Academic journal article Bulletin of the World Health Organization

Using Indicators to Determine the Contribution of Human Rights to Public Health efforts/Utilisation D'indicateurs Pour Determiner la Contribution Des Droits De L'homme Aux Efforts En Faveur De la Sante publique/Uso De Indicadores Para Determinar la Contribucion De Los Derechos Humanos a Los Esfuerzos De Salud Publica

Academic journal article Bulletin of the World Health Organization

Using Indicators to Determine the Contribution of Human Rights to Public Health efforts/Utilisation D'indicateurs Pour Determiner la Contribution Des Droits De L'homme Aux Efforts En Faveur De la Sante publique/Uso De Indicadores Para Determinar la Contribucion De Los Derechos Humanos a Los Esfuerzos De Salud Publica

Article excerpt

Introduction

Despite increasing attention paid to the apparent integration of human rights into public health policies and programmes, it is difficult to find concrete examples of the benefits that have been derived from linking human rights norms and standards to public heath imperatives. There is a need to identify existing approaches that link human rights and health concerns and then to determine the best ways to assess their impact on the effectiveness and outcomes of health policies and programmes. As basic as it sounds, this approach requires clarity, not only in defining human rights, but also in recognizing what incorporation of identified norms and standards should look like in practice.

In the interests of validity and comparability, from a public health perspective, assessment requires appropriate quantitative indicators. Implicit in the use of such indicators is a sense that they are both impartial and objective. Yet a human rights perspective suggests querying the assumed neutrality of an indicator: we should think about who uses it, for what purposes and in what ways. What occurs before, during and after the measurement process itself is equally important as what is being measured. Thus, the purpose of this paper is to begin to disentangle the diversity of approaches to health and human rights indicators and to suggest issues to consider in determining the value of existing approaches.

Human rights and public health practice

Human rights bring into focus the relationship between the government, which is the first-line provider and protector of human rights, and individuals (who hold these rights as human beings). (1) Every country in the world is party to at least one human rights treaty and all have made rights-related commitments relevant to health. (2) While for many years it was unclear what the incorporation of human rights principles meant for public health practice, certain actions are increasingly considered part of a human rights-based approach to health (Box 1).

Although generally not incorporated so systematically, many of the interventions implied by the actions named in Box 1 are familiar to people involved in public health. Those that are not so familiar, such as ensuring transparency for how decisions are made, are unique contributions that the human rights field offers to public health. A difficulty lies in determining whether, by drawing attention to the human rights aspects of those actions traditionally in the domain of public health, the nature of the indicator appropriate for their measurement should remain the same or change. Additionally, the fact that institutions may engage differently with the same concepts and even the same indicators has implications for assessing the ways in which monitoring and evaluation are done across the fields of health and human rights.

Indicators

A wide range of actors use indicators to capture human rights concerns relating to health including international and national human rights mechanisms, governments, health and development organizations and civil society.

In general terms, an indicator is "a variable with characteristics of quality, quantity and time used to measure, directly or indirectly, changes in a situation and to appreciate the progress made in addressing it". (4) Table 1 lays out definitions and examples of the two types of indicators used to capture health and human rights concerns.

It is immediately apparent that many of the human rights indicators constitute measures that fall outside the traditional definition of a health indicator. To assess the degree to which human rights are respected, protected and fulfilled in the area of health is to expand the notion of what constitutes an indicator in this field. Inevitably this brings with it complications, some of which are explored in this paper.

Human rights indicators to measure health

For those involved in monitoring the human rights compliance of States, indicators are primarily used to enhance the practice of accountability for health-related rights issues. …

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