Human Rights Facts (63): Tens of Thousands of U.S. Citizens Die of Poverty Each Year

"poverty kills", photo by Harvey Finkle, Philadelphia 1998

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Poverty kills, it seems. As if it’s not bad enough in itself. Although death is often multicausal, a study has tried to estimate in how many cases poverty is a contributing factor:

For 2000, the study attributed 176,000 deaths to racial segregation and 133,000 to individual poverty. The numbers are substantial. For example, looking at direct causes of death, 119,000 people in the United States die from accidents each year, and 156,000 from lung cancer.

How does the causal chain operate? Poverty contributes to poor health, in different ways:

• poor people tend to have jobs or occupations that are physically hazardous
• they often live in environmentally unsound circumstances
• they can’t afford a healthy diet
• their lack of education makes it harder to take the right health decisions
• they may lack adequate health insurance and health screening
• substandard housing can cause health problems etc.

More human rights facts here.

Lies, Damned Lies, and Statistics (33): The Omitted Variable Bias, Ctd.

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I discussed the so-called Omitted Variable Bias before on this blog (here and here). So I suppose I can mention this other example: guess what is the correlation, on a country level, between per capita smoking rates and life expectancy rates? High smoking rates equal low life expectancy rates, right? And vice versa?

Actually, and surprisingly, the correlation goes the other way: the higher smoking rates – the more people smoke in a certain country – the longer the citizens of that country live, on average.

Why is that the case? Smoking is unhealthy and should therefore make life shorter, on average. However, people in rich countries smoke more; in poor countries they can’t afford it. And people in rich countries live longer. But they obviously don’t live longer because they smoke more but because of the simple fact they have the good luck to live in a rich country, which tends to be a country with better healthcare and the lot. If they would smoke less they would live even longer.

Why is this important? Not because I’m particularly interested in smoking rates (although I am interested in life expectancy). It’s important because it shows how easily we are fooled by simple correlations, how we imagine what correlations should be like, and how we can’t see beyond the two elements of a correlation when we’re confronted with one that goes against our intuitions. We usually assume that, in a correlation, one element should cause the other. And apart from the common mistake of switching the direction of the causation, we often forget that there can be a third element causing the two elements in the correlation (in this example, the prosperity of a country causing both high smoking rates and high life expectancy), rather than one element in the correlation causing the other.

More posts in this series are here.

Iconic Images of Human Rights Violations (59): World’s Youngest Mother

Lina Medina, the world's youngest mother

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Lina Medina, her son and her doctor

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Lina Medina is the world’s youngest confirmed mother in medical history. Born in Peru on 27 September 1933, Lina was brought to a hospital by her parents at the age of 5 because of an increasing abdominal size. Originally thought to have tumor, her doctors determined that she was in fact seven months pregnant. Dr. Gerardo Lozada took her to Lima, Peru, prior to the surgery to have other specialists confirm that Lina was in fact pregnant. A month and a half later, on 14 May 1939, she gave birth to a boy by cesarean section necessitated by her small pelvis. Her menarche had occurred at eight months of age (or 2½ according to a different article) and she had prominent breast development by the age of four. Extreme precocious puberty in children 5 or under is very uncommon.

Her son weighed 2.7 kg at birth and was named Gerardo after her doctor. Gerardo was raised believing that Lina was his sister, but found out at the age of ten that she was his mother. He grew up healthy but died in 1979 at the age of 40 of a disease of the bone marrow. There was never evidence that Lina Medina’s pregnancy occurred in any but the usual way, but she never revealed the father of the child, nor the circumstances of her impregnation. Dr. Escomel suggested she might not actually know herself. Lina’s father was arrested on suspicion of rape and incest, but was later released due to lack of evidence.

Lina is apparently still alive today.

More about pedophilia, incest, child marriage and rape. More iconic images of human rights violations.

Related Articles

• 10-Year-Old in Spain Is Not the First or Youngest Child Mom (healthland.time.com)

Human Rights Quote (81): Victor Hugo on Poverty

Victor Hugo, by Alphonse Legros

I am one of those who think and say that it is possible to eliminate extreme poverty. Mark you, gentlemen, I am not saying “reduce”, “lessen”, “limit”, “control”, I said eliminate. Poverty is a disease of society such as leprosy was a disease of the human body, and can be eliminated just as leprosy has disappeared. Yes, it is possible. Legislators and policymakers must think about it constantly, for as long as the possible is not done, our duty will never be fulfilled.

In Paris, in these suburbs of Paris where the wind of revolt once blew so easily, there are streets, houses, sewers, where families, whole families live pell-mell, men, women, girls, children, having no beds, blankets. For clothing they have stinking heaps of rags – the cities, where human beings huddle to escape the cold of winter.

Well, gentlemen, I say that these are things that should not be, I say that society must spend all its strength, all its care, its intelligence, all its will, so that such things are not! I say that such facts in a civilized country, engage the conscience of the whole society,

[For all your efforts] gentlemen, you have done nothing as long as the people suffer! As long as those in the prime of life and work are without bread, as long as those that are old and have worked are homeless! It is not only your generosity that I appeal to, it is your wisdom, I implore you to think. You have made laws against anarchy, now make laws against poverty! Victor Hugo, speaking at the Legislative Assembly, 1849 (source)

More human rights quotes are here.

Human Rights Maps (109): Malaria

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Each year, there are around 350-500 million new cases of malaria, killing between one and three million people, the majority of whom are young children in sub-Saharan Africa. Ninety percent of malaria-related deaths occur in sub-Saharan Africa. Malaria is commonly associated with poverty – a human rights violations – and can indeed be a cause of poverty and a major hindrance to economic development.

And here’s a reminder that malaria was once common in the U.S.:

Map of malarial deaths in the United States, 1870

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More human rights maps are here (some specifically about health matters are here, some about poverty here).

Related Articles

• The terrible toll of malaria (telegraph.co.uk)
• Mathematical Model Projects Potential Impact Of Current Tools Fighting Malaria In Africa (medicalnewstoday.com)
• Good Riddance to Mosquitoes: Four Ways to Beat the Malaria-Carrying Threat (scientificamerican.com)
• Can malaria be beaten? (independent.co.uk)
• New tool to map malaria developed (physorg.com)

What is This Graph About? (10)

The answer is here. More mystery graphs.

The Most Absurd Human Rights Violations (15): Prayer is the Best Cure

At the deathbed, 1940, by Sámal Joensen Mikines

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The mother of an 11-year-old girl who died of undiagnosed diabetes as the family prayed for her to get better testified Tuesday that she believes sickness is caused by sin and can be cured by God.

Leilani Neumann told the jury in her husband’s trial that she thought her daughter’s March 2008 illness was a test of her religious faith and she didn’t take the girl to a doctor because that would have been “complete disobedience to what we believe”. (source)

More absurd human rights violations.

Human Rights Ads (32): Health Care

(source, a Make Poverty History ad)

More on the Millennium Development Goals. More on health care as a human right here. More human rights ads here.

Human Rights Facts (47): Poverty and Obesity, Ctd.

Evolution of Obesity

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In a previous post, I mentioned that poor people in the U.S. are more likely to be obese, and that they risk finding themselves in a poverty trap as a result: their poverty causes health problems, which in turn make them more poor (healthcare is obviously expensive, especially when you’re uninsured* and when your illness causes you to be absent from work or to lose your job altogether). Why does poverty cause health problems? For many reasons, but the one we’re focusing on here is obesity. It seems that poverty shifts

choices toward an energy-dense, highly palatable diet that provides maximum calories per the least volume and the least cost. The hypothesis [is] that healthier diets may indeed cost more. Adam Drewnowski and SE Specter (source)

A large body of epidemiologic data show that diet quality follows a socioeconomic gradient. Whereas higher-quality diets are associated with greater affluence, energy-dense diets that are nutrient-poor are preferentially consumed by persons of lower socioeconomic status (SES) and of more limited economic means. As this review demonstrates, whole grains, lean meats, fish, low-fat dairy products, and fresh vegetables and fruit are more likely to be consumed by groups of higher SES. In contrast, the consumption of refined grains and added fats has been associated with lower SES. … The observed associations between SES variables and diet-quality measures can be explained by a variety of potentially causal mechanisms. The disparity in energy costs ($/MJ) between energy-dense and nutrient-dense foods is one such mechanism; easy physical access to low-cost energy-dense foods is another. If higher SES is a causal determinant of diet quality, then the reported associations between diet quality and better health, found in so many epidemiologic studies, may have been confounded by unobserved indexes of social class. Conversely, if limited economic resources are causally linked to low-quality diets, some current strategies for health promotion, based on recommending high-cost foods to low-income people, may prove to be wholly ineffective. Nicole Darmon and Adam Drewnowski (source)

Poverty causes obesity, obesity causes ill health, and ill health causes poverty. And both ill health and poverty are human rights violations (see here and here respectively). So plenty of reasons to link obesity and human rights.

The reasons why poverty causes obesity and shifts diets towards low quality foods are diverse, and not limited to the relatively high cost of high quality food. There’s also something called

an “obesogenic” environment. Food options in poor neighborhoods are severely limited: It’s a lot easier to find quarter waters and pork rinds on the corner than fresh fruit and vegetables. Low-income workers may also have less time to cook their own meals, less money to join sports clubs, and less opportunity to exercise outdoors. (source)

poverty and obesity cartoon by David Fitzsimmons

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So obesity is one thing which pushes people into a vicious circle of poverty and ill health (unhealthy work, inadequate sanitation, inadequate shelter etc. also contribute to this vicious circle).  But obesity and poverty can create a vicious circle of their own. If poverty leads to obesity, obesity can also be impoverishing:

Women who are two standard deviations overweight (that’s 64 pounds above normal) make 9 percent less money. … Obese women are also half as likely to attend college as their peers and 20 percent less likely to get married. (Marriage seems to help alleviate poverty.) (source)

More about the relationship between poverty and health here and here.

* Among the 46 million people in America who lack medical insurance, about two-thirds earn less than twice the poverty level (source, source).

Update:

Contrary to conventional wisdom, … the poor have never had a statistically significant higher prevalence of overweight status at any time in the last 35 years. Despite this empirical evidence, the view that the poor are less healthy in terms of excess accumulation of fat persists. (source)

Lies, Damned Lies, and Statistics (12): Generalization

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An example from Greg Mankiw’s blog:

Should we [the U.S.] envy European healthcare? Gary Becker says the answer is no:

“A recent excellent unpublished study by Samuel Preston and Jessica Ho of the University of Pennsylvania compare mortality rates for breast and prostate cancer. These are two of the most common and deadly forms of cancer – in the United States prostate cancer is the second leading cause of male cancer deaths, and breast cancer is the leading cause of female cancer deaths. These forms of cancer also appear to be less sensitive to known attributes of diet and other kinds of non-medical behavior than are lung cancer and many other cancers. [Health effects of diet and behavior should be excluded when comparing the quality of healthcare across countries. FS]

These authors show that the fraction of men receiving a PSA test, which is a test developed about 25 years ago to detect the presence of prostate cancer, is far higher in the US than in Sweden, France, and other countries that are usually said to have better health delivery systems. Similarly, the fraction of women receiving a mammogram, a test developed about 30 years ago to detect breast cancer, is also much higher in the US. The US also more aggressively treats both these (and other) cancers with surgery, radiation, and chemotherapy than do other countries.

Preston and Hu show that this more aggressive detection and treatment were apparently effective in producing a better bottom line since death rates from breast and prostate cancer declined during the past 20 [years] by much more in the US than in 15 comparison countries of Europe and Japan.” (source)

Even if all this is true, how on earth can you assume that a healthcare system is better because it is more successful in treating two (2!) diseases? See here and here for a more complete picture.

Another example: the website of the National Alert Registry for sexual offenders used to post a few “quick facts”. One of them said:

“The chance that your child will become a victim of a sexual offender is 1 in 3 for girls… Source: The National Center for Victims of Crime“.

Someone took the trouble of actually checking this source, and found that it said:

Twenty-nine percent [i.e. approx. 1 in 3] of female rape victims in America were younger than eleven when they were raped.

One in three rape victims is a young girl, but you can’t generalize from that by saying that one in three young girls will be the victim of rape. Perhaps they will be, but you can’t know that from these data. Like you can’t conclude from the way the U.S. deals with two diseases that it “shouldn’t envy European healthcare”. Perhaps it shouldn’t, but more general data on life expectancy says it should.

These are two examples of induction or inductive reasoning, sometimes called inductive logic, a reasoning which formulates laws based on limited observations of recurring phenomenal patterns. Induction is employed, for example, in using specific propositions such as:

This door is made of wood.

to infer general propositions such as:

All doors are made of wood. (source)

More posts in this series.

The Environment and Human Rights (3): Water and Human Rights

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Following up from this post, some more information on the water crisis in the world and its implications for human rights. We obviously need water to survive, and no human rights without survival. Inadequate water supplies also cause diseases, violating our right to health. We need water – and clean water - to drink, but also to eat. Or rather, to produce our food. And we need a lot. People drink on average just a few liters a day, but they consume thousands of liters a day if we count the water required to produce their food. And evidently we should count it. Many areas of the world face already now face water shortages (there’s a map here). A fifth of the world’s population already lives in areas short of water. A global water crisis waits around the corner, and one likely consequence is famine, another human rights violation.

If we want to do something about the water crisis, we should be aware of the effect of food production on water shortages. Especially the production of meat requires huge amounts of water, compared to the production of grains or even rice. People in the West eat a lot a meat, and therefore contribute substantially to water shortages. As incomes in the developing world increase, people there will consume more meat. Hence, global water consumption will also increase. Combine this future increase with the fact that there are already shortages and that these shortages will get worse with global warming, desertification etc., and you get a real crisis.

What are the solutions? Or how can we prevent things from getting worse?

• Jokingly we could ask people to become vegetarians. That would also be better for greenhouse gas emissions, by the way.
• More seriously, and more realistically: food production, and especially agriculture and farming, represent 70% of global water consumption. That number could be cut down significantly with better irrigation; “more crop per drop”. There’s incredible waste going on there. 70% of irrigation water is lost in the process. One reason: farmers rarely pay their water bills at market prices, hence no incentives to cut waste. Unfortunately, pricing water at market prices would drive up food prices, pushing many consumers into poverty. And many poor farmers already can’t pay for expensive irrigation systems. More expensive water surely wouldn’t help them. Moreover, market prices may mean the privatization of water, and that’s dangerous. You might as well privatize oxygen.
• Other solutions: cut waste in households and industries. Here, everyone can help. Also more recycling efforts are needed. Desalination, although expensive, is an option. As are better water storage facilities, especially for poor families in developing countries. All these efforts will not only reduce the risk of a major global water crisis, but will also improve crop yields, thereby reducing the price of food and hence the risk of poverty and famine.

Economic Human Rights (30): Life Expectancy Throughout History

How is life expectancy relevant for human rights? High levels of life expectancy can mean a long life of oppression and cruelty, but it’s fair to say that a long life is generally beneficial for human rights, and that low average life expectancy rates are indicators of human rights violations. The longer people life, on average, the more they can do with their lives, and the more they can enjoy their freedom. If people’s lives are shorter, on average, it’s likely that this is because of human rights violations. For example, because:

• their healthcare isn’t provided for (and healthcare is a human right)
• their poverty traps them in a vicious circle of poverty and ill health (and poverty is a human right)
• their governments send them to war, etc.

So it’s useful to note that life expectancy, over the course of human history, has risen sharply, especially during modern times:

life expectancy through the ages

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Life expectancy during much of pre-modern history averaged just below 30 years. Part of the reason for such a low figure is that many children died at a very young age, pulling down the average life expectancy. Those who didn’t die young had a good chance of surviving to what we now call “middle age”.

After the Industrial Revolution many more children survived into adulthood and by the beginning of the 20th century average life expectancy in the developed world was close to 50, whereas for the world as a whole it was only around 40 years. The figures now are 78 and 67 respectively. This graph shows the rapid and sudden improvement after centuries of stagnation:

Life Expectancy throughout history, long trend

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The reason for this sudden improvement during and after the industrial revolution is a combination of improved medical technology and higher wealth. Not surprisingly, life expectancy is highly correlated with income levels – more wealth means higher investment in healthcare, less war etc. – but not in a linear fashion: the U.S. has very high GDP per capita but not higher life expectancy than some countries/regions with somewhat lower income levels (some blame the healthcare system, others the life-style choices of many Americans). And, compared to Africa, India has higher life expectancy with similar income levels (the HIV/AIDS epidemic is part of the explanation).

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There’s a map comparing life expectancy in the world here. And there are some more statistics on life expectancy here.

Economic Human Rights (28): The Health Consequences of the Recession and of Unemployment

the cost of healthcare cartoon

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The Economist called it the “unsurprising research finding of the day“, but I think it’s a useful confirmation of an existing intuition: this paper finds that the recession can have a beneficial effect on the health of some people who lose their job because of it, namely those people spending their new leisure time in a healthy way. Other people, however, spend their leisure time cultivating some of their pre-existing unhealthy habits, or find themselves depressed and without employer-provided healthcare (especially in the U.S.). Because their healthcare has become more expensive now that they are unemployed, they decide to go without treatment or tests.

Results showed the body mass of the average laid-off food-lover increasing by the equivalent of more than 7 pounds for a 5-foot, 10-inch man weighing 180 pounds during unemployment. Similarly, frequent drinkers on average doubled their daily alcohol intake after losing their jobs and before finding another one. (source)

Elsewhere in the world, and especially sub-Saharan Africa, it seems that the health consequences of the global recession are more dramatic:

The financial crisis will kill between 28,000 and 50,000 babies in sub-Saharan Africa this year, according to this paper. The reasoning here is straightforward. For people on subsistence incomes, a fall in GDP can be fatal. The paper’s authors, Jed Friedman and Norbert Schady, estimate that a one percentage point fall in per GDP across sub-Saharan Africa is associated with a rise in infant (defined as under-ones) mortality of between 0.34 and 0.62 per 1000. If we multiply this increase by the number of births this year and by the 2.4 percentage point difference between GDP growth this year and last (a reasonableish estimate of the effect of the crisis), we get a figure of between 28,000 and 50,000. … Of course, you can quibble with the numbers. But the general story holds. For the poor, income is a matter of life or death. Which brings me to my question. If one-in-seventeen British babies were to die this year because of the financial crisis, it would be the biggest media story for years and there’d be rioting in the streets until the government did something. So, why the silence? Chris Dillow (source)

Since health and life are human rights, we have another human rights problem thanks to the recession. Previous posts on the (possible) impact of the recession on human rights are

• here (a general overview)
• here and here (on poverty)
• here (on the recession and the death penalty)
• here (on the recession and development aid)
• here (on the recession and antisemitism)
• here (on the recession and unemployment)
• and here (on the recession and crime).

Economic Human Rights (25): Quality of Healthcare in the U.S., Ctd.

Just a brief follow-up from this post, with some additional information on the cost/quality ratio of healthcare in the U.S.:

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A short reminder of why this is a human rights issue, is here.

Limiting Free Speech (28): Free Speech at Work

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Should people be allowed to enjoy an unlimited right to free speech at work, and be able to ask courts to undo measures (such as sacking or disciplinary measures) which their employer has taken against them as a result of their speech? Or do corporations and government agencies have a right to take measures against employees engaging in certain types of speech, a right which therefore trumps the right to speech? And is there a difference between the rights of corporations and the rights of (certain) government agencies?

I could make this brief, and say that employees are citizens like all other citizens, and should have a right to free speech. I could say that, if there are any possible and acceptable (or necessary) limitations on the right to free speech, they have nothing to do with the fact that those engaging in speech act as employees or as citizens. I could say that the place where people speak – at work or elsewhere – doesn’t change anything.

Unfortunately, I can’t. The place where speech takes place does matter, as I have mentioned already in the case of hate speech (hate speech in front of an angry mob gathered at the house of a pedophile is different from the exact same speech written down in a book almost no one reads).

As I will argue, the same is true in the current case. Speech at work may be treated in another way than speech elsewhere. There are some good reasons to impose stricter limits on speech at work than on speech in general. Employers therefore also have the right to take certain measures against employees engaging in speech which may be restricted (in fact, these measures are the restrictions). Also, certain government agencies can impose more and wider restrictions than private corporations. All these restrictions on the freedom of speech are possible because they are necessary for the protection of other rights or the rights of others (I try to make this a general rule when discussing restrictions on human rights, see here).

But before I argue this, I want to sketch the baseline first. Free speech is very important, and I don’t think there are many people who believe this more than me (as any regular reader of this blog knows). As government agencies, but also private corporations, regularly violate human rights, free speech at work is perhaps even more important than free speech in general. People working for agencies or corporations engaged in rights violations, must have the right (and the possibility) to denounce these practices. So, if I argue for the right of corporations and agencies to restrict, in certain cases, the right to free speech of their employees, I have to be careful to do so without jeopardizing the important rights of whistleblowers.

The U.S. Supreme Court, which allows government agencies to limit the freedom of speech of their employees, also acknowledges the importance of whistleblowers. When the speech in question is of “public concern”,* the Court uses a higher threshold to uphold speech-related disciplinary measures against employees. (The Court uses the so-called Pickering test). (However, the Supreme Court is still oddly restrictive in this respect. Whereas, normally, free speech is considered to be very important by the Court, in case of speech at work, “public concern” is not enough to uphold the right to speech. It’s just a first threshold to be passed for the Court to asses the possibility of reviewing disciplinary action. When there is no “public concern”, there’s no right to free speech at work according to SCOTUS!).

Now, when and why should the rights of corporations and government agencies to sanction their employees for acts of speech, take precedence over the right to free speech of these employees? Corporations and agencies have a right to function without disruption. A government agency even has a duty to function without disruption, because it serves the public interest. And this interest more often than not includes certain human rights. For example, a government hospital has a duty to protect the healthcare rights of citizens. If speech acts at the hospital disrupt its normal functioning, the rights of citizens may be put at risk. If, in addition, these speech acts don’t have anything to do with the functioning or organization of the hospital, it is difficult to see why they should be more important than the rights of patients. However, if the speech acts uncover serious incompetence at the hospital, the disruption that follows these acts may be a price that is worth paying.

Regarding corporations, the burden of proof on those wishing to impose restrictions on speech at work, is heavier. Corporations usually don’t work for the protection of human rights of citizens, and therefore cannot put these rights in the balance. However, corporations are the property of certain citizens, and these citizens have a right to use this property. Speech acts in corporations can result in disturbances of a kind that makes this use of property difficult or impossible. If, in addition, these speech acts don’t serve any public purpose or address a public concern, it may be justified to consider the right to property more important than the right to speech, in certain cases. For example, should we really accept and protect flag burning during office hours and in office buildings? And who would take sides with an employee wasting huge amounts of company time on frivolous speech?

And there’s another problem with judicial protection of speech at work. Employees may claim that disciplinary measures taken against them (including dismissal) were based on their speech acts, whereas in reality these measures were based on a lack of performance. Employers may become unwilling to take such measures because of the risk of costly litigation. Outspoken but incompetent employees will then be privileged, and others discriminated. Another result: the employer’s authority and ability to organize and lead are put at risk if many of her decisions can be reversed by judges.

* This “public concern” usually means that the speech in question should have something to do with the preferable manner of operating the agency, or should contain information which is vital to proper decision-making. Both definitions of “public concern” cover the activities of whistle-blowers.

Human Rights Facts (32): Poverty and Obesity

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I already discussed in some length the relationship between poverty and ill health (see here and here). However, I haven’t mentioned one aspect of this relationship, namely obesity. Obesity is obviously a cause of ill health, and now it seems that poor people are more likely to be obese, in the U.S. at least:

There is no question that the rates of obesity and type 2 diabetes in the United States follow a socioeconomic gradient, such that the burden of disease falls disproportionately on people with limited resources, racial-ethnic minorities, and the poor. Among women, higher obesity rates tend to be associated with low incomes and low education levels. The association of obesity with low socio-economic status has been less consistent among men. Minority populations (except for Asian Americans) have higher rates of obesity and overweight than do US whites…

Our central hypothesis is that limited economic resources may shift dietary choices toward an energy-dense, highly palatable diet that provides maximum calories per the least volume and the least cost. The hypothesis [is] that healthier diets may indeed cost more. Adam Drewnowski and SE Specter (source)

This is another fact that supports the idea that poverty reduction will improve a population’s health, just as better healthcare will reduce poverty rates. (See also here). It also supports the more general idea of the interdependence of different human rights, in this case the right to healthcare and the right not to suffer poverty.

Update:

Contrary to conventional wisdom, … the poor have never had a statistically significant higher prevalence of overweight status at any time in the last 35 years. Despite this empirical evidence, the view that the poor are less healthy in terms of excess accumulation of fat persists. (source)

The Causes of Poverty (19): Does Better Healthcare Lead to More Poverty?

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This may look like a stupid – or, more kindly, counterintuitive – question. The answer is obviously “no”. At least when we focus on the level of the individual, better healthcare seems like the best way out of poverty rather than a cause of more poverty. With better health comes better education, better and more productive work, and hence less poverty. Even a society as a whole seems better off if less of its members are unhealthy. Overall productivity and wealth increase when there is less disease. Healthy people produce more, innovate more and contribute in other ways to social wealth. (See this and this post for more on the influence of health - good and bad – on wealth and income).

However, many people believe – wrongly in my view – that the question should be answered in the affirmative, especially when the topic is development aid. When a country drastically improves its healthcare system – thanks to development aid for instance – life expectancy rates will go up and child mortality rates will go down. This results in population growth which often outpaces GDP growth (for example because scarce development resources have been targeted at healthcare rather than GDP). GDP per capita will therefore decrease, which means increasing poverty levels and perhaps even famine. (See here for more on such and other worries of Malthusians).

This type of reasoning is sometimes used to justify limits on development aid in the field of healthcare. However, it’s plainly wrong. Better healthcare doesn’t lead to high population growth, and this non-existing population growth therefore cannot result in more poverty.

Now, why doesn’t better healthcare lead to population growth? With just a few exceptions, it’s the poor countries of the world that have high fertility rates, and when countries become richer, these rates drop dramatically. (See this post). Poverty leads to high fertility rates for a number of reasons (see also here), but the most important one is that people tend to have more children to offset the risk of high infant mortality rates that are typical for poor countries. See these graphs:

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This is corrobated by the folllowing graph, showing that countries with high infant mortality rates also have high population growth (contrary to intuition):

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Some other reasons why high fertility rates are correlated with poverty:

• More developed countries move away from agriculture and towards urban and industrialized economies, reducing the need for children as farmworkers.
• For the same reason, women become more active in the economy, increasing the cost (in money and time) of raising children.
• Also for the same reason, contraceptives and family planning become more common.

In this case, it seems that our initial intuitions are correct.

Human Rights Facts (28): The Recession, Poverty and Human Rights

Beggar asking for a miracle

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In mentioned in a previous post that the current economic recession (or is it a depression already?) has a number of adverse effects on human rights. One obvious effect is an increase in poverty levels. Many people lose their jobs and their homes, and producers and exporters in the third world may be hit by protectionist measures contemplated by developed countries.

We tend to forget that poverty is a human rights issue (see here). And poverty has a knock-on effect on other human rights. When you’re engrossed in the struggle for life you don’t have time for free speech or political participation, your health suffers, your education suffers (see also here) etc.

Hence the importance of unemployment benefits.

These are the best places in the world to be unemployed. In Scandinavia, for instance, you get 80-90 percent of your income for a period ranging — depending on circumstance — from 10 months to four years. Japan gives you 50 to 80 percent of your income for about a year. France gives you 57 to 75 percent of your income for about three years.

The place where you really don’t want to be unemployed: The United States. Here, most of the unemployed don’t qualify for unemployment insurance, and those who do can expect $216.17 a week for 26 weeks. Defenders of the system would say that it’s a spur to get people back to work. Critics would say that it forces people into jobs that present themselves quickly rather than jobs that are actually a good fit, depressing both productivity and happiness. And if you were laid off for no fault of your own and simply can’t find work amidst a sluggish economy — as is the case for many right now — it’s an undeniably stingy benefit. Ezra Klein (source)

Ezra Klein

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Unemployment benefits protect people against poverty, but can also stop the downward spiral of the recession: if the absence or the lack of generosity of unemployment benefits drives people into poverty, they will consume less; hence companies will sell less products and services, which leads to more bankruptcies and more unemployment etc.

Unemployment benefits are both morally necessary (from the point of views of human rights) and economically expedient in times of a recession.

The Environment and Human Rights (2): Water and Human Rights: The International Day of Water, March 22nd

[This post is by guest-writer Line Løvåsen].

Water is what experts label the most important political and environmental issue of the 21st Century. Let me start with a few quotes:

Most people drink about 2 liters of water a day, but consume 3,000 a day if the water that goes into their food is taken into account. Rich countries use more as their consumption of meat, which is far more water-intensive than grain, is higher. Around 1.2 billion people live in places that are short of water, and it is running out in others such as northern China and western America. Meanwhile, the world’s population is growing and more water will be needed to feed it. Farming, which accounts for some 70% of human water consumption, offers the best opportunity for thrift. Repairing leaks and better irrigation in poor countries could help reduce wastage by up to 70%, as could switching to less thirsty crops in arid regions. The Economist (source)

Till taught by pain, men know not water’s worth. Lord Byron

Lord Byron

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Thousands have lived without love-no one without water. W.H. Auden

W.H. Auden

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With these words by Auden starts the film “Flow – for love of water” from 2008 by Irena Salina. The background for the film is the fact that today one billion people are without access to clean water. This leads to diseases and death for millions of people, but also to conflicts and war. The issue of water is now at the very core of peace work. The amount of water is limited, and this raises demands to humanity that we distribute what we have more evenly.

Water is the source of all life on earth. It is essential for earth itself, and for our lives, for our metabolism and sanitation. As the veins and heart make us alive, rivers and oceans are the arteries and heart of earth. Water may be abundant, but fresh water is a scarce good. The earth consists of 70% water, and of this only 2,5% is fresh water. Water is also a prerequisite for economic growth and social development and use of water is a prerequisite for the eradication of poverty.

The uneven distribution of water has always been and continues to be an important cause of conflict and war. The countries that are exposed for these conflicts are those where water is scarce, and those that are dependent on other countries’ rivers. Only one third of development countries have access to clean water, which results in 30.000 deaths every day. 2 million people die every year of water diseases.

One of the UN Millennium Development Goals is to halve the number of people without access to clean water by 2015. I will now examine obstacles on the way to this goal, and some solutions for humanity.

Clean and sufficient water

Water politics is a way of warfare. Countries often use water to pressure or punish each other. For example, they may divert or block rivers, build dams etc. This can result in millions of people being displaced, and water flows to other countries being virtually blocked. Furthermore, it can affect the food supply. Organisms which would flow with the river and feed on other organisms in a natural system evolved through thousands of years, are captured and begin to rot.

Countries may even contaminate water supplies of other countries, by accident or on purpose. Pesticides have often been used in war. One example is Agent Orange in Vietnam War. And pesticides are now making our drinking water undrinkable. Agriculture uses 70% of water, industry 20%, and private consumption 10%. Chemicals used in agriculture and industry affect our drinking water. Aztrazine (herbizide) is the most dangerous and most common in the word, sold by the Swiss company Syngenta, even when it’s banned in its home country. It can travel 1.000 km through rain water.

The lack of clean water is also a problem in parts of the developed world. It’s estimated that 500.000 to 7 million people get sick in the United States each year because of bugs, bacteria and agricultural or industrial chemicals in the tap water. Even if you stick to bottled water, you can take in dangerous chemicals through showering. And a lot of so-called bottled water is in fact tap water, sold at a higher price than gasoline.

Of course, it’s the developing countries that suffer most from the water problem. The amount of money estimated to provide clean drinking water to the entire planet is 1/3 of what we spend on bottled water.

Privatization of water

Water is supposed to be free. It’s a public good that hardly needs any production cost. The process of turning water into a business and privatizing it, is creating problems. It started as a strategy to provide water to more people, but it has opposite effect. There is a tendency to depoliticize privatization as simply a standard economic and commercial transaction between users and private service providers. But this glosses over the important questions of who decides who owns water, and thus owns survival.

Since the late 1970s and early 1980s, privatization has been put forward as one part of a larger reform package intended to stabilize economies and create growth. These reforms were based on the rationale that state planning and expenditure were often less efficient than private actors operating in a free market.

Reforms were recommended by the two most important international financial institutions (IFIs) – the World Bank and the International Monetary Fund (IMF).

The World Bank provides loans to over one hundred developing economies, with the declared aim of helping the poor. Moreover, it is a leading actor in the field of water supply and sanitation. Since 1993, the World Bank has promoted privatization as an answer to the water supply and sanitation crisis. The Water Resources Management Policy Paper states that water should be treated as an economic commodity.

The World Bank says it acknowledges the difficulties with privatization, but remains committed to its belief in the underlying rationale of private participation and continues to find new ways to encourage private investment.

Many corporations that deliver water or use it (such as Coca Cola and Pepsi) are forcing poor countries to hand over control of their water supplies, supported by the policies of the World bank and the IMF.

With the shift from public to corporate service provision promoted by the World Bank, there is a clear democratic deficit. The space for civil society to provide input and decide on a just distribution of water is limited. We are now allowing profit motives to decide the fate of water issues. Profit-based companies will normally only provide water to those they know have the ability to pay. Developing countries have not proven to be profitable for multinational companies and thus there is less investment there.

More on the problem of the privatization of water here.

What needs to be done?

The governments in countries where water is scarce must invest more in the water sector. Especially irrigation can often be much more efficient. International development aid must be more focused on water. The dominant privatization philosophy must be questioned. There must be consent of civil society before policies of water privatization are promoted. Water privatization must not be made a condition of multilateral and bilateral aid, loans or debt cancelation. Clean water must be made available to everyone, at a price affordable for the poor. Governments must have the right to subsidize water to secure adequate access for all.

Resource scarcity is usually considered to be a development question, but research by official Norwegian reports shows that peace work is also an important component. Development is about providing resources, while peace work is relationship building and how to share those resources, as resources can be both a source of peace and war.

Peace work is about raising awareness of the other’s situation. Re-establishing relations is crucial in working towards a common goal. Instead of focusing on water as a source of conflict one should see it as a source of dialogue and negotiations. As an example, even after the first and second intifada, the meetings kept going on between Israelis and Palestinians in the Water Commission.

In 1948, the 30 articles of the Universal Declaration of Human Rights were ratified by most of the nations of the world. These 30 articles guaranteed human rights across many human endeavors, from life to liberty to freedom of thought. Now, sixty years later, recognizing that over a billion people across the planet lack access to clean water and that millions die each year as a result, it is urgent to add one more article to the declaration, the right to water.

The word “water” isn’t mentioned even once in the International Bill of Rights. However, one can assume that the right to water is implicitly included in the right to adequate living conditions, standard of living and food supply (art. 11 of the International Covenant on Economic, Social and Cultural Rights). However, an explicit right to water would be a very good thing.

Privatization of water makes means that without money you will not get any water. It puts water and hence survival out of reach for many people. This is as absurd as the privatization of air. There are some things that shouldn’t be privately owned and traded. Water is for people, not for profit. It is a resource of life, not a property. Just as water, air, sun, moon, stars.

Want to learn more or engage?

• The World’s Water
• WaterNews
• Blue Planet Project
• Water Justice: Resource Center on Alternatives to Privatization
• Blue October Campaign

Racism (6): The Effect of Racism on Cancer

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A new study by Ahmedin Jemal finds that blacks in the U.S. are more likely than any other group to have cancer and die from it. And when they develop cancer, they die sooner. (Death rates for cancer patients have fallen across the board, but the gap between groups is still the same).

Since there is no genetic reason for this, it’s hard not to see it as yet another symptom of anti-black racism (together with higher poverty, higher incarceration rates, etc.). The study shows that whites are diagnosed earlier and hence are more likely to get better, indicating that they receive better healthcare (and this is linked to different poverty rates).

Gender Discrimination (10): Gender Equality, Declining Birth Rates and Overpopulation

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High birth rates or high fertility rates in many developing countries are one of the causes of gender inequality, mainly for the following reasons:

• Continuous child bearing and child rearing imposes a heavy burden on many third world women. These women are deprived of the opportunities to do other things. High birth rates don’t allow them to get a proper education (we see that literacy levels in third world countries are lower for women than for men). And as a result, they don’t have equal opportunities in employment, compared to men.
• On top of that, high birth rates impose considerable health risks to women, especially in developing countries where healthcare systems are often under-performing. This is evident from the high maternal mortality rates in many developing countries.

High birth rates are unobjectionable when they result from the free choices and decisions of women. But of course they don’t in most cases. High birth rates have two primary causes, lack of education and poverty:

• A lack of education means that women often aren’t aware of the available family planning methods. It may also lead women to believe that culture or society somehow requires them to have many children.
• High birth rates are also typical of environments that lack economic security. If poverty is widespread, child mortality rates are high, and women are anxious that their children won’t survive. High birth rates are the result. Poverty also means that there is no or insufficient social security, especially for the elderly. Hence, women decide to have many children. Those children that escape the child mortality statistics can then take care of their parents in old age. Children can also be seen as an economic resource. They can go out and work and increase the family’s income. Generally (but not always) birth rates are high in countries that are poor:

(source, click on the image to enlarge)

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Although in theory when the economy is doing well families can afford to have more children in practice the higher the economic prosperity the lower the birth rate. (source)

So reductions in birth rates are typically associated with increasing gender equality and improvements in the status of women. This is a two-way causation. When birth rates fall, education levels go up, maternal mortality rates go down, etc. And when education levels go up, birth rates go down.

If it is so important for women that birth rates go down, an important question is whether birth rates should be forced down by governments. We see that birth rates go down automatically when education and healthcare are improved, and when poverty is reduced. But some say this isn’t enough, or isn’t going fast enough. The main concern of the people who believe this, isn’t the negative impact of high birth rates on gender equality, but the perceived problem of overpopulation. They say that there is a “population bomb” waiting to explode. According to them, overpopulation is such an urgent problem that we can’t wait for birth rates to go down automatically (or for better food production technologies to be developed etc.). Hence they demand measures such as the “one child policy” that seem to have successfully contributed to bringing down birth rates in China. They may even demand forced sterilization.

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There are many problems with this argument:

• For example, it’s not clear that the “population bomb theory” is true. Both food production and world GDP have risen more rapidly than the world’s population.
• Secondly, freedom isn’t without value, and imposing strict birth control measures takes away people’s reproductive freedom.
• Thirdly, compulsory birth control policies can lead to selective abortions, and neglect or the abandonment of female children. They would therefore undo the main purpose of lower birth rates, namely gender equality.
• It’s also impossible to prove how much birth rates would have gone down had the coercive policies not been implemented. Maybe the correlation between decreasing birth rates and coercive policies (as is the case in China), is just that, a correlation, and nothing more. Maybe the real causes are elsewhere (China has, compared to other developing countries, higher levels of female literacy and employment).

Economic Human Rights (22): Quality of Healthcare in the U.S.

Here are 2 graphs I found on Matt Yglesias’ blog, which, when taken together, paint a rather gloomy picture of the quality of healthcare in the U.S. (a reminder of the way in which this is a human rights issue can be found here):

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Compared to other developed countries, the U.S. spends more on healthcare, but not, it seems, with a lot of success: life expectancy, one if not the most important indicator of the quality of public health, is not as good as elsewhere.

You can find more healthcare statistics here.

Economic Human Rights (20): Health and Wealth

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A few more words about the relationship between poverty and health (see this post for a more detailed discussion).

First of all: both are human rights issues. Article 25 of the Universal Declaration states:

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.

The concern is that people may find themselves in a trap. Their poverty causes ill health because healthcare costs money, because poverty leads to malnutrition etc. And their ill health leads to further poverty, because they aren’t as productive as healthy people.

The ill health of poor people isn’t a problem only for these poor people. If they were more healthy, they would be more productive and more creative, and the economy as a whole and the wellbeing of society as a whole would benefit. Healthy children are also likely to stay in school longer, and hence will be more valuable to society when they grow up.

There is, of course, some obscurity regarding the direction of the causation: rich countries may be more healthy on average mainly because they spend more on healthcare. But it may also be that they have become rich because their health was improved first. Impossible to disentangle all this, because the “wealth of nations” is the result of hugely complex processes of many forces and counter-forces.

For example, there were some developing countries that benefited from WHO assistance after World War II and from breakthroughs in medication (such as penicillin). These countries, therefore, didn’t improve their health through economic growth and increased wealth. Health improvements were caused by external forces. One result of these health improvements was increased life expectancy, but as a result of this increase, there was population growth that went beyond GDP growth, resulting in declining levels of income per head. After some decades, the economic benefits of having more people in the economy, and reduced birth rates caused by better healthcare (and access to contraceptives), reversed the trend. There’s an interesting study by Acemoglu and Johnson here.

Others, however, have pointed out that this is just a tiny piece of the puzzle, and other factors can push societies in other directions. An increase in the population doesn’t necessarily lead to Malthusian problems. International trade and cooperation for example, but also technological improvements have sharply reduced the possible impact on an economy of an increase in population levels.

Income Inequality (9): Absolute and Relative Poverty

The problem of poverty and related problems such as income inequality have received a lot of attention on this blog, because I consider poverty to be one of the most urgent human rights problems. Now and again, I’ve also mentioned the possibility of distinguishing between different types of poverty (here for example), and one such possibility in particular, namely the difference between absolute and relative poverty. Absolute poverty meaning the lack of basic resources, and relative poverty meaning income inequality.

I’ve taken the view that absolute poverty is a more urgent priority than relative poverty (see here), and that therefore measurements of income inequality – such as the Gini coefficient – are less relevant than measurements of absolute poverty – such as the $1 a day measure. It’s the absolute income of people that matters, not the fact that other people are richer than you are and can afford more luxuries, at least from a human rights point of view (the absence of a certain minimum amount of basic resources is a human rights violation in itself and renders many other human rights meaningless; see here).

Inequality of wealth is less urgent than the fight against absolute poverty, and opposition to income inequality can be easily categorized as the politics of envy. If inequality really matters it is the inequality of opportunity and other types of inequality not related to wealth (discrimination for example).

The one exception I was willing to make is the negative influence of high levels of income inequality on the adequate functioning of democracy (see here and here). And I also pointed out that there is a correlation between relative poverty and absolute poverty: countries with relatively unequal income distribution don’t score well on absolute poverty measures either (see here).

Richard Wilkinson

It now seems that I was wrong. Richard Wilkinson has pointed out, some time ago already, that relative poverty matters. Once economic growth has pushed up absolute (albeit average per capita) income levels and done away with penury, people tend to be more healthy and live longer if levels of income inequality are relatively low. Countries with lower per capita income levels but also lower income inequality, can do better in terms of public health than high income countries with higher levels of income inequality. Poorer countries with a more equal wealth distribution are healthier and happier than richer, more unequal ones. Here’s a graph (from another, unrelated study) linking inequality (measured not by Gini but by way of the concentration of wealth in the 10% richest people) to life expectancy and child mortality:

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Some of the reasons are the stress of living at the bottom of the pecking order, the stress of disrespect and the lack of esteem and respect (including self-respect).

This doesn’t mean than countries shouldn’t try to achieve economic growth. I’ve shown here that economic growth and poverty reduction go hand in hand.

Human Rights Maps (36): Number of People With HIV/AIDS

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And, expressed as a percentage of a country’s population, for 2005:

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And for 2008:

Estimated HIV-AIDS prevalence among young adults 15-49 by country as of 2008

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2009:

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This is the evolution of new infections:

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More on HIV/AIDS here and here.

Human Rights Maps (20): Female Genital Mutilation

This map shows the percentages of girls and women aged 15–49 who have experienced FGM in some countries in Africa (source: UNICEF):

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More on female genital mutilation.

The Ethics of Human Rights (11): Organ Trade

(Ares, source)

The shortage of organs for transplantation is a universal problem. The supply of organs is way below the demand. And demand is increasing due to progress in medical science and increasing average age. The demand comes mainly from developed countries. The reason is that life expectancy is higher in these countries, and therefore also the demand for organs. Also, the health care system is more developed and hence more likely to engage in transplants.

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There are two ways to harvest organs: deceased organ donation, and live organ donation.

Deceased organ donation

In some countries, deceased organ donation is hampered by social, cultural, religious, legal and other factors. In some cases, donors have to state their intent while living. They have to opt in. In other cases, they have to opt out and hence they are donors by default, which tends to produce higher rates of donation.
In other cases still, family members of the deceased have to consent, which brings down rates.

Live organ donation

The use of live donors for non-vital organs such as kidneys and parts of liver, for example, is also practiced, but the purchase and sale of transplant organs from live donors are prohibited in many countries.

Transplant tourism and international organ trade

The shortage of a local supply of organs – due to some of the reasons given above, or a combination – has led to the development of transplant tourism and international organ trade. Poor people in developing countries are often forced to donate a non-vital organ; forced by poverty or forced by outright violence. People are kidnapped and operated under duress, and often don’t even get paid. Sometimes they simply get killed because this bypasses the requirement of consent. Corpses are also harvested, not rarely without the consent of the deceased or his or her relatives. The legality of live organ donations in some countries encourages poor people to sell some of their non-vital organs such as kidneys. However, the circumstances in which they are operated can turn a non-vital organ donation into a fatal one.

Rich people travel to countries where these different kinds of harvesting are possible, legally or illegally, and where hospitals are willing to cooperate in such a scheme and are relatively capable so as not to scare away patients. China is a well-known destination because there’s the enormous supply of thousands of people executed every year.

Although those who can afford to buy organs are obviously exploiting those who are desperate enough to sell their organs, the recipients may also suffer from the trade. They may receive substandard or even sick organs.

Some contend that the poor should be allowed to sell their organs, because we merely contribute to their poverty. Exploitation may be morally preferable to death, but given the risk of forced donation and of complications during surgery, this is a slippery slope.

Someone has aptly called the whole business New Cannibalism.

Other issues

One can also see a trend to declare a person dead at an earlier stage than in the past, for example some seconds after cessation of brain activity or heart activity, rather than minutes. Some organs become useless after a certain waiting period. This means shifting the definition of life and death, and perhaps less reanimation enthusiasm. Another, and opposite form of abuse is keeping brain-dead people artificially “alive” as an “organ warehouse” for future donations.

Also, the use of cloning and designer babies for the purpose of organ production is controversial, as is the use of animal organs.

More on the organ trade.

Human Rights Maps (5): Density of Health Workers

A measure of the quality of health care in a county is the number of doctors and other health workers per capita, on the assumption that more doctors and more health workers per capita means better health care and better health care means better health:

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The Causes of Poverty (13): The Vicious Cycle of Poverty and Ill Health

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I’ve written before on poverty traps. In this post, I’ll have a more detailed look at one of these traps. Poverty is both a cause and a result of ill health, which results in a vicious circle that’s very hard to break:

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Poverty as a CAUSE of ill health

Poverty causes ill health because it leads to:

• Insufficient or inadequate food
• Consumption of unhealthy water
• Inadequate sanitation; the poor in urban areas often live in overcrowded communities where there’s too much garbage, poor drainage and other factors that encourage disease
• Insufficient education and knowledge about healthy lifestyles
• People being forced to do unhealthy work
• Inadequate shelter
• People being forced to live in unhealthy environments; many poor people are poor because they are born in poor families or communities, and hence they have a higher risk of communicable disease
• Higher levels of maternal mortality in poor communities/families also increases the risk of ill health for the rest of the community/family: young children have to take over part of the responsibilities for care and income, and as a consequence lose out on education which has consequences for their health (see above)
• Inadequate access to health facilities, because of lack of transport, lack of money to pay for care, lack of knowledge of the possibilities of care, lack of health insurance (see below) etc.
• Many poor people live in poor countries, i.e. countries that lack the funds or other means to create a good public health system, to provide adequate and good quality sanitation, water, energy supply (heating for example) and transportation.

Obviously, poverty is not the only cause of ill health, and all poor people are not ill. An excess of wealth can also create ill health (because of gluttony for example). People have to take care of themselves, and cannot always blame poverty for their predicament.

Poverty as a RESULT of ill health

• People who are sick lose income or often even their job
• Healthcare is expensive, and may push some people into poverty. Here’s a graph showing the poverty rates in the US before and after health expenses:

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• The share of people that fall below the poverty line rises if these expenses are taken into account (especially for the elderly, of course, since they spend more on health care). Since poor people are generally less well protected by health insurance (see below), their expenses will be relatively higher.

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Data

These causal relations show up in the data. It’s no surprise that the data on poverty and health indicators show strong correlations.

Living in poverty is associated with lower life expectancy, high infant mortality, poor reproductive health, higher rates of infectious diseases (notably tuberculosis and HIV infection), higher rates of substance use (tobacco, alcohol and illegal drugs), higher rates of non-communicable diseases, depression and suicide, and increased exposure to environmental risks. Poor children are more likely to die by the age of five years and to suffer from acute respiratory infections, diarrhea, congenital anomalies and chronic diseases. (source)

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Life expectancy in a poor neighborhood of Glasgow, U.K. , is on average 20 years shorter than in the richer parts:

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Black males in the US have a life expectancy of 69, with 87 for Asian females.

What to do?

How do we break out of this vicious circle? All measures that improve the income of people should be taken, and governments should follow and implement the rules on good governance.

Economic Human Rights (14): Health

This post focuses on health and health care. I already wrote posts on the specific subjects of infant mortality, maternal mortality and life expectancy and will not come back to these in the current post.

Health and human rights

Health is a human rights issue in two respects. First, people have a right to health care and health insurance. Article 25 of the Universal Declaration states that

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.

The International Covenant on Economic, Social and Cultural Rights is more specific. Article 7 guarantees the rights to safe and healthy working conditions. Article 10 deals with child labor:

The employment of children in work harmful to their morals or health or dangerous to life or likely to hamper their normal development should be punishable by law.

See also this post on child labor. Article 12 states:

1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. 2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for: (a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child; (b) The improvement of all aspects of environmental and industrial hygiene; (c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases; (d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.

The second way in which health is a human rights issue is the fact that good health is a precondition for the enjoyment of all human rights. In this way, bad health is similar to poverty. You have to be healthy and without pain in order to be able to use freedom rights and political rights. A sick, suffering or toiling person is thrown back upon himself and unable to relate to the outside world, just as a person who concentrates exclusively on his or her body for pleasurable reasons. Intense bodily sensations of any kind – positive and negative – shut us off from the world, because they make it impossible to perceive anything except our own body. In other words, they make the use of our classical rights impossible or undesirable.

Data

Here are some data on health, health care and health insurance:

1. Health

One traditional measure for the health of a population is the average life expectancy. Levels of infant mortality and maternal mortality are also common indicators.

Another measure is the number of doctors and other health workers per capita, on the assumption that more doctors and more health workers per capita means better health care and better health care means better health:

(source)

Still another measure is the level of daily calorie intake per person. Malnourishment leads to health problems, as does over-nourishment. Worldwide, roughly the same number of people are starving as are overweight, and this in an age when the world is producing more food than ever before:

calorie intake

calorie intake

2. Health care

Levels of infant and maternal mortality (see above) are often taken as indicators, not only of the health of a country’s population, but also of the level of quality of its healthcare system (hospitals, doctors, etc.). Many cases of infant or maternal mortality are caused by deficiencies in the local health care systems.

Another indicator of the quality of health care systems is the number of doctors per capita, on the assumption that more doctors per capita means better health care (see also above).

Yet another indicator is the level of government and/or individual health care spending. One assumes that the more governments and individuals spend on health care, the better their health. This isn’t always true (spending can be wasteful or misdirected), but still it’s the case that very low levels of spending indicate poor health care systems:

healthcare spending

Another indicator of the performance of health care systems is the number of people suffering from easily treatable diseases.

3. Health insurance

In some countries such as the US, a majority of people depend on private health insurance. The disadvantage of private insurance is the cost. Relatively poor people cannot afford a good insurance whereas they may run a relatively high risk of disease.

Human Rights Quote (46): Infant Mortality

picture by Kevin Carter, winner of the 1994 Pulitzer Prize

“The child mortality rate—the number of under-fives dying per thousand live births—dropped by almost a quarter worldwide between 1990 and 2006. … Progress in sub-Saharan Africa, where the death rate is highest, has been slower. Around one in six children in the region still die before the age of five and the rate is rising in some countries. Pneumonia, diarrhoeal diseases and malaria together account for more than two-fifths of child deaths.” From The Economist

More on infant mortality.

Gender Discrimination (4): “Global Gender Gap”

The “Global Gender Gap Index 2007”, published by the World Economic Forum, ranks 128 countries according to the level of gender-inequality existing in those countries. This ranking is based on 14 indicators covering political representation, access to education, health and economic participation.

All of the world’s countries are affected by gender-based inequality, but some more than others. The Global Gender Gap Index tries to measure the levels of inequality.

These are the categories that are measured and that make up the global index:

This is the 2007 ranking (there are no long historical series so difficult to analyze evolutions):

Here’s a map of country performances:

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More on gender inequality. More on discrimination.

Human Rights Facts (13): Millennium Development Goals

I’ve mentioned the Millennium Development Goals (MDGs) before. This post gives some more data.

The United Nations agreed the 8 MDGs in 2000, to be reached in 2015. Now, half-way to that deadline, there is progress, but not all regions in the world are doing equally well. However, even in the poorest region – sub-Saharan Africa – some progress has been made.

GOAL 1: ERADICATE EXTREME POVERTY

One of the targets in this goal is to halve the number of people living on less than $1 a day:

There has been substantial progress on this target. Another, related target under this first goal is to halve the number of people suffering from hunger:

On the sub-target of the number of children who are underweight, there has been progress but much more can be done.

See also these posts on the topic of poverty and famine.

GOAL 2: ACHIEVE UNIVERSAL PRIMARY EDUCATION

Target: By 2015, all children to be able to complete a course of primary schooling:

Good progress here, but these data on enrollment do not say anything about the quality of education or the regularity of attendance.

See also this post on literacy and this one on child labor.

GOAL 3: PROMOTE GENDER EQUALITY AND EMPOWER WOMEN

This goal is more vague and less easily measured. One target is the elimination of gender disparity in primary and secondary education no later than 2015. One way to measure this target is to count how many women have secure and paid employment in areas other than agriculture:

See also this post on gender discrimination.

GOAL 4: REDUCE CHILD MORTALITY

Target: Between 1990 and 2015, reduce the under-five mortality rate by two-thirds:

Some progress again, but there are still more than 10 million children who die annually before their fifth birthday, mostly from preventable causes. And a long way away from the target.

See also this post on infant mortality.

GOAL 5: IMPROVE MATERNAL HEALTH

Target: Reduce the maternal mortality rate by three-quarters between 1990 and 2015. Maternal mortality rates remain unacceptably high across the developing world. In sub-Saharan Africa, a woman’s risk of dying from complications during childbirth is 1 in 16, compared with 1 in 3,800 in the developed world. More than half a million women die during pregnancy or childbirth every year, and many millions suffer from inadequately treated complications.

See also this post on maternal mortality.

GOAL 6: COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES

Target: Have halted and begun to reverse the spread of HIV/Aids:

The number of infections seems to be leveling off, but the number of people dying from aids isn’t.

See also this post on aids.

GOAL 7: ENSURE ENVIRONMENTAL SUSTAINABILITY

Also difficult to measure. One of the targets is to halve, by 2015, the proportion of the population without access to drinking water and basic sanitation:

GOAL 8: DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT

The total amount of international development aid is now more than $100 billion a year.

This is the progress that has been made:

(source)

See also this post on development aid.

Related Articles

• Factbox: Progress in the U.N. Millennium Development Goals (reuters.com)
• “UN Millennium Development Goals Summit Tackles PHE” and related posts (newsecuritybeat.blogspot.com)
• The millennium development goals need progressive UK leadership | Juanita During (guardian.co.uk)
• Millennium Development Goals summit opens at UN (cbc.ca)
• Meeting the Millennium Development Goals – can we do it? (leftfootforward.org)
• John W. McArthur: Our Pledges for the Millennium Development Goals (huffingtonpost.com)
• Top 5 Millennium Development Goal success stories (csmonitor.com)

Economic Human Rights (13): Maternal Mortality

Maternal death, or maternal mortality, is the death of a woman during or shortly after a pregnancy. More than half a million women die during pregnancy or childbirth every year, and many millions suffer from inadequately treated complications. About half of these deaths occur in sub-Saharan Africa and about one third occur in South Asia – the two regions together account for about 85 per cent of all maternal deaths. In sub-Saharan Africa, a woman’s risk of maternal death is 1 in 22, compared with 1 in 8.000 in developed countries.

(source)

Major causes

These are the major causes of maternal mortality, as well as the basic remedies:

(source)

Other causes

Other causes of high levels of maternal mortality are:

• Many women have to give birth without the help of a midwife or doctor
• In unsanitary conditions
• Without adequate (nearby) hospitals in case of complications
• Without adequate drug or blood supplies
• Insufficient resources to pay for these services

Preventable

Most maternal deaths are preventable given the easy treatments for infections, blood loss etc. More investments in health systems are needed, but also changes in mentalities and cultural practices so as to take women’s needs more into consideration. Maternal mortality rates are an indicator of a country’s general health service performance and of the cultural position women hold in society. (See this post on gender discrimination).

Progress

There has been some progress for some indicators, for example the number of assisted deliveries:

(source)

Children

Maternal mortality also severely impacts on the children who are left motherless. These children are 10 times more likely than their peers to die within two years of their mothers’ deaths. Young girls who survive are often forced to leave school to care for siblings, and hence diminish their chances of avoiding poverty later in life.

Young mothers

There is a strong correlation between the age of the mother and maternal mortality. Girls between the ages of l0 and 14 are five times more likely to die in pregnancy or childbirth than women aged 20-24. Girls between the ages of 15 and 19 are twice as likely to die:

(source)

Here’s a post on the related topic of infant mortality.

Human Rights Facts (7): Human Development Index

I’ve written about the Human Development Index before on this blog, but only casually. This post is meant to give a more in-depth explanation of the concept.

The word “development” as it is used in terms such as “the developed and developing (or underdeveloped) world”, “international development aid” etc. refers to an evolution or process towards greater quality of life for humans, both physically and spiritually. It encompasses economic growth, health care, education, equality, disaster preparedness, infrastructure, human rights, governance, environment etc.

The process is usually understood as an international one, whereby countries and communities are assisted by others and by the international community as represented in international institutions such as the UN, the World Bank, the IMF etc. Non-governmental organizations (NGO’s) also play an important role.

In 2000, the United Nations declared eight “Millennium Development Goals” (MDG) to be achieved by 2015 or 2020 according to measurable targets and defined indicators:

The measurement of development and of the progress of development is a difficult and complex problem, given the many aspects of development as cited above. Some aspects of the measurement include:

• National GDP
• Literacy rates
• Life expectancy
• Infant mortality rates
• Gini coefficient
• HIV infection rates
• Number of doctors per capita
• Freedom scores
• Governance scores
• Number of PhD’s
• Number of newspapers or other publications
• etc.

While each component of development is relatively easy to measure (given adequate national statistics), their aggregation and relative weighting is complex and controversial. Hence it is difficult to measure a country’s overall development rate. A simplified and widely accepted overall measurement is the “Human Development Index” (HDI). The HDI combines measures of life expectancy, literacy, educational attainment, and GDP per capita for countries, so only 4 of several possible development measures, which is why some have called the HDI a “crude” measurement. The index was developed in 1990 by Mahbub ul Haq, Sir Richard Jolly, Gustav Ranis and Lord Meghnad Desai.

The following 2 graphs show the HDI in 2002 and 2007:

This graph shows the different levels of progress by continent:

What Are Human Rights? (15): Constitutionally Universal

The theme of this post is the often difficult relationship between citizenship and human rights. This relationship is difficult because human rights, which are explicitly rights for all people everywhere, without distinctions of any kind, seem to require citizenship, and hence a distinction between groups of somehow differentiated people, for their protection. Without citizenship, it is argued, human rights remain a wish rather than a reality, potential rather than effective. Indeed, we often see that non-citizens such as refugees, asylum-seekers or stateless people suffer more rights violations than the citizens of the countries in which they happen to find themselves, even if these countries are comparatively well functioning democracies.

I want to argue that there are no legal reasons to consider citizenship as some kind of necessary condition for the protection of the rights of people within the territory of a state. Or, to put it negatively, that there are no legal reasons to treat the rights of non-citizens with less respect than the rights of citizens, or to accept violations of the rights of non-citizens with more ease than violations of the rights of citizens. There has to be, in other words, equality of protection between citizens and non-citizens. Citizenship therefore should be irrelevant for the protection of the human rights of the people within a given state territory. The state should be blind in this respect and treat non-citizens as if they were citizens. Non-citizens should have the same legal, judicial and other means to stand up for their rights.

The legal argument is based on Article 2, paragraph 1 of The International Covenant on Civil and Political Rights, which states the following:

“Each State Party to the present Covenant undertakes to respect and to ensure to all individuals within its territory and subject to its jurisdiction the rights recognized in the present Covenant, without distinction of any kind, such as race, color, sex, language, religion, political or other opinion, national or social origin, property, birth or other status”.

Albert Einstein receiving from Judge Phillip Forman his certificate of American citizenship

The widely held but mistaken belief that the rights of non-citizens residing in a state are, perhaps inevitably, more precarious than the rights of the citizens living beside them, goes back to the historically important role of citizenship in the practice of protecting human rights. Theoretically, citizenship is irrelevant to human rights. These rights are the equal rights of all human beings, equally and unconditionally. It is not justified to say that one should be white, male, citizen or whatever to be able to enjoy the protection of these rights. Universality, equality and unconditionality are perhaps the main characteristics of human rights. That is where they got their name. They would not be called human rights if this were not the case.

Although theoretically these rights come with no conditions attached, in reality and in practice there are many necessary conditions for their effective protection: a well functioning judiciary, a separation of powers, a certain mentality, certain economic conditions etc. Too many to name them all, unfortunately. But the one we should name and explain is citizenship. Historically, it was because people were citizens of a state that they could use and improve the institutions and judicial instruments of the state, including the executive powers, to enforce their rights. It is this historical contingency, the fact that people have always found their citizenship very useful for their human rights, which has led many to believe that there is some kind of special link between citizenship and human rights which makes it possible and acceptable to treat the rights of non-citizens with less respect. That rights are only accessible to citizens. That the rights of man have often been the “rights of an Englishman” in the words of Burke.

Edmund Burke

(source)

“The survivors of the extermination camps, the inmates of concentration and internment camps, and even the comparatively happy stateless people could see … that the abstract nakedness of being nothing but human was their greatest danger” (Hannah Arendt, The Origins of Totalitarianism).

Hannah Arendt

(source)

The state, although it does not grant rights, has to recognize them and make them real, but not only for citizens. The constitution, the main instrument for recognizing human rights, should and nowadays often does explicitly guarantee rights for humans, and not merely rights for citizens. Everybody within the territory of the state, not only the citizens of the state, can then enjoy the human rights protected by the constitution. Citizens as well as non-citizens can then go to court and challenge unjust laws or acts of state. Both categories of people have legal personality. This is often called the constitutional universality of rights.

The protection of the economic rights of non-citizens is an even more contentious matter. Should non-citizens have the same healthcare protection, social security, education etc.? In principle yes, but some countries may have such a large number of non-citizens in their territory that the economic viability of their social security system comes under threat. The tax payers ability to fund the system is limited, and non-citizens normally don’t pay taxes.

More on migration.

Economic Human Rights (12): Life Expectancy

(copyright Ron Tandberg)

Life expectancy, or the average length of life in a given population (mostly a country), is of importance to the issue of human rights. A low life expectancy means shorter life spans. Now, it’s not because a life is relatively short that is has to be less fulfilling, less happy or less meaningful. However, it is obvious that a longer life will allow for more activity, self-development and freedom, and hence for more enjoyment of human rights, than a shorter life.

Moreover, longer life expectancies are often an indicator of better health and healthcare, and good health is a prerequisite for human rights. Bad average health or healthcare and low life expectancy, on the contrary, are indicators of poverty, and poverty is in itself a violation of certain human rights and makes other human rights impossible.

Life expectancy in Western countries today is almost double what it was in the pre-modern era. This is the consequence of highly reduced infant mortality rates, modern medicine (e.g. before modern medicine, one in four women died in childbirth), improvements in sanitation (sewers) and nutrition, etc. Especially in the last century did we see enormous progress. In the US for example, life expectancy at the beginning of the 1900s was 50 years. At the end of the same century it was 77 (with differences of course between male and female and between social classes; poverty, in particular, has a substantial effect on life expectancy).

Of course, as in most cases, the developing countries haven’t achieved the same levels as the West. They have improved their numbers but there are still large and shocking inequalities in life expectancy, with Africa again bearing the heaviest burden. Sub-Saharan Africa (partly because of HIV) has even seen a decrease in life expectancy during the last decades. The former USSR also saw a decrease.

A person’s life in one of the poorest countries will on average be half as long as the life of a person fortunate enough to be born in a rich country.

(High infant mortality rates in a particular country (see this post), can bring down rates of life expectancy at birth drastically. In these cases, another measure such as life expectancy at age 5 can be used to exclude the effects of infant mortality to reveal the effects of causes of death other than early childhood causes. However, that’s somehow “cooking the books” since infant mortality does reduce the life expectancy of the infants in question. On the other extreme are some people who want to include aborted fetuses in life expectancy rates).

Children’s Rights (1): Infant Mortality

Infant mortality is the number of deaths of children aged one year or younger, per 1000 live births. This gives the Infant mortality rate (IMR). The rates have significantly declined over the last centuries, mainly due to improvements in basic health care, and in all regions of the world.

However, there’s still a long way to go, especially in developing countries. From the following graph we can see that in several African countries as well as in India, 1 in 10 babies die before they reach the age of 1. That’s horrendous.

Inequalities are extreme: Angola had the highest IMR in 2007: 184. And Sweden the lowest: 2.8. In a country like Bangladesh, 153,000 newborns die each year. Multiply this with the number of non-newborns death before the age of 1, and with a number of similar countries, and with a number of consecutive years, and you have an enormous massacre.

Infant mortality rate is commonly included as a part of standard of living evaluations in economics. However, the Human Development Index, or HDI (see this post), does not include it and focuses on life expectancy at birth as an index of population health.

The most common causes in developing countries are pneumonia and dehydration from diarrhea. The latter cause is a real scandal given the ridiculously easy remedy: Oral Rehydration Solution, or ORS, a mixture of salts, sugar, and water. In developed countries the causes are congenital malformation, birth defects, extreme prematurity, disease, and Sudden Infant Death Syndrome (SIDS). Neglect, abuse or outright murder are also important causes.

The infant mortality rate is an indicator of state failure. As the IMR indicates the level of a country’s health, health care system or development, an extremely high IMR can corroborate the statement that a particular state is a “failed state” in the sense that it fails in its basic responsibilities to its citizens.
Not surprisingly, wealthy countries – wealthy in the commonly accepted sense of high GDP per capita – have a lower IMR because they have the means to invest in healthcare, sanitation, drugs etc.:

I guess it’s obvious why this is a human rights issue: you can hardly say that people can enjoy their human rights when they die before they are 1. Of course, it’s not as if someone is directly violating these children’s right to life. Infant mortality is in most cases not a deliberate act. But rights can be violated by act as well as omission. In many cases, it’s easy to prevent the child from dying, and those who have the power to do something about it also have the responsibility.

The under-1 age limit for infant mortality is perhaps too restrictive. An additional indicator is the number of deaths of children under-5:

Economic Human Rights (6): Health

 

(source)

Bad health and suffering create the same problems as poverty. You have to be healthy and without pain, in order to have a cultural and political life and to be able to use freedom rights and political rights. A sick, suffering or toiling person is thrown back upon himself and unable to relate to the outside world, just as a person who concentrates exclusively on his or her body for pleasurable reasons.

Intense bodily sensations of any kind – positive and negative – shut us off from the world, because they make it impossible to perceive anything except our own body. In other words, they make our public and political life and the use of our classical rights impossible or undesirable.

Hunger and consumption, as well, force you to concentrate on yourself and your body. You do not have the time, the energy or the desire to concentrate on the world. When you are eating or thinking of eating, you are imprisoned in cyclical biological necessities and in your metabolism with nature necessary for the preservation of life. You have to avoid sickness, pain and hunger – as well as their extreme opposites – to be open to the world and fit for cultural and political life.

More on health.

Human Rights Cartoon (6): Health

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This cartoon is about one of the so-called “social and economic rights“, a subset of the system of human rights. And a very contested subset, especially in the U.S. Even many rights proponents often only recognize or prioritize freedom rights/civil rights. Economic rights are often considered to be less important or not even rights at all.

The right not to suffer bad health and to have assistance when suffering bad health is however a very important prerequisite for the full enjoyment of all other rights. And it doesn’t seem fair to have people privately ensure themselves against health misfortune because poor people, the ones most likely to suffer disease, do not have the means for such an insurance.

More on health.