Food for the right thoughts in health
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Human Rights Reader 91
THE HUMAN RIGHTS DISCOURSE IN HEALTH (Part 1 of 2)
I. The meaning of the human rights (HR) discourse in health:
1. The revived interest in a HR-based approach to development
and to work in health and nutrition is well justified and an ad-
vantage over our current approach. HR -- and the right to health
-- have a particular concern about those who are disadvantaged,
marginalized 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 institutions/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. Moreover, entitle-
ments and needs do not carry correlative duties for duty-
bearers. Rights do!
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 Analyses have also
been called Accountability Analyses, because seeking account-
ability provides claim holders with the opportunity to under-
stand how duty bearers have discharged their obligation and pro-
vides duty bearers with the opportunity to explain their con-
duct.
5. After carrying out these capacity analyses, we have to --in
an organized way, through proactive community mobilization --
embark with the beneficiaries in doing-something-about-those-
violations, knowing exactly who needs to be approached / con-
fronted and with what specific demands.
6. All unfulfilled needs, by definition, cause some kind of harm
(by omission). But the satisfaction of basic needs does not
carry a legal obligation for decision makers -- though perhaps a
moral obligation. But moral obligations have not been sufficient
to satisfy the numerous violated rights of the poor in the last
40 years (or more) of Northern-led development.
7. Unfulfilled-needs-and-entitlements-seen-as-violations-of-
human-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 HR Covenants -- and this is the most
important...we are now demanding duty bearers to legally uphold
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 human (people's) rights goals in health.
Therefore, the challenge now is to bring the right to health to
actually bear upon local, national and international policy mak-
ing processes. 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 op-
tion; it calls for forceful social mobilization: It is not about
listening to the powerless and marginal; it is for the latter to
be empowered to demand accountability for key structural changes
not occurring without a push. The court-based and the policy ap-
proach are thus mutually reinforcing and both should be used in
our struggle; we thus need to promote and mobilize people for
both. What is now left is to implement all these practices that
operationalize the right to health at the community, national
and international level by addressing issues of poverty, dis-
crimination and stigma face-on, particularly in relation to gen-
der, children, racism, HIV/AIDS and mental health issues.
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'. I
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). I am NOT seeking pro-poor
health policies! I seek "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. If not willing to cooperate, we now can face duty bearers
accusing them of violating international law. And that is a tac-
tical 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 for 'Health For All Now'.
Claudio Schuftan
Ho Chi Minh City, Vietnam
mailto:claudio@hcmc.netnam.vn