I. INITIATIVES BY PAHO/WHO FOR THE PROMOTION AND PROTECTION OF THE RIGHT TO THE ENJOYMENT OF THE HIGHEST ATTAINABLE STANDARD OF HEALTH AND OTHER RELATED HUMAN RIGHTS
PAHO, as WHO’s regional office and the OAS organ specializing in health, plays a fundamental role in ensuring the practical implementation, in its member states, of the right to the enjoyment of the highest attainable standard of health[1]/ (hereinafter referred to as the right to health) and other public health-related human rights, above all through concrete actions of technical collaboration. PAHO/WHO activities with regard to the right to workers’ health are included in the regional initiative on public health and human rights that is being conducted in coordination with WHO and which involves different areas of the Organization. This initiative is helping the member states of PAHO/WHO to promote and protect the right to health and other basic rights in the context of mental health, persons with disabilities, the HIV/AIDS virus, elderly persons, indigenous peoples, the creation of smoke-free places, and diseases that are neglected in the context of the most vulnerable groups.
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As part of the above-mentioned initiative, in 2000 PAHO/WHO started up various joint activities to promote and protect the human rights and fundamental liberties of the above-mentioned persons, including training workshops, collaboration with regional and international human rights organizations such as IACHR, technical support for the formulation/reform of national legislation and the launching of regional campaigns (“Mental Health and Human Rights: A New Approach”).
A. Training workshops: a dynamic and effective mechanism
PAHO considers that effective protection of the right to health and other human rights of vulnerable groups such as persons with disabilities, elderly persons, persons with HIV/AIDS, indigenous peoples, etc., must start with education and training among government authorities, human rights ombudsmen, public health professionals, attorneys, law students, users, their families, national and international NGOs and other persons and institutions involved in protecting and promoting health and in setting up public health services.[2]/
To achieve dissemination and training in human rights, PAHO, with the collaboration of WHO and other international organizations such as OAS, is organizing training workshops on human rights in the context of mental health, disabilities, indigenous peoples, and elderly persons, among others. These workshops are one of PAHO’s strategies not only to promote and protect the human rights of the above-mentioned persons, but also to collaborate technically with the States in drafting/reforming their public health policies, plans, and legislation and, in coordination with national networks, to promote and protect health and other human rights of the most vulnerable groups.
To date, PAHO has organized 14 training workshops on human rights and fundamental liberties in the context of the above-mentioned groups. The workshops have been held in Nicaragua, Costa Rica, Paraguay, Brazil, Argentina, Chile, Ecuador, Dominican Republic, Peru, Argentina, Honduras, El Salvador, Panama, Guatemala, Barbados, Grenada, and Antigua and Barbuda. The participants almost always represent various sectors of government, civil society, private organizations and international agencies such as IACHR (OAS), human rights ombudsmen’s offices, public hospital, ministries of education, ministries of labor, national disability councils, police departments, attorneys, law students, congressmen, judges, organizations of users and their families, nursing associations, associations of public health professionals, journalists, and artists, among others.
Regarding the monitoring of human rights and living conditions in public health institutions, it is important to mention that, in some of the above-mentioned States, the human rights ombudsmen’s offices have begun to implement mechanisms for filing complaints and monitoring human rights by visits to psychiatric hospitals, asylums and others. In Chile, Honduras, Panama, Belize, Nicaragua, Paraguay, and Guatemala, PAHO has also held training workshops on human rights exclusively for staff working in national psychiatric facilities.
It is important to mention that PAHO is currently member of the ad hoc committee that is discussing and drafting a comprehensive international convention on the protection of the rights and dignity of persons with disabilities. This Committee is headquartered in the United Nations in New York and is comprised of the member states of the UN, specialized agencies and organizations of persons with disabilities, among others.
B. Collaboration of PAHO with regional human rights organizations
In February 2001, the IACHR invited PAHO to a general hearing for the purpose of discussing the situation of persons with mental disabilities in the hemisphere in the framework of its 110th regular meeting. PAHO recommended that the Commission take specific measures to protect the human rights and fundamental liberties of these persons and suggested that the Commission collaborate closely with PAHO to promote general regulations and international standards of human rights to protect persons with mental disabilities.
As part of the collaboration between PAHO and IACHR, the latter includes visits to public health institutions of the region as part of its onsite visits. For example, in June 2001, the IACHR visited the National Psychiatric Hospital of Panama; this was the first time that the Commission had visited a psychiatric facility, and this established a major precedent in the field of human rights and public health. Furthermore, IACHR has requested technical opinions from PAHO, mainly to interpret the American Convention and the American Declaration on the Rights and Duties of Man in the light of the international protection standards applicable in public health.
In 2003, the IACHR requested PAHO a technical opinion regarding the application of international human rights standards to aspects such as the consent to receive medical treatment and physical confinement in psychiatric institutions. This opinion has been incorporated into the final reports of IACHR on individual cases in which the victims are persons with mental disabilities and could also be used by IACHR as part of the special reports that this organism approves regarding the human rights situation in OAS member states. Informal technical opinions have also been provided by PAHO to interpret the standards of the American Convention in the light of the international standards followed by PAHO in the area of persons who have HIV/AIDS and their right to receive the respective medication.
Without a doubt, this collaboration between an agency specializing in public health and a regional human rights body such as IACHR establishes a highly important precedent in international law on human rights and public health that is already yielding some results, especially with regard to the reform of mental health services and national policies and legislation, above all in areas such as physical, mental, and sensory disabilities, ageing and HIV/AIDS, among others. As indicated, IACHR has started using the “precautionary measure” mechanism successfully also in the context of psychiatric hospitals and persons with HIV/AIDS, which means that when the life, personal integrity or other rights of persons committed to psychiatric hospitals or carrying said virus are in danger, state practices—especially regarding conditions of custody in hospitals—could be revised by this body precisely to safeguard these basic rights.[3]/
II. SPECIFIC ACTIVITIES TO PROMOTE AND PROTECT THE ENJOYMENT OF THE HIGHEST ATTAINABLE STANDARD OF HEALTH IN THE CONTEXT OF SAFETY AND HYGIENE AT WORK
The activities of the PAHO Workers’ Health Program in connection with migrant workers falls mainly within the framework of every worker’s right to health and to security and hygiene at work in conformity with the international norms and standards such as those provided for by the Universal Declaration of Human Rights (Article 23), the American Declaration of the Rights and Duties of Man (Article XIV), the International Covenant on Economic, Social and Cultural Rights (Article 7) and the Protocol of San Salvador (Article 7). Basically, the PAHO/WHO activities in this field refer to the participation of PAHO in the Hispanic Forum.
The Hispanic Forum was born as an initiative focusing exclusively on meeting the environmental and occupational health needs of the Hispanic community in the United States. It is sponsored by various organizations that have forged a strategic alliance for the benefit of Hispanics, especially workers and their families. It is comprised of U.S. government agencies such as the Environmental Protection Agency (EPA) and the Occupational Safety and Health Agency (OSHA), corporations such as 3M, and nongovernmental organizations such as the National Safety Council (NSC) and the National Alliance for Hispanic Health (NAHH). Likewise, the forum is comprised of multilateral organizations such as PAHO and OAS.
Among the Forum’s general objectives, the following are noteworthy:
- Preventing, reducing and eliminating environmental and occupational risks threatening the Hispanic community in the USA.
- Improving the availability and quality of information connected to occupational and environmental health of Hispanic workers.
- Reducing inequity in terms of access to health care --to improve the occupational and environmental health status of workers and their families.
Since its establishment in 2000, two forums have been held in the framework of the activities of the annual congress of NSC, in Orlando 2000 and San Diego 2002. The first forum focused on identifying common challenges, forging partnerships and developing action plan strategies and models. Topics mainly on both environmental and occupation health and safety were addressed. On the basis of the achievements of the first forum, the second forum was aimed at building the capacity of grassroots organizations that support Hispanics so that they would develop and use better tools to duly and effectively meet both occupational and environmental health and safety needs. This forum also included border health (Mexico-USA) and transportation safety.
In December 2003, it was possible to include the Hispanic Forum as an activity on the agenda of Working Group 2 of the XIII Inter-American Conference of Ministers of Labor (IACML-OAS). With support from OAS and in the context of the IACML, the actions of what would constitute the third Hispanic Forum (it was not formally referred to as such) focused on decision makers, and in September 2004 a hemispheric meeting on leadership in occupational health and safety was held. This first meeting brought together opinion leaders in the United States (tripartite character) and in some Latin American countries to design a thematic platform that would be presented at the XVIII World Congress on Health and Safety at Work (Orlando 2005) under the heading Agenda of the Americas. The topics that were incorporated included: occupational health and safety conditions of vulnerable population groups, implications of the Free Trade Agreements on workers’ health, corporate social responsibility, and successful experiences in occupational health leadership, among others.
In 2005, actions focused on two activities:
A. Drafting the Agenda of the Americas for the XVII World Congress on Health and Safety at Work, along with the NSC of the United States and IACML-OAS. The World Congress took place in September 2005 in Orlando, Florida. At the Congress, due importance was given to the Agenda of the Americas, and it was therefore able to successfully achieve its objectives. It included a Grassroots Meeting that brought together leaders of community organizations to support immigrant workers in the United States.
B.Preparing a CD of the Hispanic Forum that would bring together various materials published in Spanish so that community and nongovernmental organizations that support Hispanic workers in the United States could benefit from a useful and accessible tool to better orient their efforts to improve the working conditions of these workers. After a phase involving the compilation and evaluation of materials published in the United States, the CD is now being assembled and copied, and it is expected that it will be ready by the end of the first semester of 2006 and distributed in the second semester. The following materials are included among others: self-taught courses, specific handbooks, informative brochures and foldouts, informative leaflets on facts, compilations, a portfolio of consolidated programs, an encyclopedia (ILO) and a directory of related organizations. All of this material has been provided mainly as a result of support from government and nongovernmental institutions, universities, and academics of the United States working on occupational health issues.
[1]. According to WHO’s Constitution, the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. The Constitution was adopted by the International Health Conference held in New York on June 19-July 22, 1946, was signed on July 22, 1946 by the representatives of 61 States and entered into force on April 7, 1948. In the United Nations Human Rights System, the International Covenant on Economic, Social and Cultural Rights recognizes the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (Article 12). This Covenant entered into force on January 3, 1976, and 142 States have ratified it. In the Inter-American Human Rights System, this right is protected by Article 10 of the Additional Protocol to the American Convention on Human Rights (Protocol of San Salvador) in the Area of Economic, Social and Cultural Rights. This Protocol entered into force on November 16, 1999 and has been ratified by 12 States.
[2]. See Heidi V. Jiménez and Javier Vásquez, “El Derecho Internacional, instrumento esencial para la promoción de la salud mental en las Américas,” Revista Panamericana de Salud Pública, 9 (4), 2001, p. 267.
[3]. Id. See also Mental Disability Rights International, OAS Human Rights Commission Orders Paraguay To End Horrendous Abuses in National Psychiatric Facility, December 18, 2003. Available at www.mdri.org/projects/americans/paraguay/pressrelease.htm
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