February 23rd, 2014 by Claudio Schuftan
Food for a thought in all policies
Human Rights Reader 333
Over 2.300 years ago, the Greek philosopher Aristotle said that “if we believe that men have any personal rights at all as human beings, they have an absolute right to such measure of good health as society, and society alone, is able to give them.”
1. We used to say that health is too important to leave it to the doctors. Then some said it was too important to leave it to the state. Now, we forcefully say it is so important that we must leave it to, nothing less than social movements. (A. C. Laurell) Why? Because effective action to address the social determination of health (SDH) and the concomitant health inequalities and violations of the right to health* will have to primarily come from civil society actions and pressures. Think of the history of your country…does this apply?
*: According to WHO, the right to health is not the same as the right to be healthy. A common misconception is that the State has to guarantee good health for everybody. However, good health is influenced by several factors that are outside the direct control of States –although human rights-based health legislation is indeed a priority. An individual’s right to health cannot be realized without realizing other rights, the violations of which are at the root of poverty, such as the rights to work, to food, to housing and to education, and to the principle of non-discrimination. This is very much the result of the fact that ill-health is a symptom or an outcome of much broader and deeper problems in society. Therefore, health practitioners must have some knowledge about the key human rights, in particular the economic, social and cultural rights. This is required to carry out very ambitious and indeed needed Causality, Capacity and Pattern Analyses as required when applying the human rights framework. (U. Jonsson)
Focusing on the ‘Health Have-Nots’ (A. Fazal)
2. All the time, ministries of health tell us human rights activists “we may have formal differences of opinion with you but, substantially, we all have the same objective”. Nothing could be further from the truth. We simply come from different, or even opposed, schools or frameworks of thought. Those of us who defend the right to health go well beyond technical issues in health, i.e., for us, nobody should lack access to comprehensive health care because s/he cannot pay for the services or lives in more remote places. If we would agree on this, yes, anything else is amenable to negotiation –but being very clear that no existing norms and policies can ignore that the aim is for progressively attaining equality in health. For instance, the respective ministry cannot call universal health insurance a progressive-public-policy when, in reality, it does not offer the same coverage for everybody; it cannot call comprehensive insurance what, in reality, may reimburse for health care that is not comprehensive, but is rather based on different health care packages –different for different groups, only trimmed-down-ones for the health have-nots.
3. The framework from which human rights activists come-from is based on reforming the health system based on three inseparable principles: Universality and Comprehensiveness of public health care and Solidarity (to each according to her/his needs and not her/his means). Only the application of these three principles can guarantee equality since they are the basis of all human rights (HR). Furthermore, in shaping equitable health systems, it has to be together-with-claim-holders that one decides and prioritizes the actions to be taken.** (A. Saco)
**: Unfortunately health services have often become places of deprivation, inequality and exclusion. Therefore, it is claim holders that must demand a better position to respond to the challenges this brings about. In this context, it is important to recognize that the human right to health actually means the-right-to-command-the-whole-health-planning,- implementation-and-monitoring-process, i.e., establishing a democratic management of health care. The aim must be a people-centered, sustainable development in health. Health, within the economy, must be changed from being considered an engine of growth and productivity to fostering truly active HR agents of change. (U. Jonsson)
4. The above is not, as far as I know, what ministries are talking about in their plans for health system reform. It needs emphasizing that, for the most part, States are not channeling resources to claim holders that need those resources the most thus securing and guaranteeing the fact that all human beings are assigned the same rights. The public health sector can simply not (but is) deny(ing) services to somebody, because s/he is living in poverty and/or is marginalized. We are not talking about ministries having to have social programs; we are talking about them having to have human rights-based programs. (Those who can afford it are free to pay for private services, but that does not deny their right to use the public services). You can thus see the differences are not formal only. We do not deny that there is plenty room for ministries to implement operational, organizational and administrative measures to improve services, but these are not in the direction of the human right to health, because they ignore the three principles above. They actually have, for long, been responsible of a further denial of universal health care coverage, have offered minimum basic packages for people rendered poor and have ignored any notion of solidarity. (A. Saco)
|The road to fulfill the right to health for all the health have-nots implies the setting up, the strengthening and the development of Tax-Based-Universal-Public-Health-Systems. This position contravenes the campaign currently being launched by international financial institutions, UN agencies and by neoliberal donor governments to address the under-discussion concept of Universal Health Coverage which they base on the widening of different insurance schemes, on limited basic health services packages for the people rendered poor and on the promotion of private investment in the health sector. But health cannot only be conceived as the provision of curative services. We know that health implies looking after a whole set of interdependent HR since health is, among other, ultimately determined by the de-facto access to an environment free of toxics, to healthy production models, as well as to decent housing and quality education, to clean water and sanitation, to land redistribution… Along the same lines, the recognition of the right of the people and of communities to a free and informed consultation and participation in the formulation of health policies has been a clear unfolding historic achievement.
We are keenly aware of the negative effects the extractivist model of natural resources and the predatory behavior of the agro/food/beverage industry both have on health and on the livelihood of communities –not forgetting the ecosystem. Numerous studies have rigorously demonstrated the fact that health is socially and environmentally determined. Therefore, from the social medicine point of view, it is alarming that much of the current discussions have been focused on the right to health care of a minority disregarding what literally is the HR to life of vast majorities. (We are talking about a class-based differential risk exposure to premature preventable deaths). Related to this, we consider that the debate on tax and fiscal reforms is crucial (and realistic) so as to come-up i) with redistribution of wealth policies (= disparity reduction), ii) with the universalization of HR, iii) with citizens participation and iv) with ‘healthy’ public health policies, as well as v) with seeking alternative production models that are not ecologically destructive and are equitable. (Asociacion Latinoamericana de Medicina Social, ALAMES)
A birds-eye view of the conditions necessary for health systems to be equitable and universal
The right to health is far more than the individual liberty to access health services and resources: it is a right to change ourselves by changing the health system. Moreover, it is a collective rather than an individual right since this transformation inevitably depends upon the collective exercise of power specifically acquired to reshape the processes of how health services are delivered. (H. Lefebvre)
5. Universal Health Coverage (UHC), even if considered a HR in the ongoing debates, does not per-se address the actual determinants of health outcomes (which include the usual indicators of the many deprivations of marginalized groups prominently including household poverty). Therefore, UHC must also, among other, include affordable access to medicines and an effective and performing domestic health care system.*** (M. Montes)
***: Sir Michael Marmot introduced the concept of ‘Proportionate Universalism’ in the UHC debate. By it, he meant that actions to achieve UHC must be universal, and of a scale and intensity that is proportionate to the level of disadvantages in health in different countries. ‘Benchmarking tables and figures’ have been used in this context to compare a country’s progress in health with that of its peers, called ‘comparator countries’.
6. Four key ingredients have been said by some to be necessary for the successful financing of UHC: i) removal of direct payments and other financial barriers; ii) compulsory pre-payment; iii) large risk pools; and iv) financing from general revenues to cover the uncovered. But conventional insurance schemes –whether private, community-based or European-style social health insurance– come up short when measured against these criteria. Since UHC is about access to quality care for everyone regardless of ability to pay, governments must move away from relying on employment-based and contributory insurance models. Instead, health care must become a right of citizenship (or actually of residency so as to include migrants), financed in large part through general government revenues. Equality must be built into the system from the beginning, rather than starting with those easiest to reach in the formal sector. (Oxfam)
A quick peek into the non-communicable diseases debate
7. The case of non-communicable diseases (NCDs) is an example of how profitable solutions are applied to potentially profitable problems. In this regard, it is striking that problems that should be addressed through binding legislation are being timidly addressed as requiring industry ‘cooperation’ or ‘voluntary’ codes of conduct. (A. Katz)
8. The 1993 WHO World Health Report (the ‘Sachs Report’) made health-as-an-input-to-increased-productivity a respectable concept. Since then, a myriad of documents promoting action on NCDs have gone and go even further: they alert the private sector to see health as a market opportunity. The ‘hard sell’ of actions to tackle NCDs overwhelmingly removes their social and economic determinants from the debate and focuses instead almost exclusively on risk factors relating to individual behavior, e.g.: “If you smoke you do so at your own risk” or “It is you who are responsible for your excess overweight”.**** This is the typical victim-blaming-approach of the neoliberal era taken to the extreme! (A. Katz)
****: Keep in mind: i) obesity is a normal response to an abnormal environment; and ii) tobacco, alcohol, sugar/transfats & fast-food big transnational corporations are to be seen as ‘vectors of disease’ that need national monitoring in the same way as other vectors. (R. Moodie)
9. The structural root causes of disease and of poverty are of no interest to the rich and powerful. On the contrary, the highlighting of these causes represents a threat to the status-quo as they address extreme and growing inequalities which bring this privileged group so many rewards both in geopolitical and economic terms. It is time to question the use of the term ‘risk factors’ and indeed the whole concept of risk. The term tends to imply individual agency and responsibility, i.e., as if people had the ability to fully control their lives and their environment. It ignores the critical distinction between risks taken and the risks imposed by the different manipulations of the market place that result in the skewed corporate power relationships we all know about.***** The terms ‘contributing factors’ or ‘determinants’ are more neutral than ‘risk factors’ and allow the real causes to be identified and analyzed without prior assumptions (or subtle suggestions) about the individual or structural origin of the causes. (A. Katz)
*****: Risks taken align four or more individual risk factors (especially for NCDs), but do so aligning them like in a Swiss cheese so that remedial arrows cannot really pass.
Claudio Schuftan, Ho Chi Minh City
February 8th, 2014 by Claudio Schuftan
Food for a fetishized thought
Human Rights Reader 332
George Bernard Shaw said that statistics is a science that demonstrates that if my neighbor has two cars and I have none, both of us have one.
1. In the language of statistics, uncertainty is a latent variable* (N. Bloom) …particularly when it is mainly statistics that lead to policy-induced uncertainty. In policy making, it too often boils down to ‘2b or not 2b’.** (M. McGrath) One can ask: Where then are human rights (HR) policy considerations relegated-to?
*: We walk many roads, all paved with uncertainty; so, choose: But do so wisely as you walk (J. Koenig) and be aware that the omnipresent ‘omitted variable bias’ is at the very center of much empirical social sciences research. The fact is that nothing plus nothing does not give nothing, but sometimes gives a little something. (Julio Cortazar)
**: Many researchers who have been prominent in identifying a certain problem say that getting involved in the solution of the same is none of their business. Deplorable. (F. Monckeberg)
2. You have to agree with me that the ‘p values’ of biostatistics are no substitute for human values, especially HR values. (Jonathan Mann) Why?, because wisdom is being reduced to knowledge which in turn has become to mean reducing knowledge to information*** –or, as we are now supposed to say, data. I posit that statistics are deliberately positioned as objective by the forces of status-quo, i.e., in the sense that statistics are ‘free from context’. But such a position is utterly reductionist and even naive. (G. Cannon)
***: Where is the word we lost in words and where is the knowledge we lost in information. (T. S. Elliot)
3. On their own, statistical indicators are inconclusive. They say nothing without clear reference points against which to judge performance and to assess the adequacy of achievements or progress over time …and the reference point, in our case, I dare say never is human rights.
4. Together with others, I am especially weary of the prevailing tendency to ‘fetishize’ particular techniques, especially the quantitative techniques that are so tempting to many. I see in them a number of unintended risks and consequences. There is, for instance, a risk that ‘perfecting’ the particular tool or technique becomes an end unto itself –the danger being that the tool becomes overly complicated and inaccessible to the intended user. Another risk of fetishizing quantitative tools and techniques is that these tools can and do narrow the lens of analysis, reducing a complex reality to simple, verifiable numbers, and thereby making invisible otherwise relevant factors. As a result, ‘the multi-dimensional can be easily confused with the two-dimensional’. So, beware of the risks of reducing assessments to a technocratic exercise that analyzes the trees while missing the forest –and masks the value judgments that are inherent to choosing particular indicators and collecting specific data –HR always being the looser here. (CESR’s OPERA approach)
5. But it does get worse: Observations derived from correlating statistical data are all too often mistaken for causal relationships. The effects of single factors are easier to pinpoint and trace than the interaction of several factors, yet these interactions are often the key that unlocks outcomes. Selecting manageable indicators to capture concepts such as empowerment, HR violations or greater democratic engagement is a struggle that HR workers often lose (the preparation of the post-2015 development agenda being only one current example). **** One key factor here is the capability of citizens and their organizations to influence the information to be gathered and making it available in a transparent manner. The latter requires the mobilization of rather vast masses of citizens who must become involved in some type of HR learning.
****: In the context of HR, we should keep in mind three types of indicators: (i) structural indicators that capture the acceptance, intent and commitment of states to undertake measures in keeping with their HR obligations; (ii) process indicators that assess states’ efforts, through its implementation of policy measures and programs of action, to transform its HR commitments into desired results and (iii) outcome indicators that assess the result of states efforts in furthering the fulfillment of HR. (email@example.com ; http://www2.ohchr.org/english/issues/indicators/index.html)
6. The rather mechanical correlation of data –and the use of many other old and new statistical techniques– fits the current obsession with counting. Numbers may be fine as far as they go, but they can neither explain our behavior nor how we experience the motivating power in our search for HR and dignity for all. In the words of the note that Albert Einstein kept on his wall: “Not everything that counts can be measured, not everything that can be measured counts”. (The Broker, Issue 25, June 2011)
7. In general, development practitioners, as it is now conventionally posited, seem to assume that the inductive method, which is to say the accumulation and ordering of facts, i.e., data, into evidence, using increasingly sophisticated statistical techniques, will of itself generate objective findings. This is just plain wrong. For a start, the very ordering of facts, the equivalent of brick-laying, implies a plan, an idea. But in any case, the purpose of evidence is to support or refute a theory. The theory comes first. This is the deductive method. True, the theory may emerge or be refined in the course of the organization of facts, just as a master mason may change the architect’s mind. Induction is comfortable. It implies that information will generate objective measured quantified conclusions: Job done! These days the inductive method is mostly worked out by computers and is becoming increasingly detached from thought. By contrast, deductive processes require constant thought. By their conformist, middle-of-the-road nature, old theories and indeed stale ideologies and systems of ideas can be and indeed should be challenged, as needs arise and, in our case, HR circumstances require. This may feel dangerous to some ‘with an axe to grind’. Indeed, but this is the way of the real world and we see no more room for HR ideas to be resisted. (G. Cannon)
8. Bottom line: We should be careful to avoid interpreting the idea of a ‘data revolution’ too narrowly, i.e., as only being about statistics. Data, as defined by the Oxford Dictionary, is “facts and statistics collected together for reference or analysis.” But facts, especially HR facts, can also come from testimonials, videos, story-telling and other participatory research approaches. Furthermore, these methods can give an important and often critical context to an issue far beyond what the numbers alone may or may not reveal. Numbers are useful, but only as long as they do not master us.
9. If we are truly serious about effective means of monitoring progress on the next set of post 2015 development goals, these approaches must be part of the ‘revolution’.
10. Keep in mind that, in an effort to bridge the digital divide between the knows and the know-nots (A. Fazal), innovations in technology can assist greatly (e.g., SMS-based polling, low cost video capturing) alongside more traditional, ‘low tech’ solutions (e.g., particularly open town hall meetings). (S. O’Shea) The ultimate effort I guess I am actually calling for is for us to increasingly step out of the exclusive ordinary range of statistics (S. Spender) and complement the use of data with the use of testimonies. [Am I talking of statistimonies or testictics?].
Claudio Schuftan, Ho Chi Minh City
-Every newspaper should be carrying HR complaints. But this carries its risks. The powers-that-be may start attacking the journalists posting such complaints and then end up closing newspapers… (Albino Gomez)
-Julian Assange has gone on record saying that justice, if it really deserves that name, must put brakes on power. If a government purports to defend its people, it must guarantee that politicians never have full control over information.
-I always say that certain forms of simplification may denote a lack of sophistication. (A. Gomez) As a matter of fact, it is easier for all of us to build a microscope than to build a macroscope. (Ch. F. Hebbel)
January 25th, 2014 by Claudio Schuftan
Food for a feminine thought
Human Rights Reader 331
-In our land of Oz, hypocrisy is without shame. Patriarchy rules. (J. Koenig)
-Women are not ‘men of the feminine sex’. (J. F. Sarmiento)
-Gender relations are a form of organizing society …as is income.
1. While sex refers to biological differences between men and women, gender refers to the roles and responsibilities that society constructs, assigns and expects of women and of men on the basis of their biological and physical characteristics. The bad thing about this is that these expectations create stereotypes.
2. Gender thus refers to the attributes and opportunities associated with being male or female and to the relationships between males and females which, in-last-instance, are socially constructed and learned through socialization processes. Therefore, gender roles change over time. Ergo: society can change the gender roles!
3. As regards gender equality, this does not mean that women and men should become the same, but rather that women and men should have equal access to opportunities and to achieve equal results. Furthermore, gender equality is not a woman’s issue, but must concern and engage men as well as women.
4. Women have traditionally been relegated to the household sphere and to a subordinate status in society –on top of being generally excluded from recognized interpretations of human rights (HR). It is the UN’s Convention on the Elimination of all Forms of Discrimination against Women (CEDAW)* that sets out the measures for the achievement of equality between men and women –regardless of their marital status, in all aspects of political, economic, social and cultural life. It is thus no longer about just achieving equality and about eradicating gender discrimination, but rather about empowering women so they can become full and equal partners in all policies and decision-making processes in their communities.
*: Surprisingly, CEDAW did not include anything about violence against women. It was only fourteen years later, in 1993, that the Declaration on the Elimination of Violence Against Women (DEVAW) proposed ways in which governments should act to prevent such violence, and to protect and defend women’s rights.
5. An important ad-hoc note here: It is said that not all inequalities are inequitable and not all equalities equitable: Indeed a very important and correct (although not that easy to understand) statement. We can use an Outcome/Process example relevant to women to put things in perspective and to explain this: Take the use of Affirmative Action in ensuring gender-equal outcomes in employment. The same can be defined as: The use of a morally defendable unequal (i.e., equitable) process in order to achieve a morally desirable gender equality. (U. Jonsson)
6. We have to be aware of three additional things. Gender discrimination:
(i) is an issue that affects the realization of several HR; (ii) is an issue that ultimately relates to women’s autonomy; and (iii) both these issues call for the de-facto empowerment of women at all levels worldwide. (UNFPA)
7. What is meant by the immediately above is that women-must-propose, society-must-respect and the-state-must-guarantee. (C. Santamaría) The role of the state in this respect is paramount; among other, it needs to create enough equally paying jobs and social services that allow men and women and their families to live in security and in dignity. But this is not going to come without a struggle: in-dignation must grow from dignity being denied. Therefore, in order to eliminate the discrimination against them, women must forcefully advance the fostering of equality and of their rights.
8. In every-day terms, this means women have to fight for their right to more and better standards of living, for their sexual and reproductive rights, for their labor rights, for their right to participation and representation, as well as many other rights. What women do not want is that their achievements be measured by maternal mortality rates, by rates of violence** and of poverty only; much more is involved in their emancipation.
**: Keep in mind that there also is what is called symbolic violence against women defined as that form of violence that is perpetrated against women with their accepting it. (P. Bourdieu)
9. In last instance, using the HR framework, women seek to address the specific disadvantages and oppression that they face through discriminatory laws, policies, allocation of resources and many, many different ingrained practices of social institutions. Their empowerment entails a process of change towards them gaining greater control over their work, their mobility, their access to resources, their reproduction, their bodily integrity and their political participation.
10. The time has come to move away from the development debate focused on all encompassing growth –where marginalized groups grow invariably slower than the rich (and women amongst them slower than men!). (R.K. Murthy)
11. Let us all remember and ponder: We are born into a world of privileged and under-privileged people, of powerful and powerless people, of a patriarchal system in which injustice is justice, a world where women exchange their right to equality for mere survival. (U. Baxi)
12. Patriarchy, and many different forms of women ‘belonging’, so widespread in the East and the West, the North and the South causes mostly women (but also men), as said, to exchange their right to equality for what is mere survival. This, in an attempt to feel safe and protected in situations where, too often, injustice is the true pattern of the prevailing system of justice. (S. Koenig)
13. As a matter of fact, gender equality needs to be understood and practiced as something that increases the size of the pie. By this I mean that gender equality is not a zero sum game; the path to equality should not be one that takes from men and gives to women until the two positions are equally constrained. Gender equality is about creating conditions where both men and women have the ability to realize their full human potential and HR. Too often, men think that the gains of women come at their expense. This is simply not true and such thinking is a real barrier to genuine progress. The case for gender equality needs to be –and is– a mutually beneficial story.
14. Agreeing with the poet Jerome Koenig, I contend that governments must protect women, certainly no less than what they protect corporations. Does that not make sense to you? Is it in any way acceptable that values governing states bend to special interests and do not address social imperatives?
15. Bottom line: Women are fighting back. Yes. But what we mostly see in the battles women have slowly won is not yet peace between women and men, but only a truce. (A. Rossi)
Claudio Schuftan, Ho Chi Minh City
-I can think of a number of reasons for gender discrimination, but I cannot think of a good one. (J. Waterlow)
-A lot of powerful men still have much to learn from the dialogue of those who think differently on gender issues. (D. Panzeri)
-There is, of course, a need for an explicit focus on income inequality, however one should strongly disagree with any suggestion to subsume the current gender equality goal under a broader inequalities goal. A stand-alone goal on gender equality and women’s empowerment is indeed needed. (Gender and Development Network)
-Women who undertake ambitious enterprises ought to act as if they were already accomplished, and thus impose upon themselves a future as irrevocable as the past. (J. L. Borges) Remember: Life goes on and a lot of good and beautiful things still happen (even in women’s affairs). Never forget though that, often, the loveliest flowers grow in the dung heap. (David Werner)
-When are problems solved? Better sooner then later… While p’s are still small. (J. Koenig)
January 15th, 2014 by Matthew Anderson
In 1999 students at Albert Einstein College of Medicine created the ECHO clinic (Einstein Community Health Outreach) to provide free care in the Bronx. The clinic, run in collaboration with the Institute for Family Health is now 15 years old and there will be a celebration on Thursday, February 13th, 2014. All of the proceeds will be used to pay for referrals to specialty appointments and health screenings for our patients.
The clinic came at the beginning of a wave of free clinics created by New York City medical students and others who saw the unmet health needs of those without insurance. Sadly, the need for such clinics will continue under the Affordable Care Act which does not cover undocumented workers.
The clinic relies heavily on volunteers. Premedical students and volunteer faculty preceptors are always welcome.
Einstein is one of the only schools in the country that has its students rotate through the free clinic as part of their family medicine clerkship. This unique component of Einstein’s clinical curriculum is critical in shaping socially conscious future physicians.
To purchase a ticket or make a donation, please click here. Since the ECHO Free Clinic is a 501(c)3 non-profit organization, all donations are tax deductible.
January 12th, 2014 by Claudio Schuftan
Food for a myth-buster thought
Human Rights Reader 330
The others “R” us.
Never forget we “R” them.
Human Rights “R” ours. (J. Koenig)
Actually, there is still much to do about nailing certain old and already stale myths in the human rights domain. Among them:
1. Not even waiting for the expected post-2015-push, our challenge is to concentrate our efforts on actively tackling disparity reduction rather than concentrate our efforts on poverty alleviation alone. (The cake is only so big; we have to slice it more fairly…).
2. Targeting interventions to ‘the poor’ is nothing but depersonalizing them and throwing at them a crumb of bread to feed them today. Targeting does nothing to address the structural determinants that perpetuate poverty, generation after generation, i.e., in thirty years we may still find ourselves ‘targeting the poor’…. (Please, also mind that it is not about ‘the poor’…it is about ‘those-being-rendered-poor’ by an unfair and unjust economic system with its clearly differential enjoyment of human rights (HR) and ultimately differential exposure to premature and preventable ill-health and deaths).*
*: Furthermore, the populations we purport to be ultimately serving are not really ‘vulnerable’; they are also rendered vulnerable by the same unfair and unjust economic system. The same is true for inequality; inequality is not our problem: it is the individuals/structures and forces that perpetuate inequality that are our problem. (V. Nabarro). In other words, looking at vulnerability this way points us towards identifying and addressing/opposing those forces, individuals and institutions responsible for it.
3. In our work in HR, our challenge thus really goes beyond tackling the social determinants of, for instance, preventable ill-health and malnutrition; the challenge rather is about tackling the social determination of the grossly unfair differential enjoyment of HR. (The latter concept points us much more directly towards the structural social, economic and political determinants really at the base of HR violations as seen worldwide).
4. A lot is being said about HR-sensitive interventions. For us HR activists, this is a deliberate way to water-down the more precise language of the HR-based framework. I ask: Do we need the (softened) new term ‘HR-sensitive’?
5. Also, much is said about safety nets and targeting, i.e., zeroing-in on the most affected (at great cost) and, as said, ‘throwing them a crumb of bread’ (or ‘giving them a fish to feed themselves for a day’**) without changing the structures of the system that perpetuates their condition of ‘most affected’. Targeting is only ethically tenable if, concomitantly, we put in place drastic measures to address the structural causes of the unfair economic system.
**: Teaching them to fish to feed themselves, as is so often repeated, is not a solution either …as long as those who control the lake where to go fishing are those vested with economic interests they resist to relinquish…
6. Given the magnitude of the problems at hand, shouldn’t we then be making a difference in our daily work between what is only interesting and what is really important? That is, aren’t the trees not letting many of us see the forest? Is it enough for us to contribute to solving the myriad problems of, again in my example, ill-health and/or malnutrition by just doing what we do everyday? Or isn’t it? New commitments are needed (beyond the so often pushed multidisciplinary/multisectoral approach) to resolve said problems; we cannot disregard the political implications of what really needs to be done: political we must become if we are to avoid the doom scenario that lies before us and threatens our common future.
7. How much does each one of us have to realign her/his priorities? We always need to keep in mind that much of what we each do, day-in-day-out, may be necessary, but is it really sufficient? For instance, to solve the global problem of malnutrition, shouldn’t we be playing a more proactive vocal role in opposing commodities-futures-markets that set prices of commodities to the whims of speculators? Or, to more forcefully oppose agricultural subsidies in the rich world? Additionally, are we forceful enough to demand a switch in our emphasis from food security to food sovereignty as an emerging competing and more correct concept? Or, will we pay more attention and act on the important issue of land grabbing? We cannot fail to address these issues. Everything technical we get involved-in fades in the light of these macro constraints.
8. Be mindful that the delaying tactic that undecided or opposed decision-makers (or many of us as well) more often than not use is to call for yet another task force or committee to ‘further study’ the issue(s) at hand.
9. The era of recommendations that start with “The government should…” is finished. The pertinent questions are: What will I do? What will you do? What will we do? What will the government actually do? The era of nice documents and nice declarations without ‘teeth’ is also finished.
10. With the UN having already accepted HR as the kingpin of the post-2015 agenda, it baffles me how little we –in the development community– are collectively acting on this needed change-of-paradigm so far. I here make an impassionate call for colleagues to become more HR literate. HR learning is an imperative!…at a massive scale.
11. Furthermore, we must face it: the era of addressing Basic Human Needs has also come to an end; we live in the era of development as a human right and that forces us to focus our attention on the violation of HR the world over and on the role of empowering claim holders and duty bearers to get rid of these violations. Will the post-215 debate finally center around this accordingly? If this is to happen, we all have to play an active role in it. Period.
Some important calls
12. Because of the above, the challenge for the post-2015 agenda is not really to set yet new outcome indicators or goals to track either progress or regression. In the era of development-as-a-human-right, the much more important focus is to be on process indicators being achieved progressively and ultimately leading towards the desired HR outcomes. (This was a big shortcoming of the MDGs).
13. The implication of this is that, post-2015, all countries should be called to prepare long-term progressive realization of HR plans in all areas; plans that specify annual benchmarks that need to be achieved to be ‘on course’. The latter can/should be monitored by watchdog civil society organizations so as to keep governments on track and accountable. This is the core of the change of paradigm we need.
14. Already these days, we hear and read too much from prophets of the post-2015 development agenda that I feel are preaching nothing but a ‘politics of the extreme center’….and this is not what we need given the cumulative evidence we are exposed-to about the multiple threats to our common future.
15. Again and again we are reminded that the problems we face are complex and multidimensional; so, calls are made for what?: for further research. This is not helpful at this point as so much of the evidence is already in. These are times of action. Details can be solved on-the-go.
16. Complex or not complex, we-have-what-we-have and we are all expected to come up with solutions. I am afraid the solutions needed will have to go quite a bit beyond the politics of the extreme center. What this implies, I will leave to you to figure out. But for us, HR activists, the challenges and needed lines of action are clear. Let the time not escape, for yesterday was the time to act! (Don’t our deliberations these days give you a slight sense of deja-vu?).
17. Calls are being made to feed our planned actions into the governmental process. Fair enough. But what about making concrete suggestions on how to feed into the myriad grassroots processes the world over? It is this that will bring us back to the centrality of adopting the HR framework and will bring us back to what metrics to select –a metrics more skewed towards process and participation indicators showing us the way to the progressive realization of HR. Therein lies the needed change of paradigm.
18. Reaching a ‘common vision’, as so often is called for, is in last instance an ideological problem. We are not primarily dealing with an inter-sectoral or multidisciplinary problem; sectors called-on to collaborate that have individuals with a conservative ideology will come up with conservative technocratic solutions. Am I very wrong?
19. Therefore, in the next 12 months, we must hold honest discussions and negotiations not only on the substantial technical issues, but also on the substantial political issues of our future development agenda. Anything short of this will …I leave it up to you to complete the sentence.
20. Last but not least, we do not really need the myriad justifications given of why health, nutrition, education, water… are important, because they improve productivity or educational performance. They are all important, because they are undeniable human rights. Period. They are all more an ethical and a political imperative, not a foremost economic imperative. We need not search for more justifications and fall prey to the game of the politics of the extreme center. That is the change of paradigm we need.
Claudio Schuftan, Ho Chi Minh City
January 12th, 2014 by Matthew Anderson
Health Policy Debate
Tuesday, January 14 at the Price Center Le Frak Auditorium, Albert Einstein College of Medicine, Bronx, New York
Motion: “Single payer is the best way to achieve universal health coverage in the U.S.”
The debate will be moderated by Dr. Patricia (Tia) Powell.
Wine, cheese and heroes will be available in the Block Pavilion (right outside of LeFrak Auditorium) at 6:30pm. The debate will kick off at 7pm.
Dr. Peter Carmel MD Former AMA president;Professor in the Department of Neurological Surgery at NJ Medical School
Dr. Oliver Fein MD, Former PNHP President; Professor of Clinical Medicine and Public Health, Weill Cornell Medical College
Dr. Alieta Eck, MD Former president of Association of American Physicians and Surgeons; Co-founder, Zarephath Health Center
Dr. Mary O’ Brien, MD Faculty at Columbia College of Physicians; Surgeons and co-author of the book “10 Excellent Reasons for National Healthcare.”
January 12th, 2014 by Matthew Anderson
The Social Medicine Course at the Albert Einstein College of Medicine was founded by a group of 8 students in 1998 and is now in its 17th year. It remains entirely student-run. Course schedules going back to 2007 can be accessed at this page on the Portal. The talks run from 5:30 to 6:30PM and take place on the 5th floor Forchheimer Lecture Room. They are open to the public.
Wednesday, January 8, 2014
Dr. Robert E. Fullilove
Health and Racial Disparities in New York City
Wednesday, January 15, 2014
Dr. Sunil Kumar Aggarwa
Compassionate Care: Medical Marijuana In New York
Wednesday, January 22, 2014
Dr. Marji Gold
Reproductive Rights and Abortion Care
Wednesday, January 29, 2014
Dr. Oliver Fein
Direct Action: Lessons from the Young Lords Occupation of Lincoln Hospital
Wednesday, February 5, 2014
Mychal Johnson South Bronx Unite:
FreshDirect and its Health and Social Costs in the South Bronx
Wednesday, February 12, 2014
Wednesday, February 19, 2014
Dr. Maria Caban
Harm Reduction and Syringe-Exchange in the South Bronx
Wednesday, February 26, 2014
Wednesday, March 5, 2014
Dr. Mark Heath
Bioethics of Lethal Injection
Wednesday, March 12, 2014
Dr. Rosy Chhabra
Community Based Participatory Research
Wednesday, March 19, 2014
Dr. Danny Lugassy
Healthcare Reform in 2014: Why do we still need Single Payer?
Wednesday, March 26, 2014
Dr. Neil Calman
Segregated Health Care in the South Bronx
Wednesday, April 2, 2014
Dr Aaron Fox
Wednesday, April 9, 2014
Dr. Nancy Berlinger
Access to Healthcare for Undocumented Immigrants
Wednesday, April 30, 2014
Dr. Alan Blum
Ending The World Tobacco Pandemic
posted by Matt Anderson, MD
December 21st, 2013 by Matthew Anderson
Our colleagues at Bronx Defenders passed on a video about Alberto Willmore, one of their clients who was arrested for marijuana possession (which has been decriminalized in New York). The film documents the mulitiple consequences such an arrest can have even when an individual’s charges are dismissed.
December 17th, 2013 by Claudio Schuftan
Food for a misleading historic thought (a)
Human Rights Reader 329a
[Just recently, I finished reading an excellent historical novel by the Cuban writer Leonardo Padura (El Hombre que Amaba a los Perros/The Man who Loved Dogs) based on the murder of Trotski in Mexico. In it, Padura actually has many reflections on history. I was pleasantly surprised to read that his points of view pretty well match my devil’s advocate view of (mainstream) history. # I already quoted a couple of them earlier. I patiently gathered his reflections spread throughout the book and combined them thus here actually paraphrasing Padura].
I am afraid history has too often been widely used as a political instrument.
1. Ultimately, I see [mainstream]# historians defeated and denigrated to the condition of pariahs left with only a chronology to which to hold on to. This, despite their dream of chronicling history in a way that, at the end, would vindicate them.
Historians have too often ‘reconstructed’ society to custom fit their own (or their lackeys’) designs. Through their writing, they have used the power to play with the destinies of ordinary people.
Historians ignore the repressions and genocides, the persecutions and mass killing of innocent people, as well as the many infamous political deals, the conquering violence of new rulers, the invasions, the geographic and cultural annexations, the prostitution of ideas and ideals and the condemnation of any dissidence by megalomaniacs. In doing so, they have destroyed any notion of legality and have played on the credulity of later generations.
Such historians miss digging out the bottom of things that chronicle the obscure matters hidden down there, i.e., the millennium long dung –dung that may be old and stale, but that needs to be brought up to the surface.
In their attempt of being ‘truly historical’, they miss narrating the history of the personal tragedies of little people, rather hidden in the comings and goings of historical periods. So, what about the individuals down there? Did mainstream historians ever think about them –about them having to postpone their dreams and their lives until the historical tiredness of mainstream history is gone and their lost utopia is rewritten?
The hypocrisy of mainstream history has shown rulers can get away with murder.
-Mainstream history really becomes a big nightmare as we find it as the written account of ‘the-truth’-as-we-are-supposed-to-believe-it. (Marx dixit)
-As historians purport to present to us the history of a given period, they inform us about how the phenomena they recount came about and what the assumptions were at the time. This is a hazardous affair, for in such an undertaking, historians tacitly place some things in light, others in shade. (paraphrasing Goethe)
2. Reading mainstream history often brings out in me adverse reactions. Why? Because, to me, it is proof of how decisions that devastate lives from within can be and have been hidden for posterity.
When it comes to deplorable, unwelcome facts or issues, mainstream history does not tolerate witnesses; it actually silences bothersome witnesses.
The price mainstream history will never repay is that of the millions of lives that could have been saved, as well as the that of the human rights (HR) of further millions of people that could have been upheld.
Mainstream history makes deadly facts look more as if they were a divine punishment than the works of men inebriated with power, with a thirst for control and with the pretentiousness of achieving historical transcendence.
Having history rewritten to place it where it is convenient to the powers that be is not something Hitler or Stalin invented… This is one more reason why it is better to keep mainstream history gagged and interpreted with a grain of salt.
Life of the have-nots and history are indeed intertwined though this fact is simply too often ignored.
3. In the name of some kind of a ‘historic necessity’, millions of have-nots are and have been literally dragged into oblivion by the vicissitudes of a history that disguises the attitudes and actions of supposed benefactors.*
*: As students of history, we cannot admit that such omissions are accepted; they are omitted by historians with the pretext of such omissions being a matter of historic or political necessity.
4. After so many infamies and all types of crimes against humanity we can authoritatively speak of the victims of history (certainly true from a HR perspective) –victims whose destinies were shaped by ulterior forces that overwhelmed them till they ground them to dung.
The beneficiaries-of-history-mis-told have entered history as henchmen receiving the veneration of their victims who were often pushed to death. This is just an example of the too often total indifference by the writers of history about the fate of these victims.
5. History has taken revenge on people who have gone through all possible phases of poverty (with shattered dreams and lost hopes for any future) that history, then, has considered to be un-appealable recounts. Millions of people actually went through life without suspecting the treason they were subjected to by their fate not being recorded fairly –all committed in the name of ‘history’. To them, history has been a fraud in their millennia-old quest for equality. What could possibly save them when they have forever been condemned by a history told to fulfill the Machiavellian designs of so many different rulers since time immemorial? History has been buried by those leaders who literally became the owners of history. To call a spade a spade, mainstream history has gotten away with defeating the truth or presenting it in a distorted, manipulated way.** One has all the right to ask: Is it that contemporaries of these atrocities did nor want to know? Or for us: Is ignoring the true past complicity-in-silence? And/or: Will we have to forever carry with us the dead weight of an untold history of crimes and deceptions?
**: Historical evidence is not only partial and epically ‘favorable’ to the haves, but is not infrequently shamelessly manipulated and different from what most people have lived through.
6. At a time when a ‘great disenchantment’ with mainstream history has become entrenched, a rupture with it is needed so as to change not only the world’s political balance, but to bring up the real ultimate truths.
With hindsight, our struggle must be against history biasedly portrayed.
History can be written in a different way with less chatter about battle and victory heroes and more told about real-life-oppressed-and-deeply-depressed-people –heroes of sacrifice, the legitimate type of heroes that deserve recognition for posterity (Albino Gomez).
To ventilate the many details of a history perverted and buried, what is needed is to rewrite it to arrive at a coherent vision more real of what has been the obscure existence of the oppressed. (But, beware, history’s vengeance can be more powerful than the vengeance of the most powerful emperor that ever existed).
7. So it is: Down with mainstream history! As necessary, we have to reinterpret it. We have to cut across the veneer of the farce and touch the tragic aspects of the underlying truth. The time is now, when we witness a progressive loss of fear and the oppressed can write their own history.
#: The word ‘mainstream’ has been added.
Claudio Schuftan, Ho Chi Minh City
Postscript: [Even more recently, I came across a blog by the Argentinian Eduardo Gruner which had the same effect on me as the quotes from L. Padura. I paraphrase from his piece here].
I have to confess that the word ‘progress’ provokes in me a certain rejection. I perfectly understand that it does not mean the same coming from the left than from the right (as understood by a liberal or a conservative); but anyway, it bothers me. The concept of progress is an ideological weapon of history of the winners (for whom, of course, there was progress: the one that put them in charge) while, for the defeated, history is a nightmarish succession of regressions. Saying it more directly: uncritically accepting the idea of progress subjects us to a linear, evolutionist, colonial, Eurocentric, classist conception of history. Such a conception of history simply amounts to an arbitrary ‘periodicization’ of events. Take, for instance, globalization (with its big bosses): it intermingles historic temporality together with the logic of accumulation. Such a conception is clearly ideological as it presents as ‘natural’ the idea of Western, bourgeois history. Genocide, the gigantic colonial ethnocide and the violence and the human rights violations of globalization are ignored in the name of an alleged progress.* It is true that, at the same time, the idea of ‘social progress’ appeared implying a clever defensive attitude against the destructive effects of capitalism.
*: The history of progress has even legitimated the argument of class exploitation, of colonial domination, of slavery, of racism; it even legitimizes present day imperial aggressions justified as humanitarian actions. (In the 19th century, ‘progress’ was being brought to inferior peoples and races; equally, in the name of progress, in the 16th century, it brought them religion…). But the real history clearly shows us the unequal development these do-gooders’ interventions ended up bringing about.
We thus have to temper our temptation and non-critical enthusiasm about the (conventional) history of governments, of political parties and of political leaders that have called themselves progressive.** Also, ponder the fact that the so-called middle class has the insatiable aspiration of an ascending social mobility; therefore, for them, progress is their favorite, fitting ideology.
**: The danger is that history focuses on ‘great men’ (and women) rather than on the crucial and essential social movements that build the structures on which the greats can stand. (T. Lang)
In the last decade or so, neoliberalism has contributed to the ‘progress paradigm’ taking roots. Its proponents believe they are the true utopians; they seriously believe that through the economics of capitalism, society is racing towards a better future. In all fairness, the paradigm really means, at best, neutralization. In this context, the word progress simply makes no sense any longer. It is then necessary to question a mere-progress-in-stages unless one is willing to condescend and make pacts with transnational corporations, the local bourgeoisies, the bureaucracy and a bunch of corrupt political barons.
But beware: Repair measures that we could take-on have nothing to do with fostering a break with the deeper logic of conventional history, i.e., with a rupture with the logic of the progress paradigm that actually for centuries became a brake for struggles by the masses –which explains the long-term regression the defeated have suffered.
‘Progressive governments’ use the State as a social referee pretending to mediate conflict between social classes with different class interests. They do that to benefit from the tail wind that this can bring them to get the support of the masses –as organized and controlled by the State. Marx warned us about the limits of such class arbitration. Sooner or later, comes the hour of truth: social conflict eventually erupts and the repressive apparatus resurges. All this, while there is no battle fought between the State and the Free Market. Why?, because class logic prevails.
The problem with the progress mentality is that when crises hit, progress has nothing to offer; its proponents are helpless and in disarray. They only, once again, have nothing to offer but to tell us: “Do trust in progress… and believe us: history knows what it does since it has come as far as to today, no?”. (One might as well believe in the advantages of socialism: That would be progress, no?).
The bad news is that we have run out of time; confidence in progress, by itself, only promises more misery and HR violations. Today, more than ever, panic reigns among the dominant classes in the rich capitalist countries (but also in emerging economies like China). Unemployment, pauperization, the crumbling of what is left of the welfare state, the degradation of health and education services, as well as of the environment are in everybody’s doorsteps. And the bad news do not stop there: consider wars, terrorism and fundamentalisms of all types. The current global crises do not only have economic roots; there is a monumental political, social, cultural and moral breakdown. The villain of this story is not dying from natural death, but from its own internal rotting; the villain’s very own history is a cancer that is invading him from his very roots up. It is now not an issue of waiting that destiny takes its course –because that cancer affects us all and will end up dragging humanity to the abyss. And from there, one cannot progress. (Eduardo Grüner)
December 16th, 2013 by Matthew Anderson
PNHP’s Dr. Robert Zarr has produced an engaging 7 minute film about the reasons for a single payer (EINO Everybody In Nobody Out) health plan for the US. The film called ”CureALL” is directed by Kaylen Larson, an undergraduate student from Sioux Falls, South Dakota, who interned with him in the fall.