Food for a flagrantly violated thought
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Human Rights Reader 112
THE HUMAN RIGHTS DISCOURSE IN HEALTH
(19 key statements)
A. Meaning of the human rights discourse in health:
1. The revived interest in a HR-based approach to development
and to our work in health is well justified and an advantage
over our current approach. Human Rights (HR) --and the Right to
Health-- have a particular concern about those who are disadvan-
taged, marginal and living in poverty.
2. Widespread unsatisfied health needs --primarily of the poor
who lack economic access to health services (and are now faced
with widespread fee-for-service charges)-- represent flagrant
violations of the rights of a majority of people. This is to be
seen in good part as a failure of beneficiaries themselves to
act as empowered claim holders placing their demands from a
power base that can force non-performing duty bearers (individu-
als and organizations) to provide the services and resources
needed to reverse those violations.
3. We have become quite good at doing detailed Situation Analy-
ses of unfulfilled needs and entitlements. But these only list
and sometimes characterize the multiple violations of the right
to health. So these represent diagnoses only.
4. To get something done about these violations we have to fur-
ther embark in Capacity Analyses that look at who is supposed to
do what about each of the violations we document (and why they
are not doing much or anything). Capacity Analysis has also been
called Accountability Analysis, because seeking accountability
provides claim holders with the opportunity to understand how
duty bearers have discharged their obligation and provides duty
bearers with the opportunity to explain their conduct.
5. After carrying out these capacity analyses, we have to --in
an organized way, through proactive community mobilization-- em-
bark with the beneficiaries in doing-something-about-those-
violations, knowing exactly who in health needs to be ap-
proached/confronted and with what specific demands.
6. All unfulfilled needs and entitlements, by definition, cause
some kind of harm (by omission). But the satisfaction of basic
needs is not always seen as a legal obligation by most decision
makers --though perhaps seen as a moral obligation. But moral
obligations have not been sufficient to satisfy the numerous un-
fulfilled needs of the poor in the last 40 years (or more) of
Northern-led development; much less will they be sufficient to
revert the violation of rights.
7. Unfulfilled-needs-and-entitlements do not bind duty bearers.
Violations-of-human (people's)-rights, on the other hand, DO
bind duty bearers legally under international law and, among
other, under the Constitution of the World Health Organization
(WHO). Most countries have signed the respective UN Human Rights
Covenants --and this is the most important... We are now demand-
ing duty bearers to legally uphold the health contents of what
has been signed by their respective countries and has now been
sanctioned by the international community.
8. Moreover, the Constitutions of over 100 countries include the
respect of health-related rights; courts around the world are
already adjudicating cases involving the right to health. There
is thus now a growing body of international HR law and practice
to help us identify the specific interventions and policies that
are needed to achieve HR goals in health. Therefore, the chal-
lenge now is to bring the Right to Health to actually bear upon
local, national and international policy making processes and
bodies. It is to be noted that proactively influencing policy
making in health does not depend on winning related HR court
cases; the policy-influencing-approach is not a soft option; it
calls for forceful social mobilization: It is not about listen-
ing to the powerless and marginal; it is for the latter to be
empowered to demand accountability for key structural changes
not occurring. The court-based and the policy-based approaches
are thus mutually reinforcing and both should be used in our
struggle; we thus need to promote both. What is now left is to
implement all these practices that operationalize the right to
health at the community, at national and international level.
This, by addressing issues of poverty, discrimination and stigma
particularly in relation to gender issues, children, racism,
HIV/AIDS and mental health (*).
9. All this represents an important quantum jump in our pros-
pects to achieve some of the changes we want to see being imple-
mented in health and in society.
10. It needs to be emphasized here that reaching the MDGs also
will have to pass through breaking the poverty syndrome behind
pretty much all the indicators of the MDGs. In our case, looking
at these goals only through the prism of the right to health
will only advance our cause in the health indicators (goals),
i.e., a very partial victory. Many are calling for specific
'contributions of the right to health to poverty reduction'. (*)
We rather see it the other way around: "how-will-poverty-
reduction-contribute-to-the-right-to-health". (Or, at best, we
see it both ways, but not the former way alone). We are NOT
seeking pro-poor health policies! We are seeking "pro-health-
poverty-reduction-policies".
11. The HR cause gives us the possibility to advance our politi-
cal agenda towards equity, towards the indispensable structural
changes that need to be made for health and other social ser-
vices to receive the resources they need to reverse the corre-
sponding rights currently being violated.
12. We now can face duty bearers accusing them of violating in-
ternational law.
And that is a tactical advantage. We can now demand structural
changes under the wing of international law. Our challenge now
is to spread the word about this so that, in alliance with claim
holders, we can muster the power to give a new direction and
greater momentum to our struggle.
B. How to strengthen the HR-based approach in our work in
health: (**)
13. The more specific challenge we face is to incorporate the
HR-based approach into the Health-For-All-Now agenda. The popu-
larization of what the HR discourse means, as characterized
above in a very simplified way, is step one. We need to do this
first with our strategic allies in bilateral, multilateral and
non-governmental organizations. Several of them have already
started: UNICEF has taken the lead among UN agencies to set the
course of what needs to be done to apply the HR-based approach
in development planning; CARE has made substantial advances in
adopting a HR-based approach in its operations worldwide. Be-
cause most international, governmental and non-governmental de-
velopment agencies have not yet re-visioned and re-missioned
themselves to adopt a HR-based approach, there is much we can
learn from the two experiences cited here --followed by much we
can (and need to) do.
14. In step two, it will be for these allies to then bring the
new concepts to their colleagues and peers, as well as to a host
of different health workers in their respective workplaces and
then to community leaders in the areas where they work.
15. The incorporation of capacity analyses to identify and char-
acterize duty bearers that are not doing what needs to be done
will, from now on, be key to our work. This process is in itself
empowering for us and for the claim holders we work with. (**).
16. Both in steps one and two, it has to be emphasized that
there is no hierarchy of HR; there are no 'competing rights'.
All rights are universal and inclusive, so we have to work for
their fulfillment in all areas; that is why looking at Health-
for-All as part of our struggle for the drastic reduction of
poverty is crucial.
17. The neoliberal development paradigm tries to fragment the
social reality into sectors allowing partial small victories to
be hailed as successes alas with absolutely no sustainability.
If the system that causes all the symptoms and signs that come
with poverty is not fixed, small victories in health, in educa-
tion or any other sector are just deceiving us. For example, the
emphasis on trade that globalization fosters is not going to
benefit the poor unless we specifically build-in fair trade
rules AND mechanisms of distribution of the benefits of trade to
the lowest income quartile. Or, an example from the health sec-
tor would be: We have seen Herculean efforts and resources being
poured into the Expanded Program of Immunization; who could
fault that when it saves lives? But saves lives for how long?
Until the child saved from dying from one of the six immunizable
diseases, because s/he is malnourished and lives in a poor and
contaminated environment, falls prey to a pneumonia or a diar-
rheal episode for which we do not have a vaccine yet. Who are we
fooling here?
18. What is highlighted here is that we cannot let the forces of
status-quo hijack the concept of HR in health. Any partial/ sec-
toral interpretation of this concept is ultimately dishonest. HR
is about a more equitable distribution of resources in society
and health is one of many entry points to achieve this goal. Hu-
man beings are born with a right to health and society has to
proactively make the investments to prevent totally preventable
ill-health and malnutrition and to treat those affected by the
diseases of poverty. Focusing our efforts in anything short of
this is a job half done, more so if we do not arrive at such a
situation through the empowerment of claim holders themselves to
relentlessly demand that the needed changes are implemented.
This is not a task for an avant-garde only: it is a mass mobili-
zation task.
19. We are not saying that all this is easy, or fast, or that
there are no small victories on the road to achieving our main
objectives. But the focus has to remain on the big picture..do
not miss the forest!
Claudio Schuftan
Ho Chi Minh City, Vietnam
mailto:claudio@hcmc.netnam.vn