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The Human Rights Approach to Health

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mango

Mustachio Nut
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Earlier this year, I was fortunate enough to attend the NAAFA convention in Chicago and heard a great speech by Lily O'Hara- a Lecturer in Public Health from University of the Sunshine Coast, Queensland, Australia.

The following is an excerpt of the main points of her speech which I have copied from the most recent NAAFA newsletter.



The Human Rights Approach to Health

by Lily O'Hara, Lecturer in Public Health, University of the Sunshine Coast, Queensland, Australia



[Editor's Note: This article was excerpted from Ms. O'Hara's Keynote presentation at the 2007 NAAFA Convention in Chicago.]



"Obesity" is now presented as an issue of global concern, and the term "globesity" has been used to illustrate this notion that everyone, everywhere is at risk of becoming too fat. Recent reports in the United States of America, Canada, the United Kingdom, New Zealand and Australia have each claimed that their country is the fattest in the world, or warned that it is at imminent risk of overtaking the USA to become number one in the fat stakes.



Do you know what the number 1 fattest country in the world is? The World Health Organisation's World Health Statistics 2006 report states that the top 10 fattest populations in the world in order of prevalence are:

  1. Nauru (where 75% of the population are classified as "obese"),
  2. Cook Islands,
  3. Samoa,
  4. Marshall Islands,
  5. Micronesia,
  6. United Arab Emirates,
  7. Bahrain,
  8. Kuwait,
  9. Jordan
  10. Fiji (24% "obese")

New Zealand adults are the 14th fattest in the world (23% "obese"); the United States of America comes in at 20th (21%), Australia at 35th (15.1%) and Canada at 37th (14.9%).

Clearly the real epidemic in these countries is the epidemic of obesity hysteria.


However, billions of government health dollars are being allocated to the "obesity epidemic." The overarching weight-centred health policies and programs of the WHO and governments around the world address the issue of "obesity" through strategies focused on making changes to diet and physical activity. Focusing on strategies to improve nutrition and opportunities for physical activity is not necessarily a bad thing -- everyone is entitled to adequate food and opportunities to move. The problem is that all of the physical activity and nutrition policies and programs are singularly predicated on the impact they will have on the "epidemic of overweight and obesity."


An increasing number of researchers, health practitioners and activists are questioning the evidence for operating within a weight-centred health paradigm. Various research has demonstrated that the problem with the weight-centred health is its ID. I'm not talking about its lack of identity. I'm talking about the Is and the Ds that sum up the limitations of this approach.


The first I stands for Inaccurate - scientifically inaccurate. There is significant evidence that demonstrates that weight is actually a very poor predictor of health outcomes, particularly when other factors are accounted for. For example, when the statistical calculations that look at associations between two factors incorporate just one more factor - physical activity - the correlation between body mass index (BMI) and a whole range of health outcomes just disappears.


The second I stands for Ineffective. Medically sanctioned weight-hate has been present in western societies for over 100 years now, and there is absolutely zero evidence that it has been effective in reducing or even maintaining average body weights. And yet the weight-centred health paradigm just gets louder and louder. Einstein once said that the definition of insanity was doing the same thing over and over and expecting a different result. I think that the weight-centred health paradigm is suffering from a bout of self induced insanity.


The third I in the weight-centred health paradigm's ID problem stands for Iatrogenic. Iatrogenic means any outcome that is induced or created by a healer. It is almost exclusively used to refer to any harmful outcomes that are caused by an individual health worker. However, iatrogenic harms are created at a systematic level by the health paradigm in which the health worker operates. There is now significant body of evidence that the weight-centred health paradigm is indeed actually harmful to health - physical health, mental health, spiritual health and social health. The range of harms make up the second part of the weight-centred health paradigm's ID problem - the Ds.


The iatrogenic harms to health from the weight-centred health paradigm include dissatisfaction, disassociation, delayed living, delayed health care, dieting, disordered eating and exercising, discrimination and other forms of oppression, disease, and death. For example, numerous studies have demonstrated for example that dieting causes mental distraction, disassociation from one's body, disordered eating, and most paradoxically, weight gain. Other studies have demonstrated that weight fluctuation brought about by constant dieting - known as the 'yo yo syndrome' - is associated with higher rates of all cause mortality.


Almost ten years ago now, the editors of the New England Journal of Medicine were so concerned with the health establishment's focus on weight that they warned, "Until we have better data about the risks of being overweight and the benefits and risks of trying to lose weight, we should remember that the cure for obesity may be worse than the condition". Whilst all of the weight-centred "anti-obesity" public health and health promotion policies and programs in the countries state that their implementation will result in public good (via reduced prevalence of "overweight" and "obesity"), they do not make any reference to the potential harms that might arise from their focus on weight:

  • Millions of people throughout the world have their right to dignity breached every day via the health-sanctioned vilification of fat and fatness.
  • Very few jurisdictions in the world have antidiscrimination legislation that allows fat people recognition before the law.
  • Fat people are considered to be acceptable targets for attacks upon their privacy, honour and reputation.
  • Fat children have been removed from families because of their body weight, and potential parents have been denied access to invitro fertilisation and adoption because of their body weight. Some states, such as China, have even introduced laws officially prohibiting people with BMIs over 40 from adopting children.
  • Fat people have been denied access to housing because of prejudices related to their size.
  • Discrimination against fat people in all aspects of employment has been demonstrated, including hiring, promotion, access to professional development, remuneration and retrenchment.
  • Fat people are less likely to attend college or university, irrespective of their level of competence to do so.

These are violations of our human rights, as codified in a range of international human rights treaties administered by the Office of the United Nations High Commissioner for Human Rights. Australia, Canada, New Zealand, United Kingdom and the United States of America are all signatories to the treaties on racial discrimination; civil and political rights; social, cultural and economics rights; torture; the rights of the child; and discrimination against women.


There is growing concern in the scientific and general community about the health and human rights impact of weight-centred public health and health promotion policies and programs. Such policies and programs at the World Health Organisation and in all of the countries examined are based on the notion that weight is a fundamental determinant of health, and that being "overweight" or "obese" is automatically unhealthy. However, these policies and programs do not implicitly or explicitly acknowledge or address in any meaningful way, the potential human rights violations arising from their implementation.


This would be bad enough if the weight-centred health paradigm was simply ineffective. It would be more problematic if it was just scientifically inaccurate. The biggest problem with the weight-centred health paradigm is that it breaches the human rights of every citizen in every country that develops health programs and policies based on the notion that weight is central to health. As citizens of these countries, it's time we stood up and said that we're not going to take such human rights abuses anymore.

:cool:
 

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