Transcript Inflammatory Bowel Disease and Cancer an update from

Epidemics: When Public Health and
Human Rights Collide
Epidemics Then & Now
University of Chicago’s Summer Institute for Educators
June 29, 2006
John Schumann, MD
Assistant Professor of Medicine
MacLean Center for Clinical Medical Ethics
Human Rights Program
University of Chicago
Objectives
• Define Epidemics
• Explore concepts of Human Rights; Health & HR
• Discuss the inherent collisions
– Abrogating an individual’s rights
• Case examples
• Rights (priorities) to scarce resources
– What is the public’s right to information during an outbreak?
– Vaccinations or medications
• Links to literature
Influenza pandemic, 1919
WPA Poster, 1930s
Avian flu, 2007(?)
Epidemics
• In epidemiology, an epidemic (from Greek epi- upon + demos
people) is a disease that appears as new cases in a given
human population, during a given period, at a rate that
substantially exceeds what is "expected", based on recent
experience (the number of new cases in the population during a
specified period of time is called the "incidence rate").
• Defining an epidemic can be subjective, depending in part on
what is "expected". An epidemic may be restricted to one locale
(an outbreak), more general (an "epidemic") or even global
(pandemic). Because it is based on what is "expected" or
thought normal, a few cases of a very rare disease like rabies
may be classified as an "epidemic", while many cases of a
common disease (like the common cold) would not.
Epidemics
• Common diseases that occur at a constant but
relatively high rate in the population are said to be
"endemic". An example of an endemic disease is
malaria in some parts of Africa (for example, Liberia)
in which a large portion of the population is expected
to get malaria at some point in their lifetimes.
• Famous examples of epidemics include the bubonic
plague epidemic of Medieval Europe known as the
"Black Death", the Great Influenza Pandemic
concurring with the end of World War I, and the
current AIDS epidemic, which some also consider to
be of pandemic proportions.
Epidemics
Non-biological usage:
• The term is often used in a non-biological sense to
refer to widespread and growing societal problems,
for example, in discussions of mental illness or drug
addiction.
-from Wikipedia
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Biomedical Epidemics
-Some examples from this
week:
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Contagion
Mesopotamia
Small pox
Diptheria
Pertussis
Tetanus
Cholera
Polio
Black Death
Ceratophyllus faciatus
Social/Political Epidemics
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Torture
Human rights
Nuclear weapons
Gun violence
Domestic violence
Accident prevention
Capital punishment
Female genital mutilation
Education (lack of access or equal opportunity)
Public Health Prevents Epidemics
• Elvis Presley gets vaccinated for Polio (1956)
Human Rights
• Universal declaration of human rights (1948)
Human Rights
• Universal Declaration of Human Rights (UDHR)
• Article I
– All human beings are born free and equal in dignity and rights.
They are endowed with reason and conscience and should act
towards one another in a spirit of brotherhood.
• Article 2
– Everyone is entitled to all the rights and freedoms set forth in
this Declaration, without distinction of any kind, such as race,
colour, sex, language, religion, political or other opinion,
national or social origin, property, birth or other status.
UDHR (1948)
• Article 3
– Everyone has the right to life, liberty and security of
person.
• Article 4
– No one shall be held in slavery or servitude; slavery and
the slave trade shall be prohibited in all their forms.
• Article 5
– No one shall be subjected to torture or to cruel, inhuman
or degrading treatment or punishment.
UDHR (1948)
• Article 9
– No one shall be subjected to arbitrary arrest, detention or
exile.
• Article 13
– (1) Everyone has the right to freedom of movement and
residence within the borders of each State.
– (2) Everyone has the right to leave any country, including his
own, and to return to his country
UDHR (1948)
• Article 25
– (1) Everyone has the right to a standard of living adequate
for the health and well-being of himself and of his family,
including food, clothing, housing and medical care and
necessary social services, and the right to security in the
event of unemployment, sickness, disability, widowhood, old
age or other lack of livelihood in circumstances beyond his
control.
– (2) Motherhood and childhood are entitled to special care
and assistance. All children, whether born in or out of
wedlock, shall enjoy the same social protection.
Is it ever OK to limit human rights?
Is it ever OK to limit human rights?
Torture
Lancet 2004; 364: 725-29
The article became a book—published June 27, 2006
Siracusa Principles (1985 update to the 1966 ICCPR)
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The restriction is provided for and carried out in
accordance with the law.
The restriction is in the interest of a legitimate
objective of general interest.
The restriction is strictly necessary in a democratic
society to achieve the objective.
There are no less intrusive and restrictive means
available to reach the same goal.
The restriction is not imposed arbitrarily, i.e., in an
unreasonable or otherwise discriminatory manner.
Why Protect Public Health using
a Human Rights Framework?
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Now more than ever
Darfur, AIDS, Avian Flu, Tsunami, Katrina
Disparities at home
Curricula?
Engagement
Doctor-Global Level Issues
• Disparity of resource allocation
– Industrialized economies vs. “rest”
• Disparity in health outcomes
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TB/AIDS
Malaria
Maternal/child health
Preventable diseases
Nutrition
Severe Acute Respiratory Syndrome
(SARS)
Quarantine
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Quarantine refers to the separation and restriction of movement of
persons who, while not yet ill, have been exposed to an infectious
agent and therefore may become infectious. Quarantine of exposed
persons is a public health strategy, like isolation, that is intended to stop
the spread of infectious disease. Quarantine is medically very effective
in protecting the public from disease.
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States generally have authority to declare and enforce quarantine
within their borders. This authority varies widely from state to state,
depending on state laws. The Centers for Disease Control and
Prevention (CDC), through its Division of Global Migration and
Quarantine, also is empowered to detain, medically examine, or
conditionally release persons suspected of carrying certain
communicable diseases. This authority derives from section 361 of the
Public Health Service Act (42 U.S.C. 264), as amended.
Severe Acute Respiratory Syndrome
(SARS)
Siracusa Principles (1985 update to the 1966 ICCPR)
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The restriction is provided for and carried out in
accordance with the law.
The restriction is in the interest of a legitimate
objective of general interest.
The restriction is strictly necessary in a democratic
society to achieve the objective.
There are no less intrusive and restrictive means
available to reach the same goal.
The restriction is not imposed arbitrarily, i.e., in an
unreasonable or otherwise discriminatory manner.
What is the public’s right to information?
World Health Organization
• Promoter of Health and Human Rights
• Handles outbreaks and sets policy regarding global
health problems
www.phrusa.org
Health Care Justice
The Special Role of the Physician
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Healer/Comforter
Intermediary
Interpreter
Advocate
Oath-taker
Seeker of Excellence (outstanding care, quality
improvement, scientific advancement)
• Societal Respect
• High-Mindedness
The Special Role of the Physician
• Societal responsibility
• Ethical imperative
• No other profession like it—so much trust with
personal and private information
• Seek social justice, global health
Ken Fox, MD, Pritzker Class of 1989
Pediatrician, Erie Family Health Center, Chicago
Medical Director, Reach out and Read
Soros Physician Advocacy Fellow
Ken Fox, MD, Pritzker Class of 1989
Epidemic: Literacy
Allen Keller, MD
Internist, Bellevue Hospital, New York
Member, Physicians for Human Rights (PHR)
Founder, NYU Program for Survivors of Torture
Allen Keller, MD
Epidemic: Torture
Paul Farmer, MD, PhD
Infectious Disease, BWH, Boston
Founder, Partners in Health
Global Reduction in death from AIDS/TB in
the world’s poorest nations
Paul Farmer, MD, PhD
Epidemic: HIV/AIDS, TB, Poverty, Global Apathy
Links to Literature
• Albert Camus
(1913-1960)
• ‘The Plague’
(1946)
Links to Literature
• Randy Shilts (19511994)
• Chronicler of the
disease that killed
him
• FDA approval of
protease inhibitors in
1995-96
Links to Literature
Links to Literature
• Jose Saramago receives
the 1998 Nobel Prize in
Literature
Conclusions
• Epidemic control: paradigm of public health protection
• Broadened definition to include social/global issues
• Explored human rights/health interactions and seen the
inevitable conflicts and strategies for mitigating
diminishment of individual rights
• Highlighted medical and informational priorities
• Some links to literature with which you can explore these
issues in the classroom
Questions?
• John Schumann, MD
• Email: [email protected]
• Phone 773-834-3247