

League of Arab States (Arabic)

Lebanon (Arabic)

Liechenstein  - Video

Luxembourg (French)  - Video

Malta  - Video

Mexico (English)

Mexico (Spanish)

Monaco (French)

New Zealand

Nicaragua (Spanish) - Video

Panama (Spanish)

Paraguay (Spanish)  - Video

Peru (Spanish)  - Video

Qatar (Arabic)

Republic of Moldova

Saudi Arabia (Arabic)

Senegal (French)

Sierra Leone

Solomon Island

South Africa

Spain (Spanish)

State of Palestine

Switzerland

Syrian Arab States (Arabic)

Timor Leste

Togo (French)

Tunisia (Arabic)  - Video

Uruguay (Spanish)  - Video

Yemen (Arabic)

Zambia - Video

• Search Search

Submissions

Health and Human Rights: Submissions

Health and Human Rights Journal , a peer-reviewed open access journal,   is published twice a year, with new issues in June and December. Selected papers in press are made available prior to issue publication, thereby fast-tracking access to new research and enabling authors to cite their work early. Submissions are welcome at any time.

Types of Submissions 

Full papers

Perspective Essays

Letters to the Editor

Special Themes

Virtual Roundtables

Student Essays

Full papers are original academic articles (research, commentary, operationalization of human rights-based approaches to health, and analysis) which contribute to, and advance, health and human rights literature. These manuscripts must be 3500-7000 words (including references), and if selected by the editorial committee, will undergo external  for peer review by at least two peers.

Health and Human Rights Journal  welcomes articles that explore the centrality of the right to health in all social, economic, cultural, and environmental contexts. The Journal publishes a wide range of topics from a health and human rights perspective—please look at our recent issues to get a sense of the range. The editors welcome papers that consider contemporary global health issues as matters of human rights.

Full papers are published in every issue of the Journal and many may be published online ahead of the publication date as a “Paper in Press”.

Further detail about style and referencing is included in the Author Guidelines.

The editors welcome Perspective Essays which are shorter papers, up to 3000 words, including references. Perspective Essays provide authors with an opportunity to provide a well reasoned and evidence-informed viewpoint, which extends the health and human rights literature. Perspectives often engage with and examine leading edge issues, and are published on the website in advance of each issue, allowing timely responses to current debates. These manuscripts are reviewed by two external peers. They are published in the Perspectives Section of each issue of the Journal.

Further detail about editorial and reference style is included in the Editorial Style Guide .

We welcome Letters to the Editor of 500 words or less in response to specific articles. Individuals interested in writing a longer response (up to 1500 words) should consider a Viewpoint and present their perspective as a counterpoint to the article, rather than a specific critique. Letters should be constructive, substantive and timely, supported by citation as appropriate, and are internally peer reviewed to check for accuracy and fairness.

Health and Human Rights Journal has a themed section in all issues. Calls for papers for these sections are made well in advance of the deadlines. The forthcoming Special Themes are also included on the website, with the names of the guest editors, information about the theme and author guidelines.

Health and Human Rights Viewpoints are published on the Journal website and selected Viewpoints may be published in each issue of the Journal.

Viewpoints began as a new series in 2019 to celebrate 25 years of publication. After initial contributions from scholars that reflected on the health and human rights movement, past, present and future challenges, we now invite human rights scholars, activists, and human rights defenders to contribute Viewpoints that reflect on their experiences and their research—addressing timely issues or controversial topics that describe what health and human rights looks like today. This may be a brief report highlighting on-going or emerging health and human rights concerns, a summary of a rights-based intervention or advocacy effort, or an analysis of new legislation that is anticipated to promote human rights—contributions should inform and engage the human rights community.

All submissions should have an engaging or novel perspective, and clear human rights grounding.

Viewpoints should be concise essays, of between 900-1500 words, including references. Viewpoints must adhere to the Journal reference style which is numerical. The contributions are internally peer reviewed for accuracy, relevance, and fairness.  We aim for a quick turnaround from receipt to publication.

Health and Human Rights welcomes proposals for Roundtable discussions which bring together human rights actors in dialogue around a specific issue.

The first Roundtable was published in 2014, but in 2020 Virtual Roundtables became a regular section. We aim to have one Virtual Roundtable published in every issue of the Journal.

Roundtables can focus on a wide range of issues, including exploring specific rights issues, current debates, and historical perspectives. The Journal encourages authors to include diverse participants with varied perspectives.

Virtual Roundtables are usually commissioned, but individuals interested in organizing and moderating a Roundtable may submit an inquiry to the editors outlining the topic of the discussion, the individuals who will participate as discussants, and why the issue is important and timely. All submissions will be internally peer reviewed for accuracy, relevance and fairness. Acceptance of an inquiry does not guarantee publication.

Health and Human Rights invites students to submit to our Student Essays section.

The essays should have a clear human rights grounding, focus on a public health issue, and use the right to health to analyse the issue. These essays should be original, well written, and engage with the relevant and current literature in the field.

The contributions are internally peer reviewed by a dedicated editorial group who review for accuracy, right to health relevance, interest, and originality. Reviewers’ comments are written to assist students to achieve publication standards. The editors reserve the right to reject papers that do not meet adequate standards. All essays accepted for publication will be published online, and some select essays may be included in the Journal.

Student essays must be between 3000 and 5000 words, including references. They should include an abstract of no more than 200 words. They must adhere to the Journal Style Guide reference section and use the numeric reference system.

Students are also encouraged to submit blogs.

Health and Human Rights Blogs are published on the Journal website but are not included in the Journal itself.

Blogs are a less formal and shorter (about 600-800 words) article on a global health topic examined as a human rights issue. The editors frequently run a blog series, for example, SDG SERIES, or COP21 SERIES, to allow contributors to participate in, and shape, an important topical issue.

Blogs can either have hyperlinks or use our normal referencing style. The contributions are internally peer reviewed, for accuracy, relevance, and fairness.  We aim for a quick turnaround from receipt to publication which is important for the topical nature of blogs.

General submission information All manuscripts submitted to   Health and Human Right s Journal   must not be before another publication for consideration.

All submissions are subject to initial assessment by the editorial committee to determine their suitability for publication.

Editors and editorial committee members can submit papers for consideration and these will be blind peer reviewed under the same rules for all papers and perspectives.

Papers and perspectives accepted for formal review will be sent to at least two independent referees with all authorship details removed. Typically the authors are advised of the outcome of the peer review phase within three months. The referees and editors may request more than one revision of a manuscript, and alternative referees may also be invited to review the manuscript at any time.

Please   submit all manuscripts to [email protected]

For specific format details, please see the Editorial Style Guide .