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A human rights approach to health is critical to address growing global health inequalities. Three aspects of the nature of health as a right are relevant to shaping a human rights approach to health: (1) the indivisibility of civil and political rights, and socio-economic rights; (2) active agency by those vulnerable to human rights violations; and (3) the powerful normative role of human rights in establishing accountability for protections and freedoms. Health professionals' practice, typically governed by ethical codes, may benefit from human rights guidelines, particularly in situations of dual loyalty where clients' or communities' human rights are threatened. Moreover, institutional accountability for protecting human rights is essential to avoid shifting responsibility solely onto the health professional. Human rights approaches can include holding states and other parties accountable, developing policies and programs consistent with human rights, and facilitating redress for victims of violations of the right to health. However, underlying all models is the need to enable active social mobilization, without which legal approaches to rights lack sustainability and power. Evidence from South and Southern Africa has shown that different conceptions of what is meant by human rights impact substantially on state willingness and ability to meet constitutional obligations with regard to the right to health. New approaches to health policy development, which draw on the agency of vulnerable groups, link local struggles with their global context, and explicitly incorporate rights frameworks into public health planning are needed. Models that move away from individualizing conflict over rights between health professionals as disempowered duty bearers and patients as frustrated rights holders, toward more mutual approaches to shared rights objectives may be possible and are being actively pursued through the development of a learning network to realize the right to health in South Africa. Adapted from the source document.

A human rights approach to health is critical to address growing global health inequalities. Three aspects of the nature of health as a right are relevant to shaping a human rights approach to health: (1) the indivisibility of civil and political rights, and socio-economic rights; (2) active agency by those vulnerable to human rights violations; and (3) the powerful normative role of human rights in establishing accountability for protections and freedoms. Health professionals' practice, typically governed by ethical codes, may benefit from human rights guidelines, particularly in situations of dual loyalty where clients' or communities' human rights are threatened. Moreover, institutional accountability for protecting human rights is essential to avoid shifting responsibility solely onto the health professional. Human rights approaches can include holding states and other parties accountable, developing policies and programs consistent with human rights, and facilitating redress for victims of violations of the right to health. However, underlying all models is the need to enable active social mobilization, without which legal approaches to rights lack sustainability and power. Evidence from South and Southern Africa has shown that different conceptions of what is meant by human rights impact substantially on state willingness and ability to meet constitutional obligations with regard to the right to health. New approaches to health policy development, which draw on the agency of vulnerable groups, link local struggles with their global context, and explicitly incorporate rights frameworks into public health planning are needed. Models that move away from individualizing conflict over rights between health professionals as disempowered duty bearers and patients as frustrated rights holders, toward more mutual approaches to shared rights objectives may be possible and are being actively pursued through the development of a learning network to realize the right to health in South Africa. Adapted from the source document.

Abstract Background Human rights approaches to health have been criticized as antithetical to equity, principally because they are seen to prioritise rights of individuals at the expense of the interests of groups, a core tenet of public health. The objective of this study was to identify how human rights approaches can promote health equity. Methods The Network on Equity in Health in Southern Africa undertook an exploration of three regional case studies – antiretroviral access, patient rights charters and civic organization for health. A combination of archival reviews and stakeholder interviews were complemented with a literature review to provide a theoretical framework for the empirical evidence. Results Critical success factors for equity are the importance of rights approaches addressing the full spectrum from civil and political, through to socio-economic rights, as well as the need to locate rights in a group context. Human rights approaches succeed in achieving health equity when coupled with community engagement in ways that reinforce community capacity, particularly when strengthening the collective agency of its most vulnerable groups. Additionally, human rights approaches provide opportunities for mobilising resources outside the health sector, and must aim to address the public-private divide at local, national and international levels. Conclusion Where it is clear that rights approaches are predicated upon understanding the need to prioritize vulnerable groups and where the way rights are operationalised recognizes the role of agency on the part of those most affected in realising their socio-economic rights, human rights approaches appear to offer powerful tools to support social justice and health equity.

South Africa's transition to democracy illustrates both obstacles and opportunities for advancing the right to health. The broad definition of human rights in the context of the anti-apartheid struggle, while instru- mental for overthrowing an unjust regime, laid the seeds for divergent emphases on how rights should be mainstreamed in post-apartheid pub- lic policy. This is evident in the current framing of public health policies as merely issues of service delivery. This retreat from embracing the place of socio-economic rights in public health policies is exacerbated by the neo-liberal policy context and lack of governance experience in translating policy into practice. The training of health professionals must by necessity include the skills to advocate for the rights of the vul- nerable and ensure the agency of communities in the redress of socio- economic rights violations. Le passage a la democratie en Afrique du Sud montre a la fois les obsta- cles et les opportunites que rencontre l'avancement du droit a la sante. La definition au sens large des droits de la personne dans le contexte de la lutte contre l'apartheid, tout en ayant joue un grand r6le dans le renverse- ment d'un regime injuste, a ee a l'origine de conceptions oppos&es sur la maniere d'integrer ces droits dans les politiques d'apres l'apartheid. On le voit bien a present dans la formulation des politiques de sante publique qu'on presente uniquement sous l'angle de la prestation de services. Ce recul par rapport a l'integration des droits socio-economiques dans les politiques de sante publique est exacerbe par le contexte politique neo- liberal et le manque d'experience en matiere de gouvernance pour mettre cette politique en pratique. La formation des professionnels de la sante doit obligatoirement inclure les aptitudes a defendre les droits des per- sonnes vulnerables et assurer un mandat aux collectivites dans les recours exerces en cas d'infractions socio-economiques. La transicion de Africa del Sur a la democracia ilustra tanto obstdculos como oportunidades para el avance del derecho a la salud. Aunque fue clave para derrocar a un regimen injusto en el contexto de la lucha con- tra el apartheid,, la definici6n general de los derechos humanos sent6 las bases para varios enfasis divergentes sobre la forma en que los derechos se deben incorporar a la polftica ptiblica post-apartheid. Esto se eviden- cia actualmente en la formulacion de politicas de salud publica como meramente cuestiones de entrega de servicios. Este paso hacia atras en el reconocimiento del lugar que deben ocupar los derechos socioe- con6micos en las polfticas de salud ptiblica se intensifica con el contex- to de la polftica neoliberal y la falta de experiencia de los que gobiernan en llevar las polfticas a la prictica. Por necesidad, la capacitaci6n de los profesionales de salud debe incluir las habilidades para abogar por los derechos de los vulnerables y asegurar la participaci6n de comunidades en la reparaci6n de violaciones de los derechos socioecon6micos.

South Africa's transition to democracy illustrates both obstacles & opportunities for advancing the right to health. The broad definition of human rights in the context of the anti-apartheid struggle, while instrumental for overthrowing an unjust regime, laid the seeds for divergent emphases on how rights should be mainstreamed in post-apartheid public policy. This is evident in the current framing of public health policies as merely issues of service delivery. This retreat from embracing the place of socio-economic rights in public health policies is exacerbated by the neo-liberal policy context & lack of governance experience in translating policy into practice. The training of health professionals must by necessity include the skills to advocate for the rights of the vulnerable & ensure the agency of communities in the redress of socioeconomic rights violations. Tables. Adapted from the source document.

Photocopies of journal articles. * Agrichemical safety practices on farms in the Western Cape. London L. SA Med J 1994 ; 84 : 273-278. * Notification of pesticide poisoning in the Western Cape 1987 - 1991. London L, Ehrlich R, Rafudien S, Krige F, Vurgarellis P. SA Med J 1994 ; 84 : 269-272. * Critical Issues in agrichemical safety in South Africa. London L, Myers JE. Am J Ind Med 1995 ; 27(1) : 1-14. * Repeatability and validity of a field kit for estimation of cholinesterase in whole blood. London L, Thomson ML, Sacks S, Fuller B, Bachmann OM, Myers JE. Occupational and Environmental Medicine 1995; 52 : 57-64. * Biological Monitoring of workers exposed to organophosphate pesticides: Guidelines for field application. London L. Occupational Health Southern Africa July/August 1995 ; 1(4) : 13-17. ; Despite playing an important role in crop protection and increasing food production, chemicals used in agriculture may have a range of unanticipated effects on human health. Such effects may range from overt and acute poisonings to gradual-onset chronic morbidity. In South Africa, data on such morbidity are sparse, and subject to much underreporting as one of the included papers illustrates. The dearth of such data has much to do with the marginalised living and working conditions in agriculture and the lack of attention to occupational and environmental health on farms in the country. We have little sense of the extent of hazardous exposures in agriculture, nor of their health impacts on rural populations. Even less so, have methods for the control of poisoning by pesticides been investigated amongst farm workers in South Africa. A public health response to this problem should aim at all levels of prevention (primary, secondary and tertiary), by characterising the extent and distribution of the problems caused by pesticides, identifying risk factors and groups at highest risk for poisoning, as well as testing intervention strategies and technologies. The set of papers presented below attempts to do that by linking a series of investigations into different aspects of agrichemical hazards in South Africa, with a focus on the Western Cape. The first paper examined various aspects of potential exposure to agrichemicals on farms in the Stellenbosch region, taking into account both environmental and occupational routes of exposure. The second paper describes the profile of agrichemical poisoning in the province from 1987 to 1991, identifying high risk groups and characterising the completeness and nature of reported poisonings. The third paper developed from the author's growing realisation of the need to contextualise problems related to agrichemical exposures and effects within the overall legislative and public health framework in South Africa. This paper therefore identifies the key public health issues that need addressing with regard to pesticide safety. Finally, the last two papers address aspects related to workplace interventions for the prevention of agrichemical poisoning. One paper deals with the evaluation of a field kit (for validity and repeatability) for monitoring workers exposed to organophosphate and carbamate insecticides, while the last paper elaborates guidelines for the use of cholinesterase testing in the primary and secondary prevention of organophosphate and carbamate poisoning. In this series, therefore, the papers attempt to address the problem of agrichemical hazards within a public health framework, tracing the problem from potential exposure to acute outcomes, through reviewing the legislative and occupational health environments, through to technologies and policy guidelines related to workplace intervention. In doing so, the papers use the term "agrichemical" to refer to all chemicals used in agriculture for pest and weed control. This supersedes the term "pesticide" which has ambiguous meanings in the technical environment. Readers are therefore advised to understand the term "agrichemical" to include the generic aspects of chemical usage on crops in agriculture. The research on which these papers was based was spawned by the involvement of the author in a larger research project investigating long-term neurobehavioural effects of organophosphate exposure on deciduous fruit farm workers over the period 1991 - 1994. This latter piece of research is not referred to here as it was the basis for another degree at the University of Cape Town.

BackgroundGlobal occupational health and safety (OHS) is strictly linked to the dynamics of economic globalization. As the global market is increasing, the gap between developed and underdeveloped countries, occupational diseases, and injuries affect a vast number of workers worldwide. Global OHS issues also become local in developed countries due to many factors, including untrained migrant workers in the informal sector, construction, and agriculture.ObjectiveTo identify the current status and challenges of global occupational health and safety and the needs for preventive action.FindingsAbsence of OHS infrastructure amplifies the devastating consequences of infectious outbreaks like the Ebola pandemic and tuberculosis. Interventions in global OHS are urgently needed at various levels:1. Increased governmental funding is needed for international organizations like the World Health Organization and the International Labor Organization to face the increasing demand for policies, guidance, and training.2.Regulations to ban and control dangerous products are needed to avoid the transfer of hazardous production to developing countries.3.The OHS community must address global OHS issues through advocacy, position papers, public statements, technical and ethical guidelines, and by encouraging access of OHS professionals from the developing countries to leadership positions in professional and academic societies.4.Research, education, and training of OHS professionals, workers, unions and employers are needed to address global OHS issues and their local impact.5.Consumers also can influence significantly the adoption of OHS practices by demanding the protection of workers who are producing he goods that are sold in the global market. ConclusionsFollowing the equation of maximized profits prompted by the inhibition of OHS is an old practice that has proven to cause significant costs to societies in the developed world. It is now an urgent priority to stop this process and promote a harmonized global market where the health of workers is guaranteed in the global perspective.

In 2013, the South African government drafted the Control of Marketing of Alcoholic Beverages Bill to address alcohol-related harms. This draft Bill aims to protect children's health by restricting alcohol advertising but was opposed with arguments that advertising restrictions will violate human rights. Using the International Covenant on Civil and Political Rights and Siracusa Principles this paper assesses the claim that restricting alcohol advertising poses an unjustifiable limitation on human rights, including the right to freedom of expression. An analysis shows that the limitation may be justifiable to protect children's right to health and their right to be free from all forms of violence. Restricting alcohol advertising is a government obligation to protect children's rights from private sector violations. ; Em 2013, o governo sul-africano elaborou o Projeto de Lei de Controle de Comercialização de Bebidas Alcoólicas para lidar com os danos relacionados ao álcool. Este projeto de lei tem como objetivo proteger a saúde das crianças restringindo a publicidade do álcool, mas foi criticado com argumentos de que as restrições de publicidade violarão os direitos humanos. Utilizando o Pacto Internacional sobre Direitos Civis e Políticos e os Princípios de Siracusa, este documento avalia a alegação de que restringir a publicidade de bebidas alcoólicas é uma limitação injustificável aos direitos humanos, incluindo o direito à liberdade de expressão. Uma análise mostra que a limitação pode ser justificável para proteger o direito das crianças à saúde e seu direito de estarem livres de todas as formas de violência. A restrição da publicidade do álcool é uma obrigação governamental de proteger os direitos das crianças contra violações do setor privado.

Introduction. In 2016, after the Western Cape Liquor Act was enacted, alcohol outlets were mapped in the six towns from a previous 2008 study to determine: (1) alcohol outlet density; (2) the association between deprivation and alcohol outlet density; (3) geospatial trends of alcohol outlet densities; and (4) the impact of alcohol legislation. Methods. Latitude and longitude coordinates were collected of legal and illegal alcohol outlets, and alcohol outlet density was calculated for legal, illegal and total alcohol outlets by km2 and per 1000 persons. To determine the impact of legislation, t-tests and hot spot analyses were calculated for both 2008 and 2016 studies. Spearman coefficients estimated the relationship between alcohol outlet density and deprivation. Results. Although not statistically significant, the number of alcohol outlets and the density per 1000 population declined by about 12% and 34%, respectively. Illegal outlets were still more likely to be located in more deprived areas, and legal outlets in less deprived areas; and a reduction or addition of a few outlets can change a town's hot spot status. Conclusions. Further studies with larger sample sizes might help to clarify the impacts of the Liquor Act, and the more recent 2017 Alcohol-Related Harms Reduction Policy on alcohol outlet density in the province.