From the Editors

Paul E. Farmer and Arlan Fuller

In the growing movement for health and human rights, the discourse among some interested parties—from nongovernmental organizations to the United Nations to medical and legal practitioners working in poor countries—has undergone a transformation. This shift reflects a greater enthusiasm and, increasingly, a recognized obligation to employ a rights-based framework in building health systems, delivering services, and informing policymaking and advocacy efforts. These recent developments reveal a shift in the discussion of a rights-based approach: current debates focus less on whether or not such an approach should be used, and more on exploring how and when it might best be applied.

Since its inception, Health and Human Rights has sought to critique the discourse of health and human rights, focusing on the tensions between theory and practice. It is a long way from abstract human rights claims to the delivery of services demanded by those rights. We hope this journal has served as an outlet for policymakers and practitioners struggling to transform rhetoric into implementation of health care efforts among the world’s poor.

As this movement gathers force, we are pleased to present the latest issue of Health and Human Rights, which speaks to many of the field’s current challenges. Specifically, a number of papers in this issue help develop normative frameworks and legal recourse to ensure accountability of health care delivery initiatives around the globe. In their paper on the “judicialization” of the right to health, Biehl and colleagues, writing on Brazil, document the increasing number of patients who sue the government for access to medicines. The authors describe how patients have mobilized legal resources in creative ways, citing, for example, the Brazilian Constitution’s declaration that “health is the right of all persons and the duty of the State.” Friedman and colleagues suggest that while the discourse of health as a human right continues to gain traction in national constitutions, legal jurisprudence, and civil society, substantive rights remain elusive. The authors offer concrete suggestions about how to advance the right to health, including a new Framework Convention on Global Health.

Ross Pink’s paper explores the paradigm of “human security,” which he suggests might serve as a legal foundation for initiatives to safeguard the rights of children by increasing access to safe water and modern sanitation. Recognizing that most practitioners of human rights work remain unaware of what relevant litigation and legal instruments do exist, Meier and colleagues highlight the utility of a searchable Global Health and Human Rights Database. This resource tracks health and human rights language employed in courts and legal documents around the world.

Although legal accountability is an important component of the fulfillment of health as a human right, a number of other authors in this issue focus in on the necessity of community-led delivery efforts. Kiss and colleagues, for instance, consider women’s help-seeking patterns vis-à-vis Brazil’s policies to reduce violence against women. The authors conclude that national messaging campaigns must be community-based to have greater effect on epidemics of violence against women in Brazil. Exploring both the debate on and practice of advocacy, Jean Drage describes the National Health and Disability Advocacy Service in New Zealand as a model of advocacy enriched by a framework of consumer rights. Mariah McGill documents the Vermont Workers’ Center advocacy for universal health care and discusses the effects of grassroots human rights efforts on perceptions of economic, social, and cultural rights in the United States. Finally, London and colleagues draw on the experience of the Learning Network for Health and Human Rights to highlight the role of civil society in bridging the gap between government commitments to human rights and the delivery of services among society’s most vulnerable members.

This issue of Health and Human Rights continues the mission of enabling those working to realize health rights in settings of adversity. To maximize the publication’s usefulness in the field and within the broader health and human rights movement, we encourage our readers to build on these contributions by actively shaping the discourse through future submissions and through the journal’s blog at http://www.hhropenforum.org.

–Paul Farmer and Arlan Fuller

Medical anthropologist and physician Paul Farmer, MD, PhD, is a founding director of Partners In Health (PIH), an international non-profit organization that provides direct health care services and has undertaken research and advocacy activities on behalf of those who are sick and living in poverty. Dr. Farmer is the Kolokotrones University Professor and Chair of the Department of Global Health and Social Medicine at Harvard Medical School; Chief of the Division of Global Health Equity at Brigham and Women’s Hospital; and the United Nations Deputy Special Envoy for Haiti, under Special Envoy Bill Clinton. He is editor-in-chief of Health and Human Rights.

Arlan Fuller, JD, is Director of Policy and Programs at the FXB Center for Health and Human Rights at the Harvard School of Public Health. He is a contributing editor for Health and Human Rights.