Social Work Interventions And Strategies To Promote Health Rights - A Panel Discussion

Social Work Interventions and Strategies to promote Health Rights - A Panel Discussion

Ragland Remo Paul*

Introduction:

Article 25 of the Universal Declaration of Human Rights at the General Assembly of the United Nations on the 10th December 1948 states as follows;

"(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

(2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection."

This is the basis on which the concept note of this conference has been formulated. People's Health Assembly on the 8th December 2000 endorsed the People's Charter for Health, which states as follows,

"HEALTH AS A HUMAN RIGHT - Health is a reflection of a society's commitment to equity and justice. Health and human rights should prevail over economic and political concerns. This Charter calls on people of the world to:

9. Support all attempts to implement the right to health.

10. Demand that governments and international organizations reformulate, implement and enforce policies and practices, which respect the right to health.

11. Build broad-based popular movements to pressure governments to incorporate health and human rights into national constitutions and legislation.

12. Fight the exploitation of people's health needs for purposes of profit."

Violations or non-existence of human rights and in specific in health rights is not a result of any single factor. Health is not merely a physical issue. It is a social, economic and political issue and above all a fundamental human right. Inequality, poverty, exploitation, violence and injustice have been instrumental in the violation of health rights for the poor and marginalized (and in some cases the rich and those with access to health care.)

Here today at this panel discussion we are going to try and explore the interventions and strategies that we as social workers can do to promote health rights. This paper does not claim to provide for the entire list of interventions and strategies to promote health rights, but will certainly look at some critical areas. The main attempt of this paper is to set our minds thinking in this critical area of human rights, to innovate and formulate strategies to promote health rights.

Just as social work interventions in any area of human rights is not possible to be done in isolation or by social workers alone, it is the same in the area of health rights. We must understand that networking is absolutely essential if we are to promote health rights. It is essential to network with health care professionals (medical, paramedical and support staff), national and international non-government organisations, social activists, government personnel and bodies and legal professionals. We shall look a little bit in detail when we look at the strategies and interventions to promote health rights.

The Indian Health Scenario:

Before we make an attempt to plan interventions and strategies to promote health rights it is essential to understand the ground realities. This section of the paper makes an attempt to do this. This section has the minimum statistics required to help us understand the realities.

On a positive note there has been large gains in health status since independence. Life expectancy has gone up from 36 years in 1951 to 62 in 1995. Infant mortality rate is down from 146 in 1951 to 71 in 1997. Crude birth rate has been reduced from 36.9 in 1970 to 26.1 in 1998 and crude death rate from 14.9 to 8.7 in the same period.

Some of the reasons for these gains are listed below

1. A vast three tier health system in the form of rural health infrastructure for very 5,000 populations, Primary Health Centre (PHC) for every 30,000 populations and Community Health Centres (CHC) for each 1,00,000 population.

2. Immunization to control communicable diseases

3. Improvements in water supply and sanitation (in some sectors.)

These aggregations, however, mask the wide differentials between and within the states. The health indicators of Kerala are comparable to those of middle-income countries, while Uttar Pradesh, Madhya Pradesh and Orissa are almost at the level of Sub-Saharan Africa.

The current health scenario however is not free of issues. Some of the issues are mentioned below so as to enable us to think and plan suitable interventions and strategies to promote health rights.

In a developing country like India where only asset that most poor and marginalized people have are their bodies, health assumes a greater significance. However good health has been denied to most of the people, specially the poor and vulnerable.

Despite the eradication of small pox the prevalence of Malaria and Tuberculosis (TB) as two major life taking communicable diseases is a blot in our provision of health for all. India accounts for 1/3rd of the global TB. As per the estimates 2.2 million people are added each year to the existing load of about fifteen million cases. Of these new cases about 8 lakhs are infectious and about 4.5 lakhs die.

With the increase of the dangerous strain of malaria, caused by Plasmodium falciparum it is becoming difficult to treat and arrest the disease. Malaria caused by Plasmodium falciparum was the cause of 50% of the cases in 2001. The vulnerable sections of the society are the most affected by this. For example in Andra Pradesh 75% of the deaths due to malaria were from tribal groups.

The threat presented by HIV/AIDS is fast growing. The first case of HIV/AIDS in South Asia was reported in India 18 years ago. Now it is estimated that India is home to four and a half million HIV positive people. India may soon surpass South Africa for the single highest number for HIV infections in the world. The infection of HIV is no longer confined to the high-risk groups or only to urban area and it is spreading