{"id":12052,"date":"2018-11-21T16:15:07","date_gmt":"2018-11-21T16:15:07","guid":{"rendered":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/11\/GA-2018-PlS-Presentation-Puras-Oct2018.pdf"},"modified":"2018-11-21T16:15:07","modified_gmt":"2018-11-21T16:15:07","slug":"ga-2018-pls-presentation-puras-oct2018-2","status":"inherit","type":"attachment","link":"https:\/\/www.wma.net\/es\/ga-2018-pls-presentation-puras-oct2018-2\/","title":{"rendered":"GA 2018-PlS Presentation Puras-Oct2018"},"author":5,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"acf":[],"description":{"rendered":"

GA 2018-PlS Presentation Puras-Oct2018<\/a><\/p>\n

1
\nTowards full realization of the right to health:
\nchallenges and opportunities
\nDainius P\u016bras
\nUN Special rapporteur on the right to health
\nWMA General Assembly
\nReykjavik, October 6, 2018
\nRIGHT TO HEALTH MANDATE
\n\u2022 Mandate established in 2002. Paul Hunt (2002-2008), Anand Grover
\n(2008-2014)
\n\u2022 This mandate is a part of UN Special Procedures mechanism
\n\u2022 Objectives:
\n\u2013 Promote and clarify right to health and rights-based approach to health
\n\u2013 Identify good practices, inform about challenges and obstacles, provide
\nrecommendations
\n\u2022 Not right to be healthy, but right to the enjoyment of the highest attainable
\nstandard of physical and mental health
\n\u2022 Not just right to medical care, but also right to determinants of health
\n\u2022 Working methods: country missions, thematic reports to UN GA and
\nHRC, communications, non-mandated activities
\n\u2022 http:\/\/www.ohchr.org\/EN\/Issues\/Health\/Pages\/SRRightHealthIndex.aspx
\n2
\nThe right to health normative
\nframework
\n\u2022 Freedoms and entitlements
\n\u2022 Progressive realization \/ immediate effect
\n\u2022 Participation
\n\u2022 Non-discrimination
\n\u2022 Healthcare (AAAQ)
\n\u2022 Social determinants
\n\u2022 Obligations: respect, protect and fulfil
\n\u2022 Accountability
\n\u2022 International cooperation
\n\u201cThe human rights framework provides a
\nmore useful approach for analyzing and
\nresponding to modern public health
\nchallenges than any framework thus far
\navailable within the biomedical tradition.\u201d
\nJonathan Mann
\nHealth and human rights, HIV\/AIDS physician & advocate
\n3
\nTHEMES (2002-2014)
\n\u2022 Indicators and benchmarks
\n\u2022 Health systems
\n\u2022 Health and human rights movement
\n\u2022 Access to essential medicines
\n\u2022 Sexual and reproductive rights
\n\u2022 Vulnerable groups \u2013 HIV\/AIDS, LGBT, disability,
\nsubstance use, elderly, migrants
\n\u2022 Underlying determinants
\nWAY FORWARD (2014 – 2020 ):
\nCHALLENGES AND OPPORTUNITIES
\n\u2022 Address existing imbalances and power asymmetries within and
\nbeyond healthcare systems
\n\u2022 Transition from Millennium Development Goals (MDGs) to
\nSustainable Development Goals SDGs). Agenda 2030. Universal
\nhealth coverage. Report to UN GA (2016)
\n\u2022 Life Cycle Approach \u2013 importance of investing in health of children
\nand adolescents. Reports to UN HRC and GA (2015).The need to
\nmove beyond sheer survival. Investing in services and interventions
\nthat promote the right to healthy emotional and social development is
\nnot a luxury. Importance of early childhood and adolescence.
\n\u2022 Mental health and emotional well-being for all in all ages
\n4
\nWAY FORWARD (2014 – 2020 ):
\nCHALLENGES AND OPPORTUNITIES
\n\u2022 Report on corruption in health sector and right to health (2017
\n\u2013 GA). Making healthcare policies and systems transparent
\nand accountable, to ensure equitable healthcare. \u201cChoosing
\nwisely\u201d initiative – preventing excessive use of medical
\ninterventions.
\n\u2022 Report on deprivation of liberty (detention) and right to health
\n(2018 \u2013 HRC)
\n\u2022 Report on people on the move (refugees, asylums seekers)
\nand right to (mental) health (2018 \u2013 GA)
\n\u2022 Next reports \u2013 on social determinants of mental health, on
\nrole of investing in health workforce and role of academic
\nmedicine and medical education
\nIssues of importance to medical
\ndoctors and their organizations
\n\u2022 Dual loyalty
\n\u2022 Importance of human rights based approach (HRBA)
\n\u2022 Migration of doctors
\n\u2022 Criminalization of impartial healthcare
\n\u2022 Primary care vs specialized medicine
\n\u2022 Initiative to prevent excessive use of diagnostic and
\ncurative interventions (e.g., \u201cchoosing wisely\u201d)
\n\u2022 Palliative care
\n\u2022 Special issues: solitary confinement, forced feeding
\n5
\nMental health as a new priority
\n\u2022 The need to invest more – but how?
\n\u2022 Main principles of the CRPD
\n\u2022 Psychiatry and human rights \u2013 issues of coercion and
\noveruse of biomedical interventions
\n\u2022 Importance of psychosocial interventions
\n\u2022 Different understanding of human rights and dignity
\n\u2022 Social determinants of mental health
\n\u2022 What about psychiatry and medicine as a social
\nscience? (R.Virchow)
\nMental health promotion
\n\u2022 Social and environmental determinants of mental health (including
\npsychosocial\/emotional environment)
\n\u2022 All forms of inequalities and violence have negative impact to mental
\nhealth
\n\u2022 States need to invest in enabling non-discriminatory and non-violent
\nenvironments in all settings (family, school, workplace, community,
\nhealthcare services, society at large)
\n\u2022 Full implementation of a human rights based approach is an obligatory
\npre-condition of effectively investing in mental health (including
\npromotion, prevention, treatment, rehabilitation, recovery)
\n\u2022 Crucial role of civil society, including organizations of users and ex-users
\nof mental health services
\n6
\nConvention on the right of persons with
\ndisabilities (CRPD)
\n\u2022 Dignity and autonomy
\n\u2022 Equality and non-discrimination
\n\u2022 Effective participation and inclusion
\n\u2022 Respect for difference and acceptance of persons with
\ndisabilities as part of human diversity and humanity
\n\u2022 Equality of opportunity
\n\u2022 Social vs medical model: obstacles are outside, they
\nneed to be removed through empowerment, inclusion,
\nparticipation and non-discrimination
\nA need for meaningful debate: dignity, substitute
\ndecision making, deprivation of liberty and involuntary
\ntreatment
\nPrevailing view among psychiatric
\nprofession and policy makers:
\nPsychiatrists as experts decide when they
\nshould step in with using non-consensual
\nmeasures (coercion) for the purposes of
\nmedical necessity or prevention of
\ndangerousness. This is their duty, even if
\nagainst will, and thus to secure right to
\nhealth. Psychiatry is a specific field, in
\nwhich such exceptions are unavoidable.
\nOnly through providing treatment it can
\nbe ensured that persons with
\npsychosocial disabilities continue living
\nin dignity.
\nSpecial cases of emergencies are
\nemphasized
\nPrevailing view among human rights
\nadvocates and UN mechanisms:
\nSubstituted decision making, deprivation
\nof liberty and forced treatment, based on
\nthe CRPD, should be banned. Alternative
\napproaches should be developed and
\nreplicated. There should be no
\nexceptions, as exceptions, allowed by the
\nlaw, use to turn into the rule and pave the
\nway to the global situation when mental
\nhealthcare services continue to be an
\nunacceptable space for systemic human
\nrights violations.
\nDignity cannot be compatible with
\npractices of forced placement and
\ntreatment which may amount to ill-
\ntreatment and torture.
\n7
\nActions to be prioritized on the way to moving
\ntowards elimination of non-consensual measures
\n\u2022 (a) Mainstream alternatives to coercion in policy with a view
\nto legal reform;
\n\u2022 (b) Develop a well-stocked basket of non-coercive alternatives
\nin practice;
\n\u2022 (c) Develop a road map to radically reduce coercive medical
\npractices, with a view to their elimination, with the
\nparticipation of diverse stakeholders, including rights holders;
\n\u2022 (d) Establish an exchange of good practices between and
\nwithin countries;
\n\u2022 (e) Scale up research investment and quantitative and
\nqualitative data collection to monitor progress towards these
\ngoals.
\nIssues for serious debate and search of
\nrights-compliant solutions
\n\u2022 If there is no hierarchy of rights, and if a right to receive effective treatment and a
\nright to be free from violence and ill-treatment are equally important, how then to
\nproceed in situation of psychiatric emergencies?
\n\u2022 Changes in normative framework in post \u2013 CRPD era. No need for mental health
\nlaws?
\n\u2022 Is the argument of applying too often non-consensual measures because of
\n\u201cdangerousness\u201d strong enough?
\n\u2022 Is the argument of applying too often non-consensual measures because of \u201cmedical
\nnecessity\u201d strong enough?
\n\u2022 Supported vs. substitute decision making
\n\u2022 Mental health disorders, conditions or diversities?
\n\u2022 What could be a new role and mission of psychiatry in the new paradigm of right-
\ncompliant mental health services?
\n\u2022 WHO Comprehensive mental health plan 2013-2020
\n\u2022 WHO Quality rights initiative
\n8
\nConclusion
\n\u2022 Human rights based approach (HRBA) is effective
\nway for realization of the right to health
\n\u2022 Social, economic, cultural, civil and political rights
\nare equally important for realization of the right to
\nhealth
\n\u2022 Universal declaration of human rights (1948) – 70
\nyears
\n\u2022 In the \u201cpost-truth\u201d era it is of vital importance to
\nstrengthen HRBA and public health approach based
\non evidence<\/p>\n"},"caption":{"rendered":"

GA 2018-PlS Presentation Puras-Oct2018 1 Towards full realization of the right to health: challenges and opportunities Dainius P\u016bras UN Special rapporteur on the right to health WMA General Assembly Reykjavik, October 6, 2018 RIGHT TO HEALTH MANDATE \u2022 Mandate established in 2002. Paul Hunt (2002-2008), Anand Grover (2008-2014) \u2022 This mandate is a part of […]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{},"post":null,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/11\/GA-2018-PlS-Presentation-Puras-Oct2018.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media\/12052"}],"collection":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/comments?post=12052"}]}}