A Toolkit on the Right to Health

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A Toolkit on the Right to Health is a practical tool linking research, training and advocacy to educate communities on their right to health, how to identify violations of such rights and how to respond to these violations. It can be used as a stand-alone source of information or as training tool for workshops on the right to health.

Each section of the toolkit uses practical examples to illustrate ideas, and has a number of exercises and case studies that could be used for training purposes. At the end of each chapter is a set of workshop handouts that can be photocopied for participants.

The toolkit is a product of the Learning Network, which was established in 2008 by the Health and Human Rights Program at the University of Cape Town and the University of the Western Cape in South Africa, Maastricht University in the Netherlands, Warwick University in the United Kingdom, as well as by South African civil society organizations—The Women’s Circle, Women on Farms Project, Ikhaya Labantu, Ikamva Labantu, Epilepsy South Africa and the Cape Metropolitan Health Forum.

While the toolkit is aimed at South African audiences, it is also hoped that it can be adapted for use in other countries in the Africa and beyond.

The toolkit is divided into four main sections:

  • Section 1: Focuses on a general understanding of human rights, particularly those rights set out in the South African Constitution, limitations on rights and the role of community members in claiming rights.
  • Section 2: Discusses the importance of the relationship between health and human rights, focusing on South African and international laws on the right to health and the duties of government in realizing the right to health.
  • Section 3: Focuses on violations of the right to health, gives an approach to identifying violations of the right to health and suggestions on whom to hold accountable when rights are violated.
  • Section 4: Covers citizen and community participation in health as a way of realizing the right to health, focuses on governance in health and the role that health committees could play as formal structures set up for community participation in health.

Click here to download a PDF of A Toolkit on the Right to Health.

1. Fick N, London L, Coomans F. A Toolkit on the Right to Health. Cape Town, South Africa: Learning Network, 2011.

Number of uninsured reduced by universal health care insurance in Thailand

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Thailand implemented a Universal Coverage Scheme of national health insurance in 2001 to finance equitable access to health care. After the Universal Coverage Scheme was introduced, the number of uninsured in Thailand fell substantially and use of health centers and community hospitals increased among lower income groups, according to a study that analyzed data from the Thai national health and welfare surveys in 2001 and 2005.

With the establishment of the Universal Coverage Scheme, Thai citizens are now covered by three main public health insurance schemes: the Civil Servant Medical Benefit Scheme for employees of the government and state enterprises, the Social Security Scheme for formal private sector employees and the Universal Coverage Scheme for the rest of the population. Health service utilization has shifted from tertiary towards primary health care facilities, an intended impact of the Universal Coverage Scheme.

As a result of Thailand’s universal health insurance, the number of uninsured fell from 24 percent in 2001 to three percent in 2005 and health service patterns changed. Use of public primary health care facilities such as health centers became more concentrated among the poor, while use of provincial/general hospitals became more concentrated among the better-off.

The increasingly common use of health centers among the poor in 2005 was substantially associated with those with lower income, residence in the rural northeast and the introduction of the Universal Coverage Scheme. The increasing use of provincial/general hospitals and private clinics among the better-off in 2005 was substantially associated with the government and private employee insurance schemes.

Although the Universal Coverage Scheme has achieved its objective in increasing insurance coverage and utilization of primary health services, “our findings point to the need for future policies to focus on the quality of this primary care and equitable referrals to secondary and tertiary health facilities when required,” the study concluded.
1. Yiengprugsawan V, Carmichael GA, Lim LL-Y, et al. Explanation of inequality in utilization of ambulatory care before and after universal health insurance in Thailand. Health Policy and Planning 2011; 26(2): 105-114. (open access)

Urban-rural inequities in knowledge of tuberculosis in Pakistan

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Knowledge of tuberculosis (TB) is poor especially in rural areas of Pakistan, according to a study conducted in Pakistan’s Punjab province. The study also found that people living in urban areas were more likely to seek treatment at a health facility, compared to rural folk. TB is re-emerging as a global public health problem and a better understanding of the urban and rural communities’ perception of the disease is needed to implement better prevention and control.

Knowledge regarding symptoms, transmission, prevention, duration of standard treatment and DOTS treatment was significantly higher in urban areas. Although more than 80 percent of both urban and rural people in the study were aware of the correct treatment for TB, less than half knew of the availability of the diagnostic facility and treatment free of cost.

People in the urban areas were more likely to feel ashamed and embarrassed being a TB patient; however, they seem to be supportive in case their family member suffered from TB. Nearly half of the study respondents, irrespective of the area of residence, believed that the community rejects TB patients.

Television (urban 80 percent, rural 68 percent) and health workers (urban 31 percent, rural 41 percent) were the main sources for people to acquire TB-related information.

“Television can be recommended as a suitable medium for future campaigns provided that information should be tailored according to the needs of all people, and health workers can be involved in this regard especially in the rural areas,” the study suggested.

1. Mushtaq MU, Shahid U, Abdullah HM, et al. Urban-rural inequities in knowledge, attitudes and practices regarding tuberculosis in two districts of Pakistan’s Punjab province. International Journal for Equity in Health 2011; 10: 8. (open access)

Asian Americans and obesity in California

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Studies show that foreign-born Asian Americans are significantly less overweight and obese than U.S.-born Asian Americans. A new study from California finds that Asian Americans who retain their Asian language are more likely to have a healthy weight. The study pinpoints those who have lost their heritage language and culture as particularly at risk for becoming overweight or obese.

One major reason for the increase in obesity is that acculturation into American culture is likely to increase the consumption of unhealthy food such as burgers, fries and soda. Promoting healthy eating and physical activity associated with the heritage culture of Asian Americans who only speak English may help prevent their increased risk for being overweight or obese.

The study authors suggest further research is needed to determine why retaining heritage culture helps prevent obesity and how the protective behaviors can be extended after each generation.

1. Wang S, Quan J, Kanaya AM, Fernandez A. Asian Americans and obesity in California: a protective effect of biculturalism. Journal of Immigrant and Minority Health, published online 13 Dec 2010. (open access)

Chance of dying early 20% higher in north than south England

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People living in the north of England are 20 percent more likely to die before age 75 years than those living in the south, according to a BMJ.com study spanning four decades. And this figure changed little between 1965-2008, the study said.

Researchers analyzed deaths and population data for all residents from the five northernmost and four southernmost English regions each year from 1965-2008. Results show that overall rates of premature death have been 14 percent higher in the north over the four decades. This inequality was larger for men (15 percent) than for women (13 percent).

This north-south divide decreased significantly but temporarily for both sexes from the early 1980s to the late 1990s, followed by a steep rise from 2000-2008, despite government initiatives to reduce health inequalities over this period.

Time trends also varied with age—most striking among the 20-34 age group, which saw a sharp rise (22 percent) in northern excess deaths from 1996-2008.

The large north-south divide has persisted despite the fact that overall mortality in England has greatly reduced since 1965—by about 50 percent for men and about 40 percent for women with north and south both experiencing similar reductions.

The north-south health divide in England is well documented and has posed a public health challenge—as well as a political and economic challenge—to successive governments. From 2003-2010, the UK government had performance targets for reducing geographical inequalities in health, but there has been little research of time trends in this divide.

More research is needed into: why policies to reduce such inequalities have failed; how the wider determinants of health may be unbalanced between north and south; and what role selective migration plays, according to the study.

1. Hacking JM, Muller S, Buchan IE. Trends in mortality from 1965 to 2008 across the English north-south divide: comparative observational study. BMJ 2011; 342: d508. (open access)

Risk of death increases for prisoners after release

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Risk of death for prisoners increases significantly after being released, according to a study of over 20,000 persons imprisoned in the state of Georgia. Six causes (HIV infection, cancer, cirrhosis, homicide, transportation and accidental poisoning) accounted for 62 percent of the excess mortality following release.

“Health care planning for prisoners should not ignore long-term health needs,” the study said.

Interventions such as treatment for hepatitis C could result in an appreciable number of years of life gained for persons who pass through a correctional institution.

1. Spaulding AC, Seals RM, McCallum VA, et al. Prisoner survival inside and outside of the institution: implications for health-care planning. American Journal of Epidemiology, published online 14 Jan 2011. (open access)

Smokers who drink heavily are at highest risk of death

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Smoking and drinking is unhealthy

Cigarette smoking and heavy alcohol drinking are both related to an increased risk of death. A study from Scotland found that smokers who drank 15 or more units of alcohol per week were at highest risk of death, particularly because these heaviest drinkers were more likely to smoke more than people who drank less.

Smoking had stronger effects than alcohol for most of the causes of early death investigated, including coronary heart disease, stroke and cancer. Blood pressure and body mass index (BMI) generally increased with alcohol consumption, but decreased with smoking, with those who had never smoked but who drank 15 or more units per week having the highest blood pressures and BMIs.

A person’s socioeconomic position and level of education were strongly related to both alcohol consumption and smoking. For example, 30 percent of men who worked in manual jobs were both smokers and heavy drinkers compared with only 13 percent of men in other jobs. “Given the increased mortality rates associated with both smoking and heavy drinking, this will inevitably contribute to socioeconomic health inequalities,” researchers said.

These findings reinforce the importance of continuing to prioritize smoking cessation. “Given the strong links between smoking and heavy drinking, it may also be helpful to devise policies aimed at reducing both smoking and alcohol consumption in population groups where this is common,” the study concluded.

1. Hart CL, Smith GD, Gruer L, Watt GCM. The combined effect of smoking tobacco and drinking alcohol on cause-specific mortality: a 30-year cohort study. BMC Public Health 2010; 10: 789. (open access)

Teen smoking and socioeconomic disparities in Ghana

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Teenagers of lower socioeconomic status are more likely to take up smoking than their more affluent counterparts, finds a study from Ghana.

Those teens in the study who are expected to end up in adulthood in a lower socioeconomic status than their families (downwardly mobile) are more likely to use tobacco than those teens who are stable in the high socioeconomic status.

Health promotion and tobacco control strategies aimed at reducing teen smoking should pay attention to adolescents of lower socioeconomic statuses and those in danger of dropping out of school, the study concludes.

1. Doku D, Koivusilta L, Raisamo S. Do socioeconomic differences in tobacco use exist also in developing countries? A study of Ghanaian adolescents. BMC Public Health 2010; 10: 758. (open access)

Social status impacts heart disease risk in Italy

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People with a lower level of education are at higher risk for cardiovascular disease, an Italian study has found. Significantly higher major cardiovascular risk factors were also detected in married or cohabitating women, with the exception of smoking. On the other hand, married men were less likely to be at risk for heart disease. Prevention interventions on cardiovascular risk should address these social factors, the study suggested.

1. Fornari C, Donfrancesco C, Riva MA, et al. Social status and cardiovascular disease: a Mediterranean case. Results from the Italian Progetto CUORE cohort study. BMC Public Health 2010; 10: 574. (open access)

Lack of health care among rural Appalachian residents

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People living in rural communities in Appalachian counties in Virginia are not receiving adequate health care, even among those with health insurance, a study has found. More than 30 percent of Appalachian residents rated their health status as poor/fair, compared to less than 18% of non-Appalachian residents.

The study researchers say that it may be that Appalachian residents wait longer to seek health care than do those from other counties due to a cultural tendency to be “self-reliant,” and perhaps “fatalistic,” which may result in cancer and other conditions being diagnosed and treated at later stages. Other barriers to adequately managing these conditions (economic hardships, co-occurring undiagnosed depression) and may also affect one’s perception of health.

Research has shown that communities in the Appalachian Mountain region of the United States have higher rates of unemployment and poverty and lower rates of high school and college graduation compared to other parts of the country. The majority of Appalachian residents are white, while five percent are black. They tend to have strong family support systems and are very religious, but strongly distrust outsiders and formalized medical systems.

1. McGarvey EL, Leon-Verdin M, Killos LF. Health disparities between Appalachian and non-Appalachian counties in Virginia USA. Journal of Community Health 2010, published online 23 Sep 2010. (open access)