Tropical Health Matters

We are in the midst of observing the 60th Anniversary of the Universal Declaration of Human Rights. Article 25 of the Declaration states that, “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

As we have noted before, The UN has appointed a Special Rapporteur of the Commission on Human Rights on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. One of the issues being pursued is that of access to medicines, including medicines for malaria, and to that end guidelines are being developed for pharmaceutical companies.

In an introductory note the draft guidelines observe that, “Almost 2 billion people lack access to essential medicines. Improving access to existing medicines could save 10 million lives each year, 4 million of them in Africa and South-East Asia. Access to medicines is characterised by profound global inequity. 15% of the world’s population consumes over 90% of the world’s pharmaceuticals.”

The suggested guidance encourages pharmaceutical companies to address human rights in their mission statements and actually act on those statements as part of corporate responsibility. One particular concern is that companies refrain from discouraging or working against country policies that are working to improve access to medicines by citizens. What comes to mind of course is efforts by countries to buy or produce generic HIV or malaria medicines in order to ensure the greatest coverage of affected people. Other issues addressed in the draft include ethics, quality, technology transfer and pricing.

What would be most helpful in the malaria arena is if more alternative and generic medicines could become available and those made available at the cheapest possible prices. For example, one possible unintended consequence of WHO’s pre-qualification process seems to be putting all our eggs in the one basket of artemether-lumefantrine, which does not make sense epidemiologically or economically. International and national based pharmaceutical companies have a role to play in rolling back malaria. They need to do this in a responsible manner that saves the most lives.

The continuing post-election saga of violence, killing and intimidation in Kenya has far reaching health impacts beyond the immediate sorrow of unnecessary deaths. News reports today indicate that food aid for displaced persons cannot reach those in need because of insecurity.

Robyn Dixon reports in the Baltimore Sun that, “Up to 100,000 Kenyans face starvation in western Kenya because of election-related tribal violence, the World Food Program warned yesterday, as rivals in last week’s disputed presidential vote showed no willingness to talk.” In addition, “More than 180,000 Kenyans have fled their homes because of tribal violence, the United Nations reported, and 500,000 will need aid in the coming month.” According to the BBC, “Food rations in many homes outside Nairobi are running short as most shops remain closed.”

It will not take long before increased susceptibility to diseases, including malaria, will plague the displaced and homeless. The situation is particularly sad because Kenya was held up as a model of success by the WHO’s Global Malaria Program in August. According to the BBC public transportation has nearly shut down. Displaced people will now have little or no access to life saving malaria interventions including prompt treatment with ACTs and ITNs/LLINs. Women will miss antenatal appointments and an opportunity to receive IPTp.

In an attempt to preserve or gain their own power, political leaders actually give more power to devastating diseases and hunger. The people of Kenya deserve better.

Do people have a right to live without malaria? This appears to be a theme that will be addressed at the first Annual Lecture on Malaria and Human Rights sponsored by the European Alliance Against Malaria and the UK Coalition Against Malaria on 10^th December 2007. The key speaker will be Professor Paul Hunt, UN Special Rapporteur on the Right to Health.

The Special Rapporteur on the right to the highest attainable standard of health defined this human right as “an inclusive right not only extending to timely and appropriate health care, but also to the underlying determinants of health, such as access to safe and potable water and adequate sanitation, healthy occupational and environmental conditions, and access to health-related education and information, including on sexual and reproductive health.”

According to the report, Water and the Right to the Highest Attainable Standard of Health, by Hunt and Khosla, “The prevention, treatment and control of epidemic, endemic, occupational and other diseases is a central obligation of the right to health.” These issues also feature prominently in the UN Millennium Development Goals.

Are the MDGs a ‘Bill of Rights’ to overcome poverty? The nations who signed on in 2000 “committed themselves to making the right to development a reality for everyone and to freeing the entire human race from want. They acknowledged that progress is based on sustainable economic growth, which must focus on the poor, with human rights at the centre.” In fact Hunt and Khosla note that the MDGs “cannot be achieved without effective health systems that are accessible to all.

Paul Hunt outlines two broad approaches to promoting the ‘right to health’, the judicial and the policy. “The “policy” approach demands vigilant monitoring and accountability.” This is where research and advocacy is needed. Hunt notes that neglected diseases affect neglected communities, and a rights approach helps spotlight the neglect and form a basis for advocacy.

UNICEF reports on use of this approach in Mozambique. “Malaria represents a significant health problem in Mozambique. Since the late 1990s UNICEF-Mozambique has developed a new strategy to fight malaria through a methodology combining human rights-based approach to programming and community capacity development,” and has used this to guarantee among others the distribution of free ITNs in areas of need. A health rights based approach is therefore, a valuable tool in the fight against malaria.