SPIRIT OF 1848: APHA 2006 PROGRAM:

The Spirit of 1848 is happy to present its program for the 134th annual meeting of the American Public Health Association

November 5-8, 2006, Boston, MA

(For a 2-page pdf version of the 2006 Spirit of 1848 Program click here.)

SESSIONS

All Spirit of 1848 Sessions will take place in the Boston Convention & Exhibition Center (BCEC).

Mon, Nov. 6:
10:30 am to 12 noon:
Health & Human Rights: Critical Historical Perspectives From The Cold War To The New World Order (Session 3152.0; BCEC 50) <more info>

2:30 pm to 4:00 pm:
Health & Human Rights: Methodologies, Monitoring, And The Politics Of Data (Session 3350.0; BCEC 253A) <more info>

4:30 pm to 6:00 pm:
Social Justice, Human Rights, And Health: From Rhetoric To Reality (Session 3424.0; BCEC 253A) <more info>

Tues, Nov. 7:
8:30 am to 10:00 am:
Health & Human Rights: Teaching In The Community And The Classroom (Session 4066.0; BCEC 50) <more info>

12:30 pm to 1:30 pm:
Social Justice & Public Health: Student Posters (Session 4099.0 BCEC Halls A/B1) <more info>

6:30 pm to 8:00 pm:
Spirit of 1848 Caucus Business Meeting (Session 437.0 BCEC 150)

Note: we are also co-sponsoring:

1). the P. Ellen Parsons Memorial Session: Universal Access: At a Tipping Point? (Session 4238.0 BCEC 206A)on Tues, Nov 7, 2:30 to 4:00 pm <more info>

2). the Tuesday night DANCE PARTY (8pm -- midnight), sponsored by the Occupational Safety & Health Section, at the Bell in Hand Tavern (45-55 Union Street near Fanueil Hall; near the Government Center T Stop on the Green Line). Tickets are available at the Occupational Safety& Health Section booth and at the door.

back to top

MON, NOV. 6

Mon, Nov. 6, 10:30 am to 12 noon:
Health & Human Rights: Critical Historical Perspectives From The Cold War To The New World Order (Session 3152.0 BCEC 50)

10:30 am
Introduction: Anne-Emanuelle Birn ScD (Department of Public Health Sciences, University of Toronto, Faculty of Medicine, 155 College St., Room 662, Toronto, ON M5T 3M7, Canada, (416) 946-5792, ae.birn@utoronto.ca)
• The discourse of human rights and the values underpinning the notion of health as a human right fundamental to all aspects of human life and well-being are widely invoked yet little explored in historical context. This panel will examine the emergence and development of health and human rights frameworks through the 20th century, presenting case studies to enhance understanding of the motives/influences, features, and application of health and human rights approaches in various time periods and settings. The panel will offer a critical historical perspective on human rights and health discourses and practices internationally, with a particular focus on the United States.

10:35 am
Physicians for Human Rights: A case study in progress toward social determinants of health.
H. Jack Geiger, MD, MSciHyg (Community Health and Social Medicine, City University of New York Medical School, City College of New York, Harris 401, 138th Street at Convent Avenue, New York, NY 10031, 212-650-6860, jgeiger@igc.org)
• Significant attention to health as a human right began after World War II with the Universal Declaration of Human Rights and the creation of the World Health Organization. The real focus of these efforts, however, was on access to health care and a vaguely defined goal of achieving "the highest attainable standard of health, and neglect by most advocacy organizations of economic and social rights as the essential determinants of a right to health. Instead, their efforts centered on the health consequences of human rights violations, ignoring the conflict between the goal of health as a human right and U.S. domestic and foreign policy. An examination of the work of Physicians for Human Rights USA and other organizations, however, shows progress over time to more direct pursuit of social justice goals.

10:55 am
Jonathan Mann, HIV/AIDS, and human rights.
Elizabeth Fee, PhD (National Library of Medicine, History of Medicine Division, National Institutes of Health, 8600 Rockville Pike, Building 38, 1E21, Bethesda, MD 20894, 301-496-5406, feee@mail.nih.gov)
• When a new immune deficiency disease was recognized in 1981, it was almost immediately characterized as gay-related. The early association of HIV/AIDS with marginal groups—homosexuals and IV drug users--structured social and political responses to the disease. Many countries began to enact restrictive travel policies and to contemplate compulsory testing or even quarantine for people with AIDS. In 1983, a team of specialists went to investigate a series of mysterious deaths in Kinshasa, Zaire, and concluded that these patients were dying of the same disease that was killing young men in New York and California. Jonathan Mann became convinced that the disease was heterosexually transmitted and had potential to become a worldwide pandemic. He in turn convinced Halfdan Mahler, Director General of WHO, that HIV/AIDS was not only killing promiscuous gay men in the western world, but was an immanent threat to the entire developing world. Mann argued that AIDS was a social disease, flourishing in conditions of poverty, oppression, urban migration, gender inequality, and social violence. Convinced, Mahler made Mann the director of the Global Program on AIDS. In that position, and because of his eloquence and passion, Mann was able to build a massive and effective program, mobilizing ministers of health around the world to address the AIDS epidemic, and advocating a human rights framework for understanding the disease. Ousted from WHO in 1990, Mann became the first professor of health and human rights at Harvard University.

11:15 am
A perspective on the future history of health and human rights.
Daniel Tarantola, MD, Professor (Faculty of Medicine School of Public Health and Community Medicine, University of New South Wales, UNSW, Samuels Building Room 228, Sydney, NSW 2052, Australia, 61 2 9385 8268, d.tarantola@unsw.edu.au)
• Lessons drawn from the health and human rights movement in the last decade are rich and diverse. Considerable progress has been achieved in the understanding of the synergy between health and human rights and of the potential of this approach to transform public health policies and practice. Yet, the evolving geo-political and economic realities--and myths--have triggered skepticism and criticism about the actual value of human rights as a means to reshape public health policy. Is there an ongoing health and human rights crisis? Or are there crises of national, international and global governance?

11:30 AM
Health and human rights history: discussant.
A. J. Taylor, MPH (REACH Boston Elders 2010, Boston Public Health, 1010 Massachusetts Ave., 2nd Floor, Boston, MA 02118, 617-233-1815, ajtaylor55@comcast.net)
• As discussant, I will draw on my local working experience with Black Elders and the Boston Public Health Commission, along with my experiences over the past two decades in linking global issues of human rights, women's rights, and reproductive rights, to reflect on what the history of health & human rights means for current work for social justice in public health today. In particular, how can health activists in the US and other countries draw on the rich history of health and human rights to hold governments accountable for eliminating health disparities.

11:45 am
Question & answer period

back to top

Mon, Nov. 6, 2:30 pm to 4:00 pm:
Health & Human Rights: Methodologies, Monitoring, And The Politics Of Data (Session 3350.0; BCEC 253A)

2:30 pm
Introduction to Politics of Public Health data session
Catherine Cubbin, PhD (Center on Social Disparities in Health, UCSF, 500 Parnassus Ave, MU-3E, Box 0900, San Francisco, CA 94143-0900, and Population Research Center, University of Texas at Austin, 512-391-0391, cubbinc@fcm.ucsf.edu)

2:35 pm
Value of human rights for monitoring and evaluation of public health policies and programs: lessons learned from review of existing HIV/AIDS indicators.
Sofia Gruskin, JD, MIA(1), Shahira Ahmed, MPH1, Laura Ferguson, MS(1), and Daniel Tarantola, Prof(2). ((1) Program on International Health and Human Rights, Harvard School of Public Health, Harvard University, 651 Huntington Ave, 7th Floor, Boston, MA 02115, 1-617-432-0650, sahmed@hpsh.harvard.edu, (2) Faculty of Medicine School of Public Health and Community Medicine, University of New South Wales, UNSW, Samuels Building Room 228, Sydney, NSW 2052, Australia)
• In public health, if human rights are considered at all, it is generally only because of their moral or legal base. Human rights, however, also provide an approach to enhance the effectiveness of public health policies and programs. We focused on the area of monitoring and evaluation as indicators often drive programmatic directions. Numerous monitoring and evaluation instruments exist in the HIV/AIDS field. We reviewed indicators promoted globally and used by many countries to determine the extent to which rights concerns were integrated within them, and to suggest approaches for better integration of rights for future efforts. Human rights principles identified as relevant to the effectiveness of HIV programming including non-discrimination, participation, and accountability, were used to conduct this assessment. Although existing indicators touched on rights issues, some key lessons were learned. The extent to which non-discrimination could be assessed was hampered by the lack of disaggregated data. While a number of indicators measured participation, existing efforts do not sufficiently grapple with the complexity of measuring participation of the most vulnerable. Even when indicators are concerned with measuring accountability through the existence of laws and policies, no information is provided on the content, quality, or process of implementation. Recommendations noted for public health efforts generally include: modification of existing indicators; the addition of a few targeted indicators; joint collection and analysis of quantitative and qualitative data; and conduct of targeted evaluation research to paint a fuller picture inclusive of human rights concerns.

2:50 pm
Opportunities and challenges for using indicators to monitor the rights to health.
Alicia Ely Yamin, JD, MPH (Director, Research and Investigations, Physicians for Human Rights, 2 Arrow Street, Suite 301, Cambridge, MA 02138, 617-301-4213, ayamin@phrusa.org)
• Overview The right to health is set out in a number of instruments under international law. Historically, one of the obstacles to the realization of the right to health has been the lack of indicators by which to measure government compliance and chart government progress. Yet it is unclear what a human rights lens adds to health indicators and what the limitations of using indicators for human rights purposes may be. Methods This presentation is based on practical and conceptual work developing and using human rights-based indicators to measure health with local non-governmental organizations in South America, expert working groups at the WHO, collaboration with the Special Rapporteur on the Right to Health, and an investigation done in conjunction with the American Association for the Advancement of Science. Discussion Significant progress has been made on the development of indicators to measure rights-based aspects of health, including a taxonomy of structural, process and outcome indicators. There is agreement that while a right to health indicator may also be a plain health indicator, its interpretation is aimed at holding duty-bearers to account. Moreover, a rights-based approach to indicators should also related human rights provisions, including non-discrimination and equality. Nevertheless, significant conceptual and practical problems remain in operationalizing the use of a rights-based approach to indicators. These include, measuring the meaningfulness of merely enacting legislation, getting access to data for non-governmental organizations, and assessing both the implications and limitations of data from a human rights perspective as well as a public health perspective.

3:05 pm
Right to health and trade: what role for human rights standards and tools in relation to medicines?
Lisa Forman, MA (Faculty of Law, University of Toronto, 25 Bedford Road Apt 504, Toronto, ON M5R 2K1, Canada, 1-416-515-7275, lisa.forman@utoronto.ca)
• International trade rules increasingly limit government policy options for accessing affordable essential medicines. These standards are not simply those imposed under the World Trade Organization's Agreement on Trade-Related Aspects of Intellectual Property (TRIPS), but include increasingly ‘TRIPS-plus' intellectual property rules in bilateral and regional free trade agreements. International human rights law however, promotes the view that access to essential medicines is a core obligation under the right to health and that this requires governments to modify trade rules to ensure that access to medicines is not unduly limited. In practice, human rights experts argue that this requires greater use of the limited flexibilities that international trade law provides, such as compulsory licensing and parallel imports. In addition, the United Nation's Special Rapporteur on the Right to Health has proposed the development of a right to health impact assessment mechanism (RTHIAM), whereby the health impact of potential trade rules on access to medicines can be assessed and modified accordingly. This presentation will both explore the human rights approach to trade law related to medicine, and outline possible approaches to developing a RTHIAM. This research is drawn both from a doctoral dissertation on international human rights law relating to AIDS medicines, as well as a research fellowship exploring the development of a RTHIAM for trade rules relating to essential medicines.

3:20 pm
LGBT health: a case study of politics and data collection.
NFN Scout, PhD (scoutout@gmail.com)
• The gold standard for population-based data collection is the federal surveys used to establish morbidity and mortality benchmarks for different population groups. But these surveys often do not collect data on lesbian, gay, bisexual and transgender (LGBT) behavior or identity. Despite this, researchers have used a series of smaller-scale surveys or proxy markers in larger surveys to uncover a consistent pattern of adverse health outcomes for this population group. This presentation will explore the persistent and deleterious effects of politics on the efforts to add LGBT data collection questions to the gold-standard federal surveys. A variety of information will be presented, including related political opposition occurring in the federal health arena, state success efforts at adding LGBT data collection questions, and the newest data emerging from California debunking the myth that asking if someone is LGBT constitutes a sensitive question (and therefore needs special extra expense management in the survey process). The case of the CDC's efforts to add an LGBT data collection question to their Adult Tobacco Survey will be presented to highlight the political opposition to this effort – despite the depth of sound science supporting the need for data collection on this issue. The impact of this political opposition will be discussed, and used as a platform to show how small population groups are especially vulnerable to population-based assessment of health needs.

3:35 pm
Discussant
Nancy Krieger, PhD (Dept of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Kresge 717, Boston, MA 02115, 617-432-1571, nkrieger@hsph.harvard.edu)
• The discussant will reflect upon the importance of a health and human rights framework for understanding the politics of public health data and for improving public health research and monitoring of health inequities, in light of the presentations provided by the session participants.

3:45 pm
Question & answer period

back to top

Mon, Nov. 6, 4:30 pm to 6:00 pm:
Social Justice, Human Rigghts, and Health: From Rhetori to Reality (Session 3424.0; BCEC 253A)

4:30 pm
Introduction
Nancy Krieger, PhD (Dept of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Kresge 717, Boston, MA 02115, 617-432-1571, nkrieger@hsph.harvard.edu)
• A key premise of the Spirit of 1848 Caucus is that there are inextricable links between social justice & public health, as embodied in: the politics of public health data, the social history of public health, and progressive pedagogy. The integrative session complements our 3 other oral sessions, which provide opportunities for more in-depth discussion regarding each of our 3 themes. In this session, we focus on: "Social justice, human rights, and health: from rhetoric to reality." At issue are the conceptual, methodological, and political issues involved in turning human rights into a meaningful tool for improving population health and reducing health inequities. The speakers will: (a) critically review the history of human rights and the development of the health and human rights framework, especially in the US context; (b) present an example of a new human rights tool for monitoring population health in relation to human rights, for purposes of accountability and making policy change; (c) discuss approaches to teaching about health and human rights to both health professionals and advocates; and (d) reflect on the 3 presentations from a global perspective and discuss future challenges to making health and human rights a reality in our troubled world.

4:35 pm
Using data to bring together health and human rights: assessing accountability and promoting program effectiveness.
Sofia Gruskin, JD, MIA (International Health and Human Rights Program., Harvard School of Public Health, Harvard University, 651 Huntington Ave., 7th floor, Boston, MA 02115, 617-432-4315, sgruskin@hsph.harvard.edu)
• Human rights have only recently been recognized as essential to advancing health and development. Data are --critical to these efforts both for the accountability generated through the use of human rights reporting mechanisms and to support evidence-informed, effective programming. Human rights provide an internationally accepted framework for state accountability, and enable systematic application of human rights principles to health policies and programs, including examination of laws and policies to ensure that they are supportive of health. Within health and human rights work, data are used for two distinct purposes: to document and draw attention to health-related human rights violations, and to inform the development, implementation, monitoring and evaluation of health policies and programs. Each of these purposes is explored with reference to specific examples. First, the use of health data to assess state accountability is discussed with emphasis on its use by the United Nations human rights treaty monitoring mechanisms. Second, the extent to which rights are generally integrated into public health tools is discussed and a data collection tool for use by national-level health programmers is presented that identifies and addresses legal, policy and regulatory barriers through the application of a human rights framework. These examples highlight two complementary approaches to the use of data in health and human rights work. Collecting reliable data linking health to human rights must be prioritised. Existing instruments can serve as models for the future but more efforts are needed which consciously consider both health and human rights in their design.

4:55 pm
Approaches to teaching about public health and human rights to health professionals and advocates in Brazil.
Ivan Franca-Junior, MD PhD(1), Jose Ricardo Ayres, MD PhD(2), Vera Paiva, PhD3, and Eliana Miura Zucchi(1). ((1) School of Public of Health - University of Sao Paulo, Av. Dr. Analdo, 715 sala 218, Cerqueira Cesar, Sao Paulo, Brazil, 55 11 30667127, ifjunior@usp.br, (2) School of Medicine - University of Sao Paulo, Av Dr. Arnaldo, 455 2o. andar, Sao Paulo, Brazil, (3) Insitute of Psychology - University of Sao Paulo, Av. Prof. Mello Moraes, 1721 bloco A, sala 113, Sao Paulo, Brazil))
• Brazil has had a strong collective health movement, which has played an important role on establishing guidelines for public health(PH) research and practice. Inspired by Marxist and other critical theories and forged fighting against dictatorship(1964-1989), it lacks a deep connection between practice and discourse of human rights (HR) movement. However, health is highly connected with HR. Thus, we have been developing, since 1998, many initiatives to introduce PH&HR in Brazilian agenda. At university, we have taught courses on HR history and theories prioritizing UN documents, and thinkers as Habermas, Bobbio and Boaventura Santos. Within health services, we have provided advisory on PH&HR for the AIDS national and Sao Paulo state programs. Regarding civil society, we have participated in many initiatives (lecturing & advisoring) along with NGOs (HIV/AIDS and child/adolescent health-related). Paulo Freire"s pedagogy which states that education must be emancipatory, dialogical and based in a problem-posing concept has been our option. “Banking” concept of education cannot be an alternative to teach PH&HR. After 8 years of work, we can say PH&HR is an emerging field, but it will take long to be an entrenched issue on health agenda. Different social actors are working with a PH&HR framework. Efforts should be kept to enhance PH&HR dissemination. Factors of resistance have been: 1)a broad social crime-related misrepresentation of human rights; 2)Brazilian collective health movement tends to see PH&HR as a liberal perspective – mechanically opposing individual to social rights; and 3)Brazilian judicial system has been pro status quo, authoritarian and disconnected from a HR perspective.

5:15 pm
Public health and human rights.
Daniel Tarantola, MD, Prof (Faculty of Medicine School of Public Health and Community Medicine, University of New South Wales, UNSW, Samuels Building Room 228, Sydney, NSW 2052, Australia, 61 2 9385 8268, d.tarantola@unsw.edu.au)
• Recognizing human rights in the design, implementation, and evaluation of health policies and programs can help point the way toward more effective action. Human rights are governmental obligations towards individuals, and because these obligations include the protection of public health, they are relevant to the design, implementation, and evaluation of health policies and programs. Examining public health through a human-rights lens means looking not only at the technical and operational aspects of public health interventions but also at the civil, political, economic, social, and cultural factors that surround them. These factors may include underlying unequal treatment or discrimination, for example on the basis of gender relations, religious beliefs, homophobia, or racism. Individually and in synergy, they influence the extent to which individuals and communities are able to access services or to make and effectuate free and informed decisions about their lives and, therefore, the extent of their vulnerability to ill-health. Health and human rights principles are relevant to the analytical and decision-making processes as well as to their outcome, measured as effective health policies, programs and practice, and greater realization of human rights. Bridging adequately the research and education gaps mapped out during this session will determine the future of public health.

5:35 pm
Discussion: Applying the human rights lens.
Makani Themba-Nixon (The Praxis Project, 1750 Columbia Rd, NW, Second Floor, Washington, DC 20009, (202) 234-5921, mthemba@thepraxisproject.org)
• Praxis' mission is to support and partner with communities to achieve health justice by providing resources and capacity for policy development, advocacy and leadership. Praxis uses innovative participatory approaches that bridge theory, research and action. Our role as a discussant will help participants bridge human rights theory and practice to its implications for community-based organizations -- especially in low income communities and communities of color.

5:45 pm
Question & answer period

back to top

TUES, NOV. 7:

Tues, Nov. 7, 8:30 am to 10:00 am:
Health & Human Rights: Teaching In The Community And The Classroom (Session 4066.0; BCEC 50)

8:30 am
Introduction.
Suzanne Christopher, PhD (Department of Health and Human Development, Montana State University, 318 Herrick Hall, Bozeman, MT 59717, 406-994-6321, suzanne@montana.edu)

8:35 am
Teaching of health and human rights: approaches, challenges, & opportunities.
Sofia Gruskin, JD, MIA(1), Daniel Tarantola, Prof(2) ((1) International Health and Human Rights Program. François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Harvard University, 651 Huntington Ave., 7th floor, Boston, MD 02115; (2) (Faculty of Medicine School of Public Health and Community Medicine, University of New South Wales, UNSW, Samuels Building Room 228, Sydney, NSW 2052, Australia, 61 2 9385 8268, d.tarantola@unsw.edu.au)
• The teaching of courses on health and human rights is growing and now exists in academic institutions around the world ranging from schools of public health and medicine to schools of law and in undergraduate education. Significant differences exist, however, in how this teaching is valued by the institutions where it takes place and how it is carried out. The Program on International Health and Human Rights at the Harvard School of Public Health and the Health and Human Rights Initiative of the University of New South Wales are co-hosting a one-day focused consultation, just prior to APHA, bringing together the range of actors who teach health and human rights courses within university settings. The meeting will be organized along two major themes: exploring the content and methodologies of health and human rights teaching within different types of academic institutions, including the course objectives, content, methods, and readings of these courses; as well as determining approaches, opportunities and challenges to teaching health and human rights within undergraduate, graduate and post-graduate training. A brief introduction to the history of teaching health and human rights and the summary results from this meeting will be presented.

8:50 am
Integrating human rights principles across health curricula.
Silvia Amesty, MD, MPH, MSEd(1), Alicia Gurdian, PhD(2)((1) Center for Family Medicine, Columbia University, 630 W. 168th St., VC 12-217, New York, NY 10032, 212-305-9107, sc1242@columbia.edu; (1) Institute of Educational Research, University of Costa Rica, San Pedro, San Jose, Costa Rica)
• Higher education has always been affected by the historical periods that contextualize it. We are constantly speaking of curricular reforms that better respond to the needs of the society at a given time; it is difficult to keep up with an ever changing, globalized world and to partake in the construction of knowledge and meaning if we do not assume a commitment to social justice, equity, peace, and the protection of the environment. Education should transcend the reproduction of knowledge, and be the vehicle for individuals to become agents of change, to understand the world they live in and make sense of their reality in order to transform it. Human rights principles may provide curricular programs with tools to define a methodology for reading the world, to delineate an approach to our quest for knowledge, to participate in the political-educational project of society, and to internalize and practice our humanity in all our endeavors. Human rights philosophy is multidimensional, and encompasses many areas of knowledge: philosophy, pedagogy, law, politics, and environment. Because of this, it cuts across all disciplines. Our proposal addresses the introduction of human rights principles across all curricula, rather than teaching these in one specific course. We are currently working with medicine and public health students and professors in developing and implementing a program that integrates human rights principles across every course. Our preliminary results show how this program has motivated participants to reflect on disparities and to “look at the world around us with different eyes”

9:05 am
Popular education: moving beyond the dialogue session.
Jessica Henry, MS, Matt Griffith, MPH, Doug Taylor, PhD, Connie Tucker, Estelle Archibold (Southeast Community Research Center, PO Box 5731, Atlanta, GA 31107, 404-373-6688, jessica@thecasaproject.org)
• The United Nations (UN) Universal Declaration of Human Rights ensures the right to take part in government. The UN Rio Declaration further states that “each individual shall have appropriate access to information concerning the environment.” However, while the United States Government has made available several informational resources regarding community environments, social institutions and financial barriers limit oppressed communities' access to and understanding of these resources, as well as their access to participate in decision-making, thus violating their human rights. The lack of understanding and obstructed access to civic society has produced health disparities and environmental injustices in numerous cases in the US South, with historically oppressed communities experiencing disproportionately high morbidity. It has been recommended in the Public Health literature that Popular Education Pedagogy be used as a tool in a Community-Based Participatory Research (CBPR) approach to assist oppressed communities in their struggle to gain access to decision-making, and in turn potentially decrease health disparities. This progressive pedagogy is often reduced to an initial dialogue session to identify health issues. The Southeast Community Research Center uses Popular Education in its CBPR approach to investigating environmental health disparities in four African American communities in Georgia and a network of environmentally affected communities in southern Louisiana. This presentation draws from experiences at each site describing successes, challenges, and lessons learned. Presenters will highlight Popular Education methods post-dialogue session, including the partnership building and research stages, and the stage of planning action to reinstate the right to participate in decision-making.

9:20 am
Valuing, vetting, and visioning: advance health and human rights in professional health programs.
Wael Noor El-Nachef(1), Jonathan Chevrier, MSc(2), L. Emily Cotter, MPH(2), Lisa Rahangdale, MD, MPH(3), Rohan Radhakrishna(4), Sheri Weiser, MD, MPH(5), and Vincent Iacopino, MD, PhD(6). ((1) Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Chicago, IL 60611, (2) School of Public Health, University of California- Berkeley, 140 Warren Hall, Berkeley, CA 94720, (3) Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California- San Francisco, 1001 Potrero Avenue, Ward 6D-8, San Francisco, CA 94110, (4) Joint Medical Program, University of California-Berkeley/San Francisco, 570 University Hall, Berkeley, CA 94720, 785-220-4266, viacopino@aol.com, (5) Center for AIDS Prevention Studies, University of California- San Francisco, 50 Beale Street, Suite 1300, San Francisco, CA 94105, (6) Physicians for Human Rights, 2 Arrow Street, Suite 301, Cambridge, MA 02138)
• In 2002, the Health and Human Rights (HHR) Curriculum Project published a review of human rights teaching in schools of public health, medicine, and nursing. The purpose of the review was to develop a framework for discussions on future development of HHR curricula in graduate health education. Since this time, events such as 9/11/01, Abu Ghraib, the Doha Declaration, and Hurricane Katrina have drastically shifted public dialogue, as well as funding sources, around human rights. Other advances, including the newly appointed UN Special Rapporteur on the Right to Health and growing global movements, such as the People's Health Movement, necessitate the incorporation of concepts such as global equity and the right to health into health professional curricula. To assess changes that have occurred since the original HHR curriculum project review, a follow-up survey of graduate health professional schools is currently being conducted. The purpose of this workshop is to discuss the results of this analysis. This includes attempts to systematically incorporate HHR throughout curricula, create HHR electives and certificate programs, develop HHR lecture series, establish HHR internships, and secure sustainable funding. Beyond institutionalized attempts, student-initiated activities such as film festivals, education and action weeks, and HHR organization affiliated chapters, have furthered awareness and engagement in this field. The session will conclude with informants' suggestions of how to advance HHR education at individual institutions including the development of online courses (e.g. CME credits), case-based learning, and solicitation of funding for a national HHR education coordinator.

9:35 am
Question & answer period

back to top

Tues, Nov. 7, 12:30 pm to 1:30 pm:
Social Justice & Public Health: Student Posters (Session 4099.0; BCEC Halls A/B1)
This session highlights posters prepared by students of public health and health-related programs focused on intersections between social justice and public health from a historical, epidemiological, global, and/or methodological perspective.

Poster #1
Human rights and humanitarian assistance: The Sphere Project.
Helen Ouyang, BA, MPH, MD candidate (School of Public Health (International Health), Harvard University, Boston, MA, helen@jhmi.edu)
• The Sphere Project was launched in 1997 by NGOs in response to the increasing need for a system of accountability and monitoring of humanitarian assistance, following the genocide in Rwanda. Sphere is unique not only because it is the first attempt made by humanitarian agencies to monitor their own activities in conflict or disaster but that it also propelled the language of human rights into the dialogue of humanitarian crises. While Sphere references human rights throughout its guidelines, the question still remains whether it is only rhetoric or if it actually brings a rights-based approach to humanitarian assistance. Currently, Sphere is still being recognized and used by the humanitarian community as only a handbook of technical standards. In addition, if humanitarian assistance is to be married to human rights, then it must be further examined whether such an approach is necessary or even suitable in a complex humanitarian space. Finally, the role of human rights in actual practice needs to be measured against quantifiable indicators. Once the association between rights and standards is made more explicit, and this disseminated to the humanitarian community, then the evolution of Sphere from a handbook to an articulation, an advocacy, and a practice founded in human rights should quickly follow.
Coalition building in African American communities: A model for reducing health disparities and achieving social justice

Poster #2
Economic Sanctions: rights-based strategies and reforms.
Zyde Raad, MS candidate (Department of Population and International Health, Harvard School of Public Health, zraad@hsph.harvard.edu)
• The use of economic sanctions by nation states and international organizations results in widespread human rights violations and disastrous health outcomes. Sanctions restrict food distribution, medical care, and access to basic sanitation, disproportionately impacting the health of susceptible sub-populations. These increasingly well-documented consequences can be mitigated using a comprehensive rights-based approach to reform sanction design, monitoring, and assessment strategies. Emphasizing non-discrimination and transparency in the design of humanitarian exemptions can improve the health of the civilian population. Given the interrelatedness of human rights, correlations between rights violations, social conditions, and health outcomes should be addressed when assessing the impact of sanctions. Vulnerability shifts that often occur during sanctions require new indicators that anticipate changes by monitoring education, social welfare, and sanitation, in addition to health status. Sanctioning parties and aid organizations should also promote both individual and administrative participation within the targeted state. National ministries and local groups can provide valuable contributions to monitoring and assessment efforts, particularly in terms of baseline health data and infrastructure analysis. Legal and humanitarian responsibilities for the protection of human rights call for a systematic integration of these principles into the work of sanctioning parties, targeted states, and independent organizations. Examples drawn from Iraq, Haiti, and Cuba will be used to demonstrate how rights-based sanctions reform can protect the dignity and health of affected individuals.

Poster #3
Who survives and why? An assessment of indigenous care seeking practices for acute respiratory infections in Bolivia.
Adriana Smith, BA(1), Kirk Dearden, DrPH, MPH(2), Jonathan Hansen(2), and Ben Brinton(2). ((1) School of Public Health, Boston University, 715 Albany Street, Boston, MA 02118, 617-638-4640, adrsmith@bu.edu, (2) Department of Health Science, Brigham Young University, 214 Richards Building, Brigham Young University, Provo, UT 84602)
• Introduction: In 2005, Bolivia elected its first indigenous president. Can Morales improve the health of indigenous populations who constitute more than 50% of Bolivia's population? This research informs our understanding of one health issue: acute respiratory infections (ARI) among indigenous children in Bolivia. Globally, 29% of children die from neonatal and childhood ARI. Methods: This study took place in El Alto, a city of 800,000 on the outskirts of La Paz. We examined indigenous parents' careseeking practices for children with acute respiratory infections (ARI). Using the Pathway to Survival, we assessed indigenous parents' ability to recognize ARI, seek treatment and access and secure adequate care for children suffering from ARI. We conducted key informant interviews, in-depth interviews and Participatory Learning and Action among physicians, pharmacists, traditional healers and 30 parents. We distinguished between parents who recognized symptoms and took action (“doers”) and those who did not (“non-doers”). Results: Parents had difficulty recognizing symptoms of ARI and confused ARI with other respiratory problems. They also delayed treatment seeking. For indigenous parents, access and quality were problematic. Indigenous parents were frequently excluded from the health system and were poorly treated when they did seek care. Conclusions: Social inequality and cultural misunderstandings discourage Aymara parents from securing appropriate healthcare for their children. Based upon discussions with the Pan American Health Organization and Non-governmental Organizations working in Bolivia, our findings will inform policies and programs designed to improve the health of indigenous and other marginalized populations.

Poster #4
EPA brownfields and Hyde Park: promises and poisons.
Olympia C. Anderson; Kenitra Robinson; Damu McBride; Gregory Wright; Brendetta Douglas (Florida A&M University, Science Research Center, Tallahassee, FL 32307, 850-559-2924, olympia1.anderson@famu.edu)
• For twenty years the residents of Hyde Park were forced to survive in poor living conditions. The community eventually became tired of these conditions and formed the Hyde and Argon Park Improvement Committee. HAPIC has had many success stories, one including that of the Goldberg Brothers Recycling and Salvage Yard in Augusta, GA. For as long as many of the residents of Hyde Park could remember the Goldberg Brothers Metal Recycling and Salvage Yard has always been part of the community. The Goldberg site has been a dumping ground for metals, wires, drums of unknown liquids, storage tanks and miscellaneous metal junk. Qualitative research methods were used to gather information. Such methods included attending focus groups with activists of Hyde Park, performing personal interviews with Hyde Park residents and community leaders, and touring the Goldberg site and other hazardous sites within the community. Our case study describes the activities that led to the cleanup of the Goldberg site and how it became part of the redevelopment plan for the City of Augusta, GA. Community activists, technical experts, local, state and federal government programs provided support that led to the community's success. Hyde Park will serve as a model for other communities fighting environmental injustice. Communication and the development of public and community linkages, as well as grassroots organizational capacity were important factors for environmental justice. The HAPIC organization will continue to work for the betterment of community needs in environmental as well as social programs in education and health.

Poster #5
An evaluation of a dismantling racism process at a county health department: social justice through a community-based participatory research approach.
Betsy E. Havens, MPH(1), Mondi Mason, DrPH(2), Michael Yonas, DrPH(1), Vanessa Jeffries, MPH(3), and Eugenia Eng, MPH, DrPH(4). ((1) School of Public Health, Department of Health Behavior and Health Education, University of North Carolina, Rosenau Hall Campus Box 7440, Chapel Hill, NC 27514, 919-923-7506, bhavens@email.unc.edu, (2) Association for Study and Development of Community, 2860 Adams Street, Denver, CO 80205, (3) Chatham County Public Health Department, Post Office Box 130, 80 East Street, Pittsboro, NC 27312, (4) Department of Health Behavior and Health Education, University of North Carolina, School of Public Health CB #7440, Chapel Hill, NC 27599)
• Anti-racism initiatives and community-academic partnerships are increasingly popular methods aimed at organizing and holding institutions accountable to eliminate healthcare disparities. Beginning in 2001, a Southern county public health department partnered with an anti-racism training and organizing firm in order to establish a Dismantling Racism (DR) process aimed at addressing institutional racism and its impact on health disparities. In order to facilitate staff in addressing the dynamics of race and power, the DR process incorporates a mandatory two-day workshop, optional bi-monthly caucus meetings (including a White caucus and People of Color caucus), and optional participation on the Change Team, which serves as the oversight committee for the comprehensive DR process. In 2005, an qualitative evaluation was conducted using a community-based participatory research (CBPR) approach in effort to understand 1) the varying levels of participation amongst staff and leadership within the DR process, 2) the perceived impact of the DR process, and 3) ways to improve the workplace intervention. This poster summarizes the CBPR process of development and implementation of the evaluation and highlights findings related to the participants' experience with the DR process. Findings include that 1) perceptions and critical consciousness about racism varied; 2) job responsibilities, experience with the DR workshop, and perceived impact of the DR process served as factors that both encourage and discourage participation in the process; and 3) the DR process has impacted participants' jobs, personal lives, and the health department overall. Implications for promoting social justice through anti-racism initiatives are also addressed.

Poster #6
Public health ethics: a framework to address social determinants of health.
Selena Ortiz, Angela Farnsworth (Center for Health Equality, Project EXPORT, University of Arizona Mel and Enid Zuckerman School of Public Health, 2501 E. Elm Street, Tucson, AZ 85716, 520-235-8374, sortiz@email.arizona.edu)
• As Project EXPORT Fellows at the University of Arizona's College of Public Health, we believe that the core societal determinants of health could be addressed as a result of the creation of public health ethics (versus bioethics in which medicine is historically linked with). We are supportive of developing a framework in which community can thrive from public health efforts which foster human rights such as access to safe and affordable housing, quality education, ability to economically provide for oneself and their family and health care. If these areas are addressed from a rights-based approach with stronger community as the objective, we believe we can then, realize a true state of health. A perspective regarding public health, human rights and social justice and a qualitative analysis of social justice courses/programs taught throughout the accredited schools of public health will be explored. Upon review of the array of social justice training programs, an introduction to the University of Arizona's Project EXPORT program, its goals and objectives, and its impact on social justice and human rights will be reviewed in the communities of Sunnyside, Elvira and Hardrock. Following, a discussion of how Project EXPORT graduate students of color are, themselves, a personification of social justice due to their ability to bridge practice-based experiences with academic discussion and insight into the development of new public health ethical theory.

Poster #7
Do race and gender moderate the relationship between socioeconomic status and obesity?
Tracy M. Hilliard, MPH (Department of Health Services, School of Public Health and Community Medicine, University of Washington, Box 357660, Seattle, WA 98195-7660, 206-715-3867, tmhill@u.washington.edu)
• The association of excess body weight with several chronic diseases makes the obesity epidemic a major public health concern. It has been well documented in the literature that among United States adults, obesity is more prevalent in lower socioeconomic status (SES) groups. Understanding the mechanisms by which race and gender influence the association between SES and obesity may help identify strategies to prevent and manage this disease. Participants were 5993 adults in the National Health and Nutrition Examination Survey (NHANES) conducted in 2001-2002. SES was defined by annual household income and education. Obesity was defined by a body mass index (BMI) of thirty or higher. The mean age in our sample was 47 years. Thirty-eight percent of our sample was obese. Nearly 48% of the sample was female. Participants' educational backgrounds ranged from 33% not being high school graduates, 24% having a high school diploma or GED, and 43% having more than high school or GED training. Income was distributed broadly across income brackets--25% of participants reported incomes between $0-$19,999, 31% reported incomes between $20,000-$44,999, 22% reported incomes between $45,000-$74,999, and 22% reported incomes of $75,000 or more. Half of our sample described their race/ethnicity as non-Hispanic White. Mexican Americans comprised 22% of the sample, followed by non-Hispanic Blacks (20%), and other-Hispanic/other race (8%). Multivariate analyses to determine whether race and gender moderate the association between SES and obesity will be presented. Investigating these mechanisms has the potential to impact public health policies and interventions.

back to top

Tues, Nov. 7, 6:30 pm to 8:00 pm:
Spirit of 1848 Caucus Business Meeting (Session 437.0 BCEC 150)
Come to a working meeting of THE SPIRIT OF 1848 CAUCUS. Our committees focus on the politics of public health data, progressive public health curricula, social history of public health, and networking. Join us in planning future sessions & projects!

NOTE: we are also co-sponsoring:

The P. Ellen Parsons Memorial Session, organized by Ellen Shaffer and sponsored by the Medical Care Section and co-sponsored by the Women’s Caucus. Tuesday, November 7, 2:30 to 4:00 pm (Session 4238.0, BCEC 206A). P Ellen Parsons was a founding member of the Spirit of 1848 Caucus, as well as a longstanding member of the Women’s Caucus and the Medical Care Section. The session information is as follows:

P. Ellen Parsons Memorial Session: “Universal Access: At a Tipping Point?”
Moderator: Ellen R. Shaffer, PhD, MPH (Center for Policy Analysis on Trade and Health; ershaffer@earthlink.net)
2:30 PM
Massachusetts’ Health Care Access Law: Consensus produced through the political process.
Emily Sherwood (Joint Committee on Health Care Financing, Massachusetts Legislature, Boston, MA 02130, (617) 722-2430, Emily.sherwood@state.ma.us)
• As has been widely reported, Massachusetts has passed legislation to provide virtually universal health care access to residents within three years. The health care access law, Chapter 58, redeploys safety net funds to subsidize comprehensive health insurance for residents with incomes below 300% of the federal poverty level; modestly expands Medicaid coverage; requires non-offering employers to pay a $295 per employee assessment to defray the state's cost of providing free care to the uninsured; creates a statewide clearinghouse, the Massachusetts Health Insurance Connector, to “connect” individuals and small business to high-value insurance products; merges the state's small- and non-group health insurance markets; and, requires all adults to have health insurance by July 1, 2007 or face tax penalties. These policy and funding elements have varying applicability to other states. However, the process of developing and passing Chapter 58 provides an instructive example of the interaction of critical health care constituencies in the development of health care policy. These constituencies include large integrated health care systems, community hospitals, safety net providers, professional guilds, insurers, managed care organizations, governmental payers, large and small employers, labor unions, state and federal regulators and health care consumers.

2:45 PM
If Health Care for All Is a Moral Right in Massachusetts, then Cost Control Is a Moral Duty.
Alan Sager, PhD, Deborah Socolar (School of Public Health, Boston University, 715 Albany Street, Boston, MA 02118, 617-638-4664, asager@bu.edu)
• In 2007, Massachusetts will pass two milestones. It will begin implementation of a new law that is said by its sponsors to cover 90 percent of the people lacking health insurance. And health care spending per person will pass $10,000 yearly, one-third above the U.S. average. Hospitals and other groups try to deny, rationalize, or explain away our higher costs. Some of these justifications are legitimate. Most are not. Even if hospitals and others could justify these costs in some statistical sense, the financial reality remains that health care in this state is becoming unaffordable for citizens, employers, and taxpayers. Family health insurance premiums are about $14,000 yearly in greater Boston, up an average of 10 percent yearly for the past decade. If this trend persists, family premiums will be over $22,000 in 2011--just 5 years from now. Failure to contain cost threatens coverage for everyone who still has it. And failure to contain cost will make it much harder to implement the already under-funded promises of the new Massachusetts health insurance law, chapter 58 of the Acts of 2006. Massachusetts health care is addicted to more money for business as usual. This is starkly unaffordable. In a few years--perhaps at the bottom of the next recession--there will not be nearly enough money to finance the types of care our hospitals, doctors, and other caregivers have become accustomed to giving. This state badly needs a health care financial disaster plan. But there's more good news than bad. One-half of current health spending is wasted. Much of the waste can be squeezed out and recycled to protect uninsured and under-insured people, hold down premium increases, and boost quality of care. Squeezing out waste will require a new type of cost control, one that rests on serious negotiations with our state's doctors. Here's why-- No past cost controls have worked. Many doctors here are hurting. Their gross incomes in this state average 30 percent below the national average (partly because we have so many doctors), and most of the rise in doctors' incomes goes to practice expenses. Doctors' decisions control almost 90 percent of health care spending. It is their patterns of care, especially for supply-sensitive services, that engender much of our state's extraordinarily high costs. Only state government can begin the job of negotiating new arrangements with doctors. It must begin the job soon. Smart gubernatorial leadership is essential.

3:00 PM
San Francisco Health Access Program: Policy and Possibilities.
Mitch Katz, MD (San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102-4593, (415) 554-2600, Mitch.Katz@sfdph.org)
• San Francisco has developed a plan to provide access to health services to the estimate 82,000 persons in the county who are uninsured. The San Francisco Health Access Plan (SF HAP) is a public/private partnership of community providers serving the uninsured population. It will provide prevention, primary care, specialty, pharmacy, laboratory, radiology and inpatient services. The estimated cost of the program is $200 million a year, or approximately $2,400 a year for each uninsured person. The program is funded through contributions by employers (businesses with more than 20 employees will be required to make contributions to the plan or expend an equal or higher dollar amount on other health benefits for employees); employees, and the City and County. Other key features of the program are the focus on preventive care, utilization of existing safety net providers, provision of choice, and maintenance of existing federal and state reimbursement for this population.

3:15 PM
Discussant.
Nancy Norman, MD, MPH (Medical Director, Boston Public Health Commission, nancy_norman@bphc.org)

3:30 PM
Question & answer period

back to top