1. Berlin, 17-18 September 2010, Health justice - worldwide! Global, gerecht, gesund Forum V. Eine neue Ethik Health care workers contribution to the Right to Health Remco van de Pas Wemos foundation, The Netherlands On behalf of the Medicus Mundi International network

2. Berlin, 17-18 September 2010, Health justice - worldwide! Ethical principles Human rights part of a 'social contract' between state and citizen (Rousseau, Rawls) Human rights part of a 'social contract' between state and citizen (Rousseau, Rawls) 'Right to Health' embodied in universal declaration of human rights (1948) and ICESCR (1966) 'Right to Health' embodied in universal declaration of human rights (1948) and ICESCR (1966) Right to Health as an inclusive right to access to care AND does extend to 'underlying determinants of health'. Indivisible relation with other HR Right to Health as an inclusive right to access to care AND does extend to 'underlying determinants of health'. Indivisible relation with other HR Equity, freedom, participation and entitlements Equity, freedom, participation and entitlements

3. Berlin, 17-18 September 2010, Health justice - worldwide! Political, economic and technical regulations Nation or state organised: freedom, security, justice and equity for its citzens Nation or state organised: freedom, security, justice and equity for its citzens Individual or groups freedom to 'invest' as to accumulate or transfer resources into capital Individual or groups freedom to 'invest' as to accumulate or transfer resources into capital Government regulations strict and vertical Government regulations strict and vertical Health care workers both civil servants by the state and investors on health services. Rights holders and duty bearers Health care workers both civil servants by the state and investors on health services. Rights holders and duty bearers

4. Berlin, 17-18 September 2010, Health justice - worldwide! Republic of Indonesia and the province of Papua

5. Berlin, 17-18 September 2010, Health justice - worldwide! Global, gerecht, gesund Forum V. Eine neue Ethik

6. Berlin, 17-18 September 2010, Health justice - worldwide! Global, gerecht, gesund Forum V. Eine neue Ethik

7. Berlin, 17-18 September 2010, Health justice - worldwide! Global, gerecht, gesund Forum V. Eine neue Ethik

8. Berlin, 17-18 September 2010, Health justice - worldwide! Medical doctor: Hippocrates oath Medical doctor: Hippocrates oath Formal health care workers: conduct duty and protocol set by national authorities Formal health care workers: conduct duty and protocol set by national authorities Non-discriminatory and ensuring equal access to available, accessible, acceptable, appropriate and good quality health services. Non-discriminatory and ensuring equal access to available, accessible, acceptable, appropriate and good quality health services. Including prevention, promotion and information on determinants of health Including prevention, promotion and information on determinants of health Health care workers and the obligation to fullfill the RtH

9. Berlin, 17-18 September 2010, Health justice - worldwide!

10. Health care workers and the obligation to respect the RtH Socio-cultural patterns of (reproductive) health seeking behaviour. Attitude Socio-cultural patterns of (reproductive) health seeking behaviour. Attitude Language and education level as to provide correct information on health Language and education level as to provide correct information on health Malnutrition: local nutritional habits Malnutrition: local nutritional habits Confidentiality for patients (HIV/TB/ STI's) Confidentiality for patients (HIV/TB/ STI's) Participation of community on health priorities Participation of community on health priorities

11. Berlin, 17-18 September 2010, Health justice - worldwide!

12. Berlin, 17-18 September 2010, Health justice - worldwide! Health care workers and the obligation to protect the RtH Impoverishing costs for health care services Impoverishing costs for health care services External companies damage environment and displace people from land; via CSR provide health services to population External companies damage environment and displace people from land; via CSR provide health services to population Rapid demographic changes (influx of migrants from other islands); discrimination Rapid demographic changes (influx of migrants from other islands); discrimination Food, products and fertilizers containing toxic and damaging materials Food, products and fertilizers containing toxic and damaging materials

13. Berlin, 17-18 September 2010, Health justice - worldwide! Ethical principles are compromised Limited regulation of dual services by health care workers Limited regulation of dual services by health care workers Proffesional regulations in place, enforcement poor Proffesional regulations in place, enforcement poor Rigid national protocol, not adapted to context. Legislation on special autonomy paralysed Rigid national protocol, not adapted to context. Legislation on special autonomy paralysed Failing leadership and governance Failing leadership and governance Limited authority & participation by indigenious population Limited authority & participation by indigenious population

14. Berlin, 17-18 September 2010, Health justice - worldwide! To return to ethical standard of the Right to Health Comprehensive PHC (Alma-Ata): services, prevention, promotion, integration, participation Comprehensive PHC (Alma-Ata): services, prevention, promotion, integration, participation Affirmative action towards indigenious concepts and (community) health care workers Affirmative action towards indigenious concepts and (community) health care workers Integrate in medical education RtH principles Integrate in medical education RtH principles Special autonomy used for protective regulation by provincial government (customary councils) Special autonomy used for protective regulation by provincial government (customary councils) Harness leadership and accountability of health care workers Harness leadership and accountability of health care workers

15. Berlin, 17-18 September 2010, Health justice - worldwide! Global, gerecht, gesund Forum V. Eine neue Ethik Questions and discussion Remco van de Pas remco.van.de.pas@wemos.nl www.wemos.nl www.medicusmundi.org