Documente Academic
Documente Profesional
Documente Cultură
Challenges, Synergies,
Methodologies
June 22nd, 2008
Core Themes
Human rights abrogation or protection can have
profound impacts on the health of individuals,
communities, and populations
Rights violations which affect populations need
to be investigated and addressed using
population-based methods
Responses based on human rights principles
may improve disease prevention and control,
and better the human rights contexts for those at
dual risk
Outline
I.
Introduction
II.
Introduction
Modern human rights movement a
response to Nazi atrocities of WWII
Universal Declaration of Human
Rights passed by United Nations on
December 10, 1948
Defines the fundamental human rights of
persons and violations of those rights
Universalist
Aspirational
Lacking enforcement mechanisms
UDHR
Resolutions include:
State Responsibilities
Signatory States must not
violate these rights
Commit to measurable progress
to:
Respect
Protect
Fulfill
Burma
Population 50 million
Ethnically diverse
90% Buddhist
Military junta (SPDC)
Poor health indicators
IMR: 76/1000
U5MR: 104/1000
WFP: 33% of children
chronically malnourished
WHO: 190 / 191 ranking for
health system
Forced labor
Destruction / seizure of crops / livestock
Arbitrary arrest and detention
Forced military conscription
Torture, rape, execution
Four cuts
Methods - Design
Retrospective household surveys
Reporting of vital events
12 month recall period
Sampling
Two stage cluster design
100 clusters
20 households / cluster
Methods - Design
Cluster selection:
Village based
Selection proportionate to population size
Census provides complete lists of
population by village
Survey elements
Context demands simplicity
Constant movement by interviewers
Travel on foot
One page limit
Household census
All deaths recorded (cause)
Listing by age / sex
Results Sample
Response rate has varied: 70-92%
Total sample 7,500-9,000
(5-6 persons / household)
Males
Females
95-100
90-95
85-90
80-85
75-80
70-75
65-70
60-65
55-60
50-55
45-50
40-45
35-40
30-35
25-30
20-25
15-20
10-15
5-10
0-5
900 800 700 600 500 400 300 200 100 0 100 200 300 400 500 600 700 800 900
Lee TJ, Mullany LC, Richards AK, et al. Mortality rates in conflict zones in Karen, Karenni, and Mon states in eastern Burma. Trop.
Med. Int. Health. 2006;11(7):1119-27.
Mullany LC, Richards AK, Lee CI, et al. Application of population-based survey methodology to quantify associations between
human rights violations and health outcomes in eastern Burma. J Epidemiol Community Health. 2007;61:908-14.
Lee TJ, Mullany LC, Richards AK, et al. Mortality rates in conflict zones in Karen, Karenni, and Mon states in eastern Burma. Trop.
Med. Int. Health. 2006;11(7):1119-27.
Sample Questions
Violation / Event
% of
Households
Forced Labor
32.6%
Forced Displacement
8.9%
25.2%
Landmine Injuries
1.3%
14.4%
Mullany LC, Richards AK, Lee CI, et al. Application of population-based survey methodology to quantify associations between
human rights violations and health outcomes in eastern Burma. J Epidemiol Community Health. 2007;61:908-14.
Mullany LC, Richards AK, Lee CI, et al. Application of population-based survey methodology to quantify associations between
human rights violations and health outcomes in eastern Burma. J Epidemiol Community Health. 2007;61:908-14.
Mullany LC, Richards AK, Lee CI, et al. Application of population-based survey methodology to quantify associations between
human rights violations and health outcomes in eastern Burma. J Epidemiol Community Health. 2007;61:908-14.
anemia:
unmet need:
No ANC:
<2 core ANC ints
Odds Ratio
2.90 (1.90, 4.44)
1.68 (1.15, 2.46)
3.34 (0.97, 11.5)
7.63 (1.85, 31.5)
Mullany LC, Lee CI, Yone L, Paw P, Shwe Oo EK, Maung C, Lee TJ, Beyrer C. Access to essential maternal health interventions and
human rights violations among displaced communities in eastern Burma. FORTHCOMING, 2008
Coverage
68%
75%
- Fe/FA supplement
91%
- Deworming
83%
- Nutrition / ENC
89%
69%
78%
PNC Intervention
- Family planning counseling provided
90%
Condom Usage
Thai Nationals
Burmese Migrants
P<0.05
Men
Women
Men
Women
Barriers to information, health care: Language, Legal, Physical, Economic, & Political
PHR/JHU: Thailands failure to provide access to services violates Thai law AND
undermines national HIV and STD programs
Source: Mullany et al, AIDS Care, 2003; Lertpiriyasuwat et al, AIDS, 2003;
Leiter et al, Health & Human Rights, 2006
Conclusions
Constraints inherent in IDP context demand
creative thinking and adapted solutions
Grass-roots community organizations can
take the lead even in refugee and IDP
settings
Building capacity to monitor PH programs
Ensures success of programs
Potential to understand direct and indirect
impacts of human rights violations on health
Ways Forward
Recognize
Human rights contexts of our work
Partner
With the grassroots, with human rights groups in
country and internationally, with those we seek to
serve facing rights violations
Act
Research, Advocate, and Fund