IN A WORLD DOMINATED BY MARKETS, WHERE RESOURCES FLOW TOWARD POWER INSTEAD OF NEED, WHAT WOULD HAPPEN IF WE REALLY CARED MORE ABOUT HUNGER AND MALNUTRITION FROM A RIGHT TO NUTRITION PERSPECTIVE? (Brooke Aksnes)

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Human Rights: Food for a narrowly focused thought

 

Human Rights Reader 418

 

The current malnutrition problem around the world is not its double burden, but its multiple burdens.

 

By narrowly focusing on the greater appeal of reducing hunger what do we risk?

 

For the hungry, there is no such thing as just a hard and dry loaf of bread. (Maria Duenias)

 

  1. By narrowly focusing on hunger, we risk solely or chiefly focusing on increasing dietary energy supply/consumption. But, beware, this will not adequately address the more complex challenges that fulfilling the right to nutrition brings about. To live up to these challenges cannot be made to mean following a number of silver-bullet interventions to achieve them. Why? Because any list of selected interventions risks being reduced to a simplistic shopping list from which one can choose according to ad-hoc preferences. So, how can it be assured that the human rights (HR) principles and standards are woven into the right to nutrition? For this, we need to start a true transformative process in order to de-block some of the block-ins that obstruct change in our system and that have been allowed to grow over the past 50 years.* Take the high level UN panels set up to deal with the topic: they have separated the political issues from the technical ones in an effort to build a purported ‘common and shared understanding’ –but where is this leading us to?.** (Biraj Partnaik)

*: “Perhaps the most significant lock-in is political in nature”. (Olivier de Schutter)

**: You know the “give me a fish and you feed me for a day” proverb, no? Well, what the Chinese wisdom failed to add is that teaching the hungry to fish does not help them to feed themselves long-term, because the pond, lake, or river is privately owned and they are not allowed to fish there…

 

  1. Nutritionists following the orthodoxy of the ruling paradigm have not been innocent in this lock-in either: ‘Laborious, duplicative, weak, grossly insufficient, poorly targeted, fragmented, dysfunctional’. These are all judgments we hear about the ‘global architecture’ designed to address under-nutrition the world over. Some architecture! (Ricardo Uauy) From this point of view, is then conventional nutrition sick as a science, as well as in practice, suffering from irrelevance and incompetence and also from ignorance, obscurity, obsolescence, complacency and venality? Likely.

 

From passive food consumers to active food citizens

 

  1. While we recognize the hugely valuable contribution that technology and innovation can make to nutritional outcomes, a growing number of us feels there is a need to redress the balance, so that traditional farming and food production practices which have evolved over millennia and greatly contribute to food security and nutrition are given equal or greater attention and are afforded the recognition and protection they deserve. (Jennifer Dias)

 

  1. Things are changing. Will cities and urban movements soon become the main leaders in a transition towards a more sustainable and fairer food system?*** Likely. For this, different food dimensions (other that its price in the market) must be properly valued, food chains must be shortened and scrutinized for excess profiteering, consumers are to become partial producers and the convivial-communal side of food production and consumption is to replace the individualistic ethos promoted by the industrial food system. The trend is moving from passive food consumers to active food citizens that develop food democracies where food must be valued as a vital resource –as a human right— as a cultural determinant and as a common good. (Jose Luis Vivero)

***: But beware, as a Flemish author said, one thousand urban agricultural initiatives do not make for a new agricultural system.

 

The identification and development of sustainable nutrition strategies must thus start from the understanding of local constraints and opportunities

 

  1. Indeed, it is key to start from the individuals suffering from malnutrition and, therefore, the households and communities they live-in. Analyzing the causes of malnutrition they face requires them understanding the food systems they interact-with and their decision-making power in them. Experience shows that malnutrition results from imposed food systems that negatively impinge on people’s livelihoods. Until now, the nutrition world (including some of the top experts) has emphasized biomedical approaches to complement nutrient deficiencies rather than looking at local specific causes –the latter always related to the determinants of the violation of the right to food. (Florence Egal)

 

  1. We all need to be aware of the fact that, in the long run, different food systems are not able to co-exist as industrial food system are rapidly outcompeting and choking more sustainable food systems. This is a trend one can observe on a daily basis in many countries —an issue of food citizenship urgently in need of being taken up… (Simone Lovera)

 

…and then there is industry…

 

  1. How long are we going to accept full corporate rule on what is available for us ‘to choose from’ to eat? I guess no longer! We must more actively work towards some degree of regulation of the market. Industry is ‘educating’ the general population on how to eat fast foods and junk (ultra-processed) foods while nutritionists go on blaming the individuals for their ‘wrong choices and behavior’, i.e., the blame is placed on the individual for making ‘unhealthy choices’ –a clever plot. (Flavio Valente)

 

  1. It is importantly poor city dwellers, not only, peasants who suffer from malnutrition. The former are unemployed, underpaid or in the grey subsistence market, the latter do not eat what they produce, have no access to markets and/or are underpaid as day laborers. Both groups are hooked on buying ultra-processed foods.****

****: Ultra-processed foods should be called ‘edible products’ –not foods. (Miryam Gorban)

 

  1. At highest risk, other than urbanites, are (a) TNCs plantation workers who produce for the global market; (b) peasants under threat due to land grabbing; (c) indigenous people, some of whom are farmers (that are further being repressed when they struggle for their ancestral lands); (d) pastoralists who have special nutrition problems (little access to vegetables and shrinking of the commons); and (e) fisherfolks whose rights are not receiving the needed attention (their major problem is lake and ocean grabbing). Among other, all these groups must fight for living wages, for access to health, for their safety and for maternity and old age benefits and must fight against the pervasive consumer misinformation by Big Food and against the privatization of the commons. The same groups must go from having their voices heard to exerting de-facto influence. Moreover, keeping nutrition policies separate from food policies makes the former very technical and too often product- and/or nutrient-based. Nutrition and food policies simply must be addressed together. (F. Valente)

 

Farmers/fisherfolk/pastoralists (claim holders) security vs food security (C. Haeberli)

 

  1. Between the World Economic Forum and La Via Campesina at the extremes of trying to address the food and nutrition security problem, there is a complex mix of intergovernmental organizations within and beyond the UN system, including FAO, WHO, WFP, UNICEF, the World Trade Organization and the World Bank. Among these agencies, a whole range of organizational approaches have been developed, but many of these carry along the corporate program.***** Among the most prominent is the SUN (Scaling Up Nutrition) Initiative, a ‘multistakeholder platform’ heavily criticized for its built-in conflicts of interest through the active and unchecked corporate sector participation in it. The SUN Initiative has no accountability to any UN intergovernmental body or process. (David Legge)

*****: Take for example the new UN lingo of ‘nutrition-sensitive social protection’. Think about it. What really is it? Why was it necessary for pertinent UN agencies to come up with a new construct/new language with a fancy name? The best I can figure is that, as externally influenced, they wanted to water-down the concept of social determinants of nutrition which is well defined as modeled by the social determinants of health. This is what it is all about: What communities really want is the social determinants of malnutrition be addressed to protect them. [Note that the same is true for UN agencies coining the term ‘non-state actors’ which lumps together private with public actors disregarding who really is for the public (and not the stockholders’) interests].

 

Pledges to combat hunger must not get stuck in ‘could’, ‘should’, and ‘may’; the politics of ‘could’, ‘should’, and ‘may’ must end (C. Schmidt, Uraban Jonnson)

 

  1. What it is all about is strengthening peoples’ right to self-determination in the economic domain****** by supporting grassroots HR organizations and by reclaiming concepts such as that of ‘food sovereignty’, i.e., the notion that involves breaking up with fundamental aspects of the heterodoxy of global capitalism. (E. Arenas) Nutrition is indeed a fundamental part of food sovereignty. (RTFN Watch 2015)

******: The economic benefits pursued are seen as an indispensible complement, not as a substitute for the intrinsically HR-centered goal of eliminating malnutrition with its multiple burdens. (John Hoddinott)

 

Claudio Schuftan, Ho Chi Minh City

schuftan@gmail.com

 

All 400+ HR Readers are available in http://www.claudioschuftan.com

 

Postscript/Marginalia

– From the Holy See come to us a few iron laws I’d like to share with you:

(a) Food shortages are not something natural. Hunger is due to a selfish and wrong distribution of resources through the merchandizing of food.

(b) Nature has made the fruits of the earth a gift to humanity; commoditizing them for the few engenders exclusion.

(c) Consumerism has made us grow accustomed to excess and to the daily waste of food.

(d) We are no longer able to see the real value of food that goes far beyond mere economic parameters.

(e) We need to be reminded that food discarded is, in a certain sense stolen from the table of those rendered poor.

These iron laws perfectly align with the current work on food as a commons and as a public good. We humans have artificially created the exclusion of the hungry from plentiful food. We can revert this social construct: food shall be given the consideration of a human right, a public good and a part of the commons —and it shall be guaranteed to every human being. (Pope Francis) (http://www.catholicherald.co.uk/…/full-text-pope-francis-a…/)

– Ask yourself: (a) Which of the foods we consume we do not get from a supermarket? (b) Which healthy and non-healthy foods purchased there do we consume? c) If all supermarkets would close, what would we eat differently?

 

POVERTY REDUCTION AS A GOAL SOUNDS LOVELY, BUT THIS FAIRY TALE VISION OF DEVELOPMENT AND OF HUMAN RIGHTS BETRAYS A SERIOUS MISUNDERSTANDING OF POVERTY. (J. Hickel)

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Human rights: Food for a misunderstood thought

 

Human Rights Reader 417

 

-An imbalance between rich and poor is the oldest and most fatal ailment of all republics. (Plutarch, ancient Greek biographer, 46–120 CE)

-Be reminded that poverty, as such, is now classified as a human rights violation. (Francine Mestrum, CETIM)

Poverty is part of the system, not an event! (Seth Godin)

-What if the problem of poverty is that it is profitable to other people…? (Matthew Desmond)

 

When people rendered poor know their rights and can act on this knowledge, long-term change becomes more likely (A. Campolina)

 

There are people rendered so poor that they only have money… (Albino Gomez)

 

  1. Poverty does not just exist out there, as if it were a natural phenomenon; rather, it is actively produced through the processes of marginalization, dispossession, and exploitation that allow for the accumulation of wealth elsewhere. In other words, there is an intimate relationship between wealth and impoverishment: As is, the flipside of development is the deprivation suffered by a sizeable chunk of the marginalized majority. Development models that fail to challenge the structure of wealth accumulation will only continue to reproduce the problem they seek to address.

 

  1. The ‘one percenters’ are going to have to feel the pinch –there is no way around it. The approach to reducing poverty and hunger as key human rights (HR) violations requires much more than just a bit of foreign aid here and there. It will require challenging particular political and economic interests. Indeed, this seems to be precisely why the world’s governments and international institutions are so eager to promote the ‘good-news’ of poverty-already-having-been-reduced. If they were to use more accurate measures of poverty and hunger, it would become clear that, to really eradicate these problems, we need to change the rules of the global economy, to make it fairer for the world’s majority. (J. Hickel)

 

  1. So, let us be clear: As much as those who have been rendered poor are made invisible –they are not forgotten or left aside; they are just not seen. (Michel Harrington) This is why the SDGs’ ‘Leave No One Behind’ motto is one more empty slogan. Hiding poverty leads to perpetuating it. A dignified life comes from having work. Therefore, to stop investing in people in the name of greater profits elsewhere is a disaster for society.* (Albino Gomez)

*: Keep in mind: Like many other civilizations before, ours surely has a date in which it will collapse. (Arturo Perez Revert) The question is how distant that date is. So, “If you happen to see the future, tell him not to come”. (Juan Lose Castelli)

 

Given the dominance of neoclassical theory in evaluating and analyzing economic outcomes, it is worthwhile examining the relationship between this approach, inequality and human rights

 

  1. The distinction between inequality of opportunity and of outcome is particularly salient when considering the HR framework. (https://en.wikipedia.org/wiki/Economic_inequality ) This, since the issues around inequality of outcome are much more central in discussions of economic and social rights than are issues around inequality of opportunity (the latter necessary but not sufficient).

 

  1. Individual purportedly ‘rational’ choices are the core of neoclassical economic theory –each firm makes choices to maximize its own profits and each individual or household maximizes its own ‘utility’, i.e., the satisfaction they get from their consumption decisions. Although neoclassical economics does have a theory of what determines income distribution, it consistently sidesteps the question of the consequences of inequality and instead evaluates economic outcomes primarily in terms of efficiency.**

**: But what does ‘efficient’ really mean? In reality it means that no one can be made better off without making someone else worse off.

 

One practical application of the idea of efficiency is the use of cost-benefit analysis to evaluate policy choices: Is this human rights-compatible?

 

  1. Cost-benefit analysis measures the costs and benefits of implementing a particular policy –if the benefits are greater than the costs, the policy should be adopted. It is precisely the concept of efficiency that is used to justify this approach. If those who benefit were to compensate those who lose (i.e., those who end up paying the costs of a particular policy), the assumed winners could fully compensate the losers –making some better off without making anyone worse off. Such compensation hardly ever takes place. Therefore, in practice, cost-benefit analysis ignores the distributive consequences of policy choices. The rich can and do receive all the benefits of a particular policy and it is still deemed a social improvement, as long as the benefits outweigh the costs.

 

The question of what is a just distribution of income and wealth falls outside of the purview of neoclassical thinking

 

  1. Fairness and social justice must be defined in terms of actually realized outcomes (not just opportunities, as said above). Realized outcomes can be measured along a number of dimensions: income, wealth, health, education, etc. People do not have similar choices to realize outcomes when they lack the income needed to pursue those choices, e.g., if they die prematurely from a preventable illness, or if they are shut out of educational opportunities.

 

  1. The human rights framework has at its core the principles of non-discrimination and equality. But note that this does not necessarily imply a perfectly equal distribution of income and wealth. Why? Because there are structural sources of inequality and indirect forms of discrimination. This is why equality/inequality have to be understood in relation to outcomes and results and not only opportunities (or access).

 

Poverty is a measure of deprivation, not of distribution

 

  1. Lower rates of poverty do not necessarily imply less inequality. Poverty declines when the incomes of poor households increase, but inequality can still worsen if the incomes of the well off grow even faster. Income and wealth are means to an end, not the end itself. Having a certain level of income helps people realize their rights –to health, education, housing, an adequate standard of living, and so forth. But what matters is all the rights taken together; that is what is ultimately important. Otherwise, disparities become permanent.

 

  1. When the political power of the elites expands as the income and wealth distribution becomes more skewed, this negatively affects the realization of human rights –economic and social rights, as well as civil and political rights.

 

  1. There is further significant evidence that supports the idea that greater inequality reinforces political processes that compromise the realization of economic and social rights. As Philip Alston, UN Special Rapporteur on Extreme Poverty, stated in his 2015 report: “Economic inequalities seem to encourage political capture and the unequal realization of civil and political rights.” (Human Rights Council, 2015).

 

  1. Greater inequality is also associated with less redistributive government spending. Related to this is the fact that economic elites are likely to resist progressive forms of taxation that, in turn, limits the ability of the government to mobilize resources for the fulfillment of the various HR. It is clear: The current structures of global economic governance are shaped by the vested interests of elites throughout the world. The HR framework does not stop short in denouncing this particular distribution of income and wealth issue as squarely unfair. (the above adapted from James Heintz and Radhika Balakrishnan)

 

The World Bank’s mantra of ‘reducing poverty’ translates into safety nets for the very poor, but this accepts and exacerbates inequality

 

  1. As I keep repeating, current strategies, including those in the SDGs, do not emphasize controlling the processes that create poverty, i.e., focusing on disparity reduction rather than on poverty reduction. (Urban Jonsson)

 

  1. What we really see is that too many poverty alleviation initiatives are all about adapting individuals to what are toxic conditions instead of eliminating toxicity from society. (Susan Rosenthal)

 

Never in human history has severe poverty been as easily and as completely eradicable as in the present period (heard this before…?)

 

  1. That we continue to perpetuate poverty through national and supranational institutional arrangements massively skewed in favor of the rich manifests a great moral failing of our generation, of governments and citizens alike. (Thomas Pogge)

 

  1. To be successful, governments and politicians in power must appear to care about the issues the citizens of their countries care about and must appear to be effective in addressing these issues. Citizens care about severe poverty, hunger and HR, both at home and abroad. Therefore, governments and politicians in power ought to have an interest in expressing support for the struggle against poverty and hunger, as well as for HR.

 

  1. Do you agree? Development goals, food summits, climate agreements… are true political spectacles: put on as propaganda, as public relations exercises. They give governments a very public way of showing that they care as much as we citizens do, and perhaps even more-so to end poverty in all its forms once and for all. Through this concerted display, governments produce not only political allegiance to themselves, but also complacency: when nearly all governments agree to something, then it is a done deal and we citizens need no longer worry about it or agitate for it. …they are on it! Right? Hmmmm! And through this, governments also divert attention away from the structural causes for the persistence of severe poverty, as well as from the powerful forces that the present organization of the global trading and financial systems produces.

 

  1. Led to celebrate the great ‘paper advances’ of the SDGs and the Paris Climate Agreement, we citizens are led to overlook the very real fact that 2015/16 also saw the richest 1 % of humanity expand its share of global private wealth to over half (50.4 %). The poorer half of humanity, meanwhile, was squeezed down to a mere 0.6 % of global private wealth, as much as is owned by the world’s richest 62 billionaires. Is it what really matters to these governments that their neoliberal globalization project is perceived as equitable and successful? Will they give up monopoly control over the official development data that show this is happening? (Beware that not all national statistical offices are wholly objective and free from political influence.) (Thomas Pogge) These are key questions for you to ponder.

 

Claudio Schuftan, Ho Chi Minh City

schuftan@gmail.com

 

All 400+ HR Readers are available in http://www.claudioschuftan.com

 

Postscript/Marginalia

Those rendered poor are tired to be poor-in-a-romantic-way. Yes, they can get to love shit if their livelihood depends on it, as long as their dignity is not degraded.

Those that have been rendered poor are men and women whose last drop of juice has often been squeezed out by the machine. i.e., the martyrs of modern progress. (Henry Miller, Tropic of Cancer)

 

HEALTH-RIGHTS AND JUSTICE-IN-GLOBAL-HEALTH HAVE A UNITY OF PURPOSE: TO GUARANTEE HEALTH OPPORTUNITIES AND OUTCOMES FOR MARGINALIZED POPULATIONS.

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Human rights: Food for an often-ignored thought

 

Human Rights Reader 416
 

Most governments ignore their human rights obligations in health

 

Currently, governments perceive no impending threat whenever they ignore their right to health obligations, whether the threat is in the form of moral blame, of being subjected to name-and-shame or by risking a number of actual sanctions.

 

  1. Let us face it, current international resource transfers in health are treated mostly as charity making these transfer fall under the category of ‘duties-of-humanity’ rather than of ‘obligations-of-justice’. This why such transfers cannot guarantee the fulfillment of relevant human rights (HR). This only shows us how the moral and political necessity (as well as the legitimacy) of transnational obligations for distributive justice are being widely denied. ‘Obligations’ are simply not framed and treated as real obligations-of-justice, i.e., as precise and potentially enforceable. It is taken for granted that such obligations exist, but what is unclear is the reasons why those-who-believe-that-such-obligations-exist do not enforce them. It is us, right to health activists and claim holders, who have not succeeded in more forcefully demanding their enforcement.

 

  1. Generally, countries are unwilling to give up their freedom in deciding how to manage their domestic and their foreign affairs: In the case of budget allocations by low-income country governments, for instance, how much of their resources they must allocate, in our case, to health. In the case of multilateral or bilateral assistance by high-income country governments, the issue is how much foreign aid is directed to the health sector of aid recipient countries.* The United Nations does not possess the normative authority on this. It is the international organizations with greater power and influence in economic and financial matters, in particular the World Trade Organization (WTO), the World Bank and the International Monetary Fund (IMF) that call the shots. Unfortunately, a ‘World Government’ with an enforceable mandate to enforce equality and justice in all member states is not on the immediate horizon.

*: As regards foreign aid, the key insight is that perfectly voluntary ODA disbursements (or any other forms of international health resource transfers) treat such transfers as charity and this does not guarantee any of it reaching the true marginalized populations. (John Barugahare)

 

  1. Note: The fact that states fail to respect their commitments is too often considered ‘the inevitable outcome of under-development’. Nevertheless, the HR perspective unequivocally contests this explanation by demonstrating that when they are the consequences of governmental neglectful policy to act, this constitutes an outright HR violation.

 

A rights-based approach to health that only implicitly includes the right to health lacks credibility and legitimacy

 

  1. The right to health encompasses all relevant human rights, including the rights to life, information, privacy, participation, association, equality, non-discrimination, and the prohibition of torture and inhuman and degrading treatment. Using such a wider lens will help devise a more comprehensive and effective strategy, i.e., the rights to health and to have access to health care can be at the center, but other rights need to be addressed as well.**

**: After all, the right to health is in the Constitution of the World Health Organization, and all states have ratified one or more treaties that include this human right, as much as it has been recognized by the UN on innumerable occasions. Nevertheless, although the international right to health found its place in the UN already in 1946, it was not subject to a more analytic treatment until more than 30 years later. (Paul Hunt)

 

Social and political engagement is not a substitute for technical validity, but is an essential addition

 

  1. Questioning power relationships in global health starts with the understanding that the data and concepts we use in global health are institutionally and politically constructed.*** What this means is that a health issue rises up the international agenda because people deemed to be experts have used ‘accepted’ methods to demonstrate its importance, and have communicated that in fora that entrench that importance on all of us thus influencing any future funding decisions. The validity of global health estimates can be improved if estimation processes are worked from the bottom up. Therefore, health data and estimates at any level are only useful if they are demonstrably used to improve the health of individuals other than those individuals (including ourselves) who make a comfortable living out of the ‘health estimates industry’.

***: Can we thus perhaps say that, as the concept is applied, global health is tipping into irrelevance?

 

  1. Mind you: health data are often presented as ‘objective’ but, like all other knowledge, they are a construct that derives meaning from the very process of its construction. Those choosing the questions may or may not be the end users of the information. But their interests and aims will certainly influence the utility of the data to all potential users.

 

  1. Moreover, the source of funding often (though not always) strongly influences the questions that get asked, and the ways in which they get answered. In-country data producers are themselves embedded in a political system, and are often under strong pressure to report statistics that support the political powers of the day. This institutional culture has led to an emphasis on the technical robustness of health estimates. Together with the imperative to publish comparable statistics on a very regular basis, this focus on the technical has undermined claim holders’ consultation and other social processes deemed indispensable.

 

  1. National authorities are sometimes unable to respond appropriately, because they do not understand the ‘black box’ that produced the data. Indeed, the desire to increase accountability and show measurable results has been a major driver of the huge rise in demand for these sorts of data. Some global health funds use these estimates not just to guide the allocation of resources, but to withdraw funding if countries do not meet numerical targets set.

 

  1. Standardized models that use estimated parameters to produce comparable data for close to 200 countries inevitably iron out precisely the differences and nuances that are most important for local decision-making. If the international community is not willing or able to work with local powers to develop better and more participative health information systems, one wonders if it would not be OK to live with blanks in global estimates.**** (Elizabeth Pisani, Maarten Kok)

****: Against the advice of the Committee on the Social Determinants of Health’s secretariat, the full CSDH team regrettably rejected the use of the HR framework in its 2008 report. This resulted in a substantially less persuasive rationale for the importance of participation, empowerment and voice of patients as claim holders, as well as in diminishing the potential role of HR in holding governments actually accountable for implementing the many recommendations in the report.

 

The context of any economic or demographic crisis does not reduce or eliminate the human rights obligations of the state

 

  1. According to international human rights law, the HR criteria that must be respected if austerity policies are implemented –if these are to comply with obligations derived from international human rights treaties– are:
  • any regressive measure must be temporary, strictly necessary and proportionate;
  • no measure can be discriminatory;
  • any measure must take into account all possible alternatives and must identify and protect the minimum core obligations of the right to health.

 

  1. Health exclusion of any kind is contrary to human dignity even if it guarantees access to just emergency services for undocumented migrants, especially minors and pregnant women. This, because the lack of access of preventive health care services in primary care, along with specialized and palliative care when these are necessary, has serious impact on the lives of these people. One cannot ignore that, in so far as the public health system is financed by direct and indirect taxes, established refugees (ex-migrants) who start working also contribute to its sustainability.

 

  1. Human rights organizations must reaffirm their commitment and determination to achieve the full respect of universal health care and, as such, must continue demanding that governments respect and/or restore a system of universal access for all persons regardless of their administrative status. (CESR)

 

The right to health cannot be ignored or applied on some occasions, but not on others (Paul Hunt)

 

Any health professional worth their salt knows that it is unrealistic to expect health policy makers or practitioners to read either a treaty provision or its corresponding General Comment and then grasp how they are to operationalize the right to health.

 

  1. Paying particular attention to access, adequacy, affordability and quality of health services (AAAQ) is necessary, but not sufficient. One also has to pay attention to the progressive realization of the right to health with maximum available resources, with international assistance and cooperation, as well as with assured privacy, participation and accountability.***** Only this ensures that the right to health has the operational potential to make a sustained contribution to the implementation of complex and costly health interventions that inevitably take years to put in place and ought to be ongoing.

*****: Take what the International Labor Organization (ILO) says about the minimum requirements for social protection floors; very much related to HR, these floors must include:

  • access to a nationally defined set of goods and services, constituting essential health care and including maternity care that meet the right to health criteria of availability, accessibility, acceptability and quality (AAAQ); and
  • basic income security (especially in cases of sickness, unemployment, maternity or disability).

 

  1. Consequently, we always have to:
  • distinguish between those human rights that are, and are not, subject to progressive realization;
  • explain that the right to health places more demanding obligations on high-income than low-income countries (except as relates to the fact that ‘core obligations’ apply uniformly to all countries, i.e., non-discrimination, equitable access******, and the adoption of an effective, participatory health strategy that gives particular attention to the disadvantaged);
  • confirm that states and others-in-a-position-to-assist have a responsibility to provide international assistance and cooperation in health, especially to low-income countries;
  • explain that duty-bearers are accountable for their right to health obligations, including optimal progressivity (just as much as they have obligations under the right to fair trial); and
  • acknowledge that, while ‘effective health monitoring’ is important, it is not the same as accountability.

******: Note that, for WHO, the inequitable distribution of the underlying social determinants of health (SDH) is the root cause of inequalities in health.

 

  1. Bottom line: Better late than never, claim holders and duty bearers better grasp the concept that the international right to health is not just a rhetorical issue. On the contrary, it very much is a contributor to improve the health and wellbeing of individuals, communities, and populations. (all the above adapted from Paul Hunt)

 

Claudio Schuftan, Ho Chi Minh City

schuftan@gmail.com

 

All 400+ HR Readers are available in http://www.claudioschuftan.com

 

Science Under Trump – A New Dark Age

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A new video from the Public Health and Social Justice website

Donohoe M. Science and Society in the New Dark Age. Conversations (Populist Dialogues – cable television program). Available at https://www.youtube.com/watch?v=UQLn8z2yjCg&feature=youtu.be – I believe it is airing on local cable this week. Program is 30 minutes long and covers the nature of the scientific enterprise, how governments and religion have responded to science throughout history, how science is and should be taught, the role of corporations in subverting science, the Trump administration’s war on science, and what scientists/journalists/citizens should be doing.

Other videos can be found on the Videos/TV/Radio page of the public health and social justice website at https://phsj.org/videos-tv-radio/. Feedback and new content always welcome.

Martin Donohoe
http://www.publichealthandsocialjustice.org
http://www.phsj.org
martindonohoe@phsj.org

 

INEQUALITY HAS BEEN A CHOICE. GLOBALIZATION THRIVES ON EXISTING INEQUALITIES. (Joseph Stiglitz)

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Human rights: Food for a not-by-chance thought

 

Human Rights Reader 415

 

-Bernie Sanders put it best: “We not only have massive wealth and income inequality, but a power structure that protects that inequality”.

-The main driver of inequality is corporate-driven globalization.

-Better machines, better technologies do not produce better wo/men. We cannot become a society in which a knowledge aristocracy will dominate an every-day-less-informed-social-mass. This will only deepen economic inequality. (Rosa Luxemburg)

Difference Yes, Inequality No! Plurality is the essence of life. (Slogan of the recent 12th Congresso de la Redeunida, held in Campo Grande, Mato Grosso do Sul, Brasil)

 

Equal relations between unequals reinforces inequality!

 

  1. To illustrate this, think for a while that equity under globalization is a bit like The Fight of the Mongoose and the Snake: Both are of about the same strength, but invariably the mongoose wins –it is more resourceful and it organizes its strategy to strike. The First World is like the mongoose; the Third World is like the snake. The lesson of this fable is that an asymmetry in the use of market power aggravates inequality: The affluent always end up having more political clout (and more wealth). Therefore, promoting self-interest (embedded in the soul of the free market adherents) is simply not good enough. The human rights framework places altruism over self-interest adding solidarity and equality to the equation. (A measure of greed-denouncing-actions is to be found there as well…).

 

  1. Hence, inequality is best understood as a proxy for how effectively an elite has set up institutions that extract value from the rest of society. (W. Hutton) It ultimately thus is the political capture of these institutions that produces the ill-gotten wealth that perpetuates economic inequality. Can this be combatted? Take an example: Latin America has significantly reduced inequality in the last decade through more progressive taxation and investments in public services, in social protection and in decent work opportunities. Central to this progress has been direct popular politics with leaders truly representing the majority, instead of being captured by a tiny minority. This has benefited all, both rich and poor. (Oxfam) [Unfortunately, latest regime changes in the region have been rolling much of this back…].

 

  1. Beyond parts of Latin America, inequality is at historic highs. It is a global phenomenon. In OECD countries, inequality increased more in the three years up to 2010 than in the preceding 12 years. (P. Lougani) It is the process of economic liberalization that has lead to increased inequality, importantly including wage inequality. ‘Benefits’ may have been given to the population, but these must be weighed against their distributional impact, i.e., to what extent they shrink the myriad burdens and human rights (HR) violations and to what extent these ‘benefits’ better protect those rendered vulnerable. Cuts in social benefits, in wages and in employment overall have accompanied fiscal consolidation and merger processes and this has disproportionately affected lower income groups. Clear evidence exists that austerity measures are followed by increases of inequality. Greater resort to progressive taxing and the protection of the social benefits of the vulnerable groups is what is needed.* (F+D 50:4, December 2013)

*: Equity-tracking-measures that contrast development outcome results between the bottom two income quintiles against the higher quintiles ought to be considered across all the post 2015 development goals. Actions focused on the bottom two quintiles can then be more heavily weighted thus prioritizing the focus of development actions on those rendered marginal and being excluded. (But will this be done?) Indicators that track and address all forms of discrimination and marginalization must then be defined and applied. (Plan International)

 

  1. In the same vein, when the proponents of giving priority to economic growth claim this growth reduces absolute poverty, they are being devious. An economic growth focus actually creates a widening gap between the haves and the have-nots and between urban and rural populations –and existing laws condone this.** Incomes of the bottom 20% have quite universally not risen nearly as much as those of the rest of the population. Policies followed leading to this situation have been to lower spending on social sector interventions together with regimes of less progressive taxes and indirect taxes disproportionately paid by those rendered poor. Furthermore, export-led policies are creating low employment gains and are concentrating the wealth in the hands of exporting corporations rather than of households. Workers also have weaker bargaining power that further depresses wages. It is more progressive tax systems that will boost the redistributive impact of fiscal policies especially when linked to increased expenditures aimed at vulnerable households. (R. Balakrishnan)

**: Justice of the bourgeois class is like a net that allows the sharks to escape and only catches the small sardines. (Rosa Luxemburg)

 

Key factors to decrease inequality are more equal distribution of earnings plus government transfers

 

  1. Many development interventions, while often well intended, result in some sort of a ‘social bribery’ where those at the margins are provided with basic social services (vaccinations, primary education, etc.) plus modest increases in income. These modest improvements keep those rendered poor afloat without changing their fundamental lack of access to life-changing opportunities or access to the current power dynamics. They are given the impression that their lane is moving, while in fact it is advancing at a much slower pace than others, and the gap between them and the wealthy is widening.

 

  1. An equity- and HR centered normative approach to tackling inequalities is one that rises above these disempowering interpretations and makes it possible to challenge existing power structures and development strategies. The search for equality inevitably involves profound changes in power relations that current power holders have limited, if any, interest in stewarding. Inequalities impose an analytical framework that exposes the close links between poverty and prosperity and highlights how the current pattern of growth thrives on marginalization and inequitable inclusion. We live under a Corporate Theory of Change. The new 2030 Sustainable Development Agenda is far from being immune to this theory of change and may as well become another powerful instrument at its service. Indeed, the entire SDGs negotiation process was characterized by the pervasive influence of the corporate sector and the unjustified confidence in the role of the private sector. (Stefano Prato)

 

  1. But there is a caveat here: Beware, many of the new equality agendas are based on a faulty non-egalitarian approach, namely prioritarianism. An important implication of this approach is the focus of these agendas on ‘poverty reduction’ rather than on ‘disparity reduction’. The first does not necessarily imply the second, while disparity reduction does imply poverty reduction especially for the most disadvantaged, including mothers and their children. Prioritarianism is favored by all those critical-of or skeptical-about any type of egalitarianism, because it is based on a humanitarian concerns, trying to help to improve the situation of people living in extreme poverty –but without any reference to the need to reduce disparity! According to prioritarianism, it is morally most important to help people who are worse off, independently of the degree of inequality. (If this rings like charity to you, you are not that far off). What is important from the HR point of view is not that everyone should have the same, but that each should have enough. If everyone had enough, it would be of no moral consequence whether some had more than others! (Urban Jonsson)

 

A strong ray of hope

 

  1. There is something about inequalities –a sort of a deep, shared aversion to unfairness shared by growing numbers of activists and the general public –and it is powerful and seems to generate an even stronger visceral reaction than poverty per-se. The emerging inequality-driven perspective focuses on both the losers and the winners, forcing a political economy analysis that highlights how the status-quo has its owners and supporting power structures. The inequality and HR-based analyses being applied give people a gender perspective, a social affiliation, a location… It demystifies averages and gives everyone his/her human face and dignity. It forces a subjective analysis of fairness that cannot be reduced to a simple number, even if numbers help. It imposes a combination of objective and subjective measurements of progress and thus highlights the importance of people’s subjective judgment of their equitable or inequitable treatment. (S. Prato)

 

Claudio Schuftan, Ho Chi Minh City

schuftan@gmail.com

 

All 400+ Readers are available in http://www.claudioschuftan.com

 

Postscript/Marginalization

Shortly before his death, Mahatma Gandhi offered a useful reflection that helps to cut through some of the complexity surrounding debates about equity. He said: “Recall the face of the poorest and the weakest person you may have seen and ask yourself if your recalling her/him is going to be of any use to that person.” (cited by K. Watkins)

 

THE GREATEST PUNISHMENT FOR THOSE WHO ARE NOT INTERESTED IN POLITICS IS THAT THEY ARE GOVERNED BY PEOPLE WHO ARE. (Arnold Toynbee)

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Human rights: Food for a punishing thought

Human Rights Reader 414

Politics without value-grounded ideas stimulates corruption (Revista Primera Piedra)

 

  1. In its true sense, politics is to be taken as an emancipatory process; in our case of human rights (HR), it calls on fellow colleagues and on claim holders to go beyond their routines to join the political struggle over equality and dignity issues.* Philanthropy (or philanthrocapitalism), on the other hand, is not emancipatory. It acts as a ‘voluntarist invasion’ of what should clearly be the space of political processes.

*: I acknowledge though that not everyone is sensitive to political facts. Beliefs, values and ideologies can be and are a big filter for the perception of facts. (V. Masson-Delmotte)

 

Critique/Trends

 

  1. In this day and age:
  • The world that has accompanied globalization has transformed political parties into machines of public opinion, directed to solve administrative problems. Citizens are deserting and politicians seem more interested in their perpetuation, and polling while marketing tools have substituted a direct dialogue with citizens. Values have regrettably disappeared from the political debate. (Roberto Savio)
  • Angry voters have one thing in common: They have been left in the dust by globalization. (Der Spiegel)
  • It is thus extremely difficult or even almost impossible for citizens to make an intelligent use of their political rights. Our educational system as a whole suffers from quite the same influence: It inculcates a competitive attitude on students that are ultimately trained to adopt greed as a preparation for their future career. (Albert Einstein)
  • The shift to the left we are seeing in younger citizens is more and more based on perceiving the growing and overwhelming evidence base.

 

Oh, politicians!

 

– The political language of tyrant politicians vies to make lies believable and to make crimes respectable. (George Orwell)

– Since light travels faster than sound, some politicians appear bright until you hear them speak.

 

  1. Four of my ‘iron laws’ apply very well here to the current situation we are living in:
  • Politicians running for office better be careful about announcing a political moment, given how many such proclamations turn out to be ludicrous. (Paul Krugman)
  • One of the dangerous concepts that you can find in a democracy is charisma. Charismatic politicians can inspire followers with soaring rhetoric –which also too often proves divisive and damaging to a nation’s fortunes. (David Barnett)
  • Worse for a politician than talking with a full mouth is talking with an empty head. (Albino Gomez)
  • If you cannot get rid of the politicians who govern you, you do not live in a democratic system. (Tony Benn)

 

It is about power, stupid!

 

Would more opportunities and more diversified sources of wealth mean more sources of power and less scope for authoritarian attitudes? (Hans Dembowski)

 

  1. Anonymity is both a symptom and a cause of the undue political power concentration we have right now. Excess power has played a major role in a remarkable variety of recent crises: the financial meltdown of 2007‐8; the offshoring of wealth and of power (of which the Panama Papers offer us merely a glimpse)*; the slow collapse of public health and education; resurgent child poverty; the epidemic of loneliness; the collapse of ecosystems, …the rise of Donald Trump. (The Guardian)

*: Some defenders of the present system are already maintaining that scandals are proof that democracy is alive and works. But if the citizen’s growing lack of trust in the political and economic elites’ power continues, it is difficult to see how scandals will help nurture democracy. (Roberto Savio)

 

  1. The rapprochement or fusion of corporate power with government generates an elite brand of politics based on a political-financial revolving logic in which money buys power and power rewards money. Calls for a post-democracy era are nothing but a rehashed imitation of what we have had. These calls have a populist ring, a consultative appearance while the real politics of power and money consists of a continuing round of inter-personal (golf club?) transactions among elite members. This cozy paradigm creates a sort of ‘designer activism’ deeply compatible with the circuitry of power in the current order. It emphasizes the role of private foundations/philanthropies as the world’s problem solvers, so that social programming is decided by the untaxed wealthy in their boardrooms in a discretionary manner –rather than by democratic processes based on universal HR and entitlements. (Alex de Waal)

 

  1. How long can it be denied? Power relations are at the heart of how our world is run. As a consequence, more and more social movements are uniting to influence power relations. It is becoming clear to them that the ideology convincing people that poverty is due to individual failure is what is making economic power structures of exploitation invisible. Therefore, opposing this approach has to start with analyzing underlying power relations. The analysis shows that all actors have power, sometimes overwhelming power; sometimes just a little, but power nonetheless. Awareness-raising simply has to start with raising the idea that change can happen and power relations can be better balanced. Bringing people together in determining their own destiny is a central feature of HR and of empowerment understood as influencing power relations. (PHM)

 

Capital will allow no one to govern, but its own

 

– The separation of powers must be preserved for the true democratic political process to resume its course.

– Members of the legislature are selected by political parties that are financed (or otherwise influenced) by private (capitalist) sector actors. For all practical purposes, this separates the electorate from the law-making process. As a consequence, the ‘representatives of the people’, in fact, end up not really protecting the interests of the non-privileged groups in the population. (Albert Einstein)

– Political domination has, so far, successfully depended on instilling a perception of legitimacy. (David Legge)

 

  1. Have you noticed? Courts deal exclusively with individual rather than collective disputes and are designed not to interfere with the ruling classes and elites that are protected by immunity and other privileges. But citizens do now increasingly have growing awareness of their rights. So, to counter, when faced with political deadlocks in controversial issues, the political elites selectively use the courts as a way of lifting the political weight off certain decisions. An example is the control of constitutionality as the tool used by the ruling political classes to defend themselves against potential threats to their interests resulting from the growing groundswell of democratic politics by the upside-down ‘tyranny of the majority’.

 

  1. Be it as it may, these developments all lead to a new kind of judicial activism known as the judicialization of politics and this inevitably leads to the politization of justice. The judicial system –supposedly the ultimate defender and guarantor of the legal order and of HR– can and has become a dangerous source of legal disorder. Blatantly illegal and unconstitutional judicial measures, plus a selective persecutory zeal, an aberrant promiscuity in which media outlets are at the service of the conservative political elites, and a seemingly anarchic judicial activism can result in injunctions relating to a single political act: bringing democracy and HR to the edge of chaos. With the legal order thus turned into legal disorder and democracy being hijacked by the non-elected sovereign elite, political and social life, as well as HR, have become a potential field at the mercy of political vultures.

 

  1. This is why: Rules are these days regularly ignored by a judicial system that has not only been conformist, but also complicit with the privileges of the ruling political elites. We must beware that the latter elite assumes a politically neutral position precisely to defend the judicial system from the attacks it is being subjected-to by those targeted by their investigations and prosecutions of activists and HR defenders. Moreover, external pushes clearly lie behind such defenses of the judiciary. Those pushes are what dictate the glaring selectivity of any investigative and accusatory zeal –HR issues quite consistently excluded. Courts can show a shocking display of double standards, punishing with severity actions committed by the far left and showing great leniency towards the violence of the far right.

 

  1. Backed by a conservative legal culture that is widely predominant in too many judicial systems and law schools, wielding a full arsenal of high-powered, high-precision media weapons, the conservative bloc does everything it can to distort facts –the political taking precedence over the judicial. Courts must be barred from putting their own independence at the service of any corporate or sectoral political interests, no matter how powerful. Although easy to say, the principle is very difficult to enforce. Disciplinary proceedings by reason of reiterated procedural abuse must be initiated. When progressive governments are defeated, the right comes to power possessed with an unprecedented virulence and bent on destroying all that was built in favor of the popular classes during the previous period. (rings a bell?) Then, along comes the vindictiveness seeking the complicity of the judiciary (even the supreme court…). (Boaventura de Sousa Santos)

 

 

Needed: Think and act bottom-up

 

  1. What I miss in the prevailing political discourse is looking at the political constraints we face globally and nationally to implement the meaningful changes we HR activists so passionately pursue in a world clearly dominated by those with excess power. Yes, many have and do document the powerlessness of the majorities, but consistently fail to conclude with advice for those powerless to mobilize so as to exert pressure (or rather counterpower) to change this indeed oppressive situation. The best self-proclaimed experts can come up-with is to say something like: “Vigilant monitoring of these inequalities, combined with forceful engagement with the economic and social determinants, will be needed to ensure that the favorable trends in the contours of human rights become each person’s priority”. I also read calls “to compile evidence across disciplines to rethink our ideas of a just society”. The question is who is ‘our’…are they talking to their already-convinced-fellow-social-scientists?

 

  1. If you allow me the generalization, these social scientists aim to deliver reports addressed to all social actors, movements, organizations, politicians and decision-makers, in order to provide them with the best ‘evidence’ on questions that bear on social change. The flaw in this thinking though is that the politicians who are to take the decisions that these experts (mostly tangentially) call-for are not convinced by evidence produced by academics; they have their own political agendas! This is why even thinking that elected members of governments and parliaments are supposed to generate public hearings and decide according to grassroots networks and not according to the policy sets and narrow ideologies for which they were chosen by the people is so senseless. Ideology plays the major, key role.* Advice-to-policy-makers is what we have been doing for decades; to what avail? Top down does not work! We cannot depoliticize the issues.

*: All of us are deeply attached-to and even defined by our beliefs and ideology, for they define our reality and are thus elemental to our very selves, so any challenge to our core beliefs tends to feel like a personal attack. This is equally true of ourselves as it is of those who hold opposing beliefs. (Maria Popova)

 

  1. We see governments, politicians, the justice system, external funders… hushing and denying the needed key change-fostering knowledge to the people. We thus have to organize the necessary debates and actions to bring that knowledge to the fore since it is intentionally eclipsed and withheld. (Hernan Cardinale)

 

Claudio Schuftan, Ho Chi Minh City

schuftan@gmail.com

 

All 400+ Readers are available in http://www.claudioschuftan.com

 

Postscript/Marginalia

– Bertrand Russell famously said, “The whole problem with the world is that fools and fanatics are so certain of themselves and wiser people so full of doubts.”

– The truth is that the UN now comprises a bunch of politically and financially exposed, as well as financially vulnerable intergovernmental agencies.

– According to the British Diplomat Lord Carnavon, the professional quality of a diplomat is best demonstrated by how efficiently he follows orders he does not agree with.

-In life, we have to avoid three geometric figures: Vicious circles, love triangles and square minds. (Mario Benedetti)

– A great advantage of your enemies over your friends is that the former are always authentic and very consequent in their behavior; additionally they give the person they consider their enemy, you, a great importance. In short, they are very stimulating. (A. Gomez)

 

HEALTH CARE FOR THOSE RENDERED POOR OFTEN ENDS UP BEING POOR HEALTH CARE, SO THAT THE MORE WE TARGET BENEFITS AT THEM ONLY … THE LESS LIKELY WE ARE TO REDUCE POVERTY AND INEQUALITY. (Amrtya Sen)

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Human rights: Food for a thought to be fought-for

 

Human Rights Reader 413

We can safely say that, in the case of health, inequality is a passive outcome: ‘it happens’; conversely, equality in health must be fought-for actively. (Hernan Sandoval) [In the same vein, we have always pointed out that political rights are guaranteed; social rights must be actively proclaimed and fought-for by claim holders].

 

Did you know?

 

When it comes to global health, there is no ‘them’…only ‘us’. (Global Health Council)

 

  1. When we want to say that Primary Health Care (PHC) is a Core Human Right Obligation, we mean that it is far more than a procedural issue; it is a structural issue encompassing equitable distribution of these services, non-discrimination, and a participatory national plan of action. The only PHC intervention actually specified as a core obligation is access to essential medicines; there is no mention of the social determinants of health, i.e., minimum essential food, basic shelter, housing and sanitation, and safe water. Other substantive components of PHC are listed, but separately, as ‘obligations of comparable priority’. Here we find reproductive, maternal, and child health care actually explicitly mentioned, as well as immunization against major infectious diseases, the prevention/treatment and control of epidemic and endemic diseases, health education, access to information and appropriate training for health personnel. Let us be clear: Core obligations refer-to and demarcate ‘essential’ aspects of the right to health as a baseline of people’s protection –regardless of any given country’s shortage of national resources or international assistance.

 

  1. Additionally, be informed that actions to realize core aspects are part of the legally binding human rights (HR) framework that was designed to have considerable normative and political implications. Primary health care as such is thus not explicitly listed as a core obligation; much of what we would expect to find in an obligation to provide essential PHC is explicitly placed outside the core obligations, i.e., under obligations of comparable priority. General Comment No. 14 does not sufficiently address the question of the resources necessary to meet core obligations; it merely emphasizes that states cannot justify non-compliance under any circumstances. The role of international assistance and cooperation is strongly reasserted in GC 14 and thus clearly applies to core obligations. Core obligations should be understood and applied as providing a universally applicable ‘bottom line’ of essential health care –in contrast to any other standards that can shift from country to country depending on available resources.

 

  1. The focus of the right to health’s understanding of core obligations is far more on processes (e.g., non-discrimination, equitable distributions, and participatory plans of actions) than on outcomes. Core obligations do not prescribe a globally applicable and fixed set of health care benefits, but rather prescribe a framework for action that encompasses non-discrimination (including affordability), equity and participatory decision-making. The emphasis on affordability elevates socio-economic status to one of the grounds for discrimination, meaning that any version of Universal Health Coverage (UHC) that is not affordable to all violates core obligations under the right to health.* (Lisa Forman et al)

*: Note that the risk of UHC becoming targeted (rather than offering comprehensive, truly universal health care) and giving inadequate attention to health systems strengthening is great. This is not a frivolous statement since states live not in an abstract world as governed by the aspirations of the SDGs, but live in the real world, where policies to implement UHC exist alongside ongoing austerity, financial crises, free trade agreements, and pressures to commodify health services –all of which directly threaten policies on access to medicines and sustainable health financing. (L. Forman)

 

It is the design of a financing mechanism that determines equality in the access-to and the payment-for health care

 

The human rights framework does offer practical guidance for addressing the political economy challenges of health care reform.

 

  1. A focus on the redistributive potential of health care financing recasts health reform as an economic policy intervention that can and will help fulfill broader economic and social rights obligations. For instance, a business tax directed against wage disparities can foreseeably generate the resources needed. A health system financed through equitable taxation can indeed produce significant redistributive effects thus increasing economic equality while generating sufficient funds to provide comprehensive health care as a universal public good.

 

  1. Regressive health care financing is a significant contributor to economic inequality, producing an inverse correlation between household income and household health care spending. Conversely, a redistributive universal health care system can deliver significant financial relief to lower- and middle-income families. Health care can thus function as a strategic lever for building a more equitable society through the universal provision of the goods and services needed to exercise/fulfill economic and social rights.**

**: The market-based insurance system in the United States demonstrates that private pre-payment schemes are neither intended nor equipped to guarantee equality in access-to and payment-for health care.

 

  1. Therefore, in the design of a financing mechanism, the three principles of universality, equality, and accountability can be achieved if: a) financing is be based on health needs and is sufficient to meet all needs; b) equitable financing is ensured through progressive taxes and guarantees free access to care at the point of service; and c) the mechanism is public so as to secure full accountability for the effective and efficient use of resources necessary to fulfill the human right to health.***

***: It is clear: The proactive engagement with the question of health system financing places right to health campaigners squarely in the territory of budget and revenue policies.

 

  1. The human rights-based approach requires budgeting for health to begin with a participatory assessment of needs to then develop a needs-based budget that calls for the mobilization of the maximum amount of resources in an equitable way to meet these budget obligations. Assessing the needs, accountable decision-making based on the depth of need****, mobilizing public funds through equitable taxation, and strengthening public sector capacity, are all prerequisites to fulfill the economic and social rights obligations pertaining to health. Promoting needs-based, equitable taxation as a rights-based instrument for achieving universal health coverage, opens up an economic and social rights perspective on health policy.

****: Universal health coverage is quintessentially a needs-based system. Human rights activists cannot afford to stand on the sidelines of the political economy debates over UHC. (Anja Rudiger)

 

We have to put states on notice that they remain accountable for the right to health and health care in the private sector (Audrey Chapman)

 

  1. An identification of the various components of UHC, on the one hand, and the right-to-health framework, on the other, reveals many close connections between the two. For example, while affordability is a key component of the right to health, it also underpins UHC. As the primary duty bearers, governments have a responsibility to ensure that health care services (even if privately provided) are available, accessible, acceptable, and of good quality. They must ensure that mechanisms are in place for patients to seek legal redress if they have received inadequate or untimely care. The HR obligation to protect is of particular significance in this context since it requires government’s active monitoring of the activities of third parties.***** When certain services fall into private hands, there is a shift from the state respecting and fulfilling the right to the state’s obligation to protect which includes the obligation to regulate; the obligation to monitor; the obligation to ensure that there is accountability for violations committed; and the obligation to ensure the population’s participation in health care decision-making. (Regulatory efforts have to cover the provision and financing of health care, as well as the manufacturing and equitable distribution of all health care goods).

*****: For example, in terms of geographic access, the operation of private hospitals should not mean that health services are available only in affluent areas. Human rights law provides an authoritative set of legal tools for assessing the consequences of private sector involvement. (Birgit Toebes)

 

Bottom line

 

  1. A focus on the redistributive nature of health systems recasts health care reform as a broader economic policy intervention. There are though a range of policy and political obstacles, e.g., the specific power relations producing these obstacles and the systemic factors contributing to human rights denials.

 

  1. Only anchored in local movement building efforts and social mobilization will the momentum for universal health care reform continue to grow. It is mass organizing that will eventually tackle political resistance through rights-based redistribution models. (A. Rudiger)

 

Claudio Schuftan, Ho Chi Minh City

schuftan@gmail.com

 

All 400+ Readers are available in http://www.claudioschuftan.com

 

Postscript/Marginalia

– UHC is like a short blanket that, as such, leaves something uncovered. It is worrisome that it does not fully cover the ‘you-know-who’, that it risks accentuating inequality by involving private insurance companies and by making health systems ever more curative and less preventive/promotive. (Daniel Esteban Manoukian)

– It is clear that equality of access to healthcare means that healthcare is to be accessed by everyone who needs it whereas priority of access implies that healthcare will be received by some and not by others. It thus is not about re-allocating resources from one type of patient to another, to the detriment of the former. It is in fact about cost-effectively manage primary health care delivery for all based on the public health principles of fairness, equality and social justice. (Denise Nascimento)

 

Science and Society – Illuminating the New Dark Age

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A new video from the Public Health and Social Justice website

Donohoe M. Science and Society: Illuminating the New Dark Age. Conversations with Dr. Don (cable television program). Available at https://www.youtube.com/watch?v=DjxgqucWmSA  (first 15 minutes general discussion, topic covered 15 minutes onward). Posted April 25, 2017 – I believe it is airing on cable later this week.

The program covers the nature of the scientific enterprise, how governments and religion have responded to science throughout history, how science is and should be taught, the role of corporations in subverting science, the Trump administration’s war on science, and what scientists/journalists/citizens should be doing.

Other videos can be found on the Videos/TV/Radio page of the public health and social justice website at https://phsj.org/videos-tv-radio/. Feedback and new content always welcome.

Keep up the fight.

 

 

YOUNG PEOPLE MUST OCCUPY THEIR RIGHTFUL PLACE IN HUMAN RIGHTS DECISION-MAKING. THEY HAVE TO PROGRESSIVELY TAKE THE HELM OF THE SHIP.

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Human rights: Food for a youth-reminding thought

 

Human Rights Reader 412
 

The future will ultimately either go in the direction of the youth’s commitment, or along their indifference about human rights. (Oscar Arias)

 

And here are a couple bonus topics for them to understand.

 

Insist on rights not goals

 

The possibility for minority groups to actively claim is perhaps one of the main reasons for the existence of human rights. (Paul Hunt)

 

  1. The absence of a specific human rights (HR) focus in Agenda 2030’s 17 goals is, as so many keep saying, problematic. In the SDGs, there rather is an accent on investment and infrastructure goals, while there clearly are more negative environmental and social and political impacts where using the HR framework would have been clearly more central …a challenge here for young activists in the next 14 years. The clock is ticking.

 

  1. What this boils down-to is that, among other, the human rights to equality, to life and to a decent livelihood, cannot be reduced, as we now have, to aspirational ‘development goals’ and to voluntary codes of conduct or guidelines that can be (and are) usually underfunded, are left to the private sector, or are missed or pushed back due to ever-new ‘unforeseen circumstances’. (ESCR-Net)

 

  1. If development is about all people’s unquestioned and equal entitlements, what must be used is binding HR language, e.g., language on claim holders and duty bearers, on HR principles and on HR standards —all referred to the respective UN HR covenants as duly ratified by nation states.* [Sure, this is further underpinned by the clearly stated principle of progressive realization –which does not undermine the idea of binding commitments— as we should have had (and did not have) in Agenda 2030].

*: As I said in HR Reader 411: We are not making this up: the vast majority of states have obligated themselves to respect, protect and fulfill all human rights.

 

Extraterritorial obligations (ETOs) are a sorely missing link in the universal human rights protection system

 

There indeed are collective obligations from states-in-a-position-to-assist to states-in-need-of-assistance.

 

  1. Without ETOs, HR cannot assume their proper role as the legal basis for putting checks on the excesses of globalization and ensuring universal protection of all people and groups the world over: A challenge our youth should not miss. ETOs also provide for state regulation of transnational corporations, provide clauses for state accountability for its actions and its omissions nationally and for the inputs it provides to intergovernmental organizations in which it participates. ETOs also set standards for the HR obligations of intergovernmental organizations themselves and are a tool needed to ultimately also address climate change and the destruction of eco-systems. (Laura Michele, FIAN)

 

  1. Although ETOs address only economic, social and cultural rights, it would be legally correct to apply them to civil and political rights as well,** except in limited instances where they refer to concepts that have been applied uniquely to economic, social and cultural rights, such as their ‘progressive realization’. (L. Michele) [To begin with, the ETO’s Maastricht Guidelines’ affirmation that economic, social and cultural rights (ESCR) impose three types of obligations on states is now widely accepted. They include the obligation to respect, to refrain from interfering with the enjoyment of ESCR; the obligation to protect, to prevent violations of such rights by third parties; and the obligation to fulfill, to take appropriate legislative, administrative, budgetary, judicial and other measures towards the full realization of such rights].***

**: A reminder here: Implementing the civil and political rights is cheap (no great investments are needed); implementing the economic, social and cultural is invariably expensive.

***: Implementation measures are bound to vary from one country to another, not least because all countries are at different stages of progressive realization (or non-realization) and have different resource capacities. (Paul Hunt)

 

Justice/Law: Although both are vital in order to protect the innocent, they do not always work to everyone’s benefit (Paulo Coelho)

 

Young activists, remember: S/he who was born privileged, does not feel the chains. (Albino Gomez)

 

  1. Given that HR are one way to challenge the negative impact of neoliberal economic policies on claim holders (Paul Hunt), it is fair to ask: Have criminal and civil justice too often become a grand and biased spectacle requiring change? I would contend that it is the judges who day-in-day-out apply unfair laws who are to be denounced; the accused, often claim holders, do deserve being given the benefit of the doubt.**** (P. Coelho)

****: Some call this ‘the futile madness of some laws’. The judiciary also often transgresses the law in judgments in which connections, influence and means triumph over claim holders’ lack of all of these. If these things continue to happen, HR are condemned with very limited right of appeal. For claim holders, justice becomes a tangle of clauses, jurisprudence and contradictory texts. (P. Coelho) (I heard somebody mention the following paradox: When God sent his Son to save the world, what happened? He fell into the hands of the very justice He had allowed to take hold).

 

International human rights law is to be understood as an instrument designed to maintain and promote the ideals and values of a true democratic society

 

  1. Built on a bedrock of HR principles, international human rights law is essentially concerned with validating the entitlements of individuals and calling on states to heed their correlative obligations. In other words, the main, but not only, focus of international HR law is intra-state; it is for the benefit of persons within the state’s jurisdiction. Our young activists are thus to relentlessly continue reminding states they have to submit themselves to a legal order within which they, for the common good, have to assume various obligations, not in relation to other states, but towards all individuals within their jurisdiction. (Paul Hunt)

 

  1. Two corollaries flow from this:

 

  • Subsidiarity applied to HR means ‘not governing anything at a higher level than need be’. If we think in terms of subsidiarity, we have to ask ourselves which problems are primarily global –then HR clearly jump to the foreground. But local HR actions are as important (although they may not always seem self-evident). Something for the youth to keep in mind thus is the fact that too much subsidiarity can lead to more influence of local powerful interests opposed to HR. [For claim holders, this calls to mind the old adage “Fool me once, shame on you; fool me twice, shame on me”] Ergo, think, strategize and act globally and think, strategize and act locally. Both.
  • Human rights standards offer a powerful, universal and comprehensive normative framework in which to ground claims importantly for tax justice. The duty to devote the ‘maximum available resources’ to economic, social and cultural rights (a HR standard) gives legal force to demands for effective and way more equitable taxation systems that better contribute to the realization of HR for all. Framing taxes as a HR issue takes it beyond the elite-technocratic sphere and into the arena of legitimate public scrutiny, active demands and debate. (CESR)

 

Claudio Schuftan, Ho Chi Minh City

schuftan@gmail.com

 

All 400+ Readers are available in http://www.claudioschuftan.com

 

Postscript/Marginalia

– I want to have faith and I have it. The best news that we can expect about the major world’s crises is that we have already achieved the ‘critical level’ of a mass consciousness of big chunks of humanity, i.e., the proportion of human beings whose respect for the whole is sufficiently big, and coalescing, so as to bring about a massive awakening of consciousness of the people, as we are, more and more, seeing these days. (Lola Hofman) [This awakening has now to lead to a mass mobilization demanding the needed changes –with HR at the very center].

– Fraternity –as in the French Revolution– is merely an individual human idea, solidarity –(as in HR)– is a universal idea. (Victor Hugo)

– The simple replacement of the word ‘stakeholders’ by ‘peoples’ (or claim holders/duty bearers) provides us with the correct hint of the sort of conceptual-HR-widening that is dear to us. Claim holders/duty bearers is original and sanctioned UN language. Stakeholders is originally business language, i.e., to have or to hold a stake in something is the same as having an interest or holding shares! (Alison Katz)

 

WE ARE NOT MAKING THIS UP: THE VAST MAJORITY OF STATES HAVE ALREADY OBLIGATED THEMSELVES TO RESPECT, PROTECT AND FULFILL ALL HUMAN RIGHTS. (ESCR-Net)

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Human Right: Food for an endangered thought

 

Human Rights Reader 411

 

The human rights framework, a major instrument for accountability, is under attack

 

  1. The UN is explicitly an intergovernmental body; if UN member states do not like human rights (HR) and accountability, then the UN does not either.*

*: It is no coincidence that the Human Rights Council (HRC) receives only 3% of the UN’s budget, less than the UN library. Moreover, within the HRC powerful members like the US, Europe and Commonwealth countries consider only political rights, not economic, social and cultural rights.

 

  1. Furthermore, regrettably, a move towards voluntary guidelines is underway throughout the UN. These lead to there being practically no HR influence in the SDGs which, if one really looks dispassionately, talk of ‘following-up’ rather than monitoring for accountability.** (Hilal Elver)

**: Accountability is to be thought-of in terms of answerability, but also of enforceability through mechanisms of redress and sanctions. The process of participation-in-accountability we often find is said to be open, but then participation is set up in a highly technocratic way so that the space for true contestation by claim holders is, in reality, reduced. (Peter Newall)

  1. Given both the above, General Comments of the United Nations’ Human Rights Treaty Bodies have attempted to add flesh to the bare bones of HR treaty provisions.*** (Paul Hunt) A ‘beginning has thus been made’ to provide treaty provisions with detailed normative and operational content. (Hurrington and Stuttaford) But beware, trade-offs and deeply contextualized political realities necessarily enter the equation in this. (Alicia Yamin)

***: Using General Comments in their assessments of Periodic Country Reviews, specialized UN HR Committees produce ‘Concluding Observations’ that are not binding, therefore making it tough to demand accountability (not to mention the fact that many States are overdue in reporting, including some States that have never reported).

 

The UN Special Rapporteur on Poverty proposes a framework for ensuring that economic, social and cultural rights are recognized and implemented

 

The framework he proposes is centered around securing Recognition, Institutionalization and Accountability (RIA). (Philip Alston)

 

  1. The Special Rapporteur makes the point of the importance of treating economic, social and cultural rights (ESCR) straightforward as HR, rather than as ‘desirable goals’, ‘development challenges’ or ‘social justice’ concerns. He strongly justifies this since, ESCR specifically:
  • focus our attention on the rights of individuals;
  • directpolicymakers to the internationally agreed HR standards, jurisprudence and accountability principles;
  • introducethe needed element of immediacy;
  • recognizeand insist on dignity and meaningful participation of all individuals and;
  • are intentionally empowering.

 

  1. He goes on to state that consequences of neglecting ESCR include:
  • the undermining of indivisibility;
  • the fracturing of the hard-fought ideological and political compromise reflected in the Universal Declaration of HR;
  • diminishing the prospects for eliminating extreme poverty and extreme inequality;
  • producing conditions conducive to violent extremism; and
  • eroding the legitimacy and credibility of the HR enterprise, particularly in the eyes of the billions of people whose fundamental needs continue to be of only minor relevance to the core HR agenda’. (P. Alston)

 

 

Is the idea of accountability in danger of being coopted, instrumentalized and emptied of political meaning?

 

  1. Evidence exists that it is. Accountability has become a part of the comfortable discourse of ‘good governance’. One finds talk about accountability everywhere in multistakeholder processes, but with no reference to grassroots democracy. Responsibility for the enforcement of accountability has been shifted onto the shoulders of public interest civil society and social movements acting as watchdogs –however, without providing them with adequate resources and political space and clout. [The essential starting point is indeed to ensure that those rendered poor are made visible and, by one means or another, attain a space to speak and to have influence. (Paul Hunt)] The challenge thus is: Should this watchdog function be forcefully reclaimed?****

****: Social movements are indeed where change has to begin, because they affect the narrative directly and they are directly affected by the dysfunctionalities and injustices of the current system. Some feel this question is related to the need to actually resist a ‘broader’ program that replaces struggling-for-rights-and-empowerment with vaguer struggles based on ‘dignity’. In this context, the idea of accountability can and should be re-politicized by asking on all occasions ‘accountability by whom, for whom, for what purpose’? So, how is this to be done? Start with the claim holders. Find ways to support their struggles against dispossession and oppression and ways to defend the solutions they are coming up with. Social participation and control, especially by those who are living the problem, is the basis of accountability. (ESCR-Net)

 

We thus need a program and a way of organizing ourselves around the needed structural changes

 

  1. La Via Campesina programs for land reform and for taking agriculture out of the free-trade context, seems to me to be really an excellent case study to look at and eventually to follow. The point the HR movement has to learn from them is that we have to better organize, to make our movements stronger and to learn to act together to demand accountability. I very much hope we will go that route. As is true for us in the HR movement, La Via Campesina is a movement that is aligned and networked, aiming at creating a post-capitalist world. But it would be an illusion, I think, to believe that our HR movement has gone far enough to be reaching the edge of ‘post-capitalism’ –much less doing so under the constraints of the still current capitalist domination. La Via Campesina is all about the creation of a new transformed productive system that works for farmers and consumers without extractive intermediaries –very much a HR objective. They, as we HR activists, are not about capitalist accommodation. (Francine Mestrum)

 

Claudio Schuftan, Ho Chi Minh City

schuftan@gmail.com

 

All 400+ Readers are now available in my website http://www.claudioschuftan.com

 

Postscript/Marginalia

– Should somebody who is not fully versed on social and economic issues voice an opinion about HR? For a number of reasons, I think that the answer is yes. We should not assume that experts are the only ones that have the rights to express themselves on issues that affect how society is organized. (Albert Einstein)

– I do come to the conclusion though that some people are so wedded to certain unrealistic ideas of human justice and rights that they cannot make concessions to necessities of any kind. They say: “This self-styled-equal-rights-based-democracy has aims and objectives that are simply not mine”. (These people, you actually do not want to do violence to –you just feel like smearing their faces…). (Philip Roth) This de-facto marginalization from HR we see is evident also in these people’s general assumption that economic, social and cultural rights are synonymous with development and poverty alleviation and need no special, separate addressing. Yet, as we by now well know, this is not necessarily the case: development initiatives can be non-rights promoting or protecting. (Philip Alston)

– When these same people’s beliefs are challenged, most hold onto them as though these are a life-vest on a sinking ship. The problem is that oftentimes their beliefs are the sinking ship. No one can decide what is right for you but you. What they ought to be going for is questioning some of the deep assumptions about their beliefs and ideology (and about HR…). They need to develop the ability to see that ‘other side’. And those few occasions when it does appear more likely and more valid, hop-on over. The fact that you are asking some guy or gal on the internet (or looking for it in a book or something) is itself part of the problem –you are looking to know what others think before acting. Lesson: Your ability to succeed and learn over the long-term is directly proportional to your ability to change what you believe in response to your ignorance and mistakes. (Mark Manson)

– One of the problems clearly is that many self-proclaimed development experts/advocates do not work with a rigorous enough perspective that searches for clarity and shared meanings, but instead start from a strong belief in the correctness of their views. They firmly believe they have the alternative for the future and once you start questioning these beliefs, they retract as if their personal integrity were threatened. Hence, what I very often feel to be a fear to even start a meaningful debate. (F. Mestrum)

 




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