Taking rights seriously in health

Few now question that population health is significantly shaped by social ecology. Power, wealth, and social status clearly matter: Their enactment in daily life makes them fundamental social determinants of health. Important as it is that we accept the broad importance of social factors in health,

it is not enough. Our current grasp of the importance of social factors in health has to be strengthened by research that more precisely delineates the workings of social health through social processes, and the investment in research must in turn be vindicated by interventions that make a difference. The work presented in this issue of the Journal of Law, Medicine & Ethics is intended to advance the agenda for research and action.

An ecological theory puts health everywhere. Population health is shaped in the hierarchies of the workplace, the neighborhood, and the home. Police officers, tax collectors, and middle managers can all be seen as agents of health or the lack thereof. And if health crosses social boundaries, research about health certainly must cross disciplinary boundaries. This project began with a desire to honor Jonathan Mann by studying more closely how law and human rights influence health. From its inception, we sought to bring together collaborators from different fields who would challenge each other to move beyond the boundaries of their own traditions.

This issue of the Journal reflects the hard work, intelligence, and dedication of many people in law and public health, to whom much gratitude is due. The project began nearly 3 years ago with a grant from the Centers for Disease Control and Prevention. Working with the unstinting support and guidance of Dr. Thomas Peterman, we convened a diverse group of researchers in law, health, and social science to read and discuss the health and human rights literature. The idea of an international conference, nurtured by Dean Robert Reinstein of Temple and a seed grant from Richard and Bonnie Moses, became real with the support of the American Foundation for AIDS Research (amfAR). We are extremely grateful to Dr. Mathilde Krim, Jerry Radwin, and the amfAR board for appreciating the importance of what we were trying to accomplish. Jane Silver, until recently amfAR's director of public policy, was a constant source of wise guidance throughout the often arduous process of planning an international conference. The International Harm Reduction Development Program of the Open Society Institute and the Association Francois-Xavier Bagnoud provided funding for scholarships. We thank amfAR again for providing the funds to produce and disseminate this issue of thejournal.

Despite its size, this issue can encompass only a fraction of the ideas and participants that made the conference so rich an experience. We are grateful to Stephen Marks and Sofia Gruskin of the Francois-Xavier Bagnoud Center for Health and Human Rights at the Harvard School of Public Health for their early and steady advice and support. We thank the World Health Organization and the United Nations Development Programme on AIDS, both of whom co-sponsored the conference.

We are grateful to Naomi Mann for gracefully representing her family at the conference. We would also like to thank the many individuals, too numerous to name, who took the conference from a concept to a real event. These included the members of our Advisory Board, the tireless individuals who agreed to act as Track Chairs, the Session Chairs, and the Rapporteurs, many of whom made significant sacrifices to accomplish what we asked for on a tight budget. We thank the many scholars who contributed their intellectual efforts to the conference, including the plenary speakers, session moderators, the authors and discussants of the case studies, and those who presented in the track sessions. Most of all we thank the hundreds of participants who traveled from around the world just three weeks after the terrorist attacks on the United States.

Finally, we thank those whose management made the project possible. The American Society of Law, Medicine & Ethics (ASLME), which designated the conference as its annual meeting, managed the conference, and produced this issue of the Journal. The staff at ASLME allowed organizing a conference and editing a journal issue to be a pleasure for us. At Temple, Deborah Feldman smoothed the way at every step, as did Theo Ungewitter at the University of Connecticut.

In his keynote address to the conference, reprinted here, Justice Michael Kirby wove together John Mann's vision of health and human rights, the revolutionary creativity of the framers of the Declaration of Independence, the continuing insufficiency of our response to the AIDS pandemic, and the world's shock and anger at the attacks on the World Trade Center and the Pentagon. Anger at unnecessary suffering and death creates the impetus to change. A sense of health as a matter and a function of rights provides a vision of a better world. Research at the intersection of public health, law, and human rights can help guide us from one to the other.

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August 1, 2002 Philadelphia, Farmington, and Oxford

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Scott Burris, J.D., is the James E. Beasley Professor of Law at the Beasley School of Law of Temple University and Associate Director of the Center for Law and the Public's Health at Georgetown and Johns Hopkins Universities.

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Lawrence 0. Gostin, J.D., LL.D. (Hon.), is Professor of Law at Georgetown University, Professor of Public Health at Johns Hopkins University, and Director of the Center for Law and the Public's Health (CDC Collaborating Center Promoting Health Through Law) at Georgetown and Johns Hopkins Universities. Professor Gostin is a Lifetime Member of the Institute of Medicine, serves on the Institute of Medicine's Board on Health Promotion and Disease Prevention, and is a member of the Committee on Assuring the Health of

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the Public in the 21st Century. His latest books are both published by the University of California Press and Milbank Memorial Fund: Public Health Law: Power, Duty, Restraint (2000) and Public Health Law and Ethics: A Reader (2002).

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Zita Lazzarini, J.D., MTH., teaches health law and bioethics at the University of Connecticut Health Center and the Harvard School of Public Health and directs the Division of Medical Humanities at the University of Connecticut Health Center. She has co-authored Human Rights and Public Health in the AIDS Pandemic, published by Oxford University Press in 1997.