On October 30, the Program on Human Rights (PHR) at Stanford's Center on Democracy, Development and the Rule of Law (CDDRL) held a day-long conference to examine health and human rights. The conference was held to discuss how a rights-based approach to health services can impact the delivery of effective health interventions and advance other socio-economic and cultural rights in developing regions. The conference titled, “Why We Should Care: Health and Human Rights” was divided into five panels with presenters from diverse backgrounds and professions including lawyers, doctors, public health experts, students and activists.

The Program:

The conference started with a welcoming address by Helen Stacy, director of the Program on Human Rights. CDDRL Director Larry Diamond introduced the keynote speaker Paul H. Wise, professor of child health and society and pediatrics at Stanford University’s School of Medicine, and director of the Center for Policy, Outcomes and Prevention. Wise's opening remarks began on a somber note, “The language of rights means very little to a child stillborn, an infant dying in pain from pneumonia or a child desiccated by famine.” In his address, Wise emphasized the need for an aligned and integrated rights-based approach that does not undermine effective and efficient medical interventions. “We need to fill the gap between the worlds of child health and child rights so that our programs and policies are both effective and just,” he stressed.

Following the keynote address, the conference presenters shared their work according to a geographic or thematic focus. The first panel brought together three generations of speakers from Stanford - a faculty member, a pre-doctoral fellow and a recent graduate - in a unique opportunity to share ideas and discuss possibilities of health work in Africa. Rebecca Walker, clinical instructor in emergency medicine at Stanford School of Medicine, presented her impressions and reactions on Mindy Roseman’s study of forced sterilization in Namibia. Roseman, academic director of the Human Rights Program and lecturer on law at Harvard Law School, was unable to attend due to flight complications after hurricane Sandy hit the East Coast.

Eric Kramon, 2011-2012 pre-doctoral fellow at CDDRL, spoke about the political sources of ethnic inequality in health outcomes in Africa.  Kramon’s work in Kenya illustrated how politics plays a determinant role in ethnic inequalities and consequently in access to health and health outcomes. Jeffrey Tran, a 2011 Stanford graduate in human biology, described the vision behind the launch of the Project of Emergency First Aid Responder in Western Cape Province, South Africa that he helped implement. Tran explained, “Individuals and communities are an integral part of the solution and we work with the communities to develop first aid training programs that are taught and eventually run by community members.”

Panel two was dedicated to the health impact of drones in Pakistan and in Gaza. Based on research by the Stanford International Clinic on Human Rights and Conflict Negotiation in Pakistan, Professor James Cavallaro and Stanford law school student Omar Shakir, explained that drones are not only responsible for deaths of civilians but also constitute a constant disturbance to social life and mental health of ordinary people, including their relations with children and the elderly. Drones impact other rights as well - such as the right to education - as children are prevented from attending schools for fear of drone strikes. Rajaie S. Batniji, resident physician in internal medicine at Stanford and a CDDRL affiliate, explained the clinical diagnosis of traumatic disorders that result from constant surveillance and insecurity. He cited the work of Jonathan Mann in defining dignity and the devastating effects on physical, mental, and social well-being when these senses are violated. Batniji explained that populations in Gaza are prevented from living life with dignity and respect because they live under constant threat to their security and intrusion into their homes and communications.

Vivek Srinivasan, manager of the Program on Liberation Technology at CDDRL, presented his experience on the Right to Food Campaign in India. He believes that this campaign has led to the mobilization for rights and the provision of services. “Not all demands are confrontational. Communities begin demanding something that is perceived as small in scope but have ramifications that extend to other rights such as the right to education, the right to housing and the right to work.” According to Srinivasan, the Right to Food Campaign in India has had a tremendous impact in putting hunger on the policy agenda. Suchi Pande, an activist-researcher who worked on the Right to Information Campaign in India for over seven years and was the secretary for the National Campaign for People’s Right to Information from 2006 to 2008, supported Srinivasan’s argument of strong correlation in achievements and right-based mobilization. However, Pande pointed out that despite successes in the Right to Food Campaign, other economic and social rights including the right to health in India continues to be a non-issue for politicians and the government. She is optimistic and believes that rural public hearings, the role of the right to information and its supporting mechanisms will facilitate access to public health in rural India.

In panel four, Sarah MacCarthy showed results that suggest that counseling and testing services for HIV-positive pregnant women remain limited, insufficient or lacking in quality in Salvador, Brazil. “While Brazil’s HIV/AIDS program has been internationally acclaimed, national practice still fails to meet national and global guidelines,” she explained. Calling attention to the regional discrepancies in the HIV/AIDS policy and program implementation in Brazil, Nadejda Marques, manager of the Program on Human Rights at CDDRL,, expressed concerns about the implementation of an HIV/AIDS program in a context of limited resources. “In Angola, counseling and voluntary testing units for HIV/AIDS don’t have drinking water or sanitary conditions to receive patients. They lack basic equipment for testing and data collection, there is a generalized shortage of doctors, and health care providers have no specific training on HIV/AIDS.” Despite this alarming situation, Marques explained that advocating for the rights of persons living with HIV/AIDS in Angola has put in evidence the failure of a heath system unable to provide even the most basic services to its population and has enabled mobilization in a context where human rights are routinely violated.

Ami Laws, adjunct associate professor of medicine at Stanford, described how a physician can provide services in collaboration with the judicial system to advance human rights. Laws is an expert witness on cases of torture survivors that require asylum status in the U.S. and has worked mainly with victims of torture in the Punjab region in India. Everaldo Lamprea, a JSD candidate at Stanford Law School and an assistant professor at Los Andes Law School in Bogotá, Colombia, spoke about his recent comparative study on health litigation in low and middle-income countries. The escalation of right-to-health litigation in these countries can have unexpected and harmful consequences to healthcare reforms and the enforceability of the right to health. In part, this is because significant financial resources are allocated to the litigation processes and not to the health system. In addition, while litigation can highlight gaps that exist in the health system that need regulation, countries have been very slow to adapt and adjust to these signals.

Next Steps:

A number of key ideas, questions and insights emerged from the conference including:

. How to identify an effective intervention that will also mobilize communities to advocate for its implementation?

. How to provide services to the more vulnerable populations without alienating a contingent that has access to basic health care services?

. What instruments can be used to share best practices among national healthcare systems?

. How do global priorities adapt to contexts of limited financial resources and human capital?

. How can punctual achievements in rights that guarantee access to health be expanded for the achievement of other social, economic and cultural rights?

The Program on Human Rights at CDDRL will continue to pursue a research agenda examining health and human rights following the conference and announced that it will be the thematic focus of the Sanela Diana Jenkins Speakers Series in 2014. The PHR is also actively seeking support for research projects that include a right to health component at the core of its academic investigation for the 2012-2013 academic year.

Outside of China, the world now has more food insecure and nutrient deficient people than it had a decade ago, and the prevalence of obesity-related diabetes, high blood pressure and cardio-vascular diseases is increasing at very rapid rates. Expanded food production has done little to address the fact that between one-third and one-half of all deaths in children under five in developing countries are still related to malnutrition.

“With only three years away from the Millennium Development Goals deadline, this is a terrible track record,” said food and nutrition policy expert Per Pinstrup-Andersen at FSE's Global Food Policy and Food Security Symposium Series last week.  

Pinstrup-Andersen, the only economist to win the World Food Prize (the ultimate award in the food security field), has dedicated his career to understanding the linkages between food, nutrition, and agriculture. What is driving persistent food insecurity and malnutrition in a food abundant world?

Poor food supply management is part of the problem. According to the United Nations Food and Agricultural Organization (FAO), 20-30% of food produced globally is lost every year. That’s enough to feed an additional 3-3.5 billion people.

Jatropha in Africa. Photo credit: Ton Rulkens/flickr.

Biofuels production, such as jatropha in Africa, now competes with food for land, and climate change is already negatively impacting crop yields in regions straddling the equator—with major implications for food supply.

For low-income consumers in both the U.S. and developing countries increasing and more volatile food prices, such as those seen in 2007, are also driving food insecurity. Poor consumers respond by purchasing cheaper, less nutrient food, and less of it.

Nutritional value chain

Consensus is developing—at least rhetorically—among national policymakers and international organizations that investments in agricultural development must be accelerated. Members of the G8 and G20 have committed $20 billion in international economic support for such investments and some developing countries such as Ethiopia and Ghana are planning large new investments.

While most of these recent initiatives focus on expanded food supplies, there is an increasing understanding that merely making more food available will not assure better food security, nutrition, and health at the household and individual levels.

“It matters for health and nutrition how increasing food supplies are brought about and of what it consists,” said Pinstrup-Andersen. “We need to turn the food supply chain into a nutritional value chain.”

Diet diversity is incredibly important for good nutrition. Agricultural researchers and food production companies need to look at a number of different commodities, not just the major food staples, said Pinstrup-Andersen.

“The Green Revolution successfully increased the production of corn, rice, and wheat, increasing incomes for farmers, and lowering prices for consumers, but now it is time to invest in fruits, vegetables and biofortification to deal with micronutrient deficiency,” said Pintrup-Andersen.

Biofortification, the breeding of crops to increase their nutritional value, offers tremendous opportunity for dealing with malnutrition in the developing world, but is not widely available.

This is particularly important for areas in sub-Saharan Africa where between one and three and one and four people are short in calories, protein, and micronutrients. Obesity is actually going up in these countries with the introduction of cheap, processed, energy-dense foods (those high in sugar and fat) contributing to the diabetes epidemic.

Pathways to better health

Women hauling water to their gardens in Benin.

The path to better health and nutrition must look beyond the availability of food at affordable prices, clean water, and good sanitation, and consider behavioral factors such as time constraints for women in low-income households.

“Field studies have shown time and time again that one of the main factors preventing women from providing themselves and their families with good nutrition is time,” explained Pinstrup-Andersen.

He told the story of a woman in Bolivia too burdened with farm and household responsibilities to take the time to breastfeed her six-month old daughter. Enhancing productivity in activities traditionally undertaken by women could be a key intervention to improving good health and nutrition at the household level.

Access is another issue. A household may be considered food secure, in that sufficient food may be available, but food may not be equally allocated in the household.

“If we focus on the most limiting constraint we can be successful,” said Pinstrup-Anderen. “But we must tailor our response to each case.”

For sub-Saharan Africa, this includes investments in rural infrastructure, roads, irrigation systems, micronutrient fertilizer, climate adaptation strategies, and other barriers holding back small farmers.

Fortunately, there has been a renewed attention to the importance of guiding food system activities towards improved health and nutrition. The Global Agriculture and Food Security Program (GAFSP), which facilitates the distribution of some of the G8 and G20 $20 billion commitments, prescribes that country proposals for funding of agricultural development projects must show a clear pathway from the proposed agricultural change to human nutrition.

“But it’s not going to be easy to implement good policies,” warned Pinstrup-Andersen. “There are few incentives in government for multidisciplinary problem solving. The economy is set up around silos and people are loyal to their silos. Agricultural and health sectors are largely disconnected in their priorities, policy, and analysis."

Incentives must change to encourage working across ministries and disciplines to identify the most important health and nutrition-related drivers of food systems, impact pathways, and policy and program interventions to find win-wins for positive health and nutrition.

President Obama and Mitt Romney meet for their third debate to discuss foreign policy on Monday, when moderator Bob Schieffer is sure to ask them about last month's terrorist attack in Libya and the nuclear capabilities of Iran.

In anticipation of the final match between the presidential candidates, researchers from five centers at Stanford’s Freeman Spogli Institute for International Studies ask the additional questions they want answered and explain what voters should keep in mind.

What can we learn from the Arab Spring about how to balance our values and our interests when people in authoritarian regimes rise up to demand freedom?  

What to listen for: First, the candidates should address whether they believe the U.S. has a moral obligation to support other peoples’ aspirations for freedom and democracy. Second, they need to say how we should respond when longtime allies like Egypt’s Hosni Mubarak confront movements for democratic change.

And that leads to more specific questions pertaining to Arab states that the candidates need to answer: What price have we paid in terms of our moral standing in the region by tacitly accepting the savage repression by the monarchy in Bahrain of that country's movement for democracy and human rights?  How much would they risk in terms of our strategic relationship with Bahrain and Saudi Arabia by denouncing and seeking to restrain this repression? What human rights and humanitarian obligations do we have in the Syrian crisis?  And do we have a national interest in taking more concrete steps to assist the Syrian resistance?  On the other hand, how can we assist the resistance in a way that does not empower Islamist extremists or draw us into another regional war?  

Look for how the candidates will wrestle with difficult trade-offs, and whether either will rise above the partisan debate to recognize the enduring bipartisan commitment in the Congress to supporting democratic development abroad.  And watch for some sign of where they stand on the spectrum between “idealism” and “realism” in American foreign policy.  Will they see that pressing Arab states to move in the direction of democracy, and supporting other efforts around the world to build and sustain democracy, is positioning the United States on “the right side of history”?

~Larry Diamond, director of the Center on Democracy, Development, and the Rule of Law

What do you consider to be the greatest threats our country faces, and how would you address them in an environment of profound partisan divisions and tightly constrained budgets? 

What to listen for: History teaches that some of the most effective presidential administrations understand America's external challenges but also recognize the interdependence between America's place in the world and its domestic situation.

Accordingly, Americans should expect their president to be deeply knowledgeable about the United States and its larger global context, but also possessed of the vision and determination to build the country's domestic strength.

The president should understand the threats posed by nuclear proliferation and terrorist organizations. The president should be ready to lead in managing the complex risks Americans face from potential pandemics, global warming, possible cyber attacks on a vulnerable infrastructure, and failing states.

Just as important, the president needs to be capable of leading an often-polarized legislative process and effectively addressing fiscal challenges such as the looming sequestration of budgets for the Department of Defense and other key agencies. The president needs to recognize that America's place in the world is at risk when the vast bulk of middle class students are performing at levels comparable to students in Estonia, Latvia and Bulgaria, and needs to be capable of engaging American citizens fully in addressing these shared domestic and international challenges.

~Mariano-Florentino Cuéllar, co-director of the Center for International Security and Cooperation

Should our government help American farmers cope with climate impacts on food production, and should this assistance be extended to other countries – particularly poor countries – whose food production is also threatened by climate variability and climate change?

What to listen for: Most representatives in Congress would like to eliminate government handouts, and many would also like to turn away from any discussion of climate change. Yet this year, U.S. taxpayers are set to pay up to $20 billion to farmers for crop insurance after extreme drought and heat conditions damaged yields in the Midwest.

With the 2012 farm bill stalled in Congress, the candidates need to be clear about whether they support government subsidized crop insurance for American farmers. They should also articulate their views on climate threats to food production in the U.S. and abroad.

Without a substantial crop insurance program, American farmers will face serious risks of income losses and loan defaults. And without foreign assistance for climate adaptation, the number of people going hungry could well exceed 15 percent of the world's population. 

~Rosamond L. Naylor, director of the Center on Food Security and the Environment

What is your vision for the United States’ future relationship with Europe? 

What to listen for: Between the end of World War II and the end of the Cold War, it was the United States and Europe that ensured world peace. But in recent years, it seems that “Europe” and “European” have become pejoratives in American political discourse. There’s been an uneasiness over whether we’re still friends and whether we still need each other. But of course we do.

Europe and the European Union share with the United States of America the most fundamental values, such as individual freedom, freedom of speech, freedom to live and work where you choose. There’s a shared respect of basic human rights. There are big differences with the Chinese, and big differences with the Russians. When you look around, it’s really the U.S. and Europe together with robust democracies such as Canada and Australia that have the strongest sense of shared values.

So the candidates should talk about what they would do as president to make sure those values are preserved and protected and how they would make the cooperation between the U.S. and Europe more effective and substantive as the world is confronting so many challenges like international terrorism, cyber security threats, human rights abuses, underdevelopment and bad governance.

~Amir Eshel, director of The Europe Center

Historical and territorial issues are bedeviling relations in East Asia, particularly among Japan, China, South Korea, and Southeast Asian countries. What should the United States do to try to reduce tensions and resolve these issues?

What to listen for: Far from easing as time passes, unresolved historical, territorial, and maritime issues in East Asia have worsened over the past few years. There have been naval clashes, major demonstrations, assaults on individuals, economic boycotts, and harsh diplomatic exchanges. If the present trend continues, military clashes – possibly involving American allies – are possible.

All of the issues are rooted in history. Many stem from Imperial Japan’s aggression a century ago, and some derive from China’s more assertive behavior toward its neighbors as it continues its dramatic economic and military growth. But almost all of problems are related in some way or another to decisions that the United States took—or did not take—in its leadership of the postwar settlement with Japan.

The United States’ response to the worsening situation so far has been to declare a strategic “rebalancing” toward East Asia, aimed largely at maintaining its military presence in the region during a time of increasing fiscal constraint at home. Meanwhile, the historic roots of the controversies go unaddressed.

The United States should no longer assume that the regional tensions will ease by themselves and rely on its military presence to manage the situation. It should conduct a major policy review, aimed at using its influence creatively and to the maximum to resolve the historical issues that threaten peace in the present day.

~David Straub, associate director of the Korea Studies Program at the Walter H. Shorentein Asia-Pacific Research Center

Compiled by Adam Gorlick.