Harvard Law School, USA.
Health Hum Rights. 2009;11(2):1-18.
The foundational princple of human rights is that all human beings are equal in rights, dignity, and worth. Yet we live in a world ravaged by social inequalities both within and between countries, which have profound implications for the distribution of population health as well as the unequal enjoyment of economic and social rights and of human rights generally. It is far from clear that we have a consensus in the human rights community about which inequalities in health constitute inequities or how egalitarian a society must be to conform to the requirements of a social order in which all human rights can be realized. Further, the conversations in the world of human rights have largely been divorced from those in the worlds of development and public health. In this article, I attempt to bring those two conversations together. I first set out how concepts of formal and substantive equality and non-discrimination are defined under international law and might be applied in practice to questions we face in public health today. I argue that the application of these concepts is far from formulaic; interpretations of equality and non-discrimination necessarily reflect deeply held understandings about justice, power, and how we are the same and different from one another. I then explore how far a human rights framework can guide us in terms of some of these underlying questions in health and development polity, particularly in relation to how much priority should be given to the worst off in society, what kind of equality we should be seeking from a human rights perspective, and how we should evaluate who is worst off in terms of health. In conclusion, I argue that the great power of applying a human rights framework to health lies in denaturalizing the inequalities that pervade our societies and our world and in establishing that all people--by virtue of being human--have both a claim for redress when they are treated unfairly and a right to participate in determining what equity and equality require in a given context.
人权的基本原则是，所有人在权利、尊严和价值方面都是平等的。然而，我们生活在一个充斥着国家内部和国家之间社会不平等的世界中，这对人口健康的分布以及经济、社会权利和普遍人权的不平等享有产生了深远的影响。在人权界，我们远未就哪些健康不平等构成不公平以及一个社会必须达到何种平等程度才能符合所有人权都能实现的社会秩序的要求达成共识。此外，人权界的对话在很大程度上与发展和公共卫生界的对话脱节。在本文中，我试图将这两个对话结合起来。我首先阐述了国际法下形式和平等实质和平等以及非歧视的概念是如何定义的，以及这些概念在实践中可能应用于我们今天在公共卫生领域面临的问题。我认为，这些概念的应用远非一成不变的；平等和非歧视的解释必然反映了对正义、权力以及我们彼此之间的相同和不同之处的深刻理解。然后，我探讨了在健康和发展政治方面，人权框架在多大程度上可以为我们提供一些基本问题的指导，特别是在社会中最弱势群体应给予多大程度的优先考虑、我们应该从人权角度追求什么样的平等以及我们应该如何根据健康状况来评估谁是最弱势群体等问题。最后，我认为，将人权框架应用于健康领域的巨大力量在于使我们社会和世界中普遍存在的不平等现象非自然化，并确立所有人——仅仅因为他们是人类——在受到不公正待遇时都有权要求纠正，并有权利参与确定在特定背景下公平和平等需要什么。
