Despite being preventable, rapidly diagnosable, treatable and curable, tuberculosis (TB) kills more people than any other infectious disease globally, with 10.4 million new cases and 1.7 million deaths (a quarter among people living with HIV) in 2016.
Recognizing that creating enabling legal environments is an integral component of an effective TB response, the O’Neill Institute has developed a Tuberculosis, Law, and Human Rights Project in partnership with Stop TB Partnership, USAID and other partners. The Project aims to address legal and human rights barriers to effective and evidence-based TB prevention, testing, treatment, care and support and to strengthen rights-based frameworks. Fueled by human rights violations including inadequate access to quality health care, nutrition, sanitation and housing, and the excessive, inappropriate and punitive use of confinement, TB disproportionately impacts the most marginalized members of society. There is an urgent need, therefore, to both document rights violations and engage in law and policy reform as a key element in the fight against tuberculosis.
The O’Neill Institute is supporting in-country partners in high burden TB countries with Legal Environment Assessments (LEAs). Developed through field and desk research and taking a human rights perspective, LEAs comprehensively review and analyze a country’s legal frameworks as they relate to TB and make recommendations to improve them. Through the process itself and activities to implement their recommendations, the Legal Environment Assessments provide opportunities for governments, civil society, and people affected by TB to tackle country-specific barriers to TB prevention and services. O’Neill is supporting LEAs in several countries, including by providing technical support for developing rights affirming policies.
The O’Neill Institute is collaborating with the UN Special Rapporteur on the Right to Health to address human rights issues concerning tuberculosis. Areas of focus include the excessive and unnecessary use of confinement and TB and human rights issues facing migrants, as well as preparing for the UN High-Level Meeting on TB in September 2018.
Migrants are often excluded from health insurance coverage schemes and have limited access to health services, leading to reduced ability to detect and treat TB. This is overwhelmingly the case for undocumented immigrants, but also for other migrants, such as migrants on temporary work visas or migrants who do not have permanent residency status. Migrant workers, refugees, and other migrants also often live in overcrowded conditions that can increase the risk of exposure and exacerbate the spread of TB. In some countries, the impact of discriminatory laws and policies and inadequate labor protections for migrant workers is further compounded by social and economic inequality, stigma, and xenophobia, which not only increase the risk of TB for migrants but also may impede access to TB testing and prevent continuity of care. The O’Neill Institute is researching the impact of migration and migrant-related laws and policies on the right to health and the fight against TB, with the aim of making recommendations to improve access to TB-related services for migrants in high burden countries.
Few populations face more risk factors to TB than persons deprived of liberty, whose rights are frequently violated, including in the context of prisons and due to punitive laws and laws authorizing mandatory hospitalization and treatment. In some high burden countries, laws criminalizing certain behaviors, inappropriate use and selective enforcement of criminal laws, and lengthy pre-trial detention leads to severe prison overcrowding; simultaneously, appalling prison conditions fuel the spread of TB (e.g., poor ventilation, unhygienic conditions, lack of nutrition and quality health services for inmates). In other confinement contexts, the coercive and overuse of hospitalization and isolation and lack of community-based care further drives TB by deterring people from treatment and support. The O’Neill Institute has been researching the impact of confinement and confinement-related laws and policies on TB in high burden TB countries. This research will support the work of in-country and other partners and contribute to the available information on this issue.
Recognizing that marginalization and inequality are drivers of TB and poor health more broadly, the O’Neill Institute proposes that as one valuable approach to give meaning to the SDG promise of “Leave No One Behind” in the sphere of health, countries develop National Health Equity Strategies (NHES). Encompassing both health systems and broader determinants of health, NHES would comprehensively review and provide programs of action to address health inequities across all populations. The O’Neill Institute is currently creating a guide to developing NHES, to be used at the country level, based on the vision of a comprehensive approach to advancing health equity developed through an inclusive, participatory process. If you are interested in participating in consultation on this guide, we would welcome and appreciate your input.
Thematic Area: Global Health Governance