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Investigating another agent of infectious disease: dictators and other violators of human rights
By the end of March, the epidemic had spread to Vietnam, Thailand, Singapore, Germany, the United Kingdom, Canada and the United States. By mid-April, the disease, now known as severe acute respiratory syndrome—SARS—had afflicted people in 19 countries on four continents, killing nearly 800 people.
When Chris Beyrer reviews this now-familiar story of a public health emergency, he sees more than a frightening epidemic. He also sees abuses of human rights, especially the civil rights of Chinese researchers and the world public’s right to information. “Dictatorships hate bad news,” Beyrer says. “They tried to control the information, not the epidemic.”
When he looks at brutal ethnic cleansing by the Burmese military junta in the countryside bordering Thailand, he sees human rights violations, but also a public health crisis. Around the globe, on every continent, Beyrer can enumerate violations of fundamental human rights that in his view also constitute dangers to the public health—dangers that an increasing number of public health specialists are anxious to study and help resolve.
This thinking represents a new human rights/public health paradigm. Beyrer is one of its leading proponents. He is an associate professor of Epidemiology at the Bloomberg School. He is also director of the Fogarty AIDS International Training and Research Program. As if that did not make for a sufficiently crowded business card, he is now director of the Bloomberg School’s new Center for Public Health and Human Rights, funded by the Open Society Institute.
“What has been missing from mainstream human rights [work],” he explains, “has been an understanding of the impact of rights violations on the health of populations.” Investigations of human rights violations typically have been conducted case by case, not at the population level, though whole populations are affected. “What has been missing, in many cases, from public health and epidemiology is an understanding of the role of human rights questions in disease transmission. Human rights workers need public health tools, and public health research needs political analysis.”
Take the case of eastern Burma. For years the Burmese government has waged a campaign of ethnic cleansing, forced labor and terror against several minorities, including the Karen ethnic group along the frontier with Thailand. The mortality rate for children under 5 years of age on the Burmese side of the border is 10 times the rate in neighboring Thailand. That’s a Burmese public health disaster. But the damage does not stop at the border. Karen farmers, forced from their land into forests, suffer very high rates of infection from malaria and filariasis—diseases once under control in Thailand but now spreading again along the Thai side of the Burmese frontier. Mosquitoes, feeding on infected people, do not respect borders. Malaria in Burma soon means malaria in Thailand.
Beyrer cites another example, this one in the United States: Inmates of many federal prisons cannot obtain condoms. “Prisoners are asking for condoms to protect themselves from forced sexual partnerships. It seems to me, since we know the prison population is the highest HIV population in the U.S., that this is a clear example of the state actually denying people the right to protect themselves.” This, he argues, is a health problem made worse by human rights violations.
Repressive and kleptocratic governments—and sometimes democratic ones—create public health problems. And public health research tools are effective means of studying the consequences of misrule and rights violations. Discrimination against marginalized social groups, suppression or distortion of information, violation of privacy rights, the use of mass rape as a weapon of war, extrajudicial executions, torture, ethnic cleansing—all cause human suffering in ways that scientists like epidemiologists are good at assessing. Those assessments, says Beyrer, can drive political change.The new human rights center grew out of ground seeded a decade ago at the School. Robert Lawrence, the Edyth Schoenrich Professor of Preventive Medicine at the Bloomberg School and associate dean for Professional Practice and Programs, recalls being approached by MPH students Heather Kuiper and Diana Hammer. They were interested in human rights issues but could find no relevant offerings at the School. They knew that in 1986 Lawrence co-founded Physicians for Human Rights, which uses scientific methodologies to investigate violations of human rights. He has investigated rights cases in El Salvador, Guatemala, Chile, South Africa, Egypt, the former Czechoslovakia, the Philippines and Kosovo. Responding to the graduate students’ request, Lawrence helped organize an informal seminar.
That seminar led, in 1996, to a certificate program in health and human rights that drew on relevant courses already listed in the School’s catalog. Several years later, Ron Brookmeyer, PhD, chair of the Bloomberg School’s Master of Public Health program, asked Lawrence and fellow faculty member Gilbert Burnham, MD, PhD, if they’d create a concentration in refugee health and human rights. They said yes. Since 1997, Beyrer had worked with the Open Society Institute (OSI), a private foundation started by financier George Soros that supports a nexus of organizations in more than 50 countries, campaigning for democracy, rule of law, civil society and respect for minority rights. Beyrer pitched OSI, and when the Institute agreed to provide $86,000, the human rights center was born in April.
“Health care workers bring specific skills to analysis of human rights problems,” says Lawrence. “For example, how to document, through careful examination and interviewing, whether someone has been tortured or abused. Or forensic determination of causes of death and assessment of abuses through field studies, surveys and other epidemiologic investigations.”
This sort of work augments the traditional case-by-case efforts of organizations like Amnesty International, which investigates and campaigns against torture, political oppression and the death penalty. An internal review some years back revealed the organization’s methodological shortcomings in Guatemala. The review found Amnesty investigators had documented the arrest, torture, murder and disappearance of more than 3,000 individuals during the country’s civil war but had failed to document the deaths of 400,000 Mayan peasants. For the 3,000 individuals, Amnesty International had names, but nobody reported the Mayans on a name-by-name basis, so they never came to the attention of Amnesty. The review offered a valuable lesson: Countrywide human rights campaigns require population-level methodologies.
Epidemiologists and other public health researchers, of course, are trained to work on such a scale. Says Beyrer, “If you think of the rights violations that impact the well-being of entire populations”—ethnic cleansing in Sudan, for example—“those need to be assessed using population-level methods.” (more)