Health is a Fundamental Human Right

(Written in the light of International Human Rights Day )

To have the highest attainable standard of physical and mental health is an intrinsic human right as recognized in major human rights instruments. Article 25 of the Universal Declaration of Human Rights, 1948 states that everyone has the right to a standard of living adequate for the health, and wellbeing of himself and his family. The preamble to the World Health Organization's (WHO) constitution also declares that it is one of the fundamental rights of every human being to enjoy the highest attainable standard of health.

Nepal formally emphasized health as a fundamental right only after the success of the pro-democracy movement of 2006 by issuing 10 point policy guidelines. Later Interim Constitution of 2007 enshrined for the first time, two health-related  fundamental rights of Nepali citizens stating that ‘every citizen shall have the right to receive basic health care services free of charge from the state as provided for in law’ (article 16.2) and ‘every women shall have the right to reproductive health and reproduction related rights’ (article 20.2). Although these instruments ensured “health for all” as a fundamental human right, the system’s definition of health and its segregation of even basic requirements of care have led to the flawed understanding of this right. Further, Nepalese health care delivery system is embarrassed by copious factors affecting the implementation of the free health services policy rolled out since December 2006, which is a key initiative towards securing the health rights of the citizens.

As one of the developing countries in the world, Nepal has a gross national income of US$440 per person and a population of more than 29 million. The quality of life and the health indictors are extremely unsatisfactory in this part of the world. Life expectancy at birth is 66 years. Though significant advances have been made in the improvements of maternal and infant morbidities and mortalities, they are yet to perk up. The maternal mortality ratio is 280 per 100000 live births and the infant mortality rate is 39 per 1000 live births. Poverty implications are widespread leaving many without even basic rights such as access to clean water, sanitation and medical care. Moreover, discrepancies in the availability, access and affordability of basic health care services has contributed to the extensive disparity in the health care indicators. The imbalances and mal-distribution in the various categories of human resources of health stands as major drawback to health service delivery. To secure health for the people in Nepal as a basic human right is therefore a challenging issue to confront.

Furthermore, abuses against women and girls are extremely common in Nepal. Limited access to adequate health care and nutrition, gendered norms and values which frontier women's ability to assess health care they need, forced trading of girls into prostitution and repression of freedom to decide self for the utilization of safe abortion services  has evidently been violating women’s rights to health care till the date. While there are continuing ample reported cases of infringement of the rights of children on one hand, the health rights of the elderly are still on shade on the other. The rights of the people suffering from mental health issues haven’t still gained a national concern and the health indicators yet do not reveal the improvements in the status of the under-privileged and disadvantaged populations. So it would be absolutely meaningless to argue that the citizen’s rights to health have been fulfilled based on exposition of few documented instruments that entitles health as the fundamental human right.

No doubt, Nepal is an area with stark contrasts in access to health care. Underdeveloped roads and fragile communication links, with remote mountainous terrain, poor infrastructure and lack of sufficient and competent health care personnel, particularly in the western Nepal has been limiting people access to health care. Therefore to dream for the fulfillment of the human rights to health care without significant changes in the current state of health service delivery patterns, technical capacity, medical infrastructures and staff expertise as per the health care demand of the country, would rather be vague and absurd.

Health is a privilege, and in developing countries like ours where particular determinants have constrained the delight of safe and stimulating health care, all the national and international instruments would be of no worth unless these commitments are achieved in realism. The state, humanitarian organizations, I/NGOs, voluntary organizations, professionals and even the general public have the key action to take upon. There is an undeniable fact that the right to the highest attainable standard of health for all cannot be realized overnight. Nevertheless the right to health imposes some obligations of immediate effect, such as non-discrimination, and the necessity that the state at least prepares a national plan for securing the health care rights of the citizen. It furthermore demands the active and informed partaking of individuals and communities in the health decision-making that affects them. The state ought to realize that right to health is something more than a slogan. The right must help to guarantee that health policies assign particular consideration to the vulnerable and marginalized, augment community involvement, and ensure that health interventions strengthen public health systems, and so on.

Collaboration Between Veterinary and Public Health

Zoonoses

Zoonoses are defined as those diseases and infections that are naturally transmitted between vertebrate animals and man, especially those diseases with reservoirs in animals.

  

Collaboration Between Veterinary Services & Public Health

Collaboration between veterinary & public health is defined as “the application of professional veterinary skills, knowledge, and resources to the protection and improvement of human health".

Areas of Collaboration

1.      Control of zoonoses

• It is the rural population that is most affected by many of the zoonoses, so the   collaboration should take a special interest in rural health and offering advice to farmers.
• Another group of hazards are the bites of animals. Thus, collaboration should be made in disaster medicine, especially in relation to animals.

 2.      Food hygiene

• The collaboration of the veterinarian & public health workers nowadays extends to supervision of slaughterhouse hygiene, ante mortem inspection of livestock, and the supervision of the hygienic aspects of the handling and storage of meat.
• The collaboration is also essential in drafting food legislation (of animal origin) and in the establishment of standards for the composition of foods and the maximum levels of biological and non-biological contaminants.

3.      Environmental medicine

• Inter-sectoral collaboration is needed in providing assistance in the detection and prevention of environmental pollution (associated with disposal of animal wastes).

4.      Joint human and animal vaccination

• Effective control of zoonosis may require collaborative joint effort from the medical & veterinary sectors in immunization programmes. For instance, zoonoses causing severe diseases in humans (rabies, anthrax), require prevention in animals using vaccination.

5.      Biomedical Research

• New opportunities for collaboration can be achieved by jointly co-ordinated bio-medical research on anatomical, physiological, pharmacological, microbiological, epidemiological (host-agent interaction) & patho-physiological processes across species including humans.
• The research on emergence of drug resistance in microorganisms living in contact with humans and animals and the risk of resistance transfer from non-pathogenic to pathogenic organisms is another important issue requiring inter-sectoral collaboration.

6.      Education

• The collaboration is essential to play a prominent part in the education of the public and special groups, e.g., farmers, animal owners, etc. on all health matters in which animals are concerned.

7.      Laboratory animal production

• Collaboration can be done in public health laboratories for ensuring a supply of healthy, standardized laboratory animals and also in using appropriate animals for particular experiments, handling, anaesthetizing, and surgery of animals.

Duties of Public Health in Veterinary Services  

(http://www.vet.utk.edu/vph/examples.shtml)

• Educate the public and other professionals about zoonotic diseases
• Serve as experts in controlling the spread of diseases such as avian influenza, brucellosis and other diseases for animals and people.
• Work in laboratories to ensure medicines are safe for human and animal use
• Insure that meat, dairy and poultry products safe for people to eat
• Train health professionals as well as agricultural and food industry workers on agro/bio terrorism prevention and training
• Implement Rabies prevention program
• Demonstrate sustainable development
• Research and appreciation of Human Animal Bond

Global Threats to Public Health In The Future

The world has been encountering the numerous public health challenges for ages. Majority of these challenges still persists to the date & further, new series of serious public health problems have been threatening the global community. The public health problem that evolved with the birth of infectious diseases during the primitive ages has now become more pronounced. On one hand, the effects of communicable diseases have diversified & become more profound, while on the other hand, chronic illnesses & ecological disasters are on the rise. With globalization, the risks to public health have been changing in the recent decades. Hence, it has become necessary to peep into the future to imagine a world that is overrun by large no. of public health problems or perpetual war.

The public health problems in the future depend upon the numerous factors, every one of which is unpredictable. Hence, no one can accurately predict what health problems are likely to occur in 10 years from now. However, if we assume that the current trends remain to continue in the future, we may not have difficulty to project what mega-challenges in public health the world will be facing.

With the mankind’s industrialization ethos & changing patterns of population, environment & diseases, the globe will be suffering from numerous public health problems in the future. Greenhouse effect & global warming will be one of the major issue threatening human health & survival. This in turn, is expected to increase the threats of extreme weather changes such as glacial melting, shore-line flooding, widespread droughts & drastic climate shifts. Further, in the next decade, the misery effects due to air, water & soil pollution are likely to be seen, followed by ozone depletion in the upper atmosphere. Hence, ecological disasters, as never seen before are likely, as the cumulative effects of population increase, resource depletion & environmental degradation becomes a global issue.

In the recent years, the risks to public health have changed. Although the HIV/AIDS, TB & Influenza like infections still persists & are on the rise in the form of pandemics, there is an undeniable fact that that the leading causes of mortality and morbidity is slowly perpetuating from infectious diseases to chronic one. The rising incidence of long-term chronic conditions exacerbated by lifestyle choices together with demographic changes in the population (including ageing) will lead to the epidemics of asthma, obesity, cancer, DM & heart diseases. The threats of communicable diseases as well as vector borne diseases will still not disappear within 10 years time. Further, the old foes like syphilis, water-borne outbreaks, West-Nile are likely to re-emerge. It is also projected that the possibilities of previous pandemics like SARS, Swine flu & Bird flu are still inevitable in the near future.

          

  Adolescent health problems will be another serious public health issue. The menace of smoking will not disappear. Moreover, the adolescent health problems will intensify with increased rates of drug taking, eating disorders, risky sexual behaviour and teenage pregnancy. This is expected to cause an unprecedented rise of STIs & HIV/AIDS as well as other physical & psychological problems. On the other hand, mental health problems will be a serious issue among the adults. Further, the public health may be compromised by bio-terrorism.

Another major issue affecting the public health will be famine aggravated by food insecurity. Food production supplies will not be able to keep pace with the increasing population demand especially in Asia, Africa & Latin America without new solutions to production & distribution.

           

Whatever the issues may be, in the lack of proper responses to these expected threats, the global community is sure to suffer wickedly. The direction of the future course of these health threats may be reversed by addressing such challenges through global commitment. What we only require is initiatives from the global community through multi-sectoral approach.