Health and human rights: a USC distinguished professor helps formulate international recommendations

The International AIDS Society Lancet Commission on Health and Human Rights, formed in 2021, brought together 23 commissioners from around the globe with a wide variety of expertise. The commissioners, including Sofia Gruskin, JD, MIA, distinguished professor of population and public health sciences and law, and director of the USC Institute on Inequalities in Global Health, met monthly for several years. Gruskin gives high praise and credit to the co-chairs and her fellow commissioners, noting their aim as a group was to collectively identify areas where they could make a difference regarding health and human rights, and to develop global recommendations around those areas. With the Universal Declaration of Human Rights as a guiding beacon, the Commission developed recommendations in eight domains that could be addressed globally in proactive ways to make a tangible difference.

Gruskin discussed the recommendations and their relationship to the Universal Declaration of Human Rights in a recent video (quotes have been edited for length and clarity).

Understanding Human Rights

“The Universal Declaration of Human Rights, which has been in existence since 1948, is the global basis for a common understanding across countries of what are human rights. The idea is to set an inspiring vision of a world that is just, equitable and tolerant, and that can give insights and support the rights and health of the most vulnerable and marginalized populations, and it should be a counterpoint to the atrocities, the repression, the horrible things that we are seeing these days.

For the past 30 years or so, health and human rights have come together in incredibly important ways, leading to so many important discoveries and change – the global expansion of access to HIV treatment; broad expanses in ensuring the sexual and reproductive health and rights of lesbian, gay, transgender and intersex individuals across the world; in minimizing the harms of war on civilian populations, and caring for populations affected by war; and most recently in the global push to achieve universal health coverage. But I think as we all know, recent times have shown significant push back against human rights, and against what it takes for there to really be healthy societies, with increasing impacts on the health and well-being of people everywhere in the world.”

Domain 1: Pandemics
“The idea that the World Health Organization’s member states should endorse a Pandemic Accord that is grounded in human rights principles – something that now as we do this seems farther away than it did even just a few weeks ago – is something that we have to work towards. An Accord that exists without attention to human rights isn’t going to work, it’s not going to make any difference. We also need investments, we need to be sure that everyone, no matter where they live, will have equal access to whatever diagnostics, vaccines, and treatment exists – that it’s not based on where we live, but that we recognize international solidarity about how people can access this. [In addition], the law was really misused in the context of the pandemic in all of our countries, and so we really need to ensure that criminal law is not misused again, and that it isn’t used to regulate behaviors through legal interventions – like what happened during COVID – in ways that are discriminatory and marginalize people unnecessarily.”

Domain 2: Climate Change
“The commission recommends that countries build momentum from COP27 to provide massive, sustainable financing to enable truly effective climate change mitigation and adaptation, and that all public subsidies that deal with climate should be diverted to support a just transition away from the use of fossil fuels. In particular, [the commission recommends] action is needed to remedy the adverse effects of climate change on marginalized communities, and very, very specifically that climate migrants should be afforded refugee status under international and national law, something that’s just beginning.”

Domain 3: Displacement, Migration, Refugees, and Conflict
“In 2020 when we started our work, there were already an estimated 281 million international migrants, and the number of people migrating because of conflict in all parts of the world keeps increasing. That obviously has huge impacts on their health and well-being, let alone on their accessing needed health services – and who is it that’s supposed to provide those services? So we recommended that the United Nations and its member states strengthen the visibility and consistency of its leadership on both health and rights obligations in the context of war and conflict. That means ensuring accountability by states when violations occur. Now, for those of us more on the health side, we have to be much more active in not just delivering services, but highlighting the health consequences of failing to protect the rights of people who are subjected to war and conflict.”

Domain 4: Structural Racism, Inequity and Discrimination
“I’d like to point out not only the rights aspects, but the health impacts of structural racism and discrimination – and I don’t mean this only in terms of the United States, but in all parts of the world. This is really something we must all collectively address. So, one thing we had agreement on is that countries that have been colonizers, or engaged in other forms of economic abuse, need to provide fiscal, technical, and other kinds of necessary support so that reparations can exist and that they can be meaningful. Those reparations, whether they’re for historical or ongoing harms to the communities that have been harmed, need to be addressed, and for that to happen, we really need global and regional political bodies to proactively explore new mechanisms for translating international commitments on anti-discrimination into meaningful obligations that actually, truly address structural racism. We all need to be much better at addressing interacting forms of discrimination – how discrimination on the basis of racism intersects with discrimination, for example, or on the basis of sex, or gender, or gender identity just as a few examples – and how these compound on one another and ultimately impact people’s health and well-being most seriously. Therefore the health community has to explicitly work to address racism and discrimination and all that it does, from public health interventions to the delivery of clinical care.”

Domain 5: Sexual and Reproductive Health and Rights
“When you think about the regression in the last year or so in the United States around access to abortion or gender affirming care, that obviously tells the story, but these regressions are really happening everywhere, and they really signal a move towards authoritarianism. Historically, we know interfering with bodily autonomy is part of anti-democratic agendas, so they’re of concern in their own right, but also for what they signal to where the world is going if we’re not careful moving forward. Here we explicitly wanted to call out that countries have to take immediate action to decrease enforcement of punitive laws and work towards decriminalization and removal of other burdens – whether they relate to contraception, to abortion, to sex work, to sexual orientations, to gender identities. Basically put into place enabling legal environments so that people can flourish.”

Domain 6: Misinformation, Disinformation and the Right to Accurate Scientific Knowledge
“We all saw during COVID the spread of health disinformation and misinformation on social media and beyond, and this is absolutely continuing, right? But we saw this alongside the empowerment of security services who could track and harass already persecuted population – and do it in the name of ‘public health’ – and the mobilization, and the hatred that was put out there for purposes of violence and social exclusion. The commission called for the global community – international donors, multilateral bodies, national governments, private sector actors – in high-, low- and middle-income countries, to collaborate much more closely to close the global digital divide and to establish mechanisms to monitor emerging technologies. We’ve got to counter technologies that facilitate disinformation through public education campaigns, and here the health community has a strong role to play in putting forward scientifically accurate information and combating disinformation.”

Domain 7: Artificial Intelligence
“Artificial intelligence is advancing so quickly that regulatory measures just cannot keep up. It has the potential to bring major benefits to humanity, but it also poses major threats. An essential first step, we believe, is to set out the implications of AI for health and for human rights – something that hasn’t yet fully been done. So our recommendations are first that this be studied and that governments ensure that existing privacy legislation, regulation, and monitoring keeps pace with the advances in artificial intelligence, which just keeps moving so fast. For this to be really effective, these measures have to be underpinned by a strong human rights framework. We need governments to work together with universities like USC, and civil society organizations, to raise awareness of the scope and nature of the different ways that AI is being used, with a focus both on how AI is helpful and harmful – not either, not one or the other, but both – and therefore the implications of that for health and rights.”

Domain 8: Economic and Commercial Determinants of Health
“We decided that we had to look at this because the highest attainable standard of health, something we all move towards, is strongly influenced by private multinational corporations. They often operate free of meaningful regulatory oversight and that impacts access and use on so many products that are harmful to human health. Our recommendations are for countries to strengthen their regulatory oversight of commercial interests and develop and enforce legal and policy frameworks. At the same time, they need to implement taxes and other restrictions on tobacco, unhealthy beverages, and other health harming products. They also need to focus on the corporations themselves and to prevent the export of harmful products or commercial practices. At the global, regional, and national levels, as a commission, we called for the reduction of socioeconomic inequalities to be a primary focus of economic and social policy.”

In addition to her work with the Commission, Gruskin and the faculty and staff at USC Institute on Inequalities in Global Health are tackling myriad topics surrounding health and human rights. Focus areas of the Institute include sexuality, gender and rights; sustainability, power, poverty and mobility; urban health in the 21st century; and communication, technology and innovation. The work of the Institute is intrinsically intertwined with the domains identified by the Commission.

Co-chairs for the AIDS Society-Lancet Commission on Health and Human Rights are Chris Beyrer, MD and Adeeba Kamarulzaman, FRACP. Commissioners as listed by The Lancet are Chris Beyrer, Adeeba Kamarulzaman, Michael Isbell, Joseph Amon, Stefan Baral, Mary T Bassett, Javier Cepeda, Harriet Deacon, Lorraine Dean, Lilianne Fan, Rita Giacaman, Carolyn Gomes, Sofia Gruskin, Ravi Goyal, Sandra Hsu Hnin Mon, Samer Jabbour, Michel Kazatchkine, Kasoka Kasoka, Carrie Lyons, Allan Maleche, Natasha Martin, Martin McKee, Vera Paiva, Lucy Platt, Dainius Puras, Robert Schooley, Gerson Smoger, Lucy Stackpool-Moore, Peter Vickerman, Josephine G Walker, Leonard Rubenstein.

Learn more and read the full report from the AIDS Society-Lancet Commission on Health and Human Rights.

Learn more about the USC Institute on Inequalities in Global Health.