Professor David Harris, Professor Aoife [EE-fa] Nolan,
Distinguished guests, dear colleagues and friends,
It is an honour to deliver the annual Human Rights Law Centre lecture on Global Health and Human Rights.
In particular, I would like to thank Professor Harris and Professor Nolan for the invitation, and I dearly wish I could be with you in person today.
I would also like to send my greetings to the Vice Chancellor, Professor Shearer West, and to my friend Professor Tony Avery.
I would also like to offer my congratulations to our University for being ranked third in the world in a list of the most sustainable universities.
As you know, the University of Nottingham holds a very special place in my heart.
I spent many happy days there completing my Ph.D. in community health, and I have many fond memories of walking around the beautiful grounds.
My supervisor, Professor Peter Byass, tragically passed away just four months ago, and I would like to dedicate today’s lecture to his memory.
It’s no overstatement to say that Peter, and the University of Nottingham, shaped my life and career. I owe them both so much.
My experience as a student in the UK and in Denmark also taught me the value of universal health coverage – a value that remains central to everything I do.
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In 1948, as the world was rebuilding from the second devastating global conflict in just 30 years, two foundational documents came into force that have shaped the health of the world’s people for more than 70 years.
One was the Universal Declaration on Human Rights; the other was the Constitution of the World Health Organization.
Both documents affirm that health is a fundamental human right, not a privilege for those who can afford it.
Over time, that right has been concretised in the statute books of an increasing number of nations.
Many now have the right to health enshrined in their constitutions.
Others have passed laws on universal health coverage – most recently the Philippines and South Africa.
Last year, all 193 Member States of the United Nations endorsed the Political Declaration on Universal Health Coverage. The first paragraph says, “We reaffirm the right of every human being, without distinction of any kind, to the enjoyment of the highest attainable standard of physical and mental health.”
Just a few weeks later, legislators from many countries met at the Inter-Parliamentary Union Congress in Belgrade to adopt a resolution on universal health coverage, pledging to leverage the power of parliaments to translate political commitment into the legislation and regulations to make UHC a reality.
The rule of law is essential for health in several ways.
First, it supports good governance by establishing formal codes or norms that effectively constrain or mandate certain actions by individuals, institutions or governments.
Second, the rule of law can help to establish clear standards for accountability, transparency, privacy, and sanctions, and to prevent or reduce corruption.
And third, the rule of law also enables individuals to access health services, to participate in decision-making, and to prohibit discrimination.
But despite all these advantages, the right to health is being challenged in unprecedented ways, especially by the COVID-19 pandemic.
In less than a year, more than 1.5 million people have lost their lives, and tens of millions of people have been driven into extreme poverty.
These data are likely underestimates of the true picture of direct and indirect morbidity and mortality due to the pandemic.
Quite apart from its health effects, COVID-19 has had ripple effects in many other areas, including human rights.
The pandemic has exposed and exploited the inequalities in our societies, disproportionately affecting the poor, the elderly, ethnic and racial minorities, indigenous peoples, and other vulnerable groups.
We have seen evidence of significant increases in rates of violence against women and children this year, exacerbated by reduced access to services for survivors.
Rates of violence and abuse against older persons have also increased.
In some communities, groups such as Roma and other ethnic minorities, migrants, people of Asian descent and LGBT communities have been targeted.
They face allegations of bringing COVID-19 into communities, or are targeted by authorities who use public health measures as a pretext for discrimination and abuse, including, in too many cases, arrests, beatings and incarceration.
Some governments have passed criminal laws or used existing ones to incarcerate people for breaches of lockdowns and curfews, or for alleged exposure to, or transmission of, COVID-19.
We know from our experience with HIV that criminalization profoundly stigmatizes people and deters them from seeking out HIV services.
Let me be clear: There is no public health rationale for criminalization, and WHO’s position is that incarcerating people under such provisions is counterproductive as a public health strategy, and raises serious human rights concerns.
There are a range of pro-active measures that authorities can take to lower the burden and danger to the incarcerated population, including reducing overcrowding, releasing non-violent offenders, and ensuring continued health care services and access to personal protective equipment for prisoners, detainees, and correctional officials.
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In addition to all of these challenges, the burden of both the virus itself and the measures to contain it fall most heavily on those who can least afford to bear it.
Stay-at-home orders and so-called lock downs have placed a huge burden on the poor, increasing hunger dramatically and denying people the ability to earn their daily bread.
Most of the world’s population do not have the luxury of being able to stay home and stay safe.
Most must go out to earn a living, or to fetch water.
Governments therefore face a difficult balancing act between implementing measures to protect and promote health, while protecting and promoting other human rights.
But to suggest we must choose between health and human rights is completely wrong. We can and must choose both.
International human rights law recognizes the need for temporary limitations of some rights in public health or other emergencies.
The Siracusa Principles provide clear guidance to ensure that limitations pursue a legitimate aim – including public health protection – are proportional, time-bound and reviewable by an independent court.
Most importantly, the principle of equality and non-discrimination must be respected.
In response to all of these challenges, WHO is supporting Member States with technical guidance to reduce transmission and save lives – and to protect the right to life, the right to health, and the right to equality and non-discrimination.
Integrating human rights protections into the response to COVID-19 is not only a moral imperative, it is a binding legal obligation.
Respect for all human rights will be fundamental to the success of the public health response.
Many of the countries that have responded to COVID-19 most successfully are those that have engaged, educated and empowered communities to implement measures to protect themselves and others.
That includes the meaningful participation of groups that often face social exclusion and discrimination in designing, implementing, and monitoring COVID-19 policies.
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COVID-19 has exposed and exploited the inequalities and injustices of our world.
But it can also be the springboard for building more equal and equitable societies.
Vaccines will help to end this pandemic. But they will not address the vulnerabilities that lie at its root.
There is no vaccine for poverty, hunger, inequality or climate change.
Once the pandemic ends, we will be left with even greater challenges than before it started.
In 2015, the nations of the world adopted the Sustainable Development Goals, with their sweeping vision for people, planet, prosperity, peace and partnership.
We were off track for the SDGs before the pandemic; now we’re even further behind.
But COVID-19 has demonstrated why the SDGs are so important, and why we must pursue them with even more determination and innovation, and how we can only do that by protecting and promoting human rights.
COVID-19 is teaching us a very hard lesson, one we ignore at our peril.
A public health crisis can quickly become a human rights crisis, threatening not only the right to life and the right to health, but the entire range of civil, political, social, economic and cultural rights.
This is a time for multilateralism and strong global health governance that places human rights at the centre of its efforts.
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As you know, yesterday was Human Rights Day, with the theme Recover Better: Stand Up for Human Rights.
And tomorrow is Universal Health Coverage Day, with the theme “Protect Everyone”.
These two days coming so close together, at the end of this very difficult year, are a reminder that as we rebuild from this crisis, we must do so on the foundation of human rights – including the right to health.
The pandemic has demonstrated that health is not simply a by-product of development, but an essential component of the social contract upon which stable, prosperous, resilient societies are built.
I would like to leave you with three areas in which I believe the rule of law is essential for providing, promoting and protecting the right to health.
First, the right to health must be provided by law.
As I mentioned, all UN Member States last year endorsed the Political Declaration on Universal Health Coverage, which affirms the right to health.
But only about 80 countries have a formal legal provision for the right to health, either in their constitutions or their statute books.
We need more political advocacy to provide the fundamental legal underpinning for health.
And we need more research on the different ways in which countries translate the right to health into law, and the different effects those laws have, in different contexts.
Second, the right to health must be promoted by law.
It’s one thing to have access to health services guaranteed by law.
But all too often, health can be undermined by other laws – or the lack of them – that regulate many of the reasons that people get sick and die, in the air they breathe, the food they eat, the water they drink, and the conditions in which they live and work.
Prevention is better than cure – and that applies to the law as well.
In recent years, many countries have introduced new legislation and regulations to address what we call the determinants of health.
For example, Australia, Canada, France, Saudi Arabia, Turkey, Thailand, Uruguay and more have mandated plain packaging for tobacco products.
Singapore has passed a bill that will ban the use of artificial trans-fats – a leading contributor to hypertension and heart disease – from its food supply by next year.
Countries including Chile, India, Malaysia and Mexico have introduced or increased taxes on sugary drinks.
And there are many other examples. Here again, more research is essential for helping to understand the impact of these laws on health, and for building the evidence base on how these laws can be used more effectively.
And third, the right to health must be protected by law, even in emergencies.
The right to health is not a privilege to be enjoyed only in times of peace and prosperity.
It is a right that must be protected at all times.
In the current context, that includes ensuring equitable access to diagnostics, treatments and vaccines.
As you know, you in the UK are among the first people in the world to benefit from vaccines against COVID-19.
To have safe and effective vaccines against a virus that was completely unknown to us only a year ago is an astounding scientific achievement.
But an even greater achievement would be to ensure all countries enjoy the benefits of science equitably.
We simply cannot accept a world in which the poor and marginalized are trampled by the rich and powerful in the stampede for vaccines.
This is a global crisis, and the solutions must be shared equitably as global public goods, not as private commodities that widen inequalities and become yet another reason some people are left behind. No one should be left behind.
In April, with support from many partners, WHO established the Access to COVID-19 Tools Accelerator.
This is a completely unprecedented partnership with two aims: to develop vaccines, diagnostics and therapeutics fast; and allocate and deliver them fairly.
The task of narrowing inequalities does not start after the pandemic. It must be part and parcel of the response.
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We have an opportunity to build back better after COVID-19, but it will take all of us to do it: governments, international organizations, businesses, civil society organizations – and universities.
The world has changed beyond recognition over the past 72 years.
But WHO’s vision has not – the right to the highest attainable standard of health for everyone, everywhere.
I thank you.