This volume of essays, a reader in fact, is a
follow-up to the 1999 edition, but it is not really to be compared. It will
serve as an excellent introduction to students and scholars alike for what is
emerging as one of the most significant areas of thought within both the health
and the human rights communities. Indeed, in one interesting chapter Paul
Farmer and Nicole Gastineau from Harvard call for a "paradigm shift"
in our thinking of the two concepts individually and together. They call, quite
rightly it seems, for the right to health to be put front and centre in the human
rights debate, and for human rights to be fundamental to health development
programs. There is no, and should be no, division of two.

The volume is divided into a number
of sensible and appropriate sections in the standard manner of many academic
readers. This allows for the easy digestion of key topic areas for the dipping
visitor, and the more assiduous or obsessive ones can still read the book as a
whole with thematic developments. It considers, in turn, the links between
health and human rights, health and human rights in development, in emerging
technologies, in sexual and reproductive health, in understanding and
responding to violence, their methods, the nature of health as a right and how
to mobilize for health and human rights. Within those sections some key
questions such as the measurement of human rights, the training and education
of health professionals in human rights and the availability of patented
medicines for those in need but without the means of payment, are addressed.
These are issues of profound ethical and moral concern and are situated within
a social, economic and cultural context. They speak to the core concept of
health as a human right; is it universal? Is it contingent? Is it a right at
all? Are there obligations that go along with the right? The arguments are
lively, stimulating, well-informed and often steeped in real experience and
pragmatic realizations. The problems faced by international health or aid
agencies in, for example, combating the spread of HIV/AIDS in a socio-cultural
climate that disparages the use of condoms, or may believe that sex with a
virgin will cure it, are well presented. The need to work at multiple levels of
engagement and involve policy makers as well as grass roots practitioners is
unpacked in a clear and constructive manner. These sections would be as useful
for scholars as practitioners.

However, it is undeniably
disappointing that mental health figures so infrequently in any of these
debates, especially in view of the recent WHO document on mental health as a
human right. Mental health receives only a passing mention either as a health
concern or as a human right. This is hard to fathom when the incidence and
prevalence of severe mental disorders is so great and depression alone is
becoming one of the major causes of the burden of disease in the world. It is
not only surprising, but a little distressing.

It is clearly and often stated that
maternal and child mortality, or the effects of HIV/AIDS are social as well as
individual concerns (and this is entirely correct, it is not my intention to
minimize them), but there is almost no discussion of the personal or communal
effects on mental health of these conditions. How does the death of children,
mothers or the young affect a community? Should not mental health be seen as an
essential element of holistic care? It is mentioned that the conditions of
prisons and camps for refugees and displaced persons give rise to major health
concerns, but there is little mention of the mental health issues that they
involve.

The lack of mental health
considerations would seem to be a major flaw in this otherwise comprehensive,
informative and well-structured volume. It is hard to understand how or why
this happened. It is neither acknowledged in the text, nor specifically
explained. It is to be hoped that if there is another edition to follow, and
there should be as the field of study is expanding in a rapid and exciting way,
that mental health and the millions for whom this is central to their lives,
receives appropriate prominence and treatment.

© 2005 Mark Welch

Mark Welch, Ph.D. Assistant Professor in the Faculty of
Nursing at the University of Alberta, Edmonton, Alberta and Co-Director of the
PAHO/WHO Collaborating Centre for Nursing & Mental Health.

Categories: Ethics