The BMA has had a long involvement in human rights. Thirty-five years ago, when it brought out a report on torture, some human rights groups were surprised that a national medical association would wish to be active in their field.
In 1992, under the memorable title Medicine Betrayed, the BMA again addressed the issue of doctors being involved in human rights abuses. And in 2001, when it published The medical profession and human rights: a handbook for a changing agenda, a leading Harvard academic wrote in the BMJ that the tone was ‘expansive’, to move the profession from ‘its narrow normative niche in medical ethics into the globalised secular debate on suffering and human values’.
In its new report, the BMA continues this theme – to stress the breadth of the concept of human rights, and the role and responsibilities of doctors around the world in upholding these rights. In six chapters, the provocatively titled report, Health and human rights in the new world (dis)order, is also a reflection of troubled times.
While there are some parallels with the previous report, the chapter about the information age would have been unimaginable 20 years ago. It gives an overview of the rise of ‘fake news’ and conspiracy theories, such as the anti-vaxx movement, which has dealt such an unnecessary, often mortal, blow to the health outcomes of so many people.
A world where information is so abundant and shared so freely carries with it the risk that, to paraphrase a former Donald Trump aide, for every actual, demonstrable fact, there are multiple ‘alternative facts’ that are anything but factual.
In this relativist world, populist politicians target scientific experts who speak inconvenient truths. The report calls for coordinated programmes to improve digital health literacy, and campaigns to target dangerous misinformation.
A chapter on migration, ethnicity and health considers the difficulties that people from ethnic minorities have found in accessing healthcare. These include migrants and indigenous people, as well as refugees. This can also involve threats to medical neutrality, such as in the UK where doctors have been pressurised to inform authorities of patients’ migration status, which the BMA has strongly opposed.
The report says states need to acknowledge barriers to healthcare and address racial equities in healthcare. The report also builds on previous work in strongly demonstrating the links between climate change and human rights, such as how it exacerbates mental health and acts as a ‘threat multiplier’ by increasing the risk of conflict and the displacement of peoples.
There is a grim circularity here as conflict – another major focus of the report – can further affect climate change. The report points to the abundant evidence from recent conflicts of medical professionals and facilities being targeted, and calls for the clear recording of all human rights violations during war, and for a strengthening of the International Criminal Court.
Work on the report started before the Russian invasion of Ukraine, but that conflict gives an even greater impetus to this work. There are still some who see human rights only as a branch of foreign policy – something to condemn and campaign about only in less fortunate societies than our own. But the report makes clear that human rights need to be defended in the UK as well, and that our own actions profoundly influence them.
The NHS, with its vast estates and reliance on single-use plastics, has an effect on climate change that affects everyone. Political systems, which do not just create inequality, but seem to need it and thrive on it, have an inevitable effect on the rights of those ‘left behind’, particularly the right to health. Human rights are universal, inalienable and indivisible, but the context in which they operate (or ‘history’ to put it more succinctly) is rapidly changing.
That is why an update such as this is so important. BMA medical ethics committee chair Zoe Greaves said: ‘This is an ambitious and wide-ranging report, which builds on decades of work by the association in articulating and defending human rights around the world.
‘It draws attention to and highlights the rapidly changing landscape in which we practise as clinicians and in which our patients live, and shines a light on the challenges this presents to us in upholding, defending and promoting the health and health rights of the most vulnerable; both at home and abroad.’