You have a Right to Mental Health

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Image: King College London,  project Emerald (emerging mental health systems in low- and middle-income countries)

One of the key sessions  I attended at the second day of “The world in denial: Global mental health matters”( March 26-27, 2013, Royal Society of Medicine, London) highlighted the existing legal tools available to achieve international recognition of the Right to Health,  AND the problems of getting mental health included in this framework.  In particular how including it under disability has implications for access to treatment. This blog summarizes the session and puts information into context with current events, including the 66th World Health Assembly recommendations.

There was much I learnt that day, yet  of much I was already aware, as CABI’s Global Health
database has 20,000 records on mental health, 25% of them
focussed on developing countries. One of the eye-openers for me was an
understanding of the various legal tools dealing with international
recognition of the Right to Health
and the problems of getting mental health included in this framework;
how including it under disability has implications for access to
treatment.

This is what I learnt, put simply, from talks given by Professor Norman Sartorius (President of World Psychiatric Association) and Gunilla Backman (Former health adviser SIDA & Editor, The right to health: theory and practice).

 

Basic Human rights: these are not defined or not universally accepted

AND

There are 5 categories of  documents related to human rights

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Health inequality, health disparity, health equity: what’s the difference?

Well if you are at the bottom of the social heap, striving to find enough money to put food on the table and keep a roof over your head…not much.

But if you want to understand how a government or a researcher or  development worker thinks and works to improve your lot (& public health in general), then you need to know the difference.

So here goes:

Health inequality and health disparity are used interchangeably, depending on the country. AS an English speaker, there is a nuanced difference between the term inequality and disparity. Inequality  to me comes with an ethical link behind it whereas disparity implies there’s just a difference.

But for researchers and policymakers, there is no difference between health inequality and health disparity. So here is their definition:  differences in health between populations (defined by country or regions) and between groups based on gender or socio-economic status or ethnicity. Having established these differences through evidence (and there’s lots), its up to you or your government to decide if the difference is worth addressing.[ In our database Global Health, records using either term are found but are all indexed with & will be retrieved consistently using “health inequalities”]

Whereas health equity is understood by all in the field that these differences in health are immoral, that they are linked to social or economic status, “the rich live 7 years longer than the poor” in the UK, the average life expectancy of a woman in Swaziland is just over 1/2 that of her equivalent in Sweden (48 vs 84 years): it comes with a value judgement that “everyone is entitled to a healthy life” unless demonstrated otherwise…and that otherwise would  have to be environmental  or genetic effects which could not be changed.  And at that point you’d move into the area of Quality of Life, which is outside the subject of this blog.

Indeed it has been suggested that it is a human right to expect a healthy life (for however long that might be);

Article 25 of the U.N. Universal Declaration of Human Rights (1948):

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 implications of this for international law &, clearly, the practicalities are still being worked out…

Two conferences in November (EUPHA 10 ( Amsterdam) and APHA  2010 (Denver) are addressing health inequality and health equity (the latter under the theme of "social justice").