Editorial

Citation

Gavrielides, T. (2015), "Editorial", International Journal of Human Rights in Healthcare, Vol. 8 No. 3. https://doi.org/10.1108/IJHRH-07-2015-0022

Editorial

Article Type: Editorial From: International Journal of Human Rights in Healthcare, Volume 8, Issue 3.

Theo Gavrielides

Human rights revisited: tackling race inequalities in health and social care

Welcome to this special edition dedicated to human rights. According to the Universal Declaration of Human Rights, "Human rights refer to the basic rights and freedoms to which all humans are entitled", or as Paper 1 states: "All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood". Human rights are minimum standards that are available to everyone simply because of our humanity.

In the UK, human rights are protected principally through the Human Rights Act 1998 (HRA), which made the European Convention on Human Rights directly enforceable into domestic law. During the Bill's passage through Parliament, hopes were created that the new "super law" would go far beyond merely influencing the nation's legal order (Klug, 2000). A new human rights culture loomed on the horizon. In fact, during the Parliamentary debates, the government said that one of the results of the new Act "will be the beginning of the strong development of a human rights culture" (O'Brien, 1999).

What is a human rights culture? "Culture is one of those words that gets used to mean a lot of different things – and sometimes nothing at all. What do we mean when we talk of building a culture of rights and responsibilities in the UK? These aren't empty words or mere jargon. It's what we want the whole public services in this country to move towards" (Straw and Jack, 1999). The Minister also explained that culture encompasses the habits of mind, the intellectual reflexes and the professional sensibilities, which are historically ingrained and typical of the behaviour of a particular group of people.

It soon became clear that human rights and the HRA were intended to be used as levers for cultural change in public service provision and society (Gavrielides, 2008). On 2 October 2015, we will be celebrating 15 years from the Act's implementation. I say "celebrating" with much hesitation as the political rhetoric recently has been rather hostile towards human rights and the contribution that human rights legislation can make to the lives of simple people whether these are left without care in hospitals, emergency departments or care homes.

In all, 15 years on and we are yet to witness a human rights culture in health care services in the UK. And yet we are debating whether the HRA should be scrapped. Some have argued that this is because the concept of human rights is not easily associated with public service provision least health and social care services (Harvey, 2005; Gavrielides, 2008; Ministry of Justice, 2008). The same seems to apply to the HRA, which is faced with a certain level of hostility by public service providers and consumers. In fact, there is some evidence to suggest that the problem is particularly acute within black and minority ethnic (BME) communities (Gavrielides, 2008; Blooden and Bamford, 2010). Even worse, this problem may be directly related to experiences of poor-quality public service delivery (JCHR, 2007; Gavrielides, 2009). In fact, according to research, BME users of health and social care services tend to experience additional barriers such as:

1. "difficulty in accessing information;

2. difficulty understanding a complex, uncertain and locally varied system;

3. stigma, low expectations or lack of confidence in one's right to access services;

4. problems in accessing general practitioners and in obtaining an accurate diagnosis, assessment and referral from them and other gatekeepers;

5. a lack of appropriate, accessible and attractive provision; and

6. housing/financial circumstances and the extent to which private and/or family care may constrain individuals' options" (Blooden and Bamford, 2010, p. 5).

BME users of health and social care services, particularly older people, may also find themselves lonely as their families tend to live abroad (JCHR, 2007). Furthermore, the issues of loneliness and lack of family care and friends' networks are exacerbated among BME gay and lesbian groups, particularly if they are elderly (EHRC, 2011).

So where do we go from here and what can we learn from the UK experience for others who live abroad? I have argued elsewhere that too much emphasis has been put on the legalistic nature of human rights rather than the underlying values characterising them (Gavrielides, 2011). According to the JCHR (2002), "Too often human rights are looked upon as something from which the State needs to defend itself, rather than to promote as its core ethical values. There is a failure to recognise the part that they could play in promoting social justice and social inclusion and in the drive to improve public services. We have found widespread evidence of a lack of respect for the rights of those who use public services, especially the rights of those who are most vulnerable and in need of protection" (p. 6).

Applying human rights with a narrow legalistic understanding will most likely lead new initiatives to build a "human rights culture" to failure. Health and social care providers will always put an emphasis on delivering services and saving lives. Mainstreaming human rights and making them part of the day-to-day service delivery is proposed as a way forward. So where should our focus be?

We should not lose sight of the underlying values of human rights legislation such as dignity, respect, equality, fairness, and involvement in decisions that affect you! How does this translate in practice? The articles in this special issue provide case studies from around the world whereby human rights values are applied within a health care context. They also help us contextualise what human rights mean in the international health care arena.

Starting with "Inequalities of general physicians and specialists visits' utilization and its determinants in Iran: a population based study", the authors argue that there are inequalities between general physicians and specialists visits in Shiraz. They proceed to identify the factors effecting the utilization of visits. Concentration index and curves, ranked by income and quality of life were used to estimate the amount of inequality in the utilization of services. Health utilization data were also used for this purpose, while Poisson regression was used to construct several models. Results of the study showed that, inequalities in specialists' visits were higher than GPs. Complementary insurance users and females used more specialist services. People with higher quality of life utilized fewer GPs and specialist services. Policy makers must find solutions to decrease inequalities in utilization of higher prices services.

Subsequently, in "Using children as informal interpreters in pediatric consultation", we learn that health care professionals (HCPs) face numerous barriers in providing services to limited English-proficient (LEP) patients and their families. The purpose of this multiple-case study was to explore and expand on the limited scholarship concerning HCPs' experiences using children as informal interpreters in pediatric consultations. Ten HCPs from five different fields participated in this study. They were interviewed over the phone and replied to follow-up correspondence about their knowledge on policies for communicating with LEP patients and/or their families when providing medical care. Using a thematic analysis five themes emerged across all cases: cultural awareness, communication quality, live interpreters as a solution, use of child language brokers, and the norm of child language brokering. Through the development of the aforementioned themes, HCPs' limited awareness of implications when using child language brokers and of the established policies related to this phenomenon were apparent. This lack of knowledge, acknowledged by HCPs, provides a platform from which to create awareness of the need for further education about the potential risks child language brokers face when interpreting medical information and of the negative impact this process can have on the overall medical outcome of a patient. Furthermore, it allows us to address the ignorance within the health care system that has allowed vulnerabilities to LEP individuals being treated in health care facilities.

In "Inequalities in addressing the HIV epidemic: the story of the Indonesian Ojek Community", the authors discuss the potential socio-cultural determinants contributing to inequalities and the susceptibility of the Ojek to HIV infection. In 2010 a qualitative enquiry was employed to collect data concerning the susceptibility of the Ojek to HIV infection. Both one-on-one open-ended in-depth interviews and focus group discussions were employed. Participants included Ojek (hired motorcycle drivers), religious and community leaders, staff from the HIV/AIDS Commission of Belu, and staff from two HIV/AIDS nongovernmental organisation. The findings showed four socio-cultural determinants of susceptibility to HIV infection within the Ojek community. These included: mobility and migration, patterns of sexual behaviours, sexual networks, and sexual incentives, cultural norms and social interactions, and the lack of resources, knowledge and awareness of HIV/AIDS. Underpinned by these factors, the main determinant of HIV susceptibility for the Ojek is an individual's engagement in sexual intercourse with multiple sex partners, including female commercial sex workers (FCSWs). The paper concludes that there is a need to disseminate HIV/AIDS information and education throughout the Ojek communities, and to engage the general population in the promotion of sexual behavioural change among the Ojek in Belu. Empowerment strategies should also be employed to empower the general community, the Ojek and FCSWs in order to address HIV/AIDS transmission.

The following paper "Discussing race, racism, and mental health: two mental health inquiries reconsidered" argues that the history of psychiatry and mental health services is scarred by racism – i.e. prejudice and discrimination based on the belief that human beings can be classified or divided into distinct biological groups and that these "races" possess distinct and inherent characteristics and traits. The paper explores the ways, in which, the issues of race and racism were examined in two mental health inquiries both of which took place in the early 1990s. The policy of "deinstitutionalisation", i.e. the closure of large psychiatric hospitals or asylums and their replacement with community-based mental health services has been followed across most industrialised nations. The term "community care" has been used as a short-hand for this range of policy developments. The failings of "community care" in the late 1980s and early 1990s led to a number of Inquiries exploring what had gone wrong in individual cases. This paper explores the differing approaches that were taken in these Inquiries to the issue of racism and racist stereotyping within mental health systems. The paper concludes that an understanding of this historical context is required these if the racism that continues to blight services is to be tackled.

In "Refugees' Resettlement in a Canadian Mid-Sized Prairie City: Examining Experiences of Multiple Forced Migrations", the authors explore the experiences of multiple forced migrations and resettlement between two refugee families in a mid-sized Canadian city. Case studies are located within the contingencies of the participants' lives and the meanings they provide to the events. A postcolonial feminist perspective guided the data analysis to explore the micro-level of individual experiences that unfold within a raced, gendered, and classed reality. Open-ended interviews and fieldnotes were used to collect participants' perspectives. Data were collected until saturation occurred. The paper concludes that shared experiences of forced migrations, the past and present construction of new identities as well as resettlement challenges and opportunities are three key themes that intersect to shape the experiences of double forced migration.

Finally, from the last paper "Democracy, political freedom, and health expenditures: evidence from Eastern Mediterranean countries", we learn that health can be influenced by many societal factors. One of these factors is the political context of the country and democracy. The paper examined the effects of freedom in press and polity index in overall, public, private, and out of pocket health expenditures. A long-term panel data approach was used to examine the relationship between democracy and health expenditures. The authors inserted polity and freedom into press indexes in the health expenditure model, showing that it has a significant impact on all the health expenditure models. Increasing freedom of the press and democracy will increase the overall, public and private health expenditures while they decrease out of pocket health expenditures.

The Publisher and I took a conscious decision to rename and relaunch our journal as the International Journal of Human Rights in Healthcare because we believe that it is through human rights that the basic entitlements of all, and particularly of those who are most vulnerable, are protected. Human rights values provide a shared vision and a common language that we should all understand, accept and protect. As Eleanor Roosevelt said: "Where, after all, do universal human rights begin? In small places, close to home – so close and so small that they cannot be seen on any maps of the world. Yet they are the world of the individual person; the neighbourhood he lives in; the school or college he attends; the factory, farm or office where he works. Such are the places where every man, woman and child seeks equal justice, equal opportunity, equal dignity without discrimination. Unless these rights have meaning there, they have little meaning anywhere. Without concerned citizen action to uphold them close to home, we shall look in vain for progress in the larger world".

References

Blooden, I. and Bamford, S.M. (2010), Equality and Diversity and Older People with High Support Needs, Joseph Rowntree Foundation, York

EHRC (2011), How Fair is Britain?, Triennial Review, Equality and Human Rights Commission, London

Gavrielides, T. (2008), "Human rights and customer satisfaction with public services: a relationship discovered", International Journal of Human Rights, Vol. 12 No. 2, pp. 187-202

Gavrielides, T. (2009), "Review by human rights specialist of improving health, supporting justice: a national delivery plan", Department of Health Equality Impact Assessment of Improving Health, Supporting Justice, Department of Health, London

Gavrielides, T. (2011), "Human rights in health and social care", Ethnicity and Inequalities in Health and Social Care, Vol. 4 No. 1, pp. 28-38

Harvey, C. (2005), Human Rights in the Community, Hart Publishing, Oregon, OR

JCHR (2007), "The human rights of older people in healthcare", HL Paper No. 156-I, Vol. I, Joint Committee on Human Rights, London

Klug, F (2000), Values for a Godless Age, Penguin, London

Ministry of Justice (2008), Human Rights Insight Project, Ministry of Justice, London, available at: www.justice.gov.uk/publications/docs/human-rights-insight-part1.pdf (accessed August 2015)

O'Brien, M. (1999), "On the human rights Act 1998", paper presented at the Local Government, Association Conference, 21 May, available at: www.nationalarchieves.gov.uk/ERORecords/HO/421/2/hract/lgaspeech.htm (accessed August 2015)

Straw, R.H and Jack, MP (1999), "Building a human rights culture", address to Civil Service College seminar, 9 December

Further reading

JCHR (2003), "The case for a Human Rights Commission", HL Paper No. 67-I and II, HC 489-I and II, Joint Committee on Human Rights, London

Roosevelt, E. (1958), "In Our Hands", speech delivered on the tenth anniversary of the Universal Declaration of Human Rights