Portal de Periódicos da CAPES

Health as a human right: implications for the dental profession

2008; Wiley; Volume: 12; Issue: s1 Linguagem: Inglês

10.1111/j.1600-0579.2007.00474.x

1600-0579

Mary Robinson,

Medical Malpractice and Liability Issues

Mary Robinson, the first woman President of Ireland (1990–1997) and more recently United Nations High Commissioner for Human Rights (1997–2002), has spent most of her life as a human rights advocate. She was educated at the University of Dublin, Trinity College, King’s Inns Dublin and Harvard Law School, to which she won a fellowship in 1967. As an academic (Trinity College Law Faculty 1968–1990), legislator (Senator 1969–1989) and barrister (1967–1990, Senior Counsel 1980, English Bar 1973) she has always sought to use law as an instrument for social change, arguing landmark cases before the European Court of Human Rights as well as in the Irish courts and the European Court in Luxemburg. A committed European, she also served on the International Commission of Jurists, the Advisory Committee of Interights and on expert European Community and Irish parliamentary committees. In 1988 Mary Robinson and her husband Nicholas Robinson, a lawyer and conservationist, founded the Irish Centre for European Law at Trinity College. Ten years later she was elected Chancellor of the University. The recipient of numerous honours and awards throughout the world, Mary Robinson is a member of the Royal Irish Academy and the American Philosophical Society and, since 2002, has been Honorary President of Oxfam International. A founding member and Chair of the Council of Women World Leaders, she serves on many boards including the Vaccine Fund, and chairs the Irish Chamber Orchestra. Now based in New York, Mary Robinson is currently leading a new project, the Ethical Globalization Initiative (EGI). Its goal is to bring the norms and standards of human rights into the globalization process and to support capacity building in good governance in developing countries, with an initial focus on Africa. I am delighted that this Global Congress on dental education is taking place in Dublin and very sorry not to be there with you in person as I had fully intended. As Chancellor of Dublin University I recall with pride that the International Federation of Dental Education Associations (IFDEA) was launched here in Dublin by Professor Derry Shanley and others during a dental educators meeting celebrating Trinity’s quatercentenary. I congratulate IFDEA on the fact that during your Congress President McAleese will launch a Global Network on Dental Education. Of course I am particularly pleased that this will include a group of African dental educators. My other regret in not being with you personally is that I am not able to share the platform with Sir Iain Chalmers. I greatly admire the work that he has been doing and the human rights approach that he has brought to evidence-based medicine. My key message to you at this Dental Congress is that we will not make substantial progress towards the objective of access to health for all without greater attention to the links between health and the realization of fundamental human rights. Implementing the right to the highest attainable standard of health should be the ultimate objective of action in the field of public health, and oral health is an integral part of general health and wellbeing. In my work as President of Realising Rights – together with my colleagues – I am very focused on making the right to health practical, making it operational and meaningful. The World Health Organisation declared in 1946 that ‘the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being’. As you well know, the right to health has been affirmed and ratified on many occasions since this time; however, like many other economic, social and cultural rights it has been neglected and violated on a huge scale in many parts of the world. I often use just one statistic to bring that home; we know, and nobody disputes it, that over 30 000 children <5-year old die every single day of preventable disease or sheer hunger. If we think about it, 30 000 children a day is a silent tsunami of children under 5 every week which is 52 tsunamis every year. That is the huge gap we have when talking about health as a human right and having health care accessible to all. Human rights principles and standards, including the right to the highest attainable standard of health, do offer powerful moral arguments for governments and the international community of the need to invest in health. In tandem with this, a human rights framework, by focusing attention on vulnerable populations and minorities – the rural poor and women especially – provides a powerful standard to ensure that the health needs of the most vulnerable in communities are being met. Closely related to the right to health is the right to functioning health services of effective health systems, including an effective oral health system. In 2002, the Commission on Human Rights created a new mandate – the United Nations Special Rapporteur on the Right to the highest attainable standard of health. The current special Rapporteur, Professor Paul Hunt of Essex University, has increasingly focused his work on how human rights principles and tools of accountability can be more directly applied to the task of strengthening health systems. He has argued that the right to health can be understood as a right to integrated and effective health systems which is responsive to national and local priorities and is assessable to all. As he has stated, the right to health underpins a call for an effective health system accessible to all, yet we know – and as you will be talking about at this Congress – the right to health is denied to many people in the developing world. As I was preparing to address you at this Global Congress on Dental Education I became aware of the stark reality in the context of oral health. I was somewhat shocked to realize that less than 5% of the global population can avail themselves of the standards of dental treatment taught to dental students in the countries with developed economies. I know that there has been, in fact, much progress in oral health in the developed world, but when we think about it probably as much as 85% of the global population doesn’t have access to appropriate emergency dental care treatment as understood in developed economies. Clearly there is an urgent need to strengthen public health programmes with evidence-based preventive strategies designed specifically for low income regions as part of a multidisciplinary approach applicable for health care workers – some of whom may not be oral health care workers – but as part of an integrated system. It seems to me that the 300 of you gathered as part of this Global Congress have a real challenge; a challenge since you come from some 60 countries, to think together and to think out of the box. You must work to implement the commitments that governments have made to progressively realise the right to health, including oral health, to focus on access that is needed especially for those that live in remote rural areas or in slums – the very poor and very often women. As in other areas of health, women neglect their own dental care because they are thinking about their husbands and their children, and so you have a huge task. I often reflect on the way in which a small group of visionaries chaired by a woman, an American woman, gave us a wonderful standard for our world in human right – the Universal Declaration of Human Rights. That declaration was adopted in Paris in December 1948 – so next year in 2008 we will mark its 60th anniversary. Eleanor Roosevelt chaired a group of very distinguished jurists who came from China, the Lebanon, France, Chile and Canada. Although she was not a lawyer she knew how to boss a group of eminent lawyers and she told them to write the universal declaration of human rights in clear straight forward language, and that is how it is. The 30 articles are very accessible in the way that they are written. Article 1 for example says ‘All human beings are born free and equal in dignity and right’. How far we are from implementing that birthright in reality for the millions living in poverty, for the millions who do not have access to emergency dental care or to preventive measures to help them in their own oral health. Eleanor Roosevelt said some very wise words that I would like to use in conclusion. She reminded us that ‘Where after all, do universal human rights begin? In small places close to home, so close and so small that they cannot be seen on any maps of the world’, and then she went on to say ‘…Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world’. You come as experts, as educators and you decide you need to do more, you need to scale up, you need to find ways to provide access for those who most need it. I wish you well and I hope that the Congress will fulfil that kind of vision. That is what the world needs. Every good wish and good luck in your deliberations. Thank you.