Using international human rights law to improve child health in low-income countries: a framework for healthcare professionals

["If you're talking about poor communities, forget it!": (lack of) human rights advocacy for adequate food in primary healthcare]

This study aimed to understand the forms of professional work and proposed actions to achieve the human right to adequate food (HRAF) in the context of primary healthcare (PHC). Using a qualitative approach, the authors conducted semi-structured interviews (from May 2013 to July 2014) with healthcare workers that conducted educational groups on food and nutrition in PHC in the city of São Paulo, Brazil. Content analysis was performed to identify the proposed actions on food, with HRAF as the theoretical basis. We identified three categories of professional work based on the proposed actions for food and nutrition. The first approaches food as a biomedical dimension. The second focuses on access and availability of foods in the territory. The third approaches users' local food reality, centered on the team's work. The proposed actions feature those conducted by individuals with obligations towards HRAF (healthcare workers in PHC) and those performed by rights-holder (users of PHC in the Brazilian Unified National Health System). Food in contexts of poverty is treated as a problem with no solution. This study allowed approximations between "what to do" and "how to act" based on ways of grasping food through the definitions, professional work, and proposed actions to achieve HRAF in PHC. It also allowed elucidating the need to understand food as a human right and strengthening the responsibility of healthcare workers in PHC as duty-bearers towards HRAF in the context of social policies.

Thirtieth anniversary of the UN Convention on the Rights of the Child: advancing a child rights-based approach to child health and well-being

Global challenges to children's health are rooted in social and environmental determinants. The UN Convention on the Rights of the Child (CRC) articulates the rights required to address these civil-political, social, economic and cultural determinants of child well-being. The principles of child rights-universality, interdependence and accountability-define the tenets of social justice and health equity required to ensure all rights accrue to all children, and the accountability of individuals and organisations (duty-bearers) to ensure these rights are fulfilled. Together, the CRC and child rights principles establish the structure and function of a child rights-based approach (CRBA) to child health and well-being-that provides the strategies and tools to transform child health practice into a rights, justice and equity-based paradigm. The 30th anniversary of the CRC is an opportune time to translate a CRBA to health and well-being into a global practice of paediatrics and child health.

Addressing inequities in child health and development: towards social justice

Inequities have a profound impact on the health and development of children globally. While inequities are greatest in the world's poorest countries, even in rich nations poorer children have poorer health and developmental outcomes. From birth through childhood to adolescence, morbidity, mortality, growth and development are socially determined, resulting in the most disadvantaged having the highest risk of poor health outcomes. Inequities in childhood impact across the life course. We consider four categories of actions to promote equity: strengthening individuals, strengthening communities, improving living and working conditions, and promoting healthy macropolicies. Inequities can be reduced but action to reduce inequities requires political will. The International Society for Social Paediatrics and Child Health (ISSOP) calls on governments, policy makers, paediatricians and professionals working with children and their organisations to act to reduce child health inequity as a priority. ISSOP recommends the following: governments act to reduce child poverty; ensure rights of all children to healthcare, education and welfare are protected; basic health determinants such as adequate nutrition, clean water and sanitation are available to all children. Paediatric and child health organisations ensure that their members are informed of the impact of inequities on children's well-being and across the life course; include child health inequities in curricula for professionals in training; publish policy statements relevant to their country on child health inequities; advocate for evidence-based pro-equity interventions using a child rights perspective; advocate for affordable, accessible and quality healthcare for all children; promote research to monitor inequity as well as results of interventions in their child populations. Paediatricians and child health professionals be aware of the impact of social determinants of health on children under their care; ensure their clinical services are accessible and acceptable to all children and families within the constraints of their country's health services; engage in advocacy at community and national level.

A systematic review of reasons for and against asking patients about their socioeconomic contexts

Background

People’s social and economic circumstances are important determinants of their health, health experiences, healthcare access, and healthcare outcomes. However, patients’ socioeconomic circumstances are rarely asked about or documented in healthcare settings. We conducted a systematic review of published reasons for why patients’ socioeconomic contexts (including education, employment, occupation, housing, income, or wealth) should, or should not, be enquired about.

Methods

Systematic review of literature published up to and including 2016. A structured literature search using databases of medicine and nursing (pubmed, embase, global health), ethics (Ethicsweb), social sciences (Web of Science), and psychology (PsychINFO) was followed by a ‘snowball’ search. Eligible publications contained one or more reasons for: asking patients about socioeconomic circumstances; collecting patients’ socioeconomic information; ‘screening’ patients for adverse socioeconomic circumstances; or linking other sources of individual socioeconomic data to patients’ healthcare records. Two authors conducted the screening: the first screened all references, the second author screened a 20% sample with inter-rater reliability statistically confirmed. ‘Reason data’ was extracted from eligible publications by two authors, then analysed and organised.

Results

We identified 138 eligible publications. Most offered reasons for why patients’ should be asked about their socioeconomic circumstances. Reasons included potential improvements in: individual healthcare outcomes; healthcare service monitoring and provision; population health research and policies. Many authors also expressed concerns for improving equity in health. Eight publications suggested patients should not be asked about their socioeconomic circumstances, due to: potential harms; professional boundaries; and the information obtained being inaccurate or unnecessary.

Conclusions

This first summary of literature on the subject found many published reasons for why patients’ social and economic circumstances should be enquired about in healthcare settings. These reasons include potential benefits at the levels of individuals, health service provision, and population, as well as the potential to improve healthcare equity. Cautions and caveats include concerns about the clinician’s role in responding to patients’ social problems; the perceived importance of social health determinants compared with biomedical factors; the use of average population data from geographic areas to infer the socioeconomic experience of individuals. Actual evidence of outcomes is lacking: our review suggests hypotheses that can be tested in future research.

A 'burning opportunity' for human rights: using human rights as a catalyst for policies to mitigate the health risk of household air pollution

With over 3 billion people dependent on traditional cooking and heating technologies, efforts to address the health burden of exposure to household air pollution (HAP), as well as other sociodemographic impacts associated with energy poverty, are central to sustainable development objectives. Yet despite overwhelming scientific consensus on the health burden of HAP exposure, particularly harms to impoverished women and children in developing countries, advocates currently lack a human rights framework to mitigate HAP exposure through improved access to cleaner household energy systems. This article examines the role of human rights in framing state obligations to mitigate HAP exposure, supporting environmental health for the most vulnerable through intersectional obligations across the human right to health, the collective right to development, and women's and children's rights. Drawing from human rights advocacy employed in confronting the public health harms of tobacco, we argue that rights-based civil society advocacy can structure the multi-sectoral policies necessary to address the impacts of HAP exposure and energy poverty, facilitating accountability for human rights implementation through international treaty bodies, national judicial challenges and local political advocacy. We conclude that there is a pressing need to build civil society capacity for a rights-based approach to cleaner household energy policy as a means to alleviate the environmental health effects of energy poverty.