Lies, Damned Lies, and Statistics (33): The Omitted Variable Bias, Ctd.

I discussed the so-called Omitted Variable Bias before on this blog (here and here). So I suppose I can mention this other example: guess what is the correlation, on a country level, between per capita smoking rates and life expectancy rates? High smoking rates equal low life expectancy rates, right? And vice versa?

Actually, and surprisingly, the correlation goes the other way: the higher smoking rates – the more people smoke in a certain country – the longer the citizens of that country live, on average.

Why is that the case? Smoking is unhealthy and should therefore make life shorter, on average. However, people in rich countries smoke more; in poor countries they can’t afford it. And people in rich countries live longer. But they obviously don’t live longer because they smoke more but because of the simple fact they have the good luck to live in a rich country, which tends to be a country with better healthcare and the lot. If they would smoke less they would live even longer.

Why is this important? Not because I’m particularly interested in smoking rates. It’s important because it shows how easily we are fooled by simple correlations, how we imagine what correlations should be like, and how we can’t see beyond the two elements of a correlation when we’re confronted with one that goes against our intuitions. We usually assume that, in a correlation, one element should cause the other. And apart from the common mistake of switching the direction of the causation, we often forget that there can be a third element causing the two elements in the correlation (in this example, the prosperity of a country causing both high smoking rates and high life expectancy), rather than one element in the correlation causing the other.

More posts in this series are here.

Lies, Damned Lies, and Statistics (12): Generalization

An example from Greg Mankiw’s blog:

Should we [the U.S.] envy European healthcare? Gary Becker says the answer is no:

“A recent excellent unpublished study by Samuel Preston and Jessica Ho of the University of Pennsylvania compare mortality rates for breast and prostate cancer. These are two of the most common and deadly forms of cancer – in the United States prostate cancer is the second leading cause of male cancer deaths, and breast cancer is the leading cause of female cancer deaths. These forms of cancer also appear to be less sensitive to known attributes of diet and other kinds of non-medical behavior than are lung cancer and many other cancers. [Health effects of diet and behavior should be excluded when comparing the quality of healthcare across countries. FS]

These authors show that the fraction of men receiving a PSA test, which is a test developed about 25 years ago to detect the presence of prostate cancer, is far higher in the US than in Sweden, France, and other countries that are usually said to have better health delivery systems. Similarly, the fraction of women receiving a mammogram, a test developed about 30 years ago to detect breast cancer, is also much higher in the US. The US also more aggressively treats both these (and other) cancers with surgery, radiation, and chemotherapy than do other countries.

Preston and Hu show that this more aggressive detection and treatment were apparently effective in producing a better bottom line since death rates from breast and prostate cancer declined during the past 20 [years] by much more in the US than in 15 comparison countries of Europe and Japan.” (source)

Even if all this is true, how on earth can you assume that a healthcare system is better because it is more successful in treating two (2!) diseases?

Another example: the website of the National Alert Registry for sexual offenders used to post a few “quick facts”. One of them said:

“The chance that your child will become a victim of a sexual offender is 1 in 3 for girls… Source: The National Center for Victims of Crime“.

Someone took the trouble of actually checking this source, and found that it said:

Twenty-nine percent [i.e. approx. 1 in 3] of female rape victims in America were younger than eleven when they were raped.

One in three rape victims is a young girl, but you can’t generalize from that by saying that one in three young girls will be the victim of rape. Perhaps they will be, but you can’t know that from these data. Like you can’t conclude from the way the U.S. deals with two diseases that it “shouldn’t envy European healthcare”. Perhaps it shouldn’t, but more general data on life expectancy says it should.

These are two examples of induction or inductive reasoning, sometimes called inductive logic, a reasoning which formulates laws based on limited observations of recurring phenomenal patterns. Induction is employed, for example, in using specific propositions such as:

This door is made of wood.

to infer general propositions such as:

All doors are made of wood. (source)

More posts in this series.

The Environment and Human Rights (3): Water and Human Rights

We obviously need water to survive, and no human rights without survival. Inadequate water supplies also cause diseases, violating our right to health. We need water – and clean water – to drink, but also to eat. Or rather, to produce our food. And we need a lot. People drink on average just a few liters a day, but they consume thousands of liters a day if we count the water required to produce their food. And evidently we should count it. Many areas of the world face already now face water shortages. A fifth of the world’s population already lives in areas short of water. A global water crisis waits around the corner, and one likely consequence is famine, another human rights violation.

If we want to do something about the water crisis, we should be aware of the effect of food production on water shortages. Especially the production of meat requires huge amounts of water, compared to the production of grains or even rice. People in the West eat a lot a meat, and therefore contribute substantially to water shortages. As incomes in the developing world increase, people there will consume more meat. Hence, global water consumption will also increase. Combine this future increase with the fact that there are already shortages and that these shortages will get worse with global warming, desertification etc., and you get a real crisis.

What are the solutions? Or how can we prevent things from getting worse?

  • Jokingly we could ask people to become vegetarians. That would also be better for greenhouse gas emissions, by the way.
  • More realistically: food production, and especially agriculture and farming, represent 70% of global water consumption. That number could be cut down significantly with better irrigation; “more crop per drop”. There’s incredible waste going on there. 70% of irrigation water is lost in the process. One reason: farmers rarely pay their water bills at market prices, hence no incentives to cut waste. Unfortunately, pricing water at market prices would drive up food prices, pushing many consumers into poverty. And many poor farmers already can’t pay for expensive irrigation systems. More expensive water surely wouldn’t help them. Moreover, market prices may mean the privatization of water, and that’s dangerous. You might as well privatize oxygen.
  • Other solutions: cut waste in households and industries. Here, everyone can help. Also more recycling efforts are needed. Desalination, although expensive, is an option. As are better water storage facilities, especially for poor families in developing countries. All these efforts will not only reduce the risk of a major global water crisis, but will also improve crop yields, thereby reducing the price of food and hence the risk of poverty and famine.

Economic Human Rights (28): The Health Consequences of the Recession and of Unemployment

The Economist called it the “unsurprising research finding of the day“, but I think it’s a useful confirmation of an existing intuition: this paper finds that the recession can have a beneficial effect on the health of some people who lose their job because of it, namely those people spending their new leisure time in a healthy way. Other people, however, spend their leisure time cultivating some of their pre-existing unhealthy habits, or find themselves depressed and without employer-provided healthcare (especially in the U.S.). Because their healthcare has become more expensive now that they are unemployed, they decide to go without treatment or tests.

Results showed the body mass of the average laid-off food-lover increasing by the equivalent of more than 7 pounds for a 5-foot, 10-inch man weighing 180 pounds during unemployment. Similarly, frequent drinkers on average doubled their daily alcohol intake after losing their jobs and before finding another one. (source)

Elsewhere in the world, and especially sub-Saharan Africa, it seems that the health consequences of the global recession are more dramatic:

The financial crisis will kill between 28,000 and 50,000 babies in sub-Saharan Africa this year, according to this paper. The reasoning here is straightforward. For people on subsistence incomes, a fall in GDP can be fatal. The paper’s authors, Jed Friedman and Norbert Schady, estimate that a one percentage point fall in per GDP across sub-Saharan Africa is associated with a rise in infant (defined as under-ones) mortality of between 0.34 and 0.62 per 1000. If we multiply this increase by the number of births this year and by the 2.4 percentage point difference between GDP growth this year and last (a reasonableish estimate of the effect of the crisis), we get a figure of between 28,000 and 50,000. … Of course, you can quibble with the numbers. But the general story holds. For the poor, income is a matter of life or death. Which brings me to my question. If one-in-seventeen British babies were to die this year because of the financial crisis, it would be the biggest media story for years and there’d be rioting in the streets until the government did something. So, why the silence? Chris Dillow (source)

Limiting Free Speech (28): Free Speech at Work

Should people be allowed to enjoy an unlimited right to free speech at work, and be able to ask courts to undo measures (such as sacking or disciplinary measures) which their employer has taken against them as a result of their speech? Or do corporations and government agencies have a right to take measures against employees engaging in certain types of speech, a right which therefore trumps the right to speech? And is there a difference between the rights of corporations and the rights of (certain) government agencies?

I could make this brief, and say that employees are citizens like all other citizens, and should have a right to free speech. I could say that, if there are any possible and acceptable (or necessary) limitations on the right to free speech, they have nothing to do with the fact that those engaging in speech act as employees or as citizens. I could say that the place where people speak – at work or elsewhere – doesn’t change anything.

Unfortunately, I can’t. The place where speech takes place does matter, as I have mentioned already in the case of hate speech (hate speech in front of an angry mob gathered at the house of a pedophile is different from the exact same speech written down in a book almost no one reads).

As I will argue, the same is true in the current case. Speech at work may be treated in another way than speech elsewhere. There are some good reasons to impose stricter limits on speech at work than on speech in general. Employers therefore also have the right to take certain measures against employees engaging in speech which may be restricted (in fact, these measures are the restrictions). Also, certain government agencies can impose more and wider restrictions than private corporations. All these restrictions on the freedom of speech are possible because they are necessary for the protection of other rights or the rights of others (I try to make this a general rule when discussing restrictions on human rights, see here).

But before I argue this, I want to sketch the baseline first. Free speech is very important, and I don’t think there are many people who believe this more than me (as any regular reader of this blog knows). As government agencies, but also private corporations, regularly violate human rights, free speech at work is perhaps even more important than free speech in general. People working for agencies or corporations engaged in rights violations, must have the right (and the possibility) to denounce these practices. So, if I argue for the right of corporations and agencies to restrict, in certain cases, the right to free speech of their employees, I have to be careful to do so without jeopardizing the important rights of whistleblowers.

The U.S. Supreme Court, which allows government agencies to limit the freedom of speech of their employees, also acknowledges the importance of whistleblowers. When the speech in question is of “public concern”,* the Court uses a higher threshold to uphold speech-related disciplinary measures against employees. (The Court uses the so-called Pickering test). (However, the Supreme Court is still oddly restrictive in this respect. Whereas, normally, free speech is considered to be very important by the Court, in case of speech at work, “public concern” is not enough to uphold the right to speech. It’s just a first threshold to be passed for the Court to asses the possibility of reviewing disciplinary action. When there is no “public concern”, there’s no right to free speech at work according to SCOTUS!).

Now, when and why should the rights of corporations and government agencies to sanction their employees for acts of speech, take precedence over the right to free speech of these employees? Corporations and agencies have a right to function without disruption. A government agency even has a duty to function without disruption, because it serves the public interest. And this interest more often than not includes certain human rights. For example, a government hospital has a duty to protect the healthcare rights of citizens. If speech acts at the hospital disrupt its normal functioning, the rights of citizens may be put at risk. If, in addition, these speech acts don’t have anything to do with the functioning or organization of the hospital, it is difficult to see why they should be more important than the rights of patients. However, if the speech acts uncover serious incompetence at the hospital, the disruption that follows these acts may be a price that is worth paying.

Regarding corporations, the burden of proof on those wishing to impose restrictions on speech at work, is heavier. Corporations usually don’t work for the protection of human rights of citizens, and therefore cannot put these rights in the balance. However, corporations are the property of certain citizens, and these citizens have a right to use this property. Speech acts in corporations can result in disturbances of a kind that makes this use of property difficult or impossible. If, in addition, these speech acts don’t serve any public purpose or address a public concern, it may be justified to consider the right to property more important than the right to speech, in certain cases. For example, should we really accept and protect flag burning during office hours and in office buildings? And who would take sides with an employee wasting huge amounts of company time on frivolous speech?

And there’s another problem with judicial protection of speech at work. Employees may claim that disciplinary measures taken against them (including dismissal) were based on their speech acts, whereas in reality these measures were based on a lack of performance. Employers may become unwilling to take such measures because of the risk of costly litigation. Outspoken but incompetent employees will then be privileged, and others discriminated. Another result: the employer’s authority and ability to organize and lead are put at risk if many of her decisions can be reversed by judges.

* This “public concern” usually means that the speech in question should have something to do with the preferable manner of operating the agency, or should contain information which is vital to proper decision-making. Both definitions of “public concern” cover the activities of whistle-blowers.

The Causes of Poverty (19): Does Better Healthcare Lead to More Poverty?

This may look like a stupid – or, more kindly, counterintuitive – question. The answer is obviously “no”. At least when we focus on the level of the individual, better healthcare seems like the best way out of poverty rather than a cause of more poverty. With better health comes better education, better and more productive work, and hence less poverty. Even a society as a whole seems better off if less of its members are unhealthy. Overall productivity and wealth increase when there is less disease. Healthy people produce more, innovate more and contribute in other ways to social wealth.

However, many people believe – wrongly in my view – that the question should be answered in the affirmative, especially when the topic is development aid. When a country drastically improves its healthcare system – thanks to development aid for instance – life expectancy rates will go up and child mortality rates will go down. This results in population growth which often outpaces GDP growth (for example because scarce development resources have been targeted at healthcare rather than GDP). GDP per capita will therefore decrease, which means increasing poverty levels and perhaps even famine.

This type of reasoning is sometimes used to justify limits on development aid in the field of healthcare. However, it’s plainly wrong. Better healthcare doesn’t lead to high population growth, and this non-existing population growth therefore cannot result in more poverty.

Now, why doesn’t better healthcare lead to population growth? With just a few exceptions, it’s the poor countries of the world that have high fertility rates, and when countries become richer, these rates drop dramatically. Poverty leads to high fertility rates for a number of reasons (see also here), but the most important one is that people tend to have more children to offset the risk of high infant mortality rates that are typical for poor countries.

Countries with high infant mortality rates also have high population growth (contrary to intuition). Some other reasons why high fertility rates are correlated with poverty:

  • More developed countries move away from agriculture and towards urban and industrialized economies, reducing the need for children as farmworkers.
  • For the same reason, women become more active in the economy, increasing the cost (in money and time) of raising children.
  • Also for the same reason, contraceptives and family planning become more common.

In this case, it seems that our initial intuitions are correct.

Economic Human Rights (20): Health and Wealth

A few more words about the relationship between poverty and health. First of all: both are human rights issues. Article 25 of the Universal Declaration states:

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The concern is that people may find themselves in a trap. Their poverty causes ill health because healthcare costs money, because poverty leads to malnutrition etc. And their ill health leads to further poverty, because they aren’t as productive as healthy people.

The ill health of poor people isn’t a problem only for these poor people. If they were more healthy, they would be more productive and more creative, and the economy as a whole and the wellbeing of society as a whole would benefit. Healthy children are also likely to stay in school longer, and hence will be more valuable to society when they grow up.

There is, of course, some obscurity regarding the direction of the causation: rich countries may be more healthy on average mainly because they spend more on healthcare. But it may also be that they have become rich because their health was improved first. Impossible to disentangle all this, because the “wealth of nations” is the result of hugely complex processes of many forces and counter-forces.

For example, there were some developing countries that benefited from WHO assistance after World War II and from breakthroughs in medication (such as penicillin). These countries, therefore, didn’t improve their health through economic growth and increased wealth. Health improvements were caused by external forces. One result of these health improvements was increased life expectancy, but as a result of this increase, there was population growth that went beyond GDP growth, resulting in declining levels of income per head. After some decades, the economic benefits of having more people in the economy, and reduced birth rates caused by better healthcare (and access to contraceptives), reversed the trend. There’s an interesting study by Acemoglu and Johnson here.

Others, however, have pointed out that this is just a tiny piece of the puzzle, and other factors can push societies in other directions. An increase in the population doesn’t necessarily lead to Malthusian problems. International trade and cooperation for example, but also technological improvements have sharply reduced the possible impact on an economy of an increase in population levels.

Income Inequality (9): Absolute and Relative Poverty

The problem of poverty and related problems such as income inequality have received a lot of attention on this blog, because I consider poverty to be one of the most urgent human rights problems. Now and again, I’ve also mentioned the possibility of distinguishing between different types of poverty, and one such possibility in particular, namely the difference between absolute and relative poverty. Absolute poverty meaning the lack of basic resources, and relative poverty meaning income inequality.

I’ve taken the view that absolute poverty is a more urgent priority than relative poverty, and that therefore measurements of income inequality – such as the Gini coefficient – are less relevant than measurements of absolute poverty – such as the $1 a day measure. It’s the absolute income of people that matters, not the fact that other people are richer than you are and can afford more luxuries, at least from a human rights point of view (the absence of a certain minimum amount of basic resources is a human rights violation in itself and renders many other human rights meaningless).

Inequality of wealth or income is less urgent than the fight against absolute poverty, and a lot of opposition to income inequality can be easily categorized as the politics of envy. If inequality really matters it is the inequality of opportunity and other types of inequality not related to wealth (<discrimination for example).

But this is perhaps putting it too strongly. There are negative effects of high levels of income inequality, for example on the adequate functioning of democracy. There is also a correlation between relative poverty and absolute poverty: countries with relatively unequal income distribution don’t score well on absolute poverty measures either.

Richard Wilkinson has pointed out, some time ago already, that relative poverty matters. Once economic growth has pushed up absolute (albeit average per capita) income levels and done away with penury, people tend to be more healthy and live longer if levels of income inequality are relatively low. Countries with lower per capita income levels but also lower income inequality, can do better in terms of public health than high income countries with higher levels of income inequality. Poorer countries with a more equal wealth distribution are healthier and happier than richer, more unequal ones. There’s also a link between inequality (measured not by Gini but by way of the concentration of wealth in the 10% richest people) and both life expectancy and child mortality.

Some of the reasons for this are the stress of living at the bottom of the pecking order, the stress of disrespect and the lack of esteem and respect (including self-respect).

The Ethics of Human Rights (11): Organ Trade

The shortage of organs for transplantation is a universal problem. The supply of organs is way below the demand. And demand is increasing due to progress in medical science and increasing average age. The demand comes mainly from developed countries. The reason is that life expectancy is higher in these countries, and therefore also the demand for organs. Also, the health care system is more developed and hence more likely to engage in transplants.

There are two ways to harvest organs: deceased organ donation, and live organ donation.

Deceased organ donation

In some countries, deceased organ donation is hampered by social, cultural, religious, legal and other factors. In some cases, donors have to state their intent while living. They have to opt in. In other cases, they have to opt out and hence they are donors by default, which tends to produce higher rates of donation.
In other cases still, family members of the deceased have to consent, which brings down rates.

Live organ donation

The use of live donors for non-vital organs such as kidneys and parts of liver, for example, is also practiced, but the purchase and sale of transplant organs from live donors are prohibited in many countries.

Transplant tourism and international organ trade

The shortage of a local supply of organs – due to some of the reasons given above, or a combination – has led to the development of transplant tourism and international organ trade. Poor people in developing countries are often forced to donate a non-vital organ; forced by poverty or forced by outright violence. People are kidnapped and operated under duress, and often don’t even get paid. Sometimes they simply get killed because this bypasses the requirement of consent. Corpses are also harvested, not rarely without the consent of the deceased or his or her relatives. The legality of live organ donations in some countries encourages poor people to sell some of their non-vital organs such as kidneys. However, the circumstances in which they are operated can turn a non-vital organ donation into a fatal one.

Rich people travel to countries where these different kinds of harvesting are possible, legally or illegally, and where hospitals are willing to cooperate in such a scheme and are relatively capable so as not to scare away patients. China is a well-known destination because there’s the enormous supply of thousands of people executed every year.

Although those who can afford to buy organs are obviously exploiting those who are desperate enough to sell their organs, the recipients may also suffer from the trade. They may receive substandard or even sick organs.

Some contend that the poor should be allowed to sell their organs, because we merely contribute to their poverty. Exploitation may be morally preferable to death, but given the risk of forced donation and of complications during surgery, this is a slippery slope.

Someone has aptly called the whole business New Cannibalism.

Other issues

One can also see a trend to declare a person dead at an earlier stage than in the past, for example some seconds after cessation of brain activity or heart activity, rather than minutes. Some organs become useless after a certain waiting period. This means shifting the definition of life and death, and perhaps less reanimation enthusiasm. Another, and opposite form of abuse is keeping brain-dead people artificially “alive” as an “organ warehouse” for future donations.

Also, the use of cloning and designer babies for the purpose of organ production is controversial, as is the use of animal organs.

Economic Human Rights (14): Health

Health is a human rights issue in two respects. First, people have a right to health care and health insurance. Article 25 of the Universal Declaration states that

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The International Covenant on Economic, Social and Cultural Rights is more specific. Article 7 guarantees the rights to safe and healthy working conditions. Article 10 deals with child labor:

The employment of children in work harmful to their morals or health or dangerous to life or likely to hamper their normal development should be punishable by law.

Article 12 states:

1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. 2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for: (a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child; (b) The improvement of all aspects of environmental and industrial hygiene; (c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases; (d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.

The second way in which health is a human rights issue is the fact that good health is a precondition for the enjoyment of all human rights. In this way, bad health is similar to poverty. You have to be healthy and without pain in order to be able to use freedom rights and political rights. A sick, suffering or toiling person is thrown back upon himself and unable to relate to the outside world, just as a person who concentrates exclusively on his or her body for pleasurable reasons. Intense bodily sensations of any kind – positive and negative – shut us off from the world, because they make it impossible to perceive anything except our own body. In other words, they make the use of our classical rights impossible or undesirable.

What Are Human Rights? (15): Constitutionally Universal

The theme of this post is the often difficult relationship between citizenship and human rights. This relationship is difficult because human rights, which are explicitly rights for all people everywhere, without distinctions of any kind, seem to require citizenship, and hence a distinction between groups of somehow differentiated people, for their protection. Without citizenship, it is argued, human rights remain a wish rather than a reality, potential rather than effective. Indeed, we often see that non-citizens such as refugees, asylum-seekers or stateless people suffer more rights violations than the citizens of the countries in which they happen to find themselves, even if these countries are comparatively well functioning democracies.

I want to argue that there are no legal reasons to consider citizenship as some kind of necessary condition for the protection of the rights of people within the territory of a state. Or, to put it negatively, that there are no legal reasons to treat the rights of non-citizens with less respect than the rights of citizens, or to accept violations of the rights of non-citizens with more ease than violations of the rights of citizens. There has to be, in other words, equality of protection between citizens and non-citizens. Citizenship therefore should be irrelevant for the protection of the human rights of the people within a given state territory. The state should be blind in this respect and treat non-citizens as if they were citizens. Non-citizens should have the same legal, judicial and other means to stand up for their rights.

The legal argument is based on Article 2, paragraph 1 of The International Covenant on Civil and Political Rights, which states the following:

“Each State Party to the present Covenant undertakes to respect and to ensure to all individuals within its territory and subject to its jurisdiction the rights recognized in the present Covenant, without distinction of any kind, such as race, color, sex, language, religion, political or other opinion, national or social origin, property, birth or other status”.

The widely held but mistaken belief that the rights of non-citizens residing in a state are, perhaps inevitably, more precarious than the rights of the citizens living beside them, goes back to the historically important role of citizenship in the practice of protecting human rights. Theoretically, citizenship is irrelevant to human rights. These rights are the equal rights of all human beings, equally and unconditionally. It is not justified to say that one should be white, male, citizen or whatever to be able to enjoy the protection of these rights. Universality, equality and unconditionality are perhaps the main characteristics of human rights. That is where they got their name. They would not be called human rights if this were not the case.

Although theoretically these rights come with no conditions attached, in reality and in practice there are many necessary conditions for their effective protection: a well functioning judiciary, a separation of powers, a certain mentality, certain economic conditions etc. Too many to name them all, unfortunately. But the one we should name and explain is citizenship. Historically, it was because people were citizens of a state that they could use and improve the institutions and judicial instruments of the state, including the executive powers, to enforce their rights. It is this historical contingency, the fact that people have always found their citizenship very useful for their human rights, which has led many to believe that there is some kind of special link between citizenship and human rights which makes it possible and acceptable to treat the rights of non-citizens with less respect. That rights are only accessible to citizens. That the rights of man have often been the “rights of an Englishman” in the words of Burke.

“The survivors of the extermination camps, the inmates of concentration and internment camps, and even the comparatively happy stateless people could see … that the abstract nakedness of being nothing but human was their greatest danger” (Hannah Arendt, The Origins of Totalitarianism).

The state, although it does not grant rights, has to recognize them and make them real, but not only for citizens. The constitution, the main instrument for recognizing human rights, should and nowadays often does explicitly guarantee rights for humans, and not merely rights for citizens. Everybody within the territory of the state, not only the citizens of the state, can then enjoy the human rights protected by the constitution. Citizens as well as non-citizens can then go to court and challenge unjust laws or acts of state. Both categories of people have legal personality. This is often called the constitutional universality of rights.

The protection of the economic rights of non-citizens is an even more contentious matter. Should non-citizens have the same healthcare protection, social security, education etc.? In principle yes, but some countries may have such a large number of non-citizens in their territory that the economic viability of their social security system comes under threat. The tax payers ability to fund the system is limited, and non-citizens normally don’t pay taxes.

Economic Human Rights (12): Life Expectancy

Life expectancy, or the average length of life in a given population (mostly a country), is of importance to the issue of human rights. A low life expectancy means shorter life spans. Now, it’s not because a life is relatively short that is has to be less fulfilling, less happy or less meaningful. However, it is obvious that a longer life will allow for more activity, self-development and freedom, and hence for more enjoyment of human rights, than a shorter life.

Moreover, longer life expectancies are often an indicator of better health and healthcare, and good health is a prerequisite for human rights. Bad average health or healthcare and low life expectancy, on the contrary, are indicators of poverty, and poverty is in itself a violation of certain human rights and makes other human rights impossible.

Life expectancy in Western countries today is almost double what it was in the pre-modern era. This is the consequence of highly reduced infant mortality rates, modern medicine (e.g. before modern medicine, one in four women died in childbirth), improvements in sanitation (sewers) and nutrition, etc. Especially in the last century did we see enormous progress. In the US for example, life expectancy at the beginning of the 1900s was 50 years. At the end of the same century it was 77 (with differences of course between male and female and between social classes; poverty, in particular, has a substantial effect on life expectancy).

Of course, as in most cases, the developing countries haven’t achieved the same levels as the West. They have improved their numbers but there are still large and shocking inequalities in life expectancy, with Africa again bearing the heaviest burden. Sub-Saharan Africa (partly because of HIV) has even seen a decrease in life expectancy during the last decades. The former USSR also saw a decrease.

 

 

 

A person’s life in one of the poorest countries will on average be half as long as the life of a person fortunate enough to be born in a rich country.

(High infant mortality rates in a particular country can bring down rates of life expectancy at birth drastically. In these cases, another measure such as life expectancy at age 5 can be used to exclude the effects of infant mortality to reveal the effects of causes of death other than early childhood causes. However, that’s somehow “cooking the books” since infant mortality does reduce the life expectancy of the infants in question. On the other extreme are some people who want to include aborted fetuses in life expectancy rates).

Children’s Rights (1): Infant Mortality

Infant mortality is the number of deaths of children aged one year or younger, per 1000 live births. This gives the Infant mortality rate (IMR). The rates have significantly declined over the last centuries, mainly due to improvements in basic health care, and in all regions of the world.

However, there’s still a long way to go, especially in developing countries. In several African countries as well as in India, 1 in 10 babies die before they reach the age of 1. That’s horrendous.

Inequalities are extreme: Angola had the highest IMR in 2007: 184. And Sweden the lowest: 2.8. In a country like Bangladesh, 153,000 newborns die each year. Multiply this with the number of non-newborns death before the age of 1, and with a number of similar countries, and with a number of consecutive years, and you have an enormous massacre.

The most common causes in developing countries are pneumonia and dehydration from diarrhea. The latter cause is a real scandal given the ridiculously easy remedy: Oral Rehydration Solution, or ORS, a mixture of salts, sugar, and water. In developed countries the causes are congenital malformation, birth defects, extreme prematurity, disease, and Sudden Infant Death Syndrome (SIDS). Neglect, abuse or outright murder are also important causes.

The infant mortality rate is an indicator of state failure. As the IMR indicates the level of a country’s health, health care system or development, an extremely high IMR can corroborate the statement that a particular state is a “failed state” in the sense that it fails in its basic responsibilities to its citizens. Not surprisingly, wealthy countries – wealthy in the commonly accepted sense of high GDP per capita – have a lower IMR because they have the means to invest in healthcare, sanitation, drugs etc.

I guess it’s obvious why this is a human rights issue: you can hardly say that people can enjoy their human rights when they die before they are 1. Of course, it’s not as if someone is directly violating these children’s right to life. Infant mortality is in most cases not a deliberate act. But rights can be violated by act as well as omission. In many cases, it’s easy to prevent the child from dying, and those who have the power to do something about it also have the responsibility.

Economic Human Rights (6): Health

Bad health and suffering create the same problems as poverty. You have to be healthy and without pain, in order to have a cultural and political life and to be able to use freedom rights and political rights. A sick, suffering or toiling person is thrown back upon himself and unable to relate to the outside world, just as a person who concentrates exclusively on his or her body for pleasurable reasons.

Intense bodily sensations of any kind – positive and negative – shut us off from the world, because they make it impossible to perceive anything except our own body. In other words, they make our public and political life and the use of our classical rights impossible or undesirable.

Hunger and consumption, as well, force you to concentrate on yourself and your body. You do not have the time, the energy or the desire to concentrate on the world. When you are eating or thinking of eating, you are imprisoned in cyclical biological necessities and in your metabolism with nature necessary for the preservation of life. You have to avoid sickness, pain and hunger – as well as their extreme opposites – to be open to the world and fit for cultural and political life.