Healthcare is a human right - but not in the United States

(Published in Harvard Public Health)

Abortion rights are just the latest casualty of the United State’s failure to ensure universal and equitable access to healthcare.

The Supreme Court’s ruling on Dobbs v. Jackson in June is just the latest blow to health rights in the United States. National medical associations in the U.S. agree that abortion is essential to reproductive healthcare. So why would abortion not be protected as such? Because the U.S. does not, and never has, protected a right to health.  

Good health is the foundation of a person’s life and liberty. Injury and disease are always disruptive, and sometimes crippling. We might have to stop working, cancel plans, quarantine, hire help, and in cases of long-term disability, build whole new support systems to accommodate a new normal.

The U.S. remains the only high-income nation in the world without universal access to healthcare. However, the U.S. has signed and ratified one of the most widely adopted international treaties that includes the duty to protect the right to life. Under international law, the right to life simply means that humans have a right to live, and that nobody can try to kill another. Healthcare, the United Nations says, is an essential part of that duty. In 2018, the U.N. Committee on Civil and Political Rights said the right to life cannot exist without equal access to affordable healthcare services (including in prisons), mental health services, and notably, access to abortion. The U.N. committee mentioned health more than a dozen times in its statement on the right to life.

The bottom line is: the U.S. can’t claim to protect life if it fails to protect health. And it has consistently failed on all three of the U.N.’s measures— the latest being access to abortion.

In the U.S., our debates around healthcare, and especially abortion, are hampered by a lack of right to health. Instead, the Supreme Court in 1973 protected access to abortion through the rights to privacy and due process, not health. Privacy is mentioned only twice by the U.N. committee commentary on the right to life.

Since Dobbs, several state legislatures have declared it fair game to criminalize abortion procedures even in cases where pregnancy threatens maternal health or life. Despite ample evidence that restrictive abortion laws lead to spikes in maternal mortality and morbidity—core public health indicators—the Court prior to the Dobb’s decision has defended abortion as merely a matter of privacy, not health or life. We know this is a myth. Abortion is deeply tied to the ability to stay healthy and in some cases, alive.

Regardless, our political parties remain deeply polarized on access to healthcare, including abortion. But lawmakers should know there is historical backing in the U.S. for elevating a right to health. None other than U.S. president Franklin D. Roosevelt, first proposed healthcare as a human right in his State of the Union address in 1944, as part of his ‘Second Bill of Rights.’ His list featured aspirational economic and social guarantees to the American people, like the right to a decent home and, of course, the right to adequate medical care.

Eleanor Roosevelt later took the Second Bill of Rights to the U.N., where it contributed to the right to health being included in the Universal Declaration of Human Rights in 1948. The right to health is now accepted international law, and is part of numerous treaties, none of which the U.S. Senate has seen fit to ratify. The U.S. conservative movement has historically declared itself averse to adopting rights that might expand government function and responsibility. In contrast, state legislatures in red states are keen to expand government responsibility when it comes to abortion. The conservative movement condemns government interference in the delivery of healthcare—except when it comes to reproductive health. The American Medical Association has called abortion bans a “direct attack” on medicine, and a “brazen violation of patients’ rights to evidence-based reproductive health services.”

Excepting access to abortion, U.S. lawmakers have largely left healthcare to the markets, rather than government. True, the government funds programs like Medicaid and Medicare but these programs vary significantly in quality and access by state, falling far short of providing fair, equitable, universal access to good healthcare.

The only two places where the U.S. government accepts some responsibility for the provision of healthcare are 1) in prisons and mental health facilities; and 2) in the military. While healthcare services in the U.S. prison system are notoriously deficient, they nevertheless exist and are recognized as an entitlement, underpinning the right to life. As an example, in 2005 a federal court seized control of the failing healthcare system in California’s Department of Corrections citing preventable deaths. In the military, free healthcare is an entitlement, and the quality of that care is deemed good enough even for the U.S. president.

So why doesn’t everyone in the U.S. have the same rights?

It is an uphill battle in a country that sees health and healthcare as a private matter for markets and individuals to navigate. But if we want to improve public health in the U.S. we need to start legislating healthcare as a right—and recognize that achieving the highest possible standards of public health is a legitimate government function.

Anti-Trans Rhetoric is Fueling a Pandemic of Violence

(Published on Globalhumanrights.org) 

Over the past months, prominent media outlets—including the Guardian and the BBC—have repeatedly published hateful expressions of transphobia. Articles cite high-profile anti-trans figures like JK Rowling and obscure transphobic talking points as open-ended questions—a way of “problematizing” the matter, as if the implication of inquiry creates some distance from the intentional hostility.

Much of this rhetoric is pushed by self-professed feminists. But evidence shows that their exclusionary arguments are harmful to all women, including those who are trans or intersex. Cattrachas, a feminist collective in Honduras supported by the Fund for Global Human Rights, has for the past two decades been documenting details of violence against LGBTQ persons and women in that country. What they’ve found has been clear: when one goes up, so does the other.

Don’t see the connection? Hear me out.

Conservative movements have long sought to define what a “real” woman is and to shame—implicitly or explicitly—anyone who doesn’t meet their standards. This has taken many different forms. For example, some seek to regulate women’s clothing, whether they are pushing for laws that forbid women from wearing headscarves or force them to. Others want to police the testosterone levels of athletes. Even mainstream women’s groups have contributed to policies that harm women, such as Equality Now and the Fawcett Society’s past support for the punitive Swedish model of sex work criminalization.

Anti-trans rhetoric comes from the same anti-feminist well. The move to exclude trans women from all-women spaces, such as bathrooms, is another way to define, restrict, and control the gendered expression of all women. In doing so, it directly affects any woman who doesn’t gender conform—in other words, any woman who doesn’t meet a narrow definition pushed by conservative groups.

I know I am a woman—and that identity is important to me. But it’s not because I have a vagina and like to wear dresses (though I do). It’s not because being a mother has been one of my greatest joys (though it has). It’s certainly not because I meet some stereotypically feminine standard. (In fact, the things people say define me are anything but: I am loud and opinionated. I own a full set of power tools that I use often and well. I am notoriously independent, physically strong, and I work hard to keep it that way.) And nothing about my identity is challenged, threatened, or otherwise nullified by someone else knowing they are a woman too.

By letting trans-exclusionary groups define who gets to call themselves a woman and who doesn’t, we’re accepting that every woman’s appearance—including our makeup, clothing, behavior, and physical attributes—can be policed in the name of “gender purity.” And because the policing of trans and gender queer folks has always been violent, trans-exclusionary rhetoric ultimately justifies misogynist violence.

That’s why it is no coincidence that the worst pandemic of anti-trans violence on record is happening at the same time that violence against all women is on the rise. In the Unites States, 2021 has already been the deadliest year for trans and gender non-conforming people.

I know, of course, that not everyone who makes these arguments or shares these articles deliberately wants to harm women. But at some point, we all have to look at the consequences of our words and actions, regardless of what we think we meant or how we intended them. This goes for the Guardian and the BBC, it goes for self-professed feminists who are harming all women through their anti-trans rhetoric, and it goes for all of us.

Next time someone you know makes an anti-trans “joke” or statement, help them make the connection between rhetoric and real-life violence. It’s literally a matter of life or death.

We women will decide what to wear

August 1, 2018, Copenhagen, Denmark. Mads Claus Rasmussen—AFP/Getty Images

(Article riginally published in Danish in Politiken, July 19, 2021)

On 15 July, the European Court of Justice - the EU's highest court - ruled that EU-based companies are free to ban visible religious symbols and that EU countries can choose to enforce such bans as they see fit. Although the ruling is worded to apply to all religious symbols and dress, experience says it will be applied almost exclusively to Muslim women who want to cover their hair or face or both.

The ban on the wearing of religious symbols raises many red flags for those who care about human rights.

And they should be of great concern in Europe, where more and more countries are restricting the use of headscarves or face veils in public. A 2018 report commissioned by Open Society Foundations found that only six countries in the EU - Croatia, Cyprus, Greece, Poland, Portugal and Romania - have not banned headscarves or face veils in some form or discussed a proposal to do so.

France was the first European country to adopt a general ban on covering one's face in public; the ban came into force in 2011. Denmark joined this dubious European trend in 2018. While both the Danish and French laws are written in a neutral way - they prohibit all persons from covering their face in public unless for specific purposes - the debate and stated motivation for the law was, at least in part, to "liberate" women from the "imposition of the veil". It should be added that although some laws 'only' prohibit face veils while allowing headscarves, the underlying motivation and trend is the same, as evidenced by Thursday's ruling. It is about gradually banning any visual expression of Islam in European countries.

The obsession with headscarves and face veils in the name of tolerance and non-discrimination is deeply misleading.

Firstly, clothing is generally a matter of freedom of expression. If a government imposes its view on how everyone should dress, it interferes with our ability to express ourselves freely, whether this is expressed as a clothing ban ('you must not wear a headscarf') or a requirement ('you must').

Secondly, it also affects our human right to freely express our beliefs when the imposed or prohibited clothing is predominantly linked to a particular religion. UN experts on freedom of religion have repeatedly made it clear that although state religions (such as the Danish one) are allowed, majority religions cannot be imposed on those who do not share that faith. Banning clothing that has a particular meaning in a particular religion is ostensibly neutral, but it is a poor veil for overt discriminatory intent. It may be that everyone in Denmark is forbidden to cover their face in public, but only those for whom covering their face is an expression of their faith suffer from this.

Third, the alleged 'liberation intention' is particularly problematic in overcoming harmful stereotypes and discrimination. When a government says or implies through its policies and actions that most Muslim women who wear headscarves do so because they are 'oppressed', far from liberating each Muslim woman, it deprives her of any autonomy in terms of freedom of expression and freedom of religion. Moreover, if a government maintains the stereotype that all Muslim women are submissive and oppressed, this is not very conducive to integration and understanding in society at large. Moreover, it only affects women and therefore actively contributes to any gender discrimination that may already exist.

From a human rights perspective, all governments have a duty to combat gender inequality across the board. Where gender inequality is reinforced by social norms and religious arguments - whether based on Islam, Christianity, Judaism or another religion - the state must ensure access to information and resources to prevent discrimination and provide redress in cases of abuse.

Indeed, the most disturbing aspect of the headscarf ban is that misplaced 'liberation' policies can make very real problems invisible. Recent studies by Amnesty International show that the Covid-19 pandemic has exacerbated already widespread violence against women in Europe. The victims of this violence are not all Muslims, and certainly not all of them cover their hair. These women need urgent state protection, but instead governments across Europe seem to prefer to spread myths and prejudice.

Thursday's ruling by the European Court of Justice on headscarves will make it easier for governments and businesses across Europe to continue this trend of divesting from real problems, such as gender-based and anti-Muslim violence, while claiming neutrality and tolerance.

But make no mistake, there is nothing neutral about it.

The continued obsession with headscarves and other symbols of Islam in Europe is inherently based on prejudice and will fuel further violence and abuse. The Danish government must take urgent steps to prevent and eliminate all forms of discrimination in the workplace, including discrimination based on religious stereotypes.

The Myth of Impossibility

A couple of weeks ago, my husband and I celebrated our wedding anniversary by spending a night in a hotel room overlooking Brooklyn Bridge Park. The view was spectacular and we spent most of the night watching barges and ferries going up and down the East River and people walking their dogs. It was indescribably beautiful and mesmerizing, and the main thought that emerged for me was, “I want to walk here at night,” immediately followed by “but that’s impossible,” and then “but is it really, though?.” 

Because what makes it feel impossible for me to walk in a semi-deserted park at night is not a physical barrier but rather a socially constructed one: I would not feel safe. Whether this is objectively true is not relevant. The point is that I intuitively articulated a key part of the world I want to live in - one where I am safe - and that it felt impossible to achieve.

This, at a much larger scale, is what is happening with our reactions to the deep structural inequalities the COVID pandemic has surfaced. 

In the United States, Black and latino individuals are up to twice as likely to die from a coronavirus infection as white people. This observable fact is linked to inequitable access to health care, as well as to stress-induced morbidity at least partially caused by underlying violence and hostility. Even when Black people do reach hospitals for care, they are sometimes distrusted and their subjective experience of their own bodies is ignored.

You don’t have to be a public health official or a policy expert to know what a better world would look like: one where access to health care is freely available, where everyone's experience can be heard, and which is prioritizing those who need it most. And yet, when we plan around even just one single health intervention - access to the COVID-vaccine - the people prioritized are those with money or in predominantly white neighborhoods.   

Another topic the pandemic has underlined is our collective misuse of natural resources, in particular in countries with high levels of personal car ownership and use. This is nothing new, of course, but the evidence highlighted by the near total worldwide stand-still of air and automobile traffic in March and April 2020 showed just how much we actually can control. Emissions picked up immediately as lockdowns lifted. Again, it is easy to imagine a more balanced world: one where we organize ourselves around collective modes of transportation and where local products - those that do not have to be flown in from abroad - are not only accessible but promoted and their exchange incentivized. And yet, one of the first things France’s President Macron did when the initial lockdown was lifted was to authorize massive governmental support for individual car-ownership in France, rather than investing that very same amount on an equally job-producing overhaul of the country’s infrastructure.

My point is that we already know what we need: a community where we are all safe, seen as our full selves, and in harmony with nature and the physical world we inhabit. But as we begin to envisage that world, we immediately revert to our current set-up. Sure, it is harmful and not sustainable, but the road to the alternative feels scary and unknown and therefore we dismiss it as impossible when really it is not.

I am not (excessively) naive. I know that there are people in power whose short term interests fuel the all-but-calcified status quo. I know that our regulatory systems often are set up to protect the interests of the powerful - observe the recent chaos and panic caused by individual speculators playing the stock market in a way that led to massive losses of established companies, when no panic ensued where the opposite was true. 

And yet, we have the tools to circumvent many of these structures: crypto-currency, collective community action, locally-grounded economies, and - yes - love. Because love is what is at the heart of the world we all know we want to live in. And the only thing standing between us and that world is the myth of impossibility.

The Day I Stopped Sewing

Earlier this year, two of my colleagues were killed in a car accident and I stopped sewing. I also stopped drinking for a while, which is odd in and of itself: I grew up in Denmark, and - like the Irish - we are known to drink to excess both in sadness and celebration. But it was the inability to sew that told me something was really wrong.

(A photo of my brother and me, probably the last year I wasn’t sewing. As you can see, however, we were really into coordinated outfits. I legit couldn’t say for sure which one is me and which one is my brother.)

Throughout my life, I have crafted items out of fabrics and yarn as a way to express and avoid emotions in equal measure.  During a painful breakup ten years ago, the first thing I did after that initial, disaster-defining, fight, was to dig out the most complicated pattern I could find and follow it to the letter, couture techniques and all. I still use the jacket I made - it is impeccably crafted, and it reminds me that beauty can grow out of pain.  When my estranged father tried to kill himself late last year, I moved in with my mother for a bit, and together we made a black-and-white quilt that mirrors the graphic oil paintings I remember from my childhood home. Every night I snuggle up in the soft cotton, knowing that home has meaning even when it is no longer there.

(OK, so this is not a quilt (in case you were wondering). This is a photo I found when I was looking through my father’s papers. This is my grandfather (the dude with the hat) and two queens. Except I think one might still have been a princess at the time.)

About five years ago, I discovered fabric design as an additional outlet. At the time, I was deeply unhappy in my job, a sentiment that translated into a temporary hatred of urbanity. The office was located in a particularly claustrophobic, downtrodden, and dingy part of New York City, and as a result I felt like I literally could only breathe when I was outdoors. I wanted to translate this feeling of relief - of life - into fabric, and so started printing flowers, snow, water, trees, pebbles, anything that helped me breathe, onto pieces of linen and cotton.

Before I knew it, the printing took on more importance than the sewing and design. My very first runway show was dominated by nature prints more so than coherent silhouettes. For a while, I didn’t make anything that didn’t carry my own prints. It felt like if I sewed anything with fabric I had not designed myself, it was somehow a cop-out, a lack of authenticity, a sadder, dimmer, carbon-copy of what I had imagined and felt.

In truth, for a short time there, fabric design and printing became the way I expressed pretty much anything, even petty spite and despair. When my father-in-law made hateful comments about immigrants (of which I am one) and immigrant children (of which I parent one), I translated my anger into marketable t-shirts and donated the proceeds in his name to a pro-immigrant organization. A miscarriage had me design another t-shirt with text expressing the flippancy I wanted to feel. The printing process prevented me from being a victim of the situation. I was doing something, and what I was doing had humor and grit. And then my colleagues died.

[Here’s a photo of my much missed colleague, Ana Paula, wearing one of Kær’s Kindness t-shirts. And one ofme wearing my miscarriage t-shirt.] I don’t know how to best explain that there is a clear before and after my colleagues’ deaths: there just is. And nowhere more so than in my creativity. It just went away. Sure, I sewed, but only realizing the vision of others. I made an impossibly romantic wedding gown for a friend’s friend, in a process that helped me focus love and loss in equal parts into tiny stitches of joy. I finally altered the many pants and jackets my husband long had begged me to outfit with zippers, hem, or otherwise make more useful. I raced through shirts I had promised my daughter to finish more than a year ago, but that somehow had been put on the backburner every time I had felt like realizing one of the colorful sketches that had been appearing in my mind.  Because after my colleagues died, the colorful sketches were just gone.

(Not everyone processes grief as loss of creativity. Here’s an amazing painting of our colleagues, Ana Paula and Sally, at a colleague organization in Honduras: Cattrachas.)

It’s been 8 months. This week I decided it was time. I pulled out a roll of fabric I designed years ago with oddly translucent cherry-red quince flowers on midnight blue. I picked a jacket pattern someone else made, complete with couture techniques and complicated twists. It will take weeks to make; the pockets alone took me a day. When I am done with the sewing, I will hand-wax it, transforming it from coarse linen into a leather-like shine. This process will also take days.  And when I am done, the sketches will come back. I know they will, because I can already see their shadows.

The birthplace of Kær: Samsø, the small island in the center of Denmark, where my mother lives and where I married the love of my life in 2014. This is where any creativity I have comes from: love