Human Rights Reader 170
*THE RESPECT OF THE RIGHT TO HEALTH IS A REFLECTION OF A SOCIETY'S
COMMITMENT TO EQUITY AND JUSTICE. *
1. The Human Rights Framework does not demand a 'right to be healthy'; it does not ask governments to commit resources they do not have to the provision of health care. But it does call for the right to the enjoyment of and access to a variety of facilities, services and conditions that are necessary for good health, for example safe water and adequate food, sanitation and shelter.
2. A Right to Health approach means that the necessary resources are given to those who have the greatest needs. It exposes situations where public funds are being used to build yet more hospitals in large cities, or where expensive equipment is being purchased for elective procedures that only benefit the wealthy or urban populations, while rural populations or vulnerable groups are denied even the minimum standards of health care.
3. Ergo, public/primary health care services and public health care facilities should be available in sufficient quantity in rural areas, taking into account a country's developmental and economic condition.
4. Let's not forget that, by signing international human rights treaties that affirm the right to health, a state has agreed to be held accountable to the international community, as well as its citizens, for the fulfillment of its obligations.
5. A human rights approach to health care poses specific challenges for health professionals as well; they usually have access to information about the conduct of public authorities. And, if health professionals have evidence of practices that violate the right to health, for example evidence of discrimination against women or against minorities, this information should be documented and reported to the appropriate authorities *and* to human rights (HR) activist organizations.
6. But, most of all, you are reminded that good health services can only be achieved if the affected people participate in their design and delivery. So, concrete steps are needed to make this happen, i.e., claim holders have to organize and demand this right of theirs. Never forget that social movements are such, as long as there are people who actually 'move' them…
7. Moreover, despite good intentions and new investments coming from outside, overseas development assistance for health (worth U$12 billion worldwide in 2004) has left the world's poor people's health still in a dire state. Through top-down vertical programs, the international community and the countries receiving the aid have too often squandered the historic opportunity to improve the health of poor people. Quite consistently, no attention has been paid to the social determinants of health (SDH). There is a disconnection between donor contributions and the actual needs of the poor in recipient countries. As we know, aid is channeled in a way that often rather interferes with countries' funding mechanisms. As we also know, money alone is insufficient; changes in the global aid architecture are needed. Many development agencies simply still need to overcome the crisis–of-legitimacy they find themselves-in right now by adopting the HR-based framework to development. The HR-based framework opens totally new policy spaces.
8. In short, countries are spending money on programs in manners that do not reflect their people's most urgent health and HR priorities. Countries should challenge donors on this so they allocate funds according to real needs. Instead, governments have (are) often reduced(ing) their own spending in the areas favored by donors. You know who the losers are given such a state of affairs…
9. The bottom line is that health systems will promote health equity and justice only when their design and management specifically considers:
• the circumstances and needs of the socially disadvantaged and marginalized populations in the country, including women, the poor and groups who currently experience stigma and discrimination,
• mechanisms to enable social action by these groups themselves together with the civil society organizations supporting them,
• ways in which the health system can generate preferential health benefits for the socially disadvantaged and marginalized groups, • providing the health care financing and the necessary arrangements to provide universal coverage and to offer extra benefits for socially disadvantaged and marginalized groups (specifically: improved access to health care; better protection against the impoverishing costs of illness; and the redistribution of resources towards poorer groups with greater health needs),
• restraining and more effectively controlling the private sector and enhancing the public and the community-based sectors, and finally,
• revitalizing the comprehensive primary health care approach as a strategy that enforces and integrates all other Alma-Ata-health-equity-promoting-features crucial to a HR-based approach to health. [Committee on the Social Determinants of Health (CSDH), WHO].
Claudio Schuftan, Ho Chi Minh City
mailto:cschuftan@phmovement.org NEW ADDRESS
[All Readers can be found in http://www.humaninfo.org/aviva under No.69]
Adapted from a speech by Mary Robinson on the right to health, from F+D,
IMF, 43:4, December 2006 and from CSDH documents.