Governance, human rights and infectious disease: theoretical, empirical and practical perspectives

This chapter explores the fundamental obligation of governments to protect health. This obligation extends not only to the provision of health care or to the control of infectious disease outbreaks, but also to the cessation of human rights violations that contribute to poor health or disease risk. The relationship between the health status of a population and the behavior of the government under which that population lives is important during war or civil crisis settings, and in the context of chronic health issues such as nutrition, famine, and child mortality. As measured by indicators such as accountability, stability, rule of law, respect for human rights, and the existence of an independent civil society, plays a significant role in health outcomes—a role independent of, and perhaps even superior to, host genetics, insect vectors, or individual behaviors. Famines stem not solely from bad weather or genetics, but also from the failure of governments to protect their populations from civil strife, or to equitably distribute food aid. Despite the widespread acceptance of these findings, the influence of governance on infectious disease spread has received far less attention. Both governance and health can be measured in many different ways, and one factor complicating efforts to measure the association between the two is the difficulty finding accurate, sensitive, and specific enough indicators for either variable. Broad measures of population health—such as life expectancy, and infant and maternal mortality—have been chosen by a number of authors, in part because these indicators capture multiple specific diseases and are broadly distributed across the population.