On October 30, the Program on Human Rights (PHR) at Stanford's Center on Democracy, Development and the Rule of Law (CDDRL) held a day-long conference to examine health and human rights. The conference was held to discuss how a rights-based approach to health services can impact the delivery of effective health interventions and advance other socio-economic and cultural rights in developing regions. The conference titled, “Why We Should Care: Health and Human Rights” was divided into five panels with presenters from diverse backgrounds and professions including lawyers, doctors, public health experts, students and activists.

The Program:

The conference started with a welcoming address by Helen Stacy, director of the Program on Human Rights. CDDRL Director Larry Diamond introduced the keynote speaker Paul H. Wise, professor of child health and society and pediatrics at Stanford University’s School of Medicine, and director of the Center for Policy, Outcomes and Prevention. Wise's opening remarks began on a somber note, “The language of rights means very little to a child stillborn, an infant dying in pain from pneumonia or a child desiccated by famine.” In his address, Wise emphasized the need for an aligned and integrated rights-based approach that does not undermine effective and efficient medical interventions. “We need to fill the gap between the worlds of child health and child rights so that our programs and policies are both effective and just,” he stressed.

Following the keynote address, the conference presenters shared their work according to a geographic or thematic focus. The first panel brought together three generations of speakers from Stanford - a faculty member, a pre-doctoral fellow and a recent graduate - in a unique opportunity to share ideas and discuss possibilities of health work in Africa. Rebecca Walker, clinical instructor in emergency medicine at Stanford School of Medicine, presented her impressions and reactions on Mindy Roseman’s study of forced sterilization in Namibia. Roseman, academic director of the Human Rights Program and lecturer on law at Harvard Law School, was unable to attend due to flight complications after hurricane Sandy hit the East Coast.

Eric Kramon, 2011-2012 pre-doctoral fellow at CDDRL, spoke about the political sources of ethnic inequality in health outcomes in Africa.  Kramon’s work in Kenya illustrated how politics plays a determinant role in ethnic inequalities and consequently in access to health and health outcomes. Jeffrey Tran, a 2011 Stanford graduate in human biology, described the vision behind the launch of the Project of Emergency First Aid Responder in Western Cape Province, South Africa that he helped implement. Tran explained, “Individuals and communities are an integral part of the solution and we work with the communities to develop first aid training programs that are taught and eventually run by community members.”

Panel two was dedicated to the health impact of drones in Pakistan and in Gaza. Based on research by the Stanford International Clinic on Human Rights and Conflict Negotiation in Pakistan, Professor James Cavallaro and Stanford law school student Omar Shakir, explained that drones are not only responsible for deaths of civilians but also constitute a constant disturbance to social life and mental health of ordinary people, including their relations with children and the elderly. Drones impact other rights as well - such as the right to education - as children are prevented from attending schools for fear of drone strikes. Rajaie S. Batniji, resident physician in internal medicine at Stanford and a CDDRL affiliate, explained the clinical diagnosis of traumatic disorders that result from constant surveillance and insecurity. He cited the work of Jonathan Mann in defining dignity and the devastating effects on physical, mental, and social well-being when these senses are violated. Batniji explained that populations in Gaza are prevented from living life with dignity and respect because they live under constant threat to their security and intrusion into their homes and communications.

Vivek Srinivasan, manager of the Program on Liberation Technology at CDDRL, presented his experience on the Right to Food Campaign in India. He believes that this campaign has led to the mobilization for rights and the provision of services. “Not all demands are confrontational. Communities begin demanding something that is perceived as small in scope but have ramifications that extend to other rights such as the right to education, the right to housing and the right to work.” According to Srinivasan, the Right to Food Campaign in India has had a tremendous impact in putting hunger on the policy agenda. Suchi Pande, an activist-researcher who worked on the Right to Information Campaign in India for over seven years and was the secretary for the National Campaign for People’s Right to Information from 2006 to 2008, supported Srinivasan’s argument of strong correlation in achievements and right-based mobilization. However, Pande pointed out that despite successes in the Right to Food Campaign, other economic and social rights including the right to health in India continues to be a non-issue for politicians and the government. She is optimistic and believes that rural public hearings, the role of the right to information and its supporting mechanisms will facilitate access to public health in rural India.

In panel four, Sarah MacCarthy showed results that suggest that counseling and testing services for HIV-positive pregnant women remain limited, insufficient or lacking in quality in Salvador, Brazil. “While Brazil’s HIV/AIDS program has been internationally acclaimed, national practice still fails to meet national and global guidelines,” she explained. Calling attention to the regional discrepancies in the HIV/AIDS policy and program implementation in Brazil, Nadejda Marques, manager of the Program on Human Rights at CDDRL,, expressed concerns about the implementation of an HIV/AIDS program in a context of limited resources. “In Angola, counseling and voluntary testing units for HIV/AIDS don’t have drinking water or sanitary conditions to receive patients. They lack basic equipment for testing and data collection, there is a generalized shortage of doctors, and health care providers have no specific training on HIV/AIDS.” Despite this alarming situation, Marques explained that advocating for the rights of persons living with HIV/AIDS in Angola has put in evidence the failure of a heath system unable to provide even the most basic services to its population and has enabled mobilization in a context where human rights are routinely violated.

Ami Laws, adjunct associate professor of medicine at Stanford, described how a physician can provide services in collaboration with the judicial system to advance human rights. Laws is an expert witness on cases of torture survivors that require asylum status in the U.S. and has worked mainly with victims of torture in the Punjab region in India. Everaldo Lamprea, a JSD candidate at Stanford Law School and an assistant professor at Los Andes Law School in Bogotá, Colombia, spoke about his recent comparative study on health litigation in low and middle-income countries. The escalation of right-to-health litigation in these countries can have unexpected and harmful consequences to healthcare reforms and the enforceability of the right to health. In part, this is because significant financial resources are allocated to the litigation processes and not to the health system. In addition, while litigation can highlight gaps that exist in the health system that need regulation, countries have been very slow to adapt and adjust to these signals.

Next Steps:

A number of key ideas, questions and insights emerged from the conference including:

. How to identify an effective intervention that will also mobilize communities to advocate for its implementation?

. How to provide services to the more vulnerable populations without alienating a contingent that has access to basic health care services?

. What instruments can be used to share best practices among national healthcare systems?

. How do global priorities adapt to contexts of limited financial resources and human capital?

. How can punctual achievements in rights that guarantee access to health be expanded for the achievement of other social, economic and cultural rights?

The Program on Human Rights at CDDRL will continue to pursue a research agenda examining health and human rights following the conference and announced that it will be the thematic focus of the Sanela Diana Jenkins Speakers Series in 2014. The PHR is also actively seeking support for research projects that include a right to health component at the core of its academic investigation for the 2012-2013 academic year.

For Mariah Halperin, it was an extraordinary moment.

The Stanford senior – who is writing a thesis on the development of democracy in Turkey – sat across a table from Kemal Dervis, a former Turkish minister of economic affairs and treasury. Halperin was among several students in the Center on Democracy, Development, and the Rule of Law honors program spending the better part of an hour listening to Dervis speak on the global economy and other topics.

“It was an amazing opportunity,” said Halperin, who was able to ask Dervis about his reform efforts as minister.

The meeting was one of more than a dozen similar sessions the students participated in over five days during a visit to Washington, D.C. The mid-September trip to the nation’s capital was a highlight of CDDRL’s honors college program, which was recently endowed with a gift from philanthropists Sakurako and William Fisher. 

Led by CDDRL Director Larry Diamond and Francis Fukuyama, this year’s honors program director and a senior fellow at the Freeman Spogli Institute for International Studies, the students saw the inside workings of government and development organizations and had lively question-and-answer sessions with a host of prominent figures.

They went to the Center for Strategic and International Studies, the World Bank, the U.S. Agency for International Development, and the Millennium Challenge Corp.  They met with Stephen Hadley, who served as President George W. Bush’s national security advisor, and Carl Gershman, president of the National Endowment for Democracy. And they spoke with Inter-American Dialogue President Michael Shifter.

“Expectations were high; the trip lived up to them,” said Imani Franklin. The international relations major joins Halperin and seven others in this year’s honors class.

“Just mind-blowing to me, that you’re meeting just all these incredibly famous people in such a small setting,” Kabir Sawhney, a management science and engineering major, said after meeting with Dervis at The Brookings Institution, where he is a vice president and director of global economy and development.

The program, whose formal name will be the Sakurako and William Fisher Family Undergraduate Honors Program at CDDRL, was created by a group headed by FSI senior fellows Kathryn Stoner and Michael A. McFaul, who is now Washington’s ambassador to Moscow.

The program allows seniors to graduate with honors in democracy, development and rule of law. Its roots go back seven years, when Stoner-Weiss was teaching a single class to 20 students. 

"Our goal had always been to truly create...an interdisciplinary program,'' Stoner-Weiss said. "It's become, I think, a lot more than we thought it might be.”

Initially the program was for students studying international relations or political science. That changed last year, when the university made CDDRL honors an interdisciplinary program. Diamond said at that point the program crossed a critical threshold, that now it can engage a wider range of students and has become more competitive and more selective.

“It wasn’t as rich and diverse a mix,” said Diamond, who also believes opening the program to students across campus has benefited those who are accepted.

“I think, in a way, it’s more fun for them because they have a more diverse group,” he said.

This year’s group does include two international relations and one political science major. But Halperin is majoring in history and others are studying human biology, public policy, earth systems and economics.

“I wanted to do it because I wanted a challenge, and I wanted to work intensely in a discipline in which I had no experiences,” said Holly Fetter, who is pursuing a bachelor’s in comparative studies in race and ethnicity and a master’s in sociology. “I knew I wanted an international perspective that I had not sought out yet as an undergraduate.”

Sawhney said the honors program allows him to pursue a thesis outside his engineering major and gain a measure of depth in something other than his major before he graduates.

“This is something I can do that’s going to be a very unique experience,” said Sawhney, whose thesis will be a study of the effect of regime type on a country’s propensity to default on its sovereign debt obligations.

Thomas Alan Hendee – who was born in Sao Paulo, Brazil, and whose thesis will be a study of the social determinants of health in Brazilian slums and how they affect child health – said he wanted to be a part of the honors program since freshman year.

“This is the second year when they’ve allowed people from all over the university to come in, and I’m really thankful for that opportunity,” he said.

Explaining the decision to endow the program, Sakurako Fisher said she and her husband are making a yearly investment in a group of students “who are going to go out and make the world a better place,’’ and that some CDDRL honors students may in their careers have an impact that brings more than a ripple of benefit to people in distant lands.

“It could be a tidal wave. It could be a tidal wave on another shore,’’ she said. “We may not know that for 30 years.’’

Fisher said whether or not an honors student ultimately works in one of the fields the program focuses on, the experience of going through the program will affect how each lives his or her life.

“Maybe they don’t stay in this area, but it always influences their decisions for the rest of their lives,’’ she said.

Julie Veroff, who was a member of the first CDDRL honors program class, said the experience has served her well since she graduated from Stanford in 2007.

Veroff went on to receive a master's in international development from Oxford and spent three years as executive director of Face AIDS, the San Francisco-based nonprofit organization that was created by Stanford students to engage high school and college students in the fight to eradicate AIDS. Veroff is now in her first year at Yale Law School. 

"First and foremost, it gave me a lot of confidence as an intellectual person,'' said Veroff, who explained that the program led her to thoroughly explore and think critically about issues and ideas, to not just accept something at face value.

She also said the program taught her how to both accept and ask for feedback and how to be more aggressive in speaking to professors and mentors about her goals. It also left her with lasting connections with peers and professors she can turn to for help - or for a simple friendly conversation. 

"I can't remember anything from statistics, but certainly that peer community is long lasting. And for that I'm grateful,'' she said. 

Honors program students must have at least a 3.5 grade point average, and they apply to the program in the winter quarter of their junior year. Those accepted begin their studies with a three-unit research seminar in the spring quarter of their junior year. 

The students are also encouraged to do field work or other research over the summer before senior year, and several members of this year’s group ranged far and wide over the globe. Keith Calix, whose thesis will examine the relationship of post-apartheid education reform and the rise of organized crime in Cape Town, spent the spring and much of the summer in South Africa.

Fetter, whose focus is the influence of U.S. funding on the development of China’s civil society, did research in Beijing. Halperin spent the summer in Turkey. And Franklin, who will assess whether exposure to Western beauty standards impacts the self-image of women in the developing world, studied Arabic in Jordan. 

Lina Hidalgo is studying the social and political impacts of media in Egypt and China and spent time in both countries. Anna Schickele spent two weeks in Peru to explore the determinants of farmer participation in agricultural development projects in the country. Vincent Chen, who was unable to make the trip to Washington, will study how democratic and autocratic systems affect the formation and efficacy of their environmental policies.

Diamond said the number of students admitted to the program is limited not only by the academic requirements, but also to allow the scholars to be able to develop strong relationships with each other and their instructors.

“I think that having somewhere between about eight to 12 students is a good size. That’s kind of been the size the last few years,” he said.

In D.C., students said bonds were being formed.

“We’re getting more of an idea of what we’re all working on,” said Halperin.  And Hendee said there must be camaraderie in order to face the work ahead.

“It’s a struggle,” he said, “a year-long struggle we’re going to be in together.”

Jenna Nicholas, who was in last year’s honors program, said it was valuable to have her colleagues’ perspectives and opinions as she worked on her thesis that examined the growth of civil society in China. She said her group offered hard analysis of one another’s work, and that the program resulted in her improving her own critical-thinking skills. Nicholas, who is completing her master’s in organizational behavior at Stanford, also advised this year’s group to “keep the commitment level up.”

Then, with a laugh, she said: “And remember what your hypothesis was.”

Diamond said that in terms of teaching, the honors program has become CDDRL’s crown jewel. He said students’ research, which results in theses of 75 to 125 pages, is having an impact.

Otis Reid, who graduated from the program last year, was recognized by the university with the David M. Kennedy Honors Thesis Prize and the Firestone Medal for Excellence - the top prizes for undergraduate social science research - for his thesis on the impact of concentrated ownership on the value of publicly traded firms on the Ghana Stock Exchange.

“They’re generating new knowledge,” Diamond said. “It’s not just an exercise.”

Before heading back to Stanford in late September, the students received an invitation to return to the nation’s capital from David Yang, director of the U.S. AID Center of Excellence on Democracy, Human Rights & Governance in the Bureau for Democracy, Conflict and Humanitarian Assistance.

“Come back,” Yang said. “We’ll share your papers and debate your findings.”

Michael McAuliffe is a freelance writer based in Greenbelt, Md.