PHR Student Blog

Welcome to a new year in the PHR student program! My name is Brendan Milliner – I’m a fourth year at Mount Sinai medical school in New York and a member of the PHR Student Advisory Board.  I’d like to say Hello to all of the new members out there, and I hope the rest of you had a great summer. As we go through this year, we’re going to be talking about specific themes each month. We want to help you to understand PHR’s mission, know what your chapter can do to help, and get all of you talking and collaborating about issues of human rights and medicine. We’re going to be sending you a monthly newsletter (check your email for October), and using THIS BLOG as a way for you to get your ideas out there and talk with people from other chapters about what you are doing. We have a nationwide network of students and physicians who are passionate about issues of human rights, so let’s start using that network

This month’s topic is ‘An Introduction to PHR and Human Rights’. Here at the SAB, we don’t necessarily know why each of you joined PHR – maybe you’ve always been interested in human rights, or maybe you needed an excuse to talk to that classmate you’ve been eyeing since anatomy started (anyone?). Whatever the case may be, we want to make sure everyone is on the same page about the fundamental ideas that form the backbone of PHR’s ideology. PHR is a group of professionals and students dedicated to using our training in medicine and the scientific method to research abuses of human rights around the world and advocate for victims. Being health care professionals gives us a lot of credibility, because we can speak to the personal impact of human rights abuses with a great deal of authority.

As I see it, PHR is an organization with one foot in the world of medicine and one foot in the world of law.As health care providers, we’re grounded in our training. We are learning to understand bodies and minds in a structured and rigorous way, and that gives us a powerful grounding in the practice and tradition of medicine. The legal side of things, on the other hand, is a little less straight-forward. What human rights are we talking about, and why do we have the authority to investigate HR abuses? The legal framework for our human rights work boils down to three critical international documents:

• the Universal Declaration of Human Rights,
• the International Covenant on Civil and Political Rights, and
• the International Covenant on Economic, Social and Cultural Rights.

These three documents form the basis of the INTERNATIONAL LAW regarding human rights, and give us the legal authority to, say, denounce attacks on health workers in Bahrain or speak out about the use of torture in the US and abroad. The newsletter from this month included a video listing the rights from the Universal Declaration. To go along with that, here’s another clip outlining the rights contained in the two covenants. It’s simplified and a little cheesy, but it’s not bad as a place to start. And while you watch, I want you to take a few minutes to think about what each of these principles means and why it might be included.

Using their medical expertise to document and bear witness to violations of these rights, PHR has been able to mount extraordinarily successful advocacy campaigns and influence international law (stay tuned for another blog post about this). I joined PHR because I was inspired by this idea that as med students and future doctors we can use our training as powerful leverage for social change.So now I want to open up the floor to all of you:

• Why did you join PHR?
• What do you hope to get out of it?
• What would you like to see from the PHR leadership in the year to come, or from me in the next blog?

Leave a comment below — even just to introduce yourself — and let’s get better acquainted with each other.

Resources to build your Chapter, educate your community, and lead meaningful advocacy

The National Student Program has launched a website dedicated to resources for students, residents, and young professionals who are interested in advocacy based on PHR’s human rights investigations.

To educate your campus or community, refer to the PHR Student Chapter Toolkit for detailed information about how to plan and lead an advocacy campaign, host educational events, and more.

Use the issue-based PHR Toolkits to lead education and advocacy:

Access to Essential Medicines

The UN Working Group on Access to Essential Medicines opened its report on Essential Medicines with the assertion that “The lack of access to life-saving and health-supporting medicines for an estimate 2 billion poor people stands as a direct contradiction to the fundamental principle of health as a human right.”

Using clinical skills to defend human rights: Asylum and Detention

Physicians for Human Rights’ Asylum Network is a community of hundreds of health professionals who offer pro bono physical and psychological evaluations to document evidence of torture and persecution for men and women fleeing danger in their home countries. As mentioned in a recent post, the Asylum Network at Physicians for Human Rights conducted 317 evaluations during the 2010-2011 academic year. 10% of these evaluations were shadowed by medical students and residents through student-run asylum clinics.

Transforming health professional education: Health and Human Rights Education

Over the course of their careers, every health professional will be confronted with patients who have endured human rights violations. However, few medical and public health schools have mainstream courses to help prepare students to deal with this effectively. Students and faculty are working together to introduce new courses and promote Health and Human Rights Education.

Prioritzing the Patient: Medical Professionalism

Medical professionalism is the basis of medicine’s contract with society. It demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health. As discussed in a previous post, there is a strong human rights basis for the integrity of medical professionalism and for prioritizing the needs of the patient.

Domestic Health Equity and Ethnic Disparities: Access to Health in Massachusetts

This Toolkit examines health disparities and health reform through the case of Massachusetts’ health reform and its relationship to federal health reform.

Other recent resources that may be of interest:

• Doctors imprisoned in Bahrain: Bahrain: Free the docs!
• Crimes against humanity in Burma: Life Under the Junta

This week, you can invest a few minutes in something that will have tremendous impact in the years to come.

Congress will meet soon to decide on the budget for the coming year. Across the US, students, medical residents, nurses, doctors, and public health professionals are working together to send a clear message to Congress: protect funding for global health. Please join us! Click here for information about the 2011 Global Health Week of Action.

Funding for global health is a smart investment. If the Senate fails to sustain or increase global health funding in fiscal year 2012, this will have a devastating impact on health outcomes for years to come:

• Interrupting the dosage of HIV drugs could allow the virus to develop resistance. If this happened for large numbers of patients currently taking medication, this could affect thousands of patients—and could result in their sexual partners becoming newly infected with resistant virus.
• Reducing critical U.S. support for vaccinations will mean a sharp spike in children’s deaths from more than a dozen preventable illnesses—and the resurgence of polio, which is closer to eradication that at any other point in history.
• Reducing U.S. bilateral assistance and support for the Global Fund will also damage efforts to stem the spread of tuberculosis, resulting in more multi-drug resistant TB cases and increasing the death toll among people living with HIV, for whom TB is the already the leading cause of death.
• Undermining family planning programs compromises HIV prevention, while contributing to greater maternal mortality and threats to child health.
• Cuts in U.S. support to vital health surveillance programs in developing countries could permit the outbreak of an epidemic like SARS or bird flu – which could cross national boundaries with little time to prepare.
• Failing to meet our global health commitments could irreparably undermine the trust of other countries. In sub-Saharan Africa—where economic growth rates are much higher than in advanced economies, and where U.S. investment in health has paid considerable foreign policy dividends—these economies are future consumers of U.S. goods and services. Health support for these countries is not only the right thing to do; it makes good economic sense for the U.S.

Please join PHR in urging Congress to protect funding for global health.

Global health spending represents less than 1% of the US federal budget. Source: Kaiser Family Foundation.

What’s the Global Health Week of Action?

During National Actions, students and residents across the US coordinate their advocacy efforts to increase their impact. Every spring, the Global Health Week of Action focuses on an urgent health issue that transcends national boundaries. Join us this May 1-7, 2011 to protect federal funding for crucial health programs and research. Interested in creating your own campaign? At the bottom of this post, there are links to new resources to customize your Global Health Week of Action.

The threat to essential global health programs and research

The struggle over the federal budget this year is far from over. As we’ve seen over the past few months, international affairs has been targeted for spending cuts – despite being less than 1% of the overall budget, and despite huge returns on investment (pdf). For background, see previous posts on January 28, February 15, and April 15.

Soon, your Senators and Representatives will decide on the federal budget for the coming year, FY2012. For this year’s annual PHR Global Health Week of Action (May 1-7, 2011), let’s make sure that Congress knows  that health professionals see that global health funding is critical – to protect the right to health, to advance international development and security, and to avoid needless suffering and death.

Recruit health leaders to join the campaign

PHR is launching an elite sign on letter that will be addressed to each member of the Senate and the House of Representatives, asking for their advocacy in Congress for a continued robust U.S. response to global health. This letter is a collaborative effort with IDSA’s Center for Global Health Policy, Partners in Health, the Foundation for AIDS Research (amfAR), Health GAP, and Physicians for Human Rights.

  Letter to Congress: Support global health funding

Please ask the leadership and health professionals at your schools and hospitals to agree to add their name to the letter above. Senators and representatives are interested in the opinions of thought-leaders, like your school’s deans and professors, the head of your hospital’s department, and doctors, nurses, and other health professionals. Recruiting these leaders to participate is an effective way to influence Congressional representatives.

Share this letter with leading health professionals on your campus or in your community. The more deans, professors, nurses, public health researchers and practitioners, and doctors who participate, the better. To sign onto the letter, please click here and enter your name, title, affiliation, and city. The deadline for signing on is Sunday, May 8^th at 9 pm EST.

You might use this script when asking people to join the campaign:

Global health spending is in jeopardy for the FY 2012 federal budget. Cuts in global health support would have dramatic and long-term consequences, and would do almost nothing to balance the budget. I would like to invite you to join us in sending a letter to Congress.

Please consider adding your name to this letter, which is a collaborative effort with IDSA’s Center for Global Health Policy, Partners in Health, the Foundation for AIDS Research (amfAR) and Physicians for Human Rights (PHR).  PHR will present these letters to our state’s members of congress to demonstrate that leaders in health support lifesaving and cost-effective global health programs. Please help show our senators and representatives that health professionals who live and work in the state they represent value U.S. leadership in global health.

You might ask for a face-to-face meeting to request that they sign on to the letter. If they agree to meet, be well-informed and prepared to make your case. Here’s a series of posts on this issue in this blog. Laurie Garret’s now-classic “The Challenge of Global Health” (pdf) and this analysis of the sources and uses of global health funding offer useful context. Your target may also be persuaded by an email or a phone call. Either way, respect their time: being able to succinctly state your case is an important skill in advocacy.

When they agree to sign on, please add their information to this form.

If they’re enthusiastic, ask them to share the letter and the link to the form with other leaders.

PHR will compile the names of the leaders who you recruit to sign on to the letter.  We will deliver the letters to your members of Congress. If you’d like to join us, please let us know! You can track the status of US funding for key global health accounts to be sure your information is up-to-date.

Ready to do more? Other options for your Global Health Week of Action.

To educate your campus or community, refer to the PHR Student Chapter Toolkit for detailed information about how to plan and lead an advocacy campaign, host educational events, and more.

You may choose from these issues and use the PHR Toolkits to lead education and advocacy, or select another issue that you’re passionate about:

• Doctors imprisoned in Bahrain: Bahrain: Free the docs!
• Crimes against humanity in Burma: Life Under the Junta
• Access to Essential Medicines
• Asylum and Detention
• Health and Human Rights Education
• Domestic Health Equity and Ethnic Disparities: Access to Health in Massachusetts
• Medical Professionalism

What is medical professionalism?

Medical professionalism is the basis of medicine’s contract with society. It demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health.

Medical professionalism prompts a thorough examination of the underlying causes of ill health in people and communities. The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national, and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities- the unfair and avoidable differences in health status seen within and between countries. For a more in depth look, visit the WHO-social determinants website.

The medical profession is confronted by an explosion of technology, changing market forces, problems in health care delivery, bioterrorism, and globalization. As a result, physicians find it increasingly difficult to meet their responsibilities to patients and society. These challenges center on increasing disparities among the legitimate needs of patients, the available resources to meet those needs, the increasing dependence on market forces to transform health care systems, and the temptation for physicians to forsake traditional commitment to the primacy of patients’ interests.

The human rights basis for professionalism in health care

The principles of patient welfare and social justice are central to the right to health and medical professionalism. The commitment to improving access and quality of care mirror the right to health’s fundamental “AAAQ” framework,  a notion that asserts that health services be available, accessible, acceptable, and of good quality. Finally, the commitment to science and the assurance of confidentiality are critical concepts to a human rights approach to health.

Health professional responsibilities can be met through a rights based approach to health utilizing human rights framework to achieve goals of accountability, participation, nondiscrimination, and universality. Examples of the use of a rights-based approach are improvement of patient care, building community health, and enhancing health policy.

Improve patient care

Employ the human rights principles of participation and non-discrimination to improve individual patient care, enhance cultural competency, recognize root causes of disease, and help people stay healthier longer.

Build community health

Apply the right to health principles of providing accessible, affordable, acceptable, quality care to build health systems that work, and recognize social determinants of health that can be addressed through programming that connects clinics with communities.

Enhance health policy

Use human rights as a platform to advocate for the closing of racial disparities by increasing funding for low income health care, to fight for immigrant health care, and to ensure that global health programs build systems that address fundamental health needs.

PHR Student Toolkit: Professionalism in Medicine

In conjunction with the American Board of Internal Medicine Foundation, which has released a Physician Charter that guides health professionals in medical professionalism, PHR has created a Medical Professionalism Toolkit for you to learn more.

Federal funding for health is in jeopardy.

In the recent State of the Union address, President Obama announced a five-year freeze on domestic spending (aka non-security discretionary spending). On Jan. 25^th, the House of Representatives approved a resolution to reduce non-security spending to 2008 levels.

We cannot balance the budget on the backs of the most vulnerable.

To avoid losing the progress that targeted spending has made in saving lives and improving health outcomes, the Senate should pass an omnibus bill that provides slight increases to FY10 levels for the majority of global health accounts. Last year’s efforts to pass an omnibus bill died in December when it became clear that 60 votes were not available to overcome a threatened Republican filibuster, the Washington Post reported. The federal budget is currently running on a Continuing Resolution that expires March 4, 2011. If the Senate fails to sustain or increase funding, this will have a direct impact on health outcomes in 2011 and the years to come.

An arbitrary freeze on spending is short-sighted and ineffective. The money saved will not adequately address the federal deficit. For example, foreign aid is a small fraction of the US budget. The International Affairs budget makes up about 1% of the overall federal budget, yet was able to fund the treatment of AIDS, TB, and malaria for millions of people. This investment is humanitarian, diplomatic, and economically sound, as it allows people to continue working and reduces the likelihood of transmission, and hence avoids increased health care costs.

A return to 2008 levels would dramatically reduce funding for the Global Health and Child Survival USAID Account (USAID-GHCS). January marked some milestones that offer a glimpse of the urgency of the need for continued investment in global health.  This month was the one year anniversary of the earthquake in Haiti and the six month anniversary of the floods in Pakistan. Yesterday, the WHO Director General, Margaret Chan, commented that increased funding is necessary and asked,

“Will progress stall? Will powerful innovations, like the meningitis vaccine, like the vaccines for preventing diarrheal disease and pneumonia, like the new diagnostic test for tuberculosis, fall short of reaching their potential? Public health has been on a winning streak. But will we still have the resources to maintain, if not accelerate, these gains?“

Domestic health is also at risk. Most insiders anticipate a healthcare reform repeal vote in the Senate before long.

Please call your Senator to share your opinion. You can use this script:

I am a voter in your state. I urge you to sustain or expand funding for global and domestic health because it’s a smart investment. When it comes to health, short-term funding cuts will have long-term repercussions. We need to continue the work to make health care affordable and accessible, make prevention a priority, and ensure that women have access to the reproductive and other health care services they need. As a member of Physicians for Human Rights, I will be keeping an eye on how you vote on this issue.

You can find your senator here.

Please report your call here.

It’s official: the Global Health Week of Action is here!  The GHWA is a chance to move from education to advocacy on your campus.

The Chapters we’ve talked to so far are doing a range of activities – from direct advocacy with their Representatives, to speaker’s panels, a health fair, fundraisers, film screenings, and a blood drive! World Health Day is April 7, so April 4-10 is the official week of action – but your school might choose a different week in April to accommodate your campus calendars.

This year we’re encouraging chapters to focus their GHWA on the global health workforce crisis and the 2010 Global HEALTH Act (HR 4933).  Rep. Barbara Lee (D-CA) has introduced the bill in the House!  For the Global HEALTH Act to be successful, the more co-sponsors, the better.

How can you tell your Representatives that you want them to co-sponsor?

• Take 10 minutes to read the bill (pdf) or 3 minutes to read our summary.
• Promote peer pressure! Encourage prominent health professionals – like your Deans and faculty – to add their names to the sign-on. Present this sample letter to your Dean or an interested faculty member, along with the fact sheet about the bill. To present this letter to your Dean, either approach them directly, or email them this text. Let us know when your Dean grants permission to use her or his name.
• Circulate the petition, then mail it to me at Hope O’Brien, Physicians for Human Rights, 2 Arrow St., Ste. 301, Cambridge MA 02138. Consider hosting a table in a high-traffic area to gather signatures – either on the petition, or (even easier) bring a laptop where people can sign the petition directly online. Attract people with info sheets, candy, music, signs… or an eye-catching costume!
• If you’re interested in a district meeting to persuade your Representative to co-sponsor the bill, read our blog post about how set one up.

These letters, petitions, phone calls and district meetings send a clear message to your Representative: We want you to support the Global HEALTH Act. You can also forward some friends the link to the petition, post it on FB, and tweet it!

PHR has put together a GHWA Toolkit that includes an Issue and Action Guide, ideas for great events, suggestions on how to fundraise and publicize, and resources to share with your community. If you’d like to brainstorm together or discuss what resources PHR has for you, just email or call me! This GHWA is a chance to energize your Chapter, build interest in health and human rights education (HHRE) – and make a real difference at the same time.

  PetitionTemplate-GHA-4-10.pdf

  Global_HEALTH_Act_health_professional_sign_on_letter.pdf

  Global_HEALTH_Act_Sign_on_Letter_Request_Email.doc

  GHA2010_fact-sheet.pdf

Promote Women’s Rights. Protect Women’s Health.

In commemoration of World AIDS Day (Dec 1) and Human Rights Day (Dec 10), mobilize your school to join the 10,000 Signatures in 10 Days campaign for US ratification of the Convention To Eliminate All Forms of Discrimination Against Women (CEDAW).

In addition to our 2009 World AIDS Toolkit, we are excited to share these new practical tools for you and your chapter to easily participate in the World AIDS Day/Human Rights Day campaign:

Organizing the National Sign-on Drive on Your Campus

• Sample sign-on e-invitation to go out to student body email lists and relevant student groups
• Sample sign-on e-invitation for your faculty and Deans
• WAD tabling flyer to host a sign-on table in a public area on your campus
• Hard-copy version of the national sign-on, in the event that you cannot use computers at tables or events to collect signatures. (Please scan and send the hardcopy petitions to Dan at dshalev[at]phrusa[dot]org to have the signatures included in the National Sign-On.)
• Guide for Tabling

Participating in an In-District Meeting with Your Senator

• Meeting talking points
• Guide to meeting with elected officials
• Fact sheet on CEDAW, Women, and HIV/AIDS

If you are interested in having an in-district meeting with your senator, we are happy to help schedule the meeting for you. Contact Dan at dshalev[at]phrusa[dot]org for more information about how to get involved.

Note: The national sign-on webpage, HumanRightsForWomen.org, will launch on World AIDS Day (Dec 1.)

If you have any questions as you prepare for World AIDS Day, please contact me.

Women all over the world are facing discrimination, abuse and systematic inequities that make then especially vulnerable to HIV/AIDS. Until we protect women from sexual violence and exploitation, provide health and prenatal care and education, and provide all women the socioeconomic power to negotiate safer sex practices, HIV/AIDS will continue to disproportionately affect women in many parts of the world.

This year, in keeping with the 2009 theme of Universal Access and Human Rights, we’re dedicating World AIDS Day and Human Rights Day to getting the United States to ratify the Convention to End All Forms of Discrimination Against Women.

Join us for the 10,000 in 10 campaign, which aims to collect ten thousand signatures for US ratification of CEDAW during the ten days between World AIDS Day (Dec 1) and Human Rights Day (Dec 10)!

There are a variety of opportunities to join the national action, depending on your interest and capacity:

1. Mobilize the health professional student and faculty communities to urge the US to ratify CEDAW as a step forward in protecting women’s rights and health. PHR is doing this in partnership with a number of other organizations, allowing for a greater national movement. Our challenge to each PHR chapter: collect 100 signatures of support for CEDAW from your community.
2. Host educational events on campuses nationwide about women, HIV, and the human rights context/approach.
3. Organize an in-district meeting with your Senator to personally deliver the signatures you collect and urge him or her to support CEDAW.

As you plan your school’s involvement in World AIDS Day, download our 2009 World AIDS Day Toolkit to receive educational & organizing resources to reach out to students and faculty, organize successful events, and educate members of your community. And stay tuned to the Student Blog for more hands-on advocacy resources available mid-November.