HEALTH AND HUMAN RIGHTSINTERNATIONAL STANDARDS & RESPONSIBILITIESSession 13 Health Providers-Duty, Rights and Conflict of Interest

CONTENT

Context Corporate Policies, Intl Standards, and

Obligations What is a HRIA/HIA/ESHIA Case Study Preliminary conclusions

CONTEXT The right to health is widely

recognized in international human rights law.

The right to health is closely related to and dependent upon the realization of other human rights including:

These other rights and freedoms address integral components of the right to health.

o The rights to foodo Housingo Worko Educationo Dignityo Lifeo Non-discriminationo Equalityo The prohibition against tortureo Privacyo Access to informationo The freedoms of association,

assembly and movement.

CONTEXT

Whose rights are we talking about?

A rights-holder is an individual and group with rights

o Employee,o consumer, o indigenous group, o citizen o etc..

A duty-bearer is an actor with an obligation to fulfill, protect, or respect those rights.

o States o Corporationso Civil Society

Organizations

CHALLENGES

What are key principles and standards that companies and governments must adhere to in order to uphold their respective responsibilities when it comes to the right to health?

How can business best work with government to ensure respect for the right to health?

What are the key challenges and lessons learned for companies in relation to implementing key principles and standards?

What are the challenges for companies in emerging and fragile states with respect to health and human rights?

How do companies understand and measure the potential risks of human rights and right to health violations?

  What are the different instruments and tools available to companies that

seek to uphold their responsibilities when it comes to the right to health? 

CONTEXT

Source: 2014 UNDP Human Development IndexSource: 2012 Wikimedia

CONTEXT

Why do developing countries or conflict-ridden countries fail to provide the right to health:

o Costo Commitment and willo Policies and weak

governmental institutions

o Infrastructureso Labor capabilities

Is it impossible for developing countries to develop a health care system?

OF COURSE NOT!

Some success stories:CubaCosta RicaOmanKyrgystan

CONTEXT

Most high and middle-income countries have health care systems that involve state capacities, private sector providers, and a role played by civil society organizations.

On the other side of the spectrum, are emerging, fragile and conflict affected countries where public sector infrastructures are weak or damaged, unable to protect basic health-rights, and where private sector actors are not effectively regulated.

CONTEXT- GOVERNMENTS

Governmental institutions have three levels of responsibility: respect, protect and fulfill.

This three leveled responsibility means that 1. States must refrain from interfering with the

enjoyment of the right to health. 2. States must take measures to prevent third

parties from interfering with the enjoyment of the right to health.

3. States must adopt legislative, administrative, budgetary, judicial, promotional and other measures towards the full realization of the right to health

CONTEXT- CORPORATIONS There is growing international

pressure on multinational companies to uphold human rights standards within their core business strategy

These standards include a series

of human rights principles and standards drafted by:o The Organization for Economic

Cooperation and Development (OECD)

o The United Nations Global Compact (UNGC)

o The International Financial Corporation’s (IFC)performance standards, and other health focused benchmarks and principles.

o Convention on Economic, social and Cultural Rights

o UN Guiding Principles o Sector focused agreements

TOWARDS SOLUTIONS Ultimately, the right to health – its respect, protection,

and fulfillment – is for the state to guarantee. Guaranteeing this right, and human rights more generally, is a political decision and commitment.

The responsibility of business, as laid out in the United Nations Guiding Principles on Business and Human Rights is to respect human rights; and among these rights, the right to health.

Here it is not only a question of respecting the human rights of employees, but also the rights of rights holders impacted by business decisions, operations, relationships, products, and services.

With evolving international requirements, it is important to ensure that business processes help a company meet its commitments.

CORPORATE POLICIES, INTERNATIONAL STANDARDS, AND OBLIGATIONS

INTERNATIONAL STANDARDS AND GUIDELINES

UNGP Business and Human RightsIn June 2011, the United Nations Human Rights Council unanimously endorsed a set of Guiding Principles on Business and Human Rights. The Guiding principles establish an authoritative global standard on the respective roles of businesses and governments in helping ensure that companies respect human rights in their own operations and through business relationships.

3 Pilars1. The state duty to protect against

human rights abuses by third parties, including business, through appropriate policies, regulation, and adjudication;

2. The corporate responsibility to respect human rights, that is, to act with due diligence to avoid infringing on the rights of others and address adverse impacts with which they are involved; and

3. The need for greater access by victims to effective remedy, both judicial and non-judicial.

INTERNATIONAL STANDARDS AND GUIDELINES

UNGP

Guidelines for

Multinational Enterprises

OECD

International Finance

Corporation

Guidance on Social

Responsibility the

International Organization for Standardization

(ISO 26000),

INTERNAL POLICIES & TOOLS

Health, Safety and Security Policies A health and safety policy sets out your general approach and commitment together with the arrangements you have put in place for managing health and safety in your business. It is a unique document that says who does what, when and how.

A policy is usually made up of three parts:1. A Statement of Intent.  (What you

intend to do) A written policy statement, which shows your staff, and anyone else, your commitment to health and safety.

2. Organization details.  (Who will be involved)  This section names those who will have responsibilities for health and safety matters in your company.

3. Arrangements. (How you will put it in place) This section explains how you will control the main hazards that have been identified in your risk assessment.

INTERNAL POLICIES & INTERNATIONAL GUIDELINES

Health Impact Assessments (HIA) HIA is a means of assessing the health impacts of policies, plans and projects in diverse economic sectors using quantitative, qualitative and participatory techniques.

A HIA helps company decision-makers make choices about alternatives and improvements to prevent disease/injury and to actively promote health.

The role of the HIA is to disentangle the determinants of health that is, individual, social and environmental, and institutional factors that are directly, indirectly, or cumulatively affected by the proposed project to allow better management of the risks associated with individual determinants (IFC 2010)

INTERNAL POLICIES & INTERNATIONAL GUIDELINES

Environmental Social and Health Impact Assessment (ESHIA) The ESHIA process is widely used in the extractive sector as it provides a systematic and risk-based approach to identifying, assessing and managing potentially significant impacts. The assessments can include potential impacts of our activities on surrounding communities, natural resources, air quality, land and water, or community health and livelihoods. Obtaining input from communities and partners is central to the ESHIA process and occurs throughout a project’s life cycle.

Environmental and Health Impact Assessment (EHIA) The EHIA is an Environmental Impact Assessment (EIA) with a health component included in the appraisal process. Often, health assessments in EHIA includes health issues that can be measured – such as chemical and pollution exposure – while focusing less on qualitative information such as community perceptions of health issues.

INTERNAL POLICIES & INTERNATIONAL GUIDELINES

Human Rights Impact Assessments A HRIA is an instrument for examining policies, legislation, programs and projects to identify and measure their effects on human rights.

HRIAs provide a reasoned, supported and comprehensive answer to the question:

“How does the project, policy or intervention affect human rights?”

Their fundamental purpose is to help prevent negative effects and to maximize positive effects.

HRIAs can reinforce existing rights-based (or rights-conscious) practices regarding participation and equality.

WHY HEALTH?

Why were Health Impact Assessments and other tools created?o Changing perceptions of health and wellbeingo A change in attitudes from treatment based

health care to a more preventative approacho Realization of the inherent health benefits (eg

in community investment, stakeholder and government support )

HRIA/HIA- THEORY VS PRACTICE

• When? o Project factors

o Location of Project o Number of people impacted o Vulnerability of impacted

people o Timescale of impact o Legacy issues o Type of projecto Workforce size & countries

of origin o Country legislation and

companyo Standards o Level of stakeholder interest o Availability of local expertise

Eithero Prior operational

deployment

Oro During operations to

assess state of affairs and compliance requirements

• Who should carry an HRIA/HIA?

HRIA- THEORY VS PRACTICE How?

o Consider context of project

o Desk researcho Field research through

thorough stakeholders engagement analysis and engagement plan

o Either normative or risk base analytical framework

o Analysiso Recommendations for

pre-emptive or remediation approach and grievance mechanisms

Contexto Location of project-

o State of countryo IP groups o International HR treaties

o Internal HR commitmentso Size of footprinto Health determinantso Environmento Lifestyleo Availability and lifestyleo Economic conditionso Social influenceo Personal circumstanceso Biological factors

HRIA/HIA/ESIA IN PRACTICE

Drivers to carry a HIA/ESHIA/HRIA Legislation Internal standards Lender requirements Pressure from civil society International best practice Risk management Salient human rights issues in your business Building community relations ie towards the social

licence to operate

HRIA/HIA/ESIA IN PRACTICE

Caveatso No off the shelf methodologyo Time consuming and can be

costlyo Short-shelf life especially in

conflict and sensitive areas due to the high volatility of the environment

Benefitso Maintaining a good company and

product reputation

o Effective risk identification and management

o Improvement of stakeholder relations

o Creating a legal and social license to operate

o Increased motivation and productivity of workers

o Understanding the society in which the company works

o Attractive investment climate

o Contribution to CSR and sustainable development

HEALTH RISKS- SECTORIAL DIFFERENCES Oil and Gas

Industry exposure to hazardous emissions, chemicals etc

Construction activity impacts Resettlement impacts Transmission of diseases Pressure on health

systems/infrastructure Sex worker influx Contamination of land and water

Construction Exposure to dust and fumes. Acute gasing Poisoning chemicals exposure like

abestos, lead, etc Height, confined spaces Base unit housing facilities Inadequate and limited healthcare

facilities in the area per population Etc..

For reference: The Safety and Health in Construction Convention, 1988 (No. 167)

Pharmaceutical• Access to medicine,

• Transparency

• Ethical marketing, pricing, monitoring and accountability

CASE STUDY IN THE MINING INDUSTRY

HEALTH AUDIT- IN MONGOLIA Context brief

A mine in Mongolia started building a base unit with accommodation buildings for its workers.

A total workforce of between 640 and 19,000 was involved in this work; the workforce itself peaked in October 2011 with a total of 18,903 individuals working on the project. Of these, 11,995 were Mongolian, 5,906 Chinese, and 1,002 of other nationalities. Mongolian and Chinese workers were accommodated separately in two camps for security purposes.

Why the Health Audit was carried out

Reports from external consultants reported inadequate due diligence on sub-contractors and violations of human rights.

MONGOLIA

How was the audit done?o Desk review of human rights

commitments and labor/working conditions related policies

o A site visit and unannounced spot checks on accommodation, living conditions at the camp (old an refurbished facilities) and at the power plant and other sites.

o Interviews of workerso Interviews of managerso Interviews of HQ senior

managerso Interviews with NGOs

Findingso Poor living conditions

(Facilities)o Inadequate clothing for

weather conditionso Poor health and hygiene

conditions (kitchen below standards)

o Non-standards bathrooms

o Remediationo Built new bathroom unitso Changed accommodation

furnitureo Created internal health and

hygiene checkso Developed a grievance

mechanisms

MONGOLIA

PRELIMINARY CONCLUSIONS

Existing corporate policies and international standards vs practice Set of international guidelines, conventions, laws and internal policies

regarding the right to health and health indicators have been put in place. Health has taken its rightful place over the last decade in international

debates on human rights, health protection and health related living conditions through consumers associations, international bodies, scientific bodies and corporations’ commitment to improving human rights policies.

Some pending questions regarding HRIA/HIA/ESIA: Where should the HIA or H component of an ESHIA sit within an

organization to be effectively managed? What more can companies be doing to improve health outcomes? Are States responsible for guaranteeing companies operating on their

territory accountable and liable for human rights violations and especially right to health? What if the state is failing itself to fulfill its responsibilities?

THANK YOU