Q&A: Human Rights Watch's Joseph Amon

Joseph Amon, director of the Health and Human Rights Division at Human Rights Watch, gave a lecture Tuesday about his work in non-communicable diseases and how human rights arguments can support greater efforts in global health. He sat down with The Daily Princetonian after the lecture to discuss human rights, public health services and theTrans-Pacific Partnership.

The Daily Princetonian: What links non-communicable diseases with human rights?

Joseph Amon: Good question. In low- and middle-income countries, non-communicable diseases are really increasing sharply. The issue of human rights is, what are governments obligated to do in terms of addressing that? There’s a range of different things. If you look at tobacco, a major cause of cancer and cardiovascular disease, there’s an international treaty on the elimination of tobacco that has obligations on governments to restrict sales, to restrict advertising and promotion for tobacco, to move tobacco to other crops, and so the human rights obligations around it are right to health, right to information, right to protection of children, and there’s a link, I think, that is not unique to non-communicable diseases, but extends around noncommunicable diseases and other diseases. A lot of the first attention around health and human rights was around HIV because there was a lot of discrimination, a lot of punitive approaches. That’s not always the case with non-communicable diseases but the underlying issues in terms of access to medicine, access to information and access to care without discrimination, that’s still there.

DP: You’re a member of the faculty of a lot of universities. How do you inspire students to get involved in human rights advocacy?

JA: It’s more about telling them different ways in which I think they can think about their careers. There’s a lot of organizations that are public health or development organizations that have strong statements around human rights – CARE, for example – and so you can work at a human rights organization, you can work at a general health or development organization, you can work in government, and you can integrate and be aware of human rights as part of the work that you do.

DP: In the United States, public health services from Obamacare to Planned Parenthood are under constant attack from certain political groups. What does Human Rights Watch do to combat this?

JA: You know, we haven’t worked explicitly on issues like Obamacare, but we have worked on access to care for marginalized or decriminalized groups. There’s an absolute lack of access to effective drug dependency treatment – methadone, for example – in the US, and there are states that still restrict needle and syringe exchange, which has proven to reduce HIV transmission. Where those states are taking those decisions, you can make a case that that’s a violation of the right to health. If you look at Indiana, southern Indiana, for example, there’s a huge outbreak associated with injected drug use because there’s no needle and syringe exchange. And so that’s one place where we work. We also work on prisons and linking prisoners upon release with access to services in the community. We work on issues around children working in tobacco fields in the U.S., which exposes them to green tobacco sickness. There’s a range of issues that we take on, but we haven’t taken on any major issues around Obamacare, per se.

DP: Do you steer clear of abortion, reproductive health?

JA: Not at all. We work on reproductive health in countries where it is limited, we work on it very clearly. In some countries they’ve tried to criminalize physicians providing life-saving abortions, It’s something that we’ve taken on, and it’s an issue that’s come up.

DP: I’ve read that the United States has signed, but has yet to ratify, the International Covenant on Economic, Social and Cultural Rights. Do you work on campaigning for them to ratify that?

JA: There’s an aspect where we look at what’s likely, and our assessment right now is that it’s unlikely that there will be an effort towards ratification. In recent years there’s been a move towards ratification of the Convention on the Rights of Persons with Disabilities, so that was something we were working on. But to me it’s a very peculiar position for the U.S. to be in, and I often use a parallel with education. We believe in a right to education, and we guarantee education to all children. The right to health is not about the right to be healthy, it’s about the right to emergency care, minimal care. The U.S. often provides that – we’ve got public hospitals, we’ve got Obamacare, but it’s often unwilling to recognize that obligation, and I find that to be quite out-of-step with most countries in the world and a very strange and archaic position to be.

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DP: To what extent do you think big pharmaceutical companies, or big pharma, aren’t doing enough to tackle diseases like HIV which may affect those who are unable to afford expensive drugs?

JA: HIV is one where I think pharma has done a lot to develop drugs, to find new drugs, second-line, third-line drugs, etc. There is a lot of companies producing endorphin drugs, companies making drugs that there aren’t a lot of alternatives for, increasing the price, and I think that’s very troubling. I think when companies do that, it casts a negative light on all pharma companies because pharma companies are trying to make an argument that their cost is rational and that it’s set in terms of research and development expenses. But when you get one pharma company that increases the price from $20 to $20,000 a year, you could call it a rogue but it’s causing a shadow on the industry as a whole.

DP: So do you think big pharma aren’t doing enough – maybe HIV was not a good example – to fight diseases which affect people who can’t pay $20,000 a year for drugs?

JA: The argument, and Hepatitis C would be an example, is one that’s more importantly focused on the government, because the idea that pharma should be pricing its drugs so that people can pay for them misses the role that government should be playing in ensuring that people can have access to health care, and so the consequence of the U.S. not having a universal health care system is that it doesn’t do a good job of ensuring affordability, so I think I would structure that argument a little differently.

DP: President Barack Obama has suggested engaging, rather than ostracizing, countries with terrible human rights records. In his inauguration he said, “We will extend a hand if you are willing to unclench your fist.” How has this changed conditions on the ground? To what extent has this been an effective strategy?

JA: There’s always a message from government about the importance of quiet diplomacy, of not sort of naming and shaming or ostracizing countries, but there’s a lot of tools in the toolbox and you see the argument as often one of how far to push or which tools to use to try and press governments to be more respectful of human rights. Obviously trade agreements are an area in which there is a lot of economic leverage, and insisting that there is free trade, respect for trade unions, environmental protections, I think that’s an area in which you can see an impact occur. Countries, I think, want to be recognized as part of the international community and acting appropriately with regards to human rights, and so the visibility of abuses can have an impact on their behaviors, but I understand the constraints that politicians sometimes feel about how far they can go.

DP: You mentioned trade agreements, and briefly touched on the Trans-Pacific Partnership in your talk. What is Human Rights Watch’s stance on the TPP?

JA: I’m not sure if we have a formal policy on the final agreement, but we engaged in advocacy during the process a bit on issues like labor and on some of the issues around forced labor in particular. Certainly there were other parts of the agreement as well, like property restrictions, that were things we were following and concerned with too.

DP: Human Rights Watch is based in New York, but it works in countries across the world. How does it develop and support advocacy groups?

JA: So it’s a challenge, because our collaboration with local advocacy groups can sometimes put them at greater risk. We have formal partnerships and coalitions in some cases, in other cases we work quietly with people, and they’re increasing our knowledge and capacity. There’s an element where it’s a real two-way street and it’s not just us coming in and building capacity. Often times what we can do is we can help elevate an issue or bring an issue beyond the borders to human rights activists, and sometimes we can act in solidarity and provide support that way. I think there’s bigger task to be done in terms of funding local human rights groups, building their capacity formally, that goes beyond what Human Rights Watch has the resources or the capacity or really the mandate to do.

DP: Other than human rights, what do you like to watch?

JA: What do I like to watch on TV? Uh…baseball.