Human Rights Council discusses mental health and the situation of women and children affected by leprosy

EVENING

GENEVA (24 June 2019) - The Human Rights Council this afternoon held a clustered interactive dialogue with Dainius Puras, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, and with Alice Cruz, Special Rapporteur on the elimination of discrimination against persons affected by leprosy and their family members.

Mr. Puras said that the realization of the right to mental health required States to respect, protect and fulfil the social and underlying determinants that promoted mental health.  The right-to-health framework highlighted the obligations of States towards promoting the determinants of mental health and provided valuable elements to help shape policies and measures towards this end.  It was important that societal well-being be placed at the centre of development and assistance decisions, and that States reviewed their social, labour and economic policies in order to promote non-violent and respectful relationships.  Mr. Puras highlighted child protection and the need to support families through effective infrastructure that improved the quality of relationships between parents and children, and then spoke about his visits to Canada and Kyrgyzstan.

Canada spoke as a concerned country.  The Canadian Human Rights Commission also spoke.

Ms. Cruz said that in her report she focused on the particular experience of women and children, and found that women were at higher risk of suffering discrimination on the grounds of leprosy and developing leprosy-related physical impairments and disabilities, which was also due to institutional barriers and factors such as the patriarchal nature of biomedicine, and discriminatory legal frames of the gender of the health care workforce in primary care services.  The low status assigned to women was at the root of women’s widespread self-concealment of the disease, while dependency of women’s access to health services on third-party authorization, women’s limited mobility, and illiteracy also played a role.  About eight per cent of the total new cases of leprosy reported by 150 countries to the World Health Organization in 2017 had been children under the age of 15, a shamefully high figure.

In the interactive dialogue that followed, speakers concurred that the adoption of a human rights-based approach to mental health was of paramount importance, especially given the continued disparity between physical and mental health.  Mental health, they insisted, was one of the key global and national health imperatives, having a very strong and wide impact on all aspects of life of any individual and the society.  More important than simply investing in mental health services was making sure that those services were of good quality, recovery-oriented, human rights and community-based, that they addressed power imbalance, respected the dignity, autonomy and preference of all persons, and included structural interventions in society, outside the health system.

Delegations thanked Ms. Cruz for her relentless efforts to showcase the dire human rights situation of persons affected by leprosy and the suffering of their family members that stemmed mostly from discrimination, stigma, stereotypes, and misconceptions.  Violence on the grounds of leprosy was a significant problem for many women around the world; it was an extreme form of discrimination and violation of their fundamental human rights and human dignity, not least their rights to health and safety.  Prophylaxis, early detection, and awareness raising must be intensified, and institutionalized discrimination that persisted in States’ administrations must be tackled through capacity building.

Speaking in the interactive dialogue were Ecuador; Saudi Arabia; Djibouti; Indonesia; Republic of Korea; ICRC; South Africa; Iraq; Iceland; Morocco; Chile; Bolivia; China; Iran; United Kingdom; Nepal; Greece; Ethiopia; UNFPA; Cyprus; Nigeria; and Bangladesh.

Speaking in right of reply were Turkey, Azerbaijan, Brazil, Spain, Colombia, China and Armenia.

The Human Rights Council will meet at 9 a.m. on Tuesday, 25 June, to hold a general debate on the oral update of the United Nations High Commissioner for Human Rights.  It will then conclude the clustered interactive dialogue on the right to health and on discrimination against persons affected by leprosy, and start a clustered interactive dialogue on migrants and on international solidarity.

Documentation

The Council has before it the Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (A/HRC/41/34).

The Council has before an addendum to the Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health – visit to Kyrgyzstan (A/HRC/41/34/Add.1).

The Council has before an addendum to the Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health – visit to Canada (A/HRC/41/34/Add.2).

The Council has before an addendum to the Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health – comments by Kyrgyzstan (A/HRC/41/34/Add.3).

The Council has before it the Report of the Special Rapporteur on the elimination of discrimination against persons affected by leprosy and their family members (A/HRC/41/47).

Presentation of Reports by the Special Rapporteur on the Right to Health and the Special Rapporteur on Leprosy

DAINIUS PURAS, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, said the realization of the right to mental health required States to respect, protect and fulfil the social and underlying determinants that promoted mental health.  Actions that promoted community inclusion, environments free from violence, and participation in cultural diversity were actions that promoted mental health as they enabled healthy relationships based on trust, respect and tolerance.  The right-to-health framework highlighted the obligations of States towards promoting the determinants of mental health and provided valuable elements to help shape policies and measures towards this end.  It was important that societal well-being be placed at the centre of development and assistance decisions, and that States reviewed their social, labour and economic policies in order to promote non-violent and respectful relationships.  Mr. Puras highlighted child protection and the need to support families through effective infrastructure that improved the quality of relationships between parents and children.  Institutional care for children should be eliminated, bullying should be addressed, and depression and suicide prevented through modern public health approaches that valued and fostered non-violent relationships, avoiding excessive medicalization.

Regrettably, many parts of mental health-care systems, such as residential institutions and psychiatric hospitals, too often themselves bred cultures of violence, stigmatization and helplessness.  Efforts should be refocused towards non-coercive alternatives that addressed holistic well-being, and placed individuals and their definition of their experiences, and their decisions, at the centre.  Mr. Puras invited States to exchange good practices and challenges to develop measures that addressed the right to mental health, including its determinants.  He invited those present to reflect on measures taken by their Governments to develop social, labour or economic policies to prevent violence and promote non-violent relationships, including between authorities and civil society.  In particular, he drew their attention to measures aiming to support healthy holistic development in childhood and adolescence; address bullying; prevent depression and suicide; prevent xenophobic action and rhetoric against persons in vulnerable situations, such as people on the move; and develop performance indicators on the reduction of coercion, institutionalization and excessive medicalization and on the sustainable funding of rights-based alternatives to biomedical frameworks and the use of coercion. 
In 2018, Mr. Puras said he visited Canada and Kyrgyzstan.  In Kyrgyzstan, there was a strong political will to realize the right to health.  The main challenges lay with effective implementation and sustainability: persisting corrupt and ineffective practices should be addressed and the Government should take ownership of the programmes that had been developed thanks to international cooperation.  As for Canada, a highly developed nation, it had a strong public health system rooted in the principle of equity and fairness – the notion that access to healthcare should be based on need, not the ability to pay.  Including a human rights-based approach to public health remained a challenge, as were disparities across provinces and territories and poor access to healthcare by persons in vulnerable situations, including indigenous peoples.
ALICE CRUZ, Special Rapporteur on the elimination of discrimination against persons affected by leprosy and their family members, presenting her reports, said that persons affected by leprosy and their family members were systematically subjected to dehumanization in different cultural backdrops.  Stigmatization against persons affected by leprosy remained institutionalized in States’ architecture and functioning: in more than 50 countries, hundreds of discriminatory laws against persons affected by leprosy remained in force and discriminatory practices by the States’ administration services endured.  In her report, the Special Rapporteur said she focused on the particular experience of women and children, and found that women were at higher risk of suffering discrimination on the grounds of leprosy and developing leprosy-related physical impairments and disabilities, which was also due to institutional barriers and factors such as the patriarchal nature of biomedicine, and discriminatory legal frames of the gender of the health care workforce in primary care services.  The low status assigned to women was at the root of women’s widespread self-concealment of the disease, while dependency of women’s access to health services on third-party authorization, women’s limited mobility, and illiteracy also played a role.

About eight per cent of the total new cases reported by 150 countries to the World Health Organization in 2017 had been children under the age of 15, a shamefully high figure.  Enduring under-detection of new cases of leprosy in children and late diagnosis were causal factors of physical impairments and disabilities.  Treatment dropout rates had as the main cause the lack of paediatric formulations for treating leprosy, given the overall lack of funds for leprosy within a global scenario of mercantilization of health.  Children affected by leprosy were systematically subjected to bullying, verbal and physical abuse from family members, neighbours, and schoolteachers, denial of access to schools, and isolation.  Ms. Cruz stressed that the enduring institutionalized, structural, and interpersonal discrimination on the grounds of leprosy intersected with the already subordinated social location of women and children in many societies.  The narrow understanding of leprosy as a biological condition hindered much-needed efforts to enforce their human rights.  To overcome this situation, States should review existing legislation and abolish or amend all discriminatory laws, in line with general comment 6 of the Committee on the Rights of Persons with Disabilities; and implement the draft principles and guidelines for the elimination of discrimination against persons affected by leprosy.

Statement by Concerned Country

Canada said that, like all nations, it faced a challenge with the benefits of good health not being equally enjoyed by all as persistent health inequalities existed for many Canadians.  Canada was working hard to find new ways to improve its health care system, respond quickly to new and emerging health concerns, and address disparities in access to health services, particularly those faced by indigenous Canadians.  Among the steps to improve the health system were the creation of a Canadian Drug Agency and the development of the national strategy for high cost drugs for rare diseases.  Canada remained committed to advancing health equity, including addressing the broader social and economic determinants of health, by strengthening the monitoring and reporting of health inequalities and assessing the effectiveness of policies and programmes in collaboration with provincial and territorial governments and stakeholders.  Furthermore, Canada was working with indigenous partners to develop new and innovative approaches to advance their right to self-determination, reduce socio-economic gaps and facilitate their overall wellbeing.

Canadian Human Rights Commission, in a video message, recognized that millions of Canadians did not have equal opportunities to enjoy the highest possible level of health due to structural obstacles, which were particularly felt by indigenous peoples, migrants and refugees, and persons with disabilities.  Indigenous peoples in particular enjoyed the poorest health, a result of colonization, disparities in access to health, and health inequalities.  As noted by the Special Rapporteur, Canada must do more, by using an approach of cooperation between the Government, provinces, community organizations, and indigenous peoples.

Interactive Dialogue

Speakers concurred with the Special Rapporteur that the adoption of a human rights-based approach to mental health was of paramount importance, especially given the continued disparity between physical and mental health.  Mental health, they insisted, was one of the key global and national health imperatives, having a very strong and wide impact on all aspects of life of any individual and the society.  They emphasized that, more important than simply investing in mental health services, was making sure that those services were of good quality, recovery-oriented, human rights and community-based, and that they addressed power imbalance, respected the dignity, autonomy and preference of all persons, and included structural interventions in society, outside the health system.  Respectful, non-violent relationships, and opportunities for solidarity and mutual reports were the foundation of well-being and resilience and offered strong protection in times of adversity.  That was why investments in promoting the right to health, particularly the mental health of mothers, children and adolescents, should be a priority; community-based and family-focused mental health and psycho-social support services for those most in need should be central to any such investments.  Several delegations raised concern about the proliferation of policies and practices in which international human rights law and principles were actively undermined or applied in a selective way, including prioritizing punitive policies and legislation to address drug use.  Drug policies must follow an approach that sought to promote the health of all, putting the human being at its core by implementing approaches to deter drug use and promote measures directed to public health concerns.  What concrete steps and strategies could be applied to ensure a shift from mental health system based on the biomedical system to more holistic services based on the respect for human rights? 

Concerning leprosy, delegations thanked Ms. Cruz for her report and her relentless efforts to showcase the dire human rights situation of persons affected by leprosy and the suffering of their family members that stemmed mostly from the discrimination, stigma, stereotypes, and misconceptions.  Violence on the grounds of leprosy was a significant problem for many women around the world, said the speakers; it was an extreme form of discrimination and violation of their fundamental human rights and human dignity, not least their rights to health and safety.  Prophylaxis, early detection, and awareness raising must be intensified, and institutionalized discrimination that persisted in States’ administrations must be tackled through capacity building.  The delegations asked the Special Rapporteur to elaborate on steps to take, particularly by the World Health Organization, to address the lack of access to medicines with an adequate formula for children; measures to put in place to ensure access to education for children affected by leprosy; and the impact of laws and policies authorizing coercive institutionalization of children and women affected by leprosy.

Interim Remarks by the Special Rapporteurs

DAINIUS PURAS, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, thanking Canada for its cooperation and willingness to seriously address the issues that he had pointed out, expressed hope that it would continue to show leadership in promoting the right to health.   The questions and comments showed a high level of agreement on the way forward.  When it came to mental health, all countries were developing countries.  Mental health was missing from the Millennium Development Goals, he recalled.  The approach in the developing countries could not be the same.  This opened the door to innovation, such as the friendship bench in Zimbabwe.  This approach illustrated how the provision of services by health professionals and non-specialized interventions could be combined.  On drug use, punitive measures and the war on drugs might have been rooted in good intentions but ended up causing more harm.  While the need to support families was obvious, it was important to protect the right of each member of the family.  The concept of the traditional family sometimes undermined the rights of women and children, even when they were victims of violence.

ALICE CRUZ, Special Rapporteur on the elimination of discrimination against persons affected by leprosy and their family members, said she felt encouraged by the comments heard today and assured that she remained available to engage with States.  She recalled that one of the Sustainable Development Goals sought to encourage partnerships and encourage multi-stakeholder approaches.  The approach promoted by this Goal could be applied to leprosy.  Sharing good practices could help make progress on eradication.  It was important to develop gender and culturally sensitive approaches, notably to fight discrimination.  Several issues needed to be addressed internationally and it would be quite important to provide information to both children and their parents, in a manner that took into account cultural differences, age, gender and disability.  To lessen the extreme suffering of children affected by leprosy, the Convention on the Rights of Persons with Disabilities could be used as a framework and an instrument.  Noting that leprosy was not contagious when treated, and stressing the importance of inclusive education, she called for the full acknowledgment of children affected by this disease.

Interactive Dialogue

Concerning mental health, speakers noted that multiple factors and social determinants could impact peoples’ mental health.  The question of how to invest in mental health was particularly thorny in humanitarian settings, as such investment and measures addressing the most basic needs had to be carried out jointly.  To create an environment conducive to mental health required cross-sectoral approaches.  Discrimination against people with mental disability should be eradicated.  Some speakers stressed the need for the international community to pull resources to strengthen international cooperation in realizing the right to mental health; States that could extend monetary assistance should do so.  Speakers asked the Special Rapporteur what best practices he had encountered on the re-integration of children who had been victims of bullying.  What were the main challenges in delivering mental health services to young people? 

On leprosy, speakers asked how could the fight against extreme poverty positively impact persons with leprosy and their families?  Speakers took note of the root causes of vulnerability of persons affected by leprosy to various forms of discrimination and stressed that leprosy was a completely curable disease and therefore there was no need to discriminate against or stigmatize the affected individuals.

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