Committee on the Elimination of Racial Discrimination Holds Day of General Discussion on its Proposed General Recommendation on Racial Discrimination and the Right to Health

The Committee on the Elimination of Racial Discrimination today held a day of general discussion on its proposed general recommendation on racial discrimination and the right to health. The day was comprised of three panel discussions focusing on racial discrimination in health as experienced by individuals and groups; legal obligations regarding the prohibition of racial discrimination and the right to health under international human rights law; and monitoring, accountability and redress for racial discrimination in the right to health.

In opening remarks, Beatriz Balbin Chamorro, Chief of the Special Procedure Branch, Thematic Engagement, Special Procedures and Right to Development Division, Office of the High Commissioner for Human Rights, said that the pandemic had evidenced the structural inequalities that were already affecting those who were marginalised and vulnerable to racial discrimination. Systemic racism remained one of the underlying causes of the differential access by vulnerable persons and groups to health care and other essential services. A new general recommendation would be an opportunity to deepen the understanding of the structural problems faced by those subjected to racial discrimination, and to make concrete recommendations on how to address them.

The first panel discussion on racial discrimination in health as experienced by individuals and groups was moderated by Bakari Diaby, Committee Expert.

Panellists were Iakovos Iakovidis, Deputy Permanent Representative of Greece to the United Nations Office at Geneva; Sanhita Ambast, Economic and Social Justice Team on the Right to Health, Amnesty International; and Rodey Kort, Senior Technical Lead for Human Rights, World Health Organization.

Speakers in the first panel were Human Reduction International; Partners for Reproductive Justice; Commision des droits de la personne et des droits de law jeunesse du Québec; Franiscans International; Roms; Bolivia; Algeria; Groupe de défenseurs de droits de l’homme pour contester les pratiques racistes; Sexual Rights Initiative; Centro de Promoción y Defensa de los Derechos Sexuales y Reproductivos – Promsex; Centre for Reproductive Rights; and International Disability Alliance.

The second panel discussion, focused on legal obligations regarding the prohibition of racial discrimination and the right to health under international human rights law, was moderated by Gay Mcdougall, Committee Expert. Panellists were Shara Duncan Villalobos, Deputy Permanent Representative of Costa Rica to the United Nations Office at Geneva; Shantha Kumari, International Federation of Gynaecology and Obstetrics; and Christie J. Edwards, Deputy Head, Tolerance and Non-Discrimination, Office for Democratic Institutions and Human Rights, Organization for Security and Cooperation in Europe.

Speakers in the second panel were Mexico; Cambodia; Open Society Foundation; Colombia; United Nations Population Fund; and Action Canada for Population Development.

The third panel discussion on monitoring, accountability and redress for racial discrimination in the right to health was moderated by Chinsung Chung, Committee Vice-Chairperson. Panellists were Paola Salwan Daher, Associate Director of Global Advocacy, Centre for Reproductive Rights; Maximiliano Nitto, Chief of Section on Health, Social Action, Education and Culture, Defensoría del Pueblo de la Nación Argentina (Office of the Ombudsman of Argentina); Rossalina Latcheva, Head of the Anti-racism and Non-discrimination Sector, European Union Agency for Fundamental Rights; and Michael Windfuhr, Deputy Director of the German Institute for Human Rights and Vice-Chair of the Committee on Economic, Social and Cultural Rights.

Speaking in the third panel were Suriname; China; Global Initiative - Economic, Cultural and Social Rights; Association for Women’s Rights in Development; the Global Justice Center; and the Commission des droits de la personne et des droits de la jeunesse du Québec.

In concluding remarks, Ibrahim Salama, Chief of the Human Rights Treaties Branch of the Office of the High Commissioner for Human Rights, thanked the panellists for their diverse range of expertise. The wide diversity of experiences gave a legitimacy and richness in trying to identify missing links. Mr. Salama said he had no doubt that the richness of the thoughts expressed would give the opportunity for the general recommendation to be expanded in the context of human rights.

Stamatia Stavrinaki, Committee Vice Chairperson, said it had been a rich and productive day and thanked all involved. Despite the efforts of States parties, persons and groups subjected to racial discrimination faced multiple barriers in accessing timely and quality health care. The next step for the Committee was to prepare the first draft of the general recommendation. Once approved, this would be disseminated and open to inputs from stakeholders.

The Committee’s one hundred and seventh session concludes on 30 August. Summaries of the public meetings of the Committee can be found here, while webcasts of the public meetings can be found here. The programme of work of the Committee’s one hundred and seventh session and other documents related to the session can be found here.

The Committee will next meet in public on Tuesday, 30 August at 3 p.m. to close its one hundred and seventh session.

Day of General Discussion on a Draft General Recommendation on the Right to Health

Opening Statement

BEATRIZ BALBIN CHAMORRO, Chief of the Special Procedure Branch, Thematic Engagement, Special Procedures and Right to Development Division, Office of the High Commissioner for Human Rights, said that the pandemic had evidenced the structural inequalities that were already affecting those who were marginalised and vulnerable to racial discrimination. COVID-19, along with the triple crises of food, energy and finance, had exacerbated the challenge to access health care, health monitoring, testing, vaccines and treatments. Systemic racism remained one of the underlying causes of the differential access by vulnerable persons and groups to health care and other essential services. In her 2021 report, the High Commissioner highlighted the obstacles faced by people of African descent in gaining equal access to health care. She referred to reports indicating higher mortality rates and a higher incidence of poor health, and studies which highlighted how the inter-generational trauma caused by racism had negative health consequences. Other groups, such as indigenous peoples, Roma, ethnic minorities, stateless persons, asylum seekers, refugees and migrants faced similar challenges and barriers.

A new general recommendation on the right to health would be an opportunity to deepen the understanding of the structural problems faced by those subjected to racial discrimination, and to make concrete recommendations on how to address them. When finalised, the general recommendation would contribute to help States build up these solutions. A holistic approach that integrated the fight against racial discrimination and its intersections with other forms of discrimination was necessary to setting effective health policies that left no one behind. The work of the Committee presented a crucial opportunity to address the key aspects of the right to health, as well as other elements such as how to ensure the effective participation of groups exposed to racial discrimination in designing and implementing health policies which affected them. Ms. Balbin Chamorro said the discussions would focus on monitoring, accountability and redress for violations related to racial discrimination and the right to health. This was crucial for the effective protection and realisation of the right to health for everyone. The discussions would also look at understanding intersectionality as it related to racial discrimination in the context of the right to health.

Panel Discussion One: Racial Discrimination in Health as Experienced by Individuals and Groups

The moderator of the panel was Bakari Diaby, Committee Expert. The panellists were Iakovos Iakovidis, Deputy Permanent Representative of the Permanent Mission of Greece to the United Nations Office at Geneva; Sanhita Ambast, Economic and Social Justice Team on the Right to Health, Amnesty International; and Rodey Kort, Senior Technical Lead for Human Rights, World Health Organization.

IAKOVOS IAKOVIDIS, Deputy Permanent Representative of Greece to the United Nations Office at Geneva, said that groups facing racial discrimination encountered barriers when accessing health services. Some practices which had been implemented in Greece included advances in the Roma people and the National Roma Integration Strategy, through the establishment of community centres; the existence of cultural mediators; and health indicators, which were instrumental in assessing the health conditions of the Roma people.

SANHITA AMBAST, Economic and Social Justice Team on the Right to Health, Amnesty International, said Amnesty International had researched States’ fulfilment of the right to health across several countries and had determined four ways which individuals subject to racism experienced inequal access to health care. These included barriers to health; unequal access to the social detriments of health; the inequal impact of coercive public health measures; and the impact of current patterns of international cooperation and assistance on racism in health. Recommendations from the findings included that States should put in place processes to understand the range of barriers racialised groups faced in accessing health care, and take urgent steps to remove them, and ensure that legal health systems had effective accountability mechanisms in place to address discrimination based on race.

RODEY KORT, Senior Technical Lead for Human Rights, World Health Organization, said the World Health Organization had co-organised a cross-United Nations Frontier Dialogue, with the United Nations Educational Scientific and Cultural Organization, which included civil society, academics, and human rights experts, on tackling structural racial and ethnicity-based discrimination in building forward better from COVID-19. The final report included action areas and interventions to address systemic racial discrimination within and beyond the health sector, followed by trainings with United Nations country teams across the regions.

In the ensuing discussion, speakers underlined the effect of drug control policies on the right to health. Drug control had perpetuated a colonial legacy which affected ethnic minorities, and these systemic issues would not be addressed until using drugs for personal use was decriminalised, among other initiatives. Concerning maternal mortality, one country said it had one of the biggest maternal mortality rates worldwide, exacerbated by the pandemic. In 2021, Black women were responsible for 48 per cent of total hospitalisation due to COVID-19. People subject to racism faced multiple barriers to accessing timely and quality health care.

It was noted that indigenous peoples were victims of collective trauma and inequitable services since the time of colonialism. Indigenous peoples required greater healthcare services, had worse health, and had greater difficulty accessing quality health services, compared to non-indigenous people. It was vital for disaggregated data on indigenous and ethnic minorities to be collected, to ensure that equal access to healthcare services could be provided, and to eliminate all forms of discrimination. Indigenous peoples had proved to be one of the most marginalised groups during the pandemic. Lack of information in indigenous languages and lack of respect for the culture impacted indigenous peoples from being able to access health services. The vaccination of indigenous peoples was not guaranteed, and was often carried out without consulting the local populations, resulting in their reluctance to be vaccinated. In many countries across the world, business activities had directly impacted the right to health for indigenous peoples.

Speakers said that health and reproductive rights remained an issue for women in marginalised communities, including Roma women. States must increase access and affordability for Roma women and girls to midwives and healthcare. Abortion access was an integral component of public health care, and legal barriers to abortion should be removed. These laws impacted communities who already faced barriers to accessing care. States should be called on to implement the guidelines of the World Health Organization, including for the complete decriminalisation of abortion.

Health care needed to include the right to water, housing and a life in dignity, which was linked to the right to life and equality. Violence was a key risk factor for poor health and those who grew up living in violent communities would have limited movement and therefore limited access to healthcare services. It was important that the impact of police violence on the impact of health was addressed in the general recommendation.

In concluding remarks, the panellists stated that the right to health had many parameters. All the recommendations received deserved to be carefully examined by the Committee. It was important to address intersectionality in people’s experiences of discrimination and access to health care, and to ensure that the measures States put in place were adequately and fairly financed. Due to structural and racial discrimination, the world was a long way from achieving the 2030 Sustainable Development Goals.

Panel Discussion Two: Legal Obligations Regarding the Prohibition of Racial Discrimination and the Right to Health under International Human Rights Law

The moderator was Gay Mcdougall, Committee Expert. The panellists were

Shara Duncan Villalobos, Deputy Permanent Representative of Costa Rica to the United Nations Office at Geneva; Shantha Kumari, International Federation of Gynaecology and Obstetrics; and Christie J. Edwards, Deputy Head, Tolerance and Non-Discrimination, Office for Democratic Institutions and Human Rights, Office for Security and Cooperation in Europe.

SHARA DUNCAN VILLALOBOS, Deputy Permanent Representative of Costa Rica to the United Nations Office at Geneva, said that it was vital to recognise that there were ongoing inequalities in Latin America, which impacted persons of African descent. This population had high levels of poverty and low school involvement, which were exacerbated by racism. For States to ensure access to health, there needed to be health equality, which meant that people could develop their maximum potential when it came to health care, regardless of social factors. This could only be achieved by actions from the healthcare authorities. Addressing structural discrimination in the right to health was a new sphere being undertaken in Costa Rica. The ongoing lack of data was an issue and each State needed to improve its sources and gather disaggregated data to ensure effective policies.

SHANTHA KUMARI, International Federation of Gynaecology and Obstetrics, said that many women died around the world due to post-partum haemorrhage. Women needed to have the freedom to make decisions regarding their own health, including when to have an abortion. Forty-five per cent of all abortions were unsafe, and the risk of dying of unsafe abortion was highest in Africa. The right to health needed to be available accessible, acceptable, and quality, and the elimination of racial discrimination and discrimination against women was vital in this regard. Maternal mortality and disability were rooted in gender injustice and intersectional inequalities. Globally, approximately 295,000 women died during and following pregnancy and childbirth in 2017, with coloured or indigenous women accounting for 94 per cent of these deaths. Every woman should have access to sexual and reproductive health, irrespective of where they lived.

CHRISTIE J. EDWARDS, Deputy Head, Tolerance and Non-Discrimination, Office for Democratic Institutions and Human Rights, Office for Security and Cooperation in Europe, said minority groups, including ethnic minorities and migrant workers, were disproportionality affected by the pandemic. In the area of addressing intolerance and discrimination in the context of the pandemic, some States recognised the need for special support to minority communities by announcing new healthcare support for indigenous communities amid the pandemic. Special commissions were created to monitor the impact of the pandemic on vulnerable groups. Any measures and restrictions imposed by States needed to be done in a non-discriminatory manner and working with civil society organizations and minority communities during this process was crucial.

In the ensuing discussion, speakers said that equality in health care was vital in all areas of human rights, including the rights to food and housing. One country said that efforts had been made for vulnerable groups to assess health services according to their needs. The Ministry of Health had committed to provide equitable health services to the population and remove barriers to quality care. Investment had been prioritised to improve the quality of health centres, to ensure that people in every corner could have access to health care when needed.

One speaker said that drug prohibition was inherently inconsistent with the right to health, and the obligation to eliminate racial discrimination in all forms, and a human rights model should instead be adopted. States parties should decriminalise drug use and possession for personal use; release persons detained for drug use or for personal use; and regularly assess and report on drug prohibitions. Indigenous and other groups who used controlled substances in cultural practices should be engaged, to assess the impact of drug prohibition on communities.

One country said it had been working with ethnic groups to build an indigenous public health policy. To ensure ethnic groups were supported by the general health system, the Government had passed norms which guaranteed universal coverage for the public health system. The absence of data and vital statistics remained a challenge in many countries, resulting in limited visibility about the lives of Afro-descendants and other populations, particularly in access to healthcare services. However, indicators showed that these groups had unfavourable conditions and were predisposed to early mortality and maternal mortality, among other health conditions.

At the global level, speakers said that health funding came mostly from high income countries and donor priories dictated the funding given to specific issues without consultation. States should be called on to fund health publicly, and the privatisation of health care should be treated as incompatible with human rights.

In closing remarks, the panellists said that States needed to have robust policies, including disaggregated data, to improve conditions. Institutions forming public policies needed to receive support. The sexual and reproductive rights of women needed to be upheld and every woman had the right to have access to safe abortion. Laws prohibiting abortion needed to be repealed. The barriers that affected minority groups and people of colour in accessing health care needed to be addressed.

Panel Discussion Three: Monitoring, Accountability and Redress for Racial Discrimination in the Right to Health

The moderator was Chinsung Chung, Committee Vice-Chairperson. The panellists were Paola Salwan Daher, Associate Director of Global Advocacy, Centre for Reproductive Rights; Maximiliano Nitto, Chief Section on Health, Social Action, Education and Culture, Defensoría del Pueblo de la Nación Argentina (Office of the Ombudsman of Argentina); Rossalina Latcheva, Head of the Anti-racism and Non-discrimination Sector, European Union Agency for Fundamental Rights; and Michael Windfuhr, Deputy Director of the German Institute for Human Rights and Vice-Chair of the Committee on Economic, Social and Cultural Rights.

PAOLA SALWAN DAHER, Associate Director of Global Advocacy, Centre for Reproductive Rights, said that accountability was a core principle underpinning international human rights law. Monitoring, disaggregated data collection, and financial and budgetary allocation were critical to the realisation of rights and ensuring accountability. Another core human rights principle that States needed to integrate in all their interventions was the principle of participation. The full participation of the primarily concerned people was crucial to ensuring that the laws, policies and practices reflected the lived experiences of marginalised populations and paved the way for the creation of transformative reparations.

MAXIMILIANO NITTO, Chief of Section on Health, Social Action, Education and Culture, Defensoría del Pueblo de la Nación Argentina (Office of the Ombudsman of Argentina), said that Argentina had a National Institute against Discrimination, Xenophobia and Racism whose objectives included developing public policies and promoting concrete actions to combatting discrimination, among others. The National Ombudsman's Office was an important monitoring mechanism which, thanks to the processing of complaints, could detect whether there were adequate public policies, or warn that in the absence of public policies, a certain sector was experiencing the violation of their rights.

ROSSALINA LATCHEVA, Head of the Anti-racism and Non-discrimination Sector, European Union Agency for Fundamental Rights, said that effective monitoring and evaluation required the active participation of all groups impacted by racism and racial discrimination, as well as civil society organizations and national human rights institutions. States should establish structures that facilitated reporting such as complaints bodies which were independent from healthcare services. States should also take steps to establish structured cooperation and effective referral mechanisms between equality bodies and health complaint bodies, and to increase awareness of anti-discrimination legislation among health complaint bodies.

MICHAEL WINDFUHR, Deputy Director of the German Institute for Human Rights and Vice-Chair of the Committee on Economic, Social and Cultural Rights, said there were several underlying components which related to the right to health, including the enjoyment of facilities, the right of prevention to disease, access to water and sanitation, and the ability to control one’s sexual and reproductive health. These all needed to be monitored as well as the accessibility, acceptability, and quality of services. Governments had an obligation to monitor and address proper policies towards human rights violations. Civil society organizations were also highly important within the monitoring process. It was difficult to identify the underlying components of the right to health which were often hidden. This needed to be learned and was something States should invest in.

In the ensuing discussion, one speaker said that challenges in their country to ensure the right to health without any form of racial discrimination included gaining access to remote areas and providing specialised treatment. Another speaker said studies were needed to evaluate the impact of racial discrimination on the right to health. Data showed that the risk of dying from COVID-19 was twice as high for ethnic minorities as it was for Caucasian people. The right to health was undermined when States excessively relied on for-profit actors to deliver healthcare services. States had an obligation to ensure that quality healthcare services could be accessed without discrimination, regardless of who was providing the service.

The Committee should use an intersectional approach to discrimination and adopt an expansive and intersectional approach to health and its determinants. One speaker said that in their country, restrictions on reproductive health severely undermined access to health care and the impact felt by black and ethnic minorities was stark. Speakers said that there was nothing more important than the protection of health. The Committee had noted that very little importance had been given to the issue of determining if there was a need to consider the issue of health as being a form of racial discrimination. Health was a major issue which had been highlighted over the past two years. The general recommendation needed to consider that it was time for the State to assign a platform to the issue of health, at a Constitutional level, which was effective.

In closing remarks, the panellists highlighted the need for reparation and access to remedies. There was a responsibility for States to provide access for reparation and to create and fund accountability mechanisms. There was a responsibility of donors to make sure that the way they allocated funds took into account intersectional discrimination, especially against refugee and migrant populations. It was important to address all the underlying environments of health, including the housing environment and water and sanitation, and these elements needed to be addressed in any monitoring framework. Comprehensive, disaggregated data was needed from different sources to monitor intersectional discrimination. Monitoring of the right to health and monitoring of racial discrimination regarding health needed to be integrated.

Closing Remarks

IBRAHIM SALAMA, Chief of the Human Rights Treaties Branch of the Office of the High Commissioner for Human Rights, thanked the panellists for their diverse range of expertise. The wide diversity of experiences gave a legitimacy and richness in trying to identify missing links. Mr. Salama said he had no doubt that the richness of the thoughts expressed would give the opportunity for the general recommendation to be expanded in the context of human rights.

STAMATIA STAVRINAKI, Committee Vice Chairperson, said it had been a rich and productive day and thanked all involved. Despite the efforts of States parties, persons and groups subjected to racial discrimination faced multiple barriers in accessing timely and quality health care. Panellists had exposed structural and cultural barriers, distance and transport barriers, and the underfunding of services. Special reference was made to systemic issues, including those with a criminalising effect. A holistic approach required the participation of the persons and communities subject to discrimination and providers of health and State authorities with these people. Speakers had highlighted the importance of monitoring mechanisms and to the collection of data. The next step for the Committee was to prepare the first draft of the general recommendation. Once approved, this would be disseminated and open to inputs from stakeholders.

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