Tuesday, June 09, 2009

Human Rights Treaties and Health

Following on from my previous post on idealism meets realism....when it comes to public health, the consequences of different courses of action, in terms of their impact on health and disease, are complex and often difficult to predict.

Things one might be inclined to think are very important to promoting health turn out to be, in the big picture of things, of little importance. And conversely, things that people might think are unimportant turn out to be extremely important.

So in the contemporary situation, just to pick some obvious examples, many people believe that a global effort to control the surface temperature of the planet would yield significant health benefits. The same goes for eliminating all cancers. Climate change and cancer are important issues. But most people vastly over-estimate what the benefits of the "climate ideal" (whatever one takes that to be) and "cancer-free life" would be. And this is to say nothing about the large empirical assumptions concerning how likely it is that either could actually be accomplished.

Conversely, many of the people who champion global action for tackling (human influences on) climate change and cancer will probably not support, indeed some might even oppose, the aspiration to decelerate human ageing. And yet I would conjecture that the latter would yield health and economic benefits that surpass both, combined. Why do I say this? (1) humans have been very successful in adapting to different climates. This is a good thing as the climate has never remained constant. And so adaptation could mitigate many of the worse case scenarios people envision with climate change. (2) cancer largely affects elderly people. Most tumours arise in the last quarter of life, with the incidence increasing exponentially with time (source). Removing cancer as a cause of death would only extend, by a few years, the healthy life of most people as aging populations would soon suffer one of the other afflictions of senescence- like heart disease or stroke. Whereas retarding aging would delay all the afflictions of senescence, yielding health and economic dividends far bigger than what we could hope to reap via eliminating any specific disease of aging.

If there is anything to learn from historical examples of important public health innovations, like the sanitation revolution, it is that we cannot rely on our intuitions in these cases. We should premise public policy on credible empirical evidence and data, not our "gut feelings" about what will do most good in the world.

Many see human rights treatises as an essential step towards creating more healthy polities. Do such treatises actually lead to better health and social outcomes? Well, this study in the latest issue of The Lancet asks this question and examined data for health and social indicators from 170 countries. Their conclusion: there is no consistent association between ratification of human-rights treaties and health or social outcomes. Here is the abstract:

Human-rights treaties indicate a country’s commitment to human rights. Here, we assess whether ratification of human-rights treaties is associated with improved health and social indicators. Data for health (including HIV prevalence, and maternal, infant, and child [<5 years] mortalities) and social indicators (child labour, human development index, sex gap, and corruption index), gathered from 170 countries, showed no consistent associations between ratification of human-rights treaties and health or social outcomes. Established market economy states had consistently improved health compared with less wealthy settings, but this was not associated with treaty ratification. The status of treaty ratification alone is not a good indicator of the realisation of the right to health. We suggest the need for stringent requirements for ratification of treaties, improved accountability mechanisms to monitor compliance of states with treaty obligations, and financial assistance to support the realisation of the right to health.

The paper concludes: "The fact that economic status was the greatest predictor of good health, but was not associated with likelihood of treaty ratification, emphasises the central role of financing in the realisation of the right to

This reinforces a point I think is often neglected- that it is important not just to "feel" we are doing good, but rather "to actually do good!". Figuring out what would actually do most good is an enormously complex challenge. What are the odds that the real challenges of today will be solved by measures that just happen to cohere with our "intuitions" about what would do great good (like ratifying human rights treaties)? I say they are slim to none. And the sooner we realize this the better.