Respect for equal human dignity, the rule of law, and health in all sectors – these are three preconditions of realizing the right to health. Respect for equal human dignity is the core principle of the right to health and all human rights. Respect for the rule of law is an underlying requirement for the right to health and all other human rights to have meaning. Without the rule of law, governments will do as they wish, too often to benefit the interests of those in power. Any nominal commitment to human rights would then mean little. And for the right to health to be realized, it must be respected across all sectors. Whatever level of health care is available, if people do not have clean water and sanitation, safe housing, education, employment, and so forth, their ability to achieve the highest attainable standard of physical and mental health will suffer enormously.
That these elements are foundational to the right to health gives considerable cause for concern about the right to health in the coming four years under the incoming U.S. President and his Administration. On this blog, my colleagues provide their perspectives about particular areas of concern, and there are many – how U.S. policy could affect reproductive rights both at home and abroad, implications for foreign assistance for health, whether years of expanding access to health services will go into reverse. Here, I reflect briefly on the implications of how the overall tone and policy approach of the incoming Administration may affect the right to health.
First, respect for equal dignity. Non-discrimination and equal treatment, with an emphasis on ending inequities (unfair inequalities), is an overarching principle of all human rights. Entire human rights treaties (such as those on race and women) have been developed around precisely this principle. Yet in his statements during the campaign, as well as his early post-election appointment of a Chief White House Strategist “who has either ridiculed or demonized women, LGBT people, Muslims, Jews and others,” the President-elect has failed to respect this principle. This attitude appears to have unleashed a kind of license to disrespect, with the Southern Poverty Law Center collected more than 400 reports of incidents of hate and harassment in the first 6 days after the election, with the largest number focusing on immigrants, blacks, LGBT people, and Muslims. (A difficult, painful to watch, graphic video of some of the images and words of this hatred can be found here.)
The rule of law
Second, respect for the rule of law. Though the President-elect often has spoken of the need to re-establish law and order, this priority does not seem to encompass international law. For example, he has stated that he would “cancel” the landmark Paris Agreement on climate change. Also during the campaign, he indicated that the United States might not come to the defense of NATO allies that had not paid their fair share into the Alliance, despite an agreement on mutual defense being at the core of NATO’s founding treaty.
With respect to human rights law in particular, the President-elect made statements directly at odds with at least one of the relatively few human rights treaties that the United States has ratified: the Convention Against Torture. He has stated his support for waterboarding against ISIS, even saying that he did not think it was tough enough. Yet the Committee Against Torture (among others, including the U.S. State Department) (p. 55), the authoritative UN body interpreting that treaty, has recognized that waterboarding constitutes torture which is, of course, prohibited. [UPDATE: 11/23/16: He since stepped back from his support for waterboarding, recognizing based on a conversation with a top general that torture is ineffective at eliciting information, though would “still go for it” – waterboarding – “[i]f it’s…important to the American people.”] Further, in his threats to sue media outlets, he has shown a disregard for freedom of press, a human right as well as a centerpiece of the U.S. Constitution’s First Amendment and basic to any democracy.
Such loose regard for international and constitutional rights may cause harm that extends beyond particular treaties or constitutional commands. Presidents and prime ministers elsewhere who are already inclined to suppress the press or disregard international legal commitments may now point to the United States, the notional bastion of democracy, and its President as cover for their actions.
The right to health in all sectors
And third, the importance of respecting the right to health in all aspects of our lives. Our social, economic, and physical environments have considerable effects on our health (p. 4), even more than health care itself. Here, again, proposals of the President-elect stand to undermine the right to health. For instance, his campaign promises around tax policies, if enacted, would exacerbate income inequalities. Closing such disparities was a core recommendation of the landmark 2008 report of the World Health Organization’s Commission on Social Determinants of Health.
One of the next Administration’s signature aims – as stated during the campaign – is to deport large numbers of undocumented immigrants. This could lead to massive disruptions in their health care and tear apart families and communities, though strong social bonds contribute to longer and healthier lives. Deportations and even its mere threat promise to cause mental trauma and severe stress (a major negative determinant of health) and drive undocumented immigrants further underground, making an already exploited population (such as in terms of wages, workplace safety, and housing) even more vulnerable. This flies in the face of the right to health for all.
Fledging yet significant steps the federal government has taken on criminal justice reform, including to recognize drug addiction as a public health rather than criminal issue, and the need to reduce our prison population, may be reversed with the President-elect’s misdirected and narrow focus on “law and order.” His nominee for Attorney General has opposed criminal justice reforms, including to reduce mandatory minimum prison sentences and reform drug policies. And there is little hope for meaningful gun control measures at the federal level. Washington may even be in a position come January to more successfully undermine state gun control laws, such as if new a federal law is enacted to establish nationwide recognition of state-issued concealed carry permits – as the President-elect supports.
Also, in the area of challenging the right to health, the President-elect’s antipathy towards the Environmental Protection Agency and environmental regulations in general could lead to loosening environmental standards and thus increasing air and water pollution, harming health and impeding efforts to address climate change. Like so much else, the negative impacts would fall heaviest on poorer and minority communities, for pollution sources, such as industrial plants and bus depots, are disproportionately sited near communities that have less ability (or political clout) to keep such facilities out of their neighborhoods.
At the same time, I should note that several of the incoming Administration’s policy proposals – if enacted properly and equitably – could, by contrast, positively affect health. A new and large national infrastructure program, which the President-elect has strongly supported, would boost employment. During the campaign the President-elect expressed genuine interest in making college more affordable, including through reforms to lessen the burden of student loans. Employment and education both positively impact health.
At the same time, though, there is speculation that the incoming administration would seek to diminish the Department of Education, including disbanding its Office of Civil Rights, or even eliminate the Department entirely. Such actions could “have a ‘devastating’ effect on disadvantaged students.” Another policy possibility, a voucher program to incentivize school choice programs, could likewise further disadvantage already disadvantaged students. The result again would be to curtail their opportunities and lead to a lower standard of living – and of health.
So what is next? What should those of us who are concerned about human rights in general and the right to health in particular do? I offered eight ideas in an earlier post-election blog. Here is one more: In the words of the great labor movement song: Solidarity Forever.
Solidarity. Togetherness. Diverse movements for human rights and social justice will need to join together. The forces threatening the right to health threaten all rights. To disregard our equal dignity is to put all rights at risk; non-discrimination and human dignity underlie each of the precepts we hold dear. To disregard the rule of law creates an atmosphere where any right may be violated. And all rights are interrelated – no more so than in considering our right to health. The right to health can only truly be realized when the right to education, to a justice system that is fair, to the opportunity for political participation, and other rights are realized as well.
The U.S. right to health movement will need to offer its support to social justice and human rights advocates in all spheres. The struggle for the social and political conditions that underlie the right to health is a struggle for the conditions that underlie all our rights. There is nothing new in this truth.
Now, though, the need for us to band together has taken on a new urgency. And while we will not be able to prevent all policies from being implemented that may undermine the right to health, each of us can help create an atmosphere of respect for the dignity of all people. Each of us can assert the need for our government to respect and operate within the law – with no laws more fundamental than human rights law. Each of us can join and otherwise offer support to movements to protect people’s rights and advance policies in all areas of our lives, which will, in turn, help protect the right to health that we seek to ensure for all.
In the era now upon us, each of us must take these steps. Human rights solidarity forever. Human rights solidarity now.