19. Memorandum from Physicians for Human
Rights-UK
I. INTRODUCTION
Physicians for Human Rights-UK [hereinafter
PHR-UK] is grateful to the Joint Committee on Human Rights for
this opportunity to comment on the UK's Report and the Concluding
Observations of CESCR. We respond to your questions from the perspective
of our particular expertise in the right to health, which is the
subject of Article 12 of the ICESCR.
In May 2002, PHR-UK submitted a parallel report
on Article 12 of the International Covenant on Economic, Social
and Cultural Rights to the Committee on Economic, Social and Cultural
Rights, [hereinafter the Committee] at the time of the UK's fourth
periodic report. PHR-UK's senior advisor presented oral evidence
from the report to the Committee on 29 April 2002.
Article 12 deals with the right to the highest
attainable standard of physical and mental health. It has been
the subject of a General Comment by the Committee, which was adopted
in May 2000, more than two years after the UK previously presented
a report to the Committee. PHR-UK modelled its report on that
General Comment. See Appendix 1 for further on this.
The report presented evidence that decisions
about access to investigations and treatment are sometimes based
upon whom patients are, rather than their health care needs. Research
indicates for instance that some doctors discriminate against
many vulnerable groups including the elderly people, people with
learning disabilities, and women in terms of life saving primary
and secondary care of coronary heart disease.
A number of the recommended questions for the
UK delegation proposed within the PHR-UK report, were put to the
UK delegation by Committee members during their dialogue on 6-7
May. In its Concluding Observations, the Committee expressed concern
at "de facto discrimination in relation to some marginalised
and vulnerable groups" and urged the UK government to ensure
that the human rights education curricula and training programmes
for doctors (amongst others) give adequate attention to the right
to the highest attainable standard of health.
PHR-UK sent a copy of its parallel report to
the Foreign and Commonwealth Office in April 2002 but apart from
a request for a copy of the report, there has been no other response.
II. REPLY TO
THE JOINT
COMMITTEE'S
SPECIFIC QUESTIONS
Is there a case for incorporation of guarantees
of economic social and cultural rights in UK law? Can the Covenant
rights be adequately protected without incorporation?
Until the Covenant on Economic Social and Cultural
Rights becomes incorporated within UK law, its articles will remain
non-binding and risk remaining inadequately observed. On past
record, the UK will remain less than diligent over observation
of the rights within, until they are justiciable. We note, for
example, two recent official National Health Service guidelines,
on controlling disturbed behaviour in people with learning disabilities,
and on criteria to assess whether a patient should be resuscitated
or not, both quote from the 1998 Human Rights Act (predominantly
civil and political rights), yet ignore the more relevant International
Covenant on Economic, Social and Cultural Rights with its pre-eminent
authority on the right to the highest attainable standard of health—General
Comment. [154]
Can you provide evidence of areas where you believe
the lack of such guarantees leads to lesser or unsatisfactory
protection of economic, social and cultural rights, such as to
breach the UK's obligations under the Covenant?
The areas are listed below, along with the criteria
derived from General Comment 14, which validate each recommendation.
It is our view that legislation on these social rights would lead
to their protection. The areas are formulated as questions that
are prompted by the violations of Article 12 enumerated in the
PHR-UK report, "Physicians for Human Rights-UK—Report
to the United Nations Committee on Economic, Social and Cultural
Rights: Response to the UK Governments Fourth Report under the
International Covenant on Economic, Social and Cultural Rights—Article
12 the Right to Health."
The government should be asked whether it will
make condoms and clean needles for drug users available to prisoners
for HIV prevention, and provide appropriate immunisation.
Required under UK obligations to:
(i) refrain from limiting access to contraceptives
and other means of maintaining sexual and reproductive health;
(ii) ensure public health infrastructures
that provide for sexual and reproductive health services;
(iii) take measures to protect consumers
and workers from practices detrimental to health, and ensure that
third parties do not limit people's access to health-related information;
(iv) adopt measures against environment and
occupational health hazards and against any other threat as demonstrated
by epidemiological data;
(v) ensure that third parties do not limit
people's access to health-related information and services for
behaviour-related health concerns, such as sexually transmitted
diseases, in particular HIV/AIDS, and others adversely affecting
sexual and reproductive health;
(vi) establish and promote prevention and
education/information campaigns for behaviour-related health concerns
such as HIV/AIDS;
(vii) promote sexual and reproductive health
by discouraging domestic violence, the abuse of alcohol and the
use of cigarettes, narcotics and other harmful substances;
(viii) ensure the provision of health care,
including immunisation programmes against major infectious diseases;
(ix) take measures to refrain from denying
or limiting equal access for all persons including prisoners,
detainees, minorities, asylum seekers and illegal immigrants,
to preventative, curative, and palliative health services.
PHR-UK members have not reported any changes
consistent with Article 12.
The government should be asked what steps it
will take to ensure the healthcare needs of people with learning
disabilities are met.
Required under UK obligations to:
(i) take measures to refrain from denying
or limiting equal access for all persons including prisoners,
detainees, minorities, asylum seekers and illegal immigrants,
to preventative, curative, and palliative health services;
(ii) take measures to ensure that medical
practitioners and other health professionals meet appropriate
standards of education, skill and ethical codes of conduct;
(iii) take measures to ensure the provision
of sufficient numbers of hospitals, clinics and other health-related
facilities;
(iv) take measures to ensure the appropriate
training of doctors and other medical personnel;
(v) take measures to ensure health services
are culturally appropriate and that health care staff members
are trained to recognise and respond to the specific needs of
vulnerable or marginalised groups;
(vi) focus expenditure on rectifying existing
imbalances in the provision of health services, goods and facilities.
PHR-UK members have not reported any changes
consistent with Article 12.
The government should be asked what steps it
will take to ensure that people with HIV have adequate access
to healthcare, and to protect people with HIV from discrimination
in the healthcare system.
Required under UK obligations to:
(i) take measures to refrain from denying
or limiting equal access for all persons including prisoners,
detainees, minorities, asylum seekers and illegal immigrants,
to preventative, curative, and palliative health services;
(ii) take measures to ensure that medical
practitioners and other health professionals meet appropriate
standards of education, skill and ethical codes of conduct;
(iii) take measures to ensure the provision
of sufficient numbers of hospitals, clinics and other health related
facilities;
(iv) take measures to ensure the appropriate
training of doctors and other medical personnel;
(v) take measures to ensure health services
are culturally appropriate and that health care staff members
are trained to recognise and respond to the specific needs of
vulnerable or marginalised groups;
(vi) focus expenditure on rectifying existing
imbalances in the provision of health services, goods and facilities.
PHR-UK members have not reported any changes
consistent with Article 12.
The government should be asked what measures
are being taken to target HIV education at vulnerable groups and
provide medical services for communities with high rates of HIV.
Required under UK obligations to:
(i) take measures to refrain from denying
or limiting equal access for all persons including prisoners,
detainees, minorities, asylum seekers and illegal immigrants,
to preventative, curative, and palliative health services;
(ii) take measures to ensure that medical
practitioners and other health professionals meet appropriate
standards of education, skill and ethical codes of conduct;
(iii) take measures to ensure the provision
of sufficient numbers of hospitals, clinics and other health-related
facilities;
(iv) take measures to ensure the appropriate
training of doctors and other medical personnel;
(v) take measures to ensure health services
are culturally appropriate and that health care staff members
are trained to recognise and respond to the specific needs of
vulnerable or marginalised groups;
(vi) focus expenditure on rectifying existing
imbalances in the provision of health services, goods and facilities.
PHR-UK members have not reported any changes
consistent with Article 12.
The government should be asked what steps are to
be taken to avoid discrimination in healthcare against elderly
people.
Required under UK obligations to:
(i) take measures to refrain from denying
or limiting equal access for all persons including prisoners,
detainees, minorities, asylum seekers and illegal immigrants,
to preventative, curative, and palliative health services;
(ii) take measures to ensure that medical
practitioners and other health professionals meet appropriate
standards of education, skill and ethical codes of conduct;
(iii) take measures to ensure the provision
of sufficient numbers of hospitals, clinics and other health related
facilities;
(iv) take measures to ensure the appropriate
training of doctors and other medical personnel;
(v) take measures to ensure health services
are culturally appropriate and that health care staff members
are trained to recognise and respond to the specific needs of
vulnerable or marginalised groups;
(vi) focus expenditure on rectifying existing
imbalances in the provision of health services, goods and facilities.
PHR-UK members have not reported any changes
consistent with Article 12.
The government should be asked what measures
it is adopting to eliminate discrimination in the selection for
training as, and employment of, doctors from certain groups.
Required under UK obligations to:
(i) take measures to refrain from denying
or limiting equal access for all persons including prisoners,
detainees, minorities, asylum seekers and illegal immigrants,
to preventative, curative, and palliative health services;
(ii) take measures to ensure that medical
practitioners and other health professionals meet appropriate
standards of education, skill and ethical codes of conduct;
(iii) take measures to ensure the provision
of sufficient numbers of hospitals, clinics and other health related
facilities;
(iv) take measures to ensure the appropriate
training of doctors and other medical personnel;
(v) take measures to ensure health services
are culturally appropriate and that health care staff members
are trained to recognise and respond to the specific needs of
vulnerable or marginalised groups;
(vi) focus expenditure on rectifying existing
imbalances in the provision of health services, goods and facilities.
PHR-UK members have not reported any changes
consistent with Article 12.
The government should be asked what measures
it is adopting to eliminate bullying from the training or the
employment of doctors, particularly those from certain groups.
Required under UK obligations to:
(i) take measures to refrain from denying
or limiting equal access for all persons including prisoners,
detainees, minorities, asylum seekers and illegal immigrants,
to preventative, curative, and palliative health services;
(ii) take measures to ensure that medical
practitioners and other health professionals meet appropriate
standards of education, skill and ethical codes of conduct;
(iii) take measures to ensure the appropriate
training of doctors and other medical personnel;
(iv) take measures to ensure health services
are culturally appropriate and that health care staff members
are trained to recognise and respond to the specific needs of
vulnerable or marginalised groups.
Bullying is still an issue within healthcare,
as described in a British Medical Journal editorial of 12 April,
2003. BMJ 2003;326:776-777
PHR-UK members have not reported any changes
consistent with Article 12.
The government should be asked what strategies
are in place to ensure access for everyone in need of it to palliative
care.
Required under UK obligations to:
(i) take measures to refrain from denying
or limiting equal access for all persons including prisoners,
detainees, minorities, asylum seekers and illegal immigrants,
to preventative, curative, and palliative health services;
(ii) take measures to ensure that medical
practitioners and other health professionals meet appropriate
standards of education, skill and ethical codes of conduct;
(iii) take measures to ensure the provision
of sufficient numbers of hospitals, clinics and other health-related
facilities;
(iv) take measures to ensure the appropriate
training of doctors and other medical personnel;
(v) take measures to ensure health services
are culturally appropriate and that health care staff members
are trained to recognise and respond to the specific needs of
vulnerable or marginalised groups;
(vi) focus expenditure on rectifying existing
imbalances in the provision of health services, goods and facilities.
PHR-UK members have not reported any changes
consistent with Article 12.
The Government should be asked what human rights
education currently takes place in medical schools, and what measures
it is taking to increase this.
Required under UK obligations to:
(i) take measures to refrain from denying
or limiting equal access for all persons including prisoners,
detainees, minorities, asylum seekers and illegal immigrants,
to preventative, curative, and palliative health services;
(ii) take measures to ensure that medical
practitioners and other health professionals meet appropriate
standards of education, skill and ethical codes of conduct;
(iii) take measures to ensure the appropriate
training of doctors and other medical personnel;
(iv) take measures to ensure health services
are culturally appropriate and that health care staff members
are trained to recognise and respond to the specific needs of
vulnerable or marginalised groups.
PHR-UK members have not reported any changes
consistent with Article 12.
The government should be asked what measures
are being taken to ensure that palliative services are culturally
suitable for all ethnic and socially deprived groups, including
people with learning disabilities.
Required under UK obligations to:
(i) focus expenditure on rectifying existing
imbalances in the provision of health services, goods and facilities;
(ii) take measures to refrain from denying
or limiting equal access for all persons including prisoners,
detainees, minorities, asylum seekers and illegal immigrants,
to preventative, curative, and palliative health services;
(iii) take measures to ensure that medical
practitioners and other health professionals meet appropriate
standards of education, skill and ethical codes of conduct;
(iv) take measures to ensure the provision of sufficient
numbers of hospitals, clinics and other health-related facilities;
(v) take measures to ensure the appropriate
training of doctors and other medical personnel;
(vi) take measures to ensure health services
are culturally appropriate and that health care staff members
are trained to recognise and respond to the specific needs of
vulnerable or marginalised groups.
PHR-UK members have not reported any changes
consistent with Article 12.
The government should be asked when it will
enact legislation that allows the recognition of the right to
health in domestic law.
Required under UK obligations to give sufficient
recognition to the right to health in national political and legal
systems, preferably by way of legislative implementation.
There have been no reported changes consistent
with Article 12.
What steps could be taken to make the reporting
process more useful or relevant to government or wider civil society?
The reporting process would be more useful and
relevant if the Committee on Economic, Social and Cultural Rights
would establish a Rapporteur to follow up on the reporting process,
and monitor any action taken by the government in response to
its Concluding Observations in the same way as the treaty monitoring
body of its sister Covenant does.
The Government should make the Concluding Observations
widely available to all relevant governmental and civil bodies
within four weeks of receiving them, which is normally at the
close of the Committee's periodic meeting.
Civil Society organisations should follow up
on the reporting process by advising the Committee of any developments
in implementation, particularly with respect to the Committee's
Concluding Observations, as NGOs from other States Parties, such
as Japan, have done.
NGOs writing to the Committee or providing parallel
reports might consider whether following the structure of the
Committee's General Comments could enhance the effectiveness of
their communications.
The Reporting Process
The CESCR recommended dissemination of the concluding
observations widely at all levels of society, in particular among
State officials and the judiciary. It also recommended that the
UK should involve NGOs and other members of civil society in the
preparation of its next periodic report. The Joint Committee would
welcome views on the reporting process, on its accessibility to
NGOs, trade unions and interested individuals, on the possibilities
for co-operation with government and with the UN, and on the dissemination
of the government Report and the concluding observations. The
Joint Committee seeks views on the following matters.
What more could be done to increase awareness
of the reporting process? What steps could be taken to make the
reporting process more useful or relevant to government or wider
civil society?
The Government should inform health authorities,
associations of health professionals, royal colleges, medical
schools, patients' associations, bodies specialising in particular
medical conditions and human rights groups at least two years
before the UK periodic report to the Committee is due. A copy
of the previous concluding observations together with relevant
details about the committee and how to contact it should accompany
this information.
The Government should hold a meeting for NGOs
and others 12 months before it plans to publish its report, and
consult with them during the drafting of the report.
The Government should provide funds to an independent
trust to ensure that sufficient resources are available to enable
civil society organisations to share their expert knowledge with
one another, with the Government and with the Committee.
The Government should ensure that health professionals
are taught about health and human rights to ensure that medical
practice adheres to human rights law and that health professionals
interest themselves in the Committee's Concluding Observations.
III CONCLUSION
PHR-UK has sought to provide the Joint Committee
with evidence in response to all of the issues it has raised.
We have done this from the perspective of our specialised knowledge
on the right to health. We have, in the process, sought to raise
matters we feel should be considered in the context of the UK's
report under the ICESCR or the UN Committee's observations upon
it. We would be happy to supply any further information that would
assist the Joint Committee in its considerations.
April 2003
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