WHO/SDE/HDE/HHR/01.2 • Original: English • Distribution: General WHO’s Contribution to the WorldWorld ConferenceConference AgainstAgainst Racism,Racism, RacialRacial “Vulnerable and marginalized groups in society bear an undue proportion of health problems. Many health disparities are rooted in fundamental social structural inequalities, which are inextricably related to racism and other forms of discrimination Discrimination,Discrimination, in society... Overt or implicit discrimination violates one of the fundamental principles of human rights and often lies at the root of poor health status.” XenophobiaXenophobia The World Health Organization’s contribution to the World Conference Against Racism, Racial Discrimination, Xenophobia and Related Intolerance urges the Conference to consider the and Related link between racial discrimination and health, noting in and Related particular the need for further research to be conducted to explore the linkages between health outcomes and racism, racial discrimination, xenophobia and related intolerance. IntoleranceIntolerance Health and freedom from discrimination Health & Human Rights Publication Series–Issue No. 2 For more information, please contact: Helena Nygren-Krug Health and Human Rights Globalization, Cross-sectoral Policies and Human Rights Department of Health and Development World Health Organization Health & Human Rights 20, avenue Appia – 1211 Geneva 27 – Switzerland Publication Series Tel. (41) 22 791 2523 – Fax: (41) 22 791 4726 E-mail: [email protected] Issue No. 2, August 2001 World Health Organization Health and freedom from discrimination This document was produced by the World Health Organization: Department of Health and Development, Sustainable Development and Healthy Environments Cluster, WHO Headquarters, Geneva, together with the Public Policy and Health Program, Pan American Health Organization (PAHO), WHO Regional Office for the Americas, Washington, D.C. © World Health Organization, 2001 This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The views expressed in documents by named authors are solely the responsibility of those authors. Designer: François Jarriau, SCM7 Cover photo: WHO/PAHO/Armando Waak WHO/SDE/HDE/HHR/01.2 • Original: English • Distribution: General WHO’s Contribution to the World Conference Against Racism, Racial Discrimination, Xenophobia and Related Intolerance: Health and freedom from discrimination World Health Organization Health and freedom from discrimination Table of contents 1. Introduction page 5 2. Background 2.1 Health, human rights and discrimination page 6 2.2 Inequalities in health due to discrimination page 7 3. Determinants to inequalities in health 3.1 Health sector determinants page 8 3.2 Socioeconomic determinants page 11 4. Conclusions page 12 Annex: Variations in health and service access indicators: A regional perspective page 15 Photo: WHO/PAHO/Carlos Gaggero 3 Health and freedom from discrimination 1-Introduction 1 - The Constitution of the World Health Organization (WHO) of 1948 declares that “[t]he enjoyment of the highest attainable standard of health is one of the fundamental 1 rights of every human being” . It Photo: WHO/PAHO/Carlos Gaggero defines health as “a state of com- plete physical, mental and social 2 - The World Health Organization well-being and not merely the recognizes the World Conference absence of disease or infirmity” and against Racism, Racial Discrimination, prohibits discrimination in its Xenophobia and Related Intolerance 2 (1) Basic documents. enjoyment. as presenting a unique opportunity Forty-third edition. Geneva, World Health for the development and adoption Organization, 2001. of a new approach to addressing The Constitution was adopted by the the health impact of racism, racial International Health Conference in 1946. discrimination, xenophobia and (2) Id. Preamble. related intolerance. Photo: WHO/PAHO/Carlos Gaggero 5 Health and freedom from discrimination 2-Background 2.1 Health, that relevant rights “will be exer- human rights cised without discrimination...”. and discrimination 6 - Overt or implicit discrimination violates one of the fundamental 3 - Vulnerable and marginalized principles of human rights and often groups in society bear an undue lies at the root of poor health status. proportion of health problems. Discrimination against women; the Many health disparities are rooted elderly; ethnic, religious and lin- in fundamental social structural guistic minorities; persons with dis- inequalities, which are inextricably abilities; indigenous populations related to racism and other forms of and other marginalized groups in discrimination in society. Mortality society both causes and magnifies and health in general rarely diverge poverty and ill-health. far from economics and social rela- tions, which leads to the conclusion that to eliminate differentials in health outcomes requires address- ing the underlying social inequali- ties that so reliably produce them. 4 - Human rights provide a useful framework to identify, analyze and respond directly to the societal determinants of health. Vulnerabil- ity to ill-health can be reduced by Photo: WHO/PAHO/Carlos Gaggero taking steps to respect, protect and fulfil human rights. Government 7 - The observance of human rights is efforts towards meeting their human permeated and characterized by the rights obligations must be deliber- principle of freedom from discrimi- ate, concrete and targeted as clearly nation. Governmental responsibility as possible. for nondiscrimination includes ensur- ing equal protection and opportuni- 5 - Freedom from discrimination on ty under the law, as well as de facto account of race and ethnicity, sex enjoyment of rights such as the right and gender roles, and language and to public health, medical care, social religion, is an overarching and fun- security and social services. The damental norm relevant to all International Convention on the aspects of public life. While the Elimination of All Forms of Racial International Covenant on Eco- Discrimination places an obligation nomic, Social and Cultural Rights on States parties to prohibit and to provides for progressive realization eliminate racial discrimination in all and acknowledges the constraints its forms and to guarantee the right due to the limits of available of everyone without distinction as to resources, it also imposes various race, colour of the skin or national or obligations of immediate effect. Of ethnic origin, and equality before the particular importance in this regard law, notably in the enjoyment of the is the “undertaking to guarantee” above-mentioned rights. 6 Health and freedom from discrimination Respect for human rights, the standards of which are contained in numerous international human rights instruments, is an important tool for protecting health. It is those who are most vulnerable in society—women, children, 8 - A general comment on the right to the poor, persons with disabilities, the the highest attainable standard of internally displaced, migrants and health, recently adopted by the refugees—who are most exposed to the Committee which monitors the risk factors which cause ill-health. International Covenant on Economic, Discrimination, inequality, violence and Social and Cultural Rights, enumer- poverty exacerbate their vulnerability. ates the grounds for non-discrimi- It is therefore crucial not only to nation in health by proscribing “any defend the right to health but to ensure discrimination in access to health that all human rights are respected and care and the underlying determi- that the root economic, social and nants of health, as well as to means cultural factors that lead to ill-health are and entitlements for their procure- addressed. ment, on the grounds of race, colour, sex, language, religion, political or Mary Robinson, UN High Commissioner other opinion, national or social ori- for Human Rights, 9th International gin, property, birth, physical or Congress of the World Federation of (3) General comment mental disability, health status Public Health Associations, Beijing, on the right to health (including HIV/AIDS), sexual ori- adopted by the 2–6 September 2000 Committee on entation, civil, political, social or Economic, Social and Cultural Rights on 11 other status, which has the intention May 2000, paragraph 18. (E/C.12/2000/4, or effect of nullifying or impairing CESCR General the equal enjoyment or exercise of 10 - Gender is a cross-cutting theme in comment 14, 4 July 2000.) the right to health”. 3 all matters concerning health and development which concerns how polices and programmes impact dif- ferently on women and men. Anoth- er important dimension to consider is how racial discrimination com- 2.2 Inequalities bines and multiplies in relation to in health due other grounds for discrimination, such as sex and gender roles; age to discrimination (children and the elderly); sexual orientation; religion; political affilia- 9 - Research has shown that inequali- tion; physical and mental disability; ties in the health and health care of and other health status. For exam- ethnic and racial groups 4 are evi- ple, the combination of racial and (4) See Annex: Variations in health dent and that racism is the most dis- gender discrimination has resulted