Health and Human Rights: An International Journal, 2016
The right to enjoy the benefits of scientific progress (REBSP) is a little-known but potentially ... more The right to enjoy the benefits of scientific progress (REBSP) is a little-known but potentially valuable right that can contribute to rights-based approaches to addressing multidrug-resistant TB (MDR-TB). We argue that better understanding of the REBSP may help to advance legal and civil society action for health rights. While the REBSP does not provide an individual entitlement to have a new drug developed for MDR-TB, it sets up entitlements to expect a state to establish a legislative and policy framework aimed at developing scientific capacity to address the most important health issues and at disseminating the outcomes of scientific research. By making scientific findings available and accessible, people can be enabled to claim the use of science for social benefits. Inasmuch as the market fails to address neglected diseases such as MDR-TB, the REBSP provides a potential counterbalance to frame a positive obligation on states to both marshal their own resources and to coordinat...
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2008
The country concerned, however, is not South Africa but its northern neighbour Zimbabwe - once th... more The country concerned, however, is not South Africa but its northern neighbour Zimbabwe - once the breadbasket of southern Africa but now in a deep political crisis following a disputed presidential election in March 2008 and a flawed runoff poll.
Understanding how higher education institutions become a part of society-wide discrimination in S... more Understanding how higher education institutions become a part of society-wide discrimination in South Africa (SA) has implications for training health professionals, 1-4 given that health institutions and professionals applied discriminatory practices under apartheid. 5 This concern underpinned research to explore how black alumni, 6 who attended the Faculty of Health Sciences (FHS) of the University of Cape Town (UCT) before 1994, experienced racial discrimination, how this discrimination affected the core academic mission of the institution, and what future challenges this experience poses for the FHS. Racial segregation and medical training at UCT Before 1948 no formal legislation existed to restrict the admission of black persons into SA universities. However, university policies effectively barred blacks from study. In 1923 UCT's Council declined to admit 'native or coloured' students; and when blacks were eventually admitted into universities, participation in sports and social activities was restricted. 7 In the Medical Faculty, prior to 1929, black students were denied admission, to avoid mixed classes and 'white patients being examined by black students'. 7 By 1937 a total of 40 coloured and Indian students had been admitted to UCT's Arts, Science, Education, and Medical faculties. However, black medical students could not complete the course, as local hospitals barred access to white patient wards for their clinical training. 8 When UCT admitted coloured and Indian students for the first time when World War II precluded travelling overseas for training, admission was conditional on signing a declaration that effectively entrenched selfimposed racial exclusion. From 1959 to 1985 black students were required to obtain permission from the relevant Minister to attend a 'white' university. 9 The 1983 University Amendment Act replaced the permit system to attend universities with a racially determined quota that universities were required to administer. 10 Despite this, UCT was instructed not to admit African students to study medicine, and only admitted its first African medical student in 1985. 10,11 Methods Data were obtained by qualitative and quantitative methods. Pre-1994 black alumni were recruited using purposive and snowball sampling. An initial list of potential participants was compiled, and supplemented by interviewee suggestions for others to interview. Of the 86 alumni contacted, 11 declined to participate. In-depth, semi-structured interviews were conducted with 52 respondents. Where face-to-face interviews were not possible (in 23), respondents were interviewed telephonically. Open-ended data were analysed using Strauss and Corbin's 'open coding' method. 12 Analysis reliability was enhanced by a coderecode procedure conducted by one researcher. 13 No discrepancies were found in this procedure. Coding reliability was confirmed by a comparison of independent coding of 10 pages of transcribed data by 2 researchers. Results Results are presented with 3 themes: (i) discrimination and its impact on medical training, (ii) perceived attitudes of white staff and students, and (iii) black students' resistance to discrimination.
(NAPHISA) Draft Bill 2015 for public comment. The aim of the Draft Bill is: '[t]o provide for the... more (NAPHISA) Draft Bill 2015 for public comment. The aim of the Draft Bill is: '[t]o provide for the establishment of the National Public Health Institute of South Africa in order to conduct disease and injury surveillance and to provide specialised public health services, public health interventions, training and research directed towards the major health challenges affecting the population of the Republic. ' [1] CORRESPONDENCE provision for OHS as well as EH within NAPHISA. A reference group was established at the conclusion of the meeting and tasked to consolidate views from the meeting into a formal submission to inform revisions on the NAPHISA Draft Bill. It is important that SA seizes this important policy moment to establish sustainable plans and systems that will respect, protect, fulfil and promote workers' rights to OHS and the population's right to live in a health-promoting environment.
This article explores the relevance of international human rights law in the response to the HIV/... more This article explores the relevance of international human rights law in the response to the HIV/AIDS epidemic at national and international levels. Public health advocates can use arguments based on this body of law to promote responses to HIV/AIDS that reflect sound public health principles and documented best practice. Development assistance is increasingly linked to rights-based approaches, such as participatory processes, and strategic alliances between health professionals, organizations of people living with HIV/AIDS, and affected communities. Legal and human rights advocacy strategies are increasingly productive and necessary.
Objectives Neuropsychiatric disorders and increased suicide rates have been associated with expos... more Objectives Neuropsychiatric disorders and increased suicide rates have been associated with exposure to cholinesterase inhibiting organophosphates. This study examined symptoms of psychological distress, including suicidal ideation, among banana workers in Costa Rica previously exposed to a cholinesterase inhibiting pesticide. Methods 78 workers who had received medical attention 1e3 years previously for occupational pesticide poisoning were recruited: 54 had been exposed to organophosphate, 24 to carbamate, and 43 and 35, respectively, had single and multiple poisoning episodes with a cholinesterase inhibitor. Referents were 130 nonpoisoned workers randomly selected from company payrolls. Psychological distress symptoms during the month prior to interview were obtained using the Brief Symptom Inventory (BSI), which has a general severity index and nine subscale scores. Differences in abnormal BSI scores (T score$63) were assessed through multivariate logistic regression for all poisoned and for subcategories of poisoned as compared to non-poisoned workers. Results Organophosphate poisoned workers reported significantly more symptoms than non-poisoned on all but one symptom dimension. Significant trends of increasing symptoms with increasing number of previous poisonings were seen for somatisation, obsessivecompulsiveness, interpersonal sensitivity, depression and anxiety. Carbamate poisoned workers only had increased scores for somatisation. The ORs for suicidal thoughts were: all poisoned 3.58 (95% CI 1.45 to 8.84); organophosphate poisoned 3.72 (1.41 to 9.81); carbamate poisoned 2.57 (0.73 to 9.81); and 2.65 and 4.98, respectively for 1 and $2 poisonings (trend p¼0.01). Conclusions This cross-sectional study showed a relationship between acute occupational poisoning with organophosphates and psychological distress including suicidal ideation. Stronger designs are needed to address causality.
Journal of Exposure Analysis and Environmental Epidemiology, 2005
Valid and reliable semi-quantitative dermal exposure assessment methods for epidemiological resea... more Valid and reliable semi-quantitative dermal exposure assessment methods for epidemiological research and for occupational hygiene practice, applicable for different chemical agents, are practically nonexistent. The aim of this study was to assess the reliability of a recently developed semi-quantitative dermal exposure assessment method (DREAM) by (i) studying inter-observer agreement, (ii) assessing the effect of individual observers on dermal exposure estimates for different tasks, and (iii) comparing inter-observer agreement for ranking of body parts according to their exposure level. Four studies were performed in which a total of 29 observers (mainly occupational hygienists) were asked to fill in DREAM while performing side-by-side observations for different tasks, comprising dermal exposures to liquids, solids, and vapors. Intra-class correlation coefficients ranged from 0.68 to 0.87 for total dermal exposure estimates, indicating good to excellent inter-observer agreement. The effects of individual observers on task estimates were estimated using a linear mixed effect model with logged DREAM estimates as explanatory variable; ''task'', ''company/department'', and the interaction of ''task'' and ''company/department'' as fixed effects; and ''observer'' as a random effect. Geometric mean (GM) dermal exposure estimates for different tasks were estimated by taking the exponent of the predicted betas for the tasks. By taking the exponent of the predicted observer's intercept (exp oi), a multiplier (M O) was estimated for each observer. The effects of individual observers on task estimates were relatively small, as the maximum predicted mean observers' multiplier was only a factor 2, while predicted GMs of dermal exposure estimates for tasks ranged from 0 to 1226, and none of the predicted individual observers' multipliers differed significantly from 1 (t-test a ¼ 0.05). Inter-observer agreement for ranking of dermal exposure of nine body parts was moderate to good, as median values of Spearman correlation coefficients for pairs of observers ranged from 0.29 to 0.93. DREAM provides reproducible results for a broad range of tasks with dermal exposures to liquids, solids, as well as vapors. DREAM appears to offer a useful advance for estimations of dermal exposure both for epidemiological research and for occupational hygiene practice.
The need for health professionals to address their human rights obligations has emerged in the la... more The need for health professionals to address their human rights obligations has emerged in the last decade both internationally as well as nationally following the findings of South Africa’s Truth and Reconciliation Commission. Support for human rights norms has become a priority for institutions as well as practitioners within the health sector. Training plays a crucial role in shaping health professional practice. In addition to creating a clear understanding of the linkages between human rights and health, educators can role-model how health professionals should act to support human rights. This article explores human rights derived from the South African Constitution in relation to the obligation on health professionals to respect, protect, promote and fulfill human rights. The implications of this commitment to human rights training of nurses are discussed, drawing on the authors’ nine years of experience in running courses for South African health professional educators. Theme...
SABMiller is a major beer supplier to approximately 34 000 licensed outlets in South Africa and t... more SABMiller is a major beer supplier to approximately 34 000 licensed outlets in South Africa and through them an estimated 200 000 illegal outlets (called "shebeens") that act as a de facto distribution arm. It has established an educational intervention that aims to minimize alcohol-related harm in men, and reduce male violence against women and children as well as the spread of HIV/AIDS.
Background The complicity of the South African health sector in apartheid and the international r... more Background The complicity of the South African health sector in apartheid and the international relevance of human rights as a professional obligation prompted moves to include human rights competencies in the curricula of health professionals in South Africa. A Train-the-Trainers course in Health and Human Rights was established in 1998 to equip faculty members from health sciences institutions nationwide with the necessary skills, attitudes and knowledge to teach human rights to their students. This study followed up participants to determine the extent of curriculum implementation, support needed as well as barriers encountered in integrating human rights into health sciences teaching and learning. Methods A survey including both quantitative and qualitative components was distributed in 2007 to past course participants from 1998-2006 via telephone, fax and electronic communication. Results Out of 162 past participants, 46 (28%) completed the survey, the majority of whom were sti...
The controversy about the use of data from human volunteer studies involving experimental exposur... more The controversy about the use of data from human volunteer studies involving experimental exposure to pesticides as part of regulatory risk assessment has been widely discussed, but the complex and interrelated scientific and ethical issues remain largely unresolved. This discussion paper, generated by authors who comprised a workgroup of the ICOH Scientific Committee on Rural Health, reviews the use of human experimental studies in regulatory risk assessment for pesticides with a view to advancing the debate as to when, if ever, such studies might be ethically justifiable. The discussion is based on three elements: (a) a review of discussion papers on the topic of human testing of pesticides and the positions adopted by regulatory agencies in developed countries; (b) an analysis of published and unpublished studies involving human testing with pesticides, both in the peer-reviewed literature and in the JMPR database; and (c) application of an ethical analysis to the problem. The paper identifies areas of agreement which include general principles that may provide a starting point on which to base criteria for judgements as to the ethical acceptability of such studies. However, the paper also highlights ongoing unresolved differences of opinion inherent in ethical analysis of contentious issues, which we propose should form a starting point for further debate and the development of guidelines to achieve better resolution of this matter.
Health and Human Rights: An International Journal, 2016
The right to enjoy the benefits of scientific progress (REBSP) is a little-known but potentially ... more The right to enjoy the benefits of scientific progress (REBSP) is a little-known but potentially valuable right that can contribute to rights-based approaches to addressing multidrug-resistant TB (MDR-TB). We argue that better understanding of the REBSP may help to advance legal and civil society action for health rights. While the REBSP does not provide an individual entitlement to have a new drug developed for MDR-TB, it sets up entitlements to expect a state to establish a legislative and policy framework aimed at developing scientific capacity to address the most important health issues and at disseminating the outcomes of scientific research. By making scientific findings available and accessible, people can be enabled to claim the use of science for social benefits. Inasmuch as the market fails to address neglected diseases such as MDR-TB, the REBSP provides a potential counterbalance to frame a positive obligation on states to both marshal their own resources and to coordinat...
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2008
The country concerned, however, is not South Africa but its northern neighbour Zimbabwe - once th... more The country concerned, however, is not South Africa but its northern neighbour Zimbabwe - once the breadbasket of southern Africa but now in a deep political crisis following a disputed presidential election in March 2008 and a flawed runoff poll.
Understanding how higher education institutions become a part of society-wide discrimination in S... more Understanding how higher education institutions become a part of society-wide discrimination in South Africa (SA) has implications for training health professionals, 1-4 given that health institutions and professionals applied discriminatory practices under apartheid. 5 This concern underpinned research to explore how black alumni, 6 who attended the Faculty of Health Sciences (FHS) of the University of Cape Town (UCT) before 1994, experienced racial discrimination, how this discrimination affected the core academic mission of the institution, and what future challenges this experience poses for the FHS. Racial segregation and medical training at UCT Before 1948 no formal legislation existed to restrict the admission of black persons into SA universities. However, university policies effectively barred blacks from study. In 1923 UCT's Council declined to admit 'native or coloured' students; and when blacks were eventually admitted into universities, participation in sports and social activities was restricted. 7 In the Medical Faculty, prior to 1929, black students were denied admission, to avoid mixed classes and 'white patients being examined by black students'. 7 By 1937 a total of 40 coloured and Indian students had been admitted to UCT's Arts, Science, Education, and Medical faculties. However, black medical students could not complete the course, as local hospitals barred access to white patient wards for their clinical training. 8 When UCT admitted coloured and Indian students for the first time when World War II precluded travelling overseas for training, admission was conditional on signing a declaration that effectively entrenched selfimposed racial exclusion. From 1959 to 1985 black students were required to obtain permission from the relevant Minister to attend a 'white' university. 9 The 1983 University Amendment Act replaced the permit system to attend universities with a racially determined quota that universities were required to administer. 10 Despite this, UCT was instructed not to admit African students to study medicine, and only admitted its first African medical student in 1985. 10,11 Methods Data were obtained by qualitative and quantitative methods. Pre-1994 black alumni were recruited using purposive and snowball sampling. An initial list of potential participants was compiled, and supplemented by interviewee suggestions for others to interview. Of the 86 alumni contacted, 11 declined to participate. In-depth, semi-structured interviews were conducted with 52 respondents. Where face-to-face interviews were not possible (in 23), respondents were interviewed telephonically. Open-ended data were analysed using Strauss and Corbin's 'open coding' method. 12 Analysis reliability was enhanced by a coderecode procedure conducted by one researcher. 13 No discrepancies were found in this procedure. Coding reliability was confirmed by a comparison of independent coding of 10 pages of transcribed data by 2 researchers. Results Results are presented with 3 themes: (i) discrimination and its impact on medical training, (ii) perceived attitudes of white staff and students, and (iii) black students' resistance to discrimination.
(NAPHISA) Draft Bill 2015 for public comment. The aim of the Draft Bill is: '[t]o provide for the... more (NAPHISA) Draft Bill 2015 for public comment. The aim of the Draft Bill is: '[t]o provide for the establishment of the National Public Health Institute of South Africa in order to conduct disease and injury surveillance and to provide specialised public health services, public health interventions, training and research directed towards the major health challenges affecting the population of the Republic. ' [1] CORRESPONDENCE provision for OHS as well as EH within NAPHISA. A reference group was established at the conclusion of the meeting and tasked to consolidate views from the meeting into a formal submission to inform revisions on the NAPHISA Draft Bill. It is important that SA seizes this important policy moment to establish sustainable plans and systems that will respect, protect, fulfil and promote workers' rights to OHS and the population's right to live in a health-promoting environment.
This article explores the relevance of international human rights law in the response to the HIV/... more This article explores the relevance of international human rights law in the response to the HIV/AIDS epidemic at national and international levels. Public health advocates can use arguments based on this body of law to promote responses to HIV/AIDS that reflect sound public health principles and documented best practice. Development assistance is increasingly linked to rights-based approaches, such as participatory processes, and strategic alliances between health professionals, organizations of people living with HIV/AIDS, and affected communities. Legal and human rights advocacy strategies are increasingly productive and necessary.
Objectives Neuropsychiatric disorders and increased suicide rates have been associated with expos... more Objectives Neuropsychiatric disorders and increased suicide rates have been associated with exposure to cholinesterase inhibiting organophosphates. This study examined symptoms of psychological distress, including suicidal ideation, among banana workers in Costa Rica previously exposed to a cholinesterase inhibiting pesticide. Methods 78 workers who had received medical attention 1e3 years previously for occupational pesticide poisoning were recruited: 54 had been exposed to organophosphate, 24 to carbamate, and 43 and 35, respectively, had single and multiple poisoning episodes with a cholinesterase inhibitor. Referents were 130 nonpoisoned workers randomly selected from company payrolls. Psychological distress symptoms during the month prior to interview were obtained using the Brief Symptom Inventory (BSI), which has a general severity index and nine subscale scores. Differences in abnormal BSI scores (T score$63) were assessed through multivariate logistic regression for all poisoned and for subcategories of poisoned as compared to non-poisoned workers. Results Organophosphate poisoned workers reported significantly more symptoms than non-poisoned on all but one symptom dimension. Significant trends of increasing symptoms with increasing number of previous poisonings were seen for somatisation, obsessivecompulsiveness, interpersonal sensitivity, depression and anxiety. Carbamate poisoned workers only had increased scores for somatisation. The ORs for suicidal thoughts were: all poisoned 3.58 (95% CI 1.45 to 8.84); organophosphate poisoned 3.72 (1.41 to 9.81); carbamate poisoned 2.57 (0.73 to 9.81); and 2.65 and 4.98, respectively for 1 and $2 poisonings (trend p¼0.01). Conclusions This cross-sectional study showed a relationship between acute occupational poisoning with organophosphates and psychological distress including suicidal ideation. Stronger designs are needed to address causality.
Journal of Exposure Analysis and Environmental Epidemiology, 2005
Valid and reliable semi-quantitative dermal exposure assessment methods for epidemiological resea... more Valid and reliable semi-quantitative dermal exposure assessment methods for epidemiological research and for occupational hygiene practice, applicable for different chemical agents, are practically nonexistent. The aim of this study was to assess the reliability of a recently developed semi-quantitative dermal exposure assessment method (DREAM) by (i) studying inter-observer agreement, (ii) assessing the effect of individual observers on dermal exposure estimates for different tasks, and (iii) comparing inter-observer agreement for ranking of body parts according to their exposure level. Four studies were performed in which a total of 29 observers (mainly occupational hygienists) were asked to fill in DREAM while performing side-by-side observations for different tasks, comprising dermal exposures to liquids, solids, and vapors. Intra-class correlation coefficients ranged from 0.68 to 0.87 for total dermal exposure estimates, indicating good to excellent inter-observer agreement. The effects of individual observers on task estimates were estimated using a linear mixed effect model with logged DREAM estimates as explanatory variable; ''task'', ''company/department'', and the interaction of ''task'' and ''company/department'' as fixed effects; and ''observer'' as a random effect. Geometric mean (GM) dermal exposure estimates for different tasks were estimated by taking the exponent of the predicted betas for the tasks. By taking the exponent of the predicted observer's intercept (exp oi), a multiplier (M O) was estimated for each observer. The effects of individual observers on task estimates were relatively small, as the maximum predicted mean observers' multiplier was only a factor 2, while predicted GMs of dermal exposure estimates for tasks ranged from 0 to 1226, and none of the predicted individual observers' multipliers differed significantly from 1 (t-test a ¼ 0.05). Inter-observer agreement for ranking of dermal exposure of nine body parts was moderate to good, as median values of Spearman correlation coefficients for pairs of observers ranged from 0.29 to 0.93. DREAM provides reproducible results for a broad range of tasks with dermal exposures to liquids, solids, as well as vapors. DREAM appears to offer a useful advance for estimations of dermal exposure both for epidemiological research and for occupational hygiene practice.
The need for health professionals to address their human rights obligations has emerged in the la... more The need for health professionals to address their human rights obligations has emerged in the last decade both internationally as well as nationally following the findings of South Africa’s Truth and Reconciliation Commission. Support for human rights norms has become a priority for institutions as well as practitioners within the health sector. Training plays a crucial role in shaping health professional practice. In addition to creating a clear understanding of the linkages between human rights and health, educators can role-model how health professionals should act to support human rights. This article explores human rights derived from the South African Constitution in relation to the obligation on health professionals to respect, protect, promote and fulfill human rights. The implications of this commitment to human rights training of nurses are discussed, drawing on the authors’ nine years of experience in running courses for South African health professional educators. Theme...
SABMiller is a major beer supplier to approximately 34 000 licensed outlets in South Africa and t... more SABMiller is a major beer supplier to approximately 34 000 licensed outlets in South Africa and through them an estimated 200 000 illegal outlets (called "shebeens") that act as a de facto distribution arm. It has established an educational intervention that aims to minimize alcohol-related harm in men, and reduce male violence against women and children as well as the spread of HIV/AIDS.
Background The complicity of the South African health sector in apartheid and the international r... more Background The complicity of the South African health sector in apartheid and the international relevance of human rights as a professional obligation prompted moves to include human rights competencies in the curricula of health professionals in South Africa. A Train-the-Trainers course in Health and Human Rights was established in 1998 to equip faculty members from health sciences institutions nationwide with the necessary skills, attitudes and knowledge to teach human rights to their students. This study followed up participants to determine the extent of curriculum implementation, support needed as well as barriers encountered in integrating human rights into health sciences teaching and learning. Methods A survey including both quantitative and qualitative components was distributed in 2007 to past course participants from 1998-2006 via telephone, fax and electronic communication. Results Out of 162 past participants, 46 (28%) completed the survey, the majority of whom were sti...
The controversy about the use of data from human volunteer studies involving experimental exposur... more The controversy about the use of data from human volunteer studies involving experimental exposure to pesticides as part of regulatory risk assessment has been widely discussed, but the complex and interrelated scientific and ethical issues remain largely unresolved. This discussion paper, generated by authors who comprised a workgroup of the ICOH Scientific Committee on Rural Health, reviews the use of human experimental studies in regulatory risk assessment for pesticides with a view to advancing the debate as to when, if ever, such studies might be ethically justifiable. The discussion is based on three elements: (a) a review of discussion papers on the topic of human testing of pesticides and the positions adopted by regulatory agencies in developed countries; (b) an analysis of published and unpublished studies involving human testing with pesticides, both in the peer-reviewed literature and in the JMPR database; and (c) application of an ethical analysis to the problem. The paper identifies areas of agreement which include general principles that may provide a starting point on which to base criteria for judgements as to the ethical acceptability of such studies. However, the paper also highlights ongoing unresolved differences of opinion inherent in ethical analysis of contentious issues, which we propose should form a starting point for further debate and the development of guidelines to achieve better resolution of this matter.
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Papers by Leslie London