Modern concepts of public health recognize health "not merely as the absence of disease or infirmity," as defined by the World Health Organization (WHO), but "a state of complete physical, mental, and social well-being" (1978). Modern public health theory further recognizes this broad characterization of health as a fundamental human right and the attainment of the highest possible level of health as an important worldwide social goal. Thus, there is an enlightened understanding that societal factors, such as the denial of human rights, clearly affect the health status of populations.
As far back as the fourth century B.C.E., Aristotle expressed this connection among health, human rights, and treatment by society. He wrote: "If we believe men have any personal rights at all as human beings, they have an absolute right to such a measure of good health as society, and society alone, is able to give them." It is clear that a society that practices or tolerates discrimination, or that otherwise fails to respect and protect the human rights of minorities and other groups, compromises the health—the physical, mental, social, and spiritual well-being—of its citizens, especially minorities and other marginalized groups subjected to discrimination.
Despite the provisions under many countries constitutions and laws and under numerous international human rights instruments (e.g., the Universal Declaration of Human Rights, the International Covenant on Economic, Social, and Cultural Rights, Convention on the Elimination of Discrimination Against Women) aimed in large part at ensuring equal rights and protection for minorities against discrimination, health disparities exist among different populations in many countries. In the United States, for example, minorities generally have shorter life spans, and they receive less, and often inferior, medical treatment. Minorities also disproportionately lack health insurance—an important means of obtaining access to health care in the United States. The rate of uninsured African Americans is more than 50 percent higher than that of whites. Although employers provide most of the private insurance for workers and their families in the United States, African-American workers and their families are much less likely to have insurance through their employers than whites. A wide gap in income also exists, with African Americans three times more likely than whites to live in poverty.
In much of the world, women experience discrimination and resulting poor health. The global AIDS (acquired immunodeficiency syndrome) epidemic highlights the interrelationship between health and the lack of women's rights. Women and girls face human rights issues in a number of social and economic spheres that increase their risk of exposure to and inadequate care for HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome), resulting in higher incidence of illness and death from the disease. According to the WHO, these include lack of control by women and girls over their own sexuality and sexual relationships, resulting in coerced sex and sex abuse; poor reproductive and sexual health; inadequate or delayed access to health care and support for women with AIDS (due to family resources being devoted to caring for the man); clinical management of the disease based on research on men; cultural practices such as genital mutilation; stronger AIDS-related stigma and discrimination against women; obstacles to educational and employment opportunities for girls and women; and other similar human rights violations. Noting the intimate relationship between autonomy in decisions relating to sexuality and economic independence, WHO concludes that unless and until the scope of human rights is fully extended to economic security, women's right to safe sexuality and protection from illness and death from AIDS will not be achieved.
For public health to ensure the health of all members of society, both as a discipline and a field of practice, it must address inequality in the provision of preventative care, in access to health care, in treatment for the ill, and in all the other health functions traditionally viewed as its mission. It also must address the underlying societal conditions and determinants of health, including discrimination in education, employment, access to income, and other areas of society, and to promote policies and interventions to create favorable societal conditions that will ensure the equal treatment of all people in all realms of society.
(SEE ALSO: Access to Health Services; African Americans; American Indians and Alaska Natives; Demography; Ethnicity and Health; Hispanic Cultures; Inequalities in Health; Social Class; Social Determinants)
Bibliography
Centers for Disease Control and Prevention. "Eliminating Racial and Ethnic Disparities." In CDCFY2000 Performance Plan-XV. Atlanta, GA: Author.
UCLA Center for Health Policy Research (2000). Racial and Ethnic Disparities in Access to Health Insurance and Health Care. Los Angeles, CA: UCLA.
World Health Organization (1978). Declaration of Alma-Ata. Geneva: Author.
—— (2000). Women and HIV/AIDS. Fact Sheet No. 247. June 2000. Available at http://www.who.int/inf-fs/en/fact247.html.
— ROSE NATHAN
