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Human rights: food for a socially determined thought


Human Rights Reader 424


[Adapted from Anchoring Universal Health Coverage in the RTH: What difference would it make? Policy Brief, WHO, 2015, G. Ooms and R. Hammond Editors].




The human right to health is indispensable for the exercise of other human rights.


  1. The link between an individuals’ state of health and his/her access to health care services is clear. It needs no saying that the most vulnerable people have the greatest needs, but have extremely limited, or even practically non-existent, access to health care services and yet health is an inalienable human right (HR)*.

*: The right to health (RTH) is enshrined in the Universal Declaration of Human Rights of 1948 (Art. 25) and in the International Covenant on Economic, Social and Cultural Rights of 1966.


  1. For WHO, the RTH is to enshrine both freedoms and rights: the right to control one’s own health and one’s own body (for example sexual and reproductive rights); the right to physical integrity (for example the right not to be subject to torture and not to be subject to any medical experimentation without consent) and the right to access a health protection system which guarantees equal possibilities to all to enjoy the best possible state of health.


So what does the human right to health actually mean?


  1. In the year 2000, the UN Committee on Economic, Social and Cultural Rights adopted its General Comment 14 on the right to the highest attainable standards of health. It states that:
  • A health system must function properly: Accordingly, the key to health is a functional/ing health care system, one that is available, accessible and acceptable to all without any form of discrimination and is of high quality. Let us see what this entails:
    • Available means that the facilities, goods, public health programs and health care services are functional and in sufficient supply.
    • Accessible means that the facilities, goods and health care services are accessible to all without any form of discrimination. Accessibility includes four interdependent dimensions: non-discrimination, physical accessibility, economic accessibility (being sufficiently affordable) and free access to information.
    • Acceptable means that all facilities, goods and services in the domain of health care must respect medical and commensurate ethics from a cultural point of view. In other words, they are to respect the culture of communities, individuals and minorities and be receptive to the specific requirements linked to sex and to the different stages of life. They must further be designed to respect confidentiality and to objectively/measurably improve people’s state of health.
    • Quality means that, as well as having to be acceptable from a cultural point of view, installations, medicines, goods and services in the domain of health care must also be scientifically and medically appropriate and of a high quality.
  • But acting on the other determinants of health is as indispensible, i.e.,

the RTH extends beyond the health care system. It covers an array of factors that help individuals to live a healthy life and improve the way in which the same is promoted. The Committee on Economic, Social and Cultural Rights refers to this using the term ‘underlying determinants of health. These comprise: a) drinking water; b) adequate living conditions; c) nutritiously safe food; d) appropriate housing conditions; e) a healthy environmental and healthy working conditions; f) health education and information; g) information relating to sexual and reproductive health; and, last but not least, h) gender equality.


  1. Now, as the deeply ethical and political principles of the Alma Ata Declaration were disregarded and sidestepped for decades, the international community is adding the latest attempt to bring health to all in the seemingly catch-all and ill-defined initiative of Universal Health Coverage.     But is this a step in the direction of the RTH? Let us see:


Any claim to Universal Health Coverage that does not serve the purpose of the human right to health is simply not truly universal (!)


  1. Efforts towards achieving universal health coverage (UHC) do engage in some, but not necessarily all of the efforts required from governments for the realization of the right to health (RTH). The RTH covers more than the right to health care. At present, much debate surrounding UHC remains focused on health care services.


UHC leaves too much leeway for the inclusion of private-for-profit providers and does not sufficiently emphasize the responsibility of governments


  1. As enshrined in the International Covenant of Economic, Social and Cultural Rights (ICESR), the RTH makes no mention of the role of private providers in realizing this or any other rights. The state is the primary duty bearer. If the state relies on private providers, it must ensure these providers fulfill their role on behalf of the government (!).


  1. As often pointed out in these Readers, health equality is in many respects an ideational sibling of the RTH. Equality is the principle of being fair to all persons. The RTH is somewhat better defined than health equality though.


  1. The RTH perspective insists on no discrimination and adds that non-discrimination is not optional, but a matter of legal obligation. However, often-used-cost-effectiveness-criteria do push things below the limits that are acceptable from a HR perspective —particularly as regards discrimination.


  1. UHC has little to say about the principle of shared responsibility. It does not mention that foreign assistance is also a matter of legal obligation. UHC does not imply a minimum level of core contents as the RTH does. Shared (national and international) responsibility for UHC is not clearly mentioned in the norms underpinning UHC.


  1. The RTH insists that countries have to allocate maximum available resources, but, when it comes to domestic financing, UHC provides very little, if any guidance on this. If a state does not use the maximum of its available resources for the realization of the RTH, it is in violation of its obligations.


  1. It is too often taken for granted that any form of pooling financial resources for UHC contributes to the rich subsidizing the poor; it does not (!).


If UHC is not anchored in the RTH it risks not being universal (!)


  1. Like in the case of the RTH, progress towards UHC is about the journey, not the destination. UHC anchored in the RTH requires that authorities engage with those who are excluded and come up with policies that include them in deliberations about the directions the health system should take.


Note: The Policy Brief here summarized has a very good table on the ‘OPERA HR framework and methodology’: For a summary of the same, also see HR Readers 310 and 311 at www.claudioschuftan.com


Claudio Schuftan, Ho Chi Minh City




-I sincerely hope that we will all write an obituary to that type of health education which has been concerned with telling people how to act and that, instead, health education will emphasize taking due consideration of the social forces that bring them to act as they so negatively do. (posthumously by Halfdan Mahler)

-Somebody proposed to, on World Health Day each month of May, send an annual letter to both the WHO Director General and minsters of health the world over complaining about the unfulfilled promises on the RTH. …worth considering.



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Human rights: Food for a non-token thought


Human Rights Reader 423


Look at the travesty of language: ‘The excluded’ are the majority, no?; actually, the ‘included’ are the minority. [By the way: We, human rights activists, are also part of the excluded since our advice is, so far, ignored].


  1. Inviting a token ‘voice’ to speak briefly at an international conference or ministerial meeting does nothing to advance the real human right to participation and the true inclusion of community representatives. Although meaningful participation is a key principle of human rights, explicitly stated in the Right to Development (among other UN resolutions), it is the people most impacted by inequalities that are quite systematically excluded and ignored from having a say on decisions and policies that directly affect them.* The clear lack of participation ‘at the table’ of policy-makers is not only the missing element in efforts to achieve the UN’s Agenda to 2030, but it signals a failure of the UN agencies to fulfill their agreed obligations to implement a human rights-based approach. (Case Gordon)

*: Being invisible is different from groups being ignored (they are visible!) Therefore, what is needed is a change in the balance of power so the ignored become protagonists. (Walter Flores)


  1. Rightly so, some are of the interesting (and plausible) opinion that public interest civil society organizations (PICSOs) staying absent from the global governance discussions (not exactly level-playing-field dialogue venues) would speak louder than them being coopted to participate as a token in these fora. (Stefano Prato)


You know this


In most of the literature we find calls for ‘more coordinated intersectoral action’. But this means coopting different technical sectors —not considering the community as a sector!


  1. Participation processes often cut off participation following the planning phase at the point and time when implementation starts. This frustratingly limits the accountability to grassroots claim holders. Given the emphasis nowadays put on participation in the self-proclaimed ‘equality discourse’ found everywhere we read, we have to be aware of the pitfalls and potential harms of so-called participation processes that are not relevant to equality theory and practice –and not relevant to what we pursue in human rights work.


  1. For people-focused policies to address human rights (HR), they must acknowledge the fact that people’s own knowledge, practices and creativity are key driving forces for social change. Since all indications make us doubt the commitment of governments, local community involvement is a prerequisite (i.e., a people-centered and inclusive participation). (Stineke Oenema)


You may not know this


  1. The guiding principle of any successful development action is the following: The material force has to be in the masses and the moral force in their organized movement(s). (S. Rodríguez, 1840) It is only when having recognized and organized their own forces as a social force that claim holders will no longer separate their social force from their political force –and this marks the beginning of human emancipation. (adapted from Karl Marx, 1843)


  1. The above applies to true claim holder participation which entails, not only being free from coercion or manipulation, but being directly involved in decision-making before plans are made, having the technical and legal knowledge required to make decisions, and ultimately reserving the right to withhold consent.**

**: In the absence of the right to say NO, participatory methods can be empty and meaningless or, at worst, smokescreens for elite control in which elites merely provide information on decisions already made. (INESCR)


  1. We find an illustrative example of saying NO in Guatemala where groups in rural areas have decided to mind no more about the so many technical documents on participation. They have instead organized into groups of right-to-health-community-defenders that de-facto engage in reclaiming public services by deciding on issues in their health services. They collect information on all good and bad aspects of those services and open channels of engagement with duty bearers. Since they are not regularly invited, they claim their spaces of influence. They have variously engaged the National HR Commission, the judiciary, the MOH authorities. Furthermore, educators do not come to their communities from the city; the educators are local natural leaders. Activists in the capital do not go to speak with the authorities ‘on behalf of the people’; local leaders are trained to do their own demanding. The focus is on raising consciousness so as to be able to challenge politicians, for example, asking them: “Have you been in a public hospital or clinic?” These local leaders understand the local health care scene and the providers in rural areas (who, by the way, often also are victims, i.e., claim holders). (Walter Flores)


A relevant aside


  1. These days, we find a growing number of group initiatives struggling for the commons (land, water, other). These are civic movements pursuing actions that represent the de-facto growing expression of people’s resistance against the commodification of resources and the privatization of services that affect their living conditions. These initiatives are not based on the historically-more-traditional working-class-power-struggles aimed at coercing the capitalist class by calling for strikes. The demand for change they are placing as part of their civil rights goes beyond these traditional strategies of working-class movements. Movements demanding access to the commons actually channel people’s felt needs for change into pointed citizens’ actions including transnational actions. To be valid though, the commons movement must be able to create a social and political alliance with the HR movement thus increasing the potential to challenge commodification as a HR issue.


We have to make participation the central activity of the political obligation we all have (P. Dardot, C. Laval)


  1. As per the above, the challenge, therefore, is to move participation from the realm of a social movements to that of a political movement; At the core, it is a matter of mounting counter-power to power. We must thus speak of the political economy of power on which the political participation and representation of claim holders depends; their participation must thus be binding in character so that it not only allows them to be vocal, but to have the power to influence decisions.


  1. In the end, popular mobilization of claim holders will be the only means to reach our goals in the battle for the protection of human rights. (D. Cordova)


  1. The monitoring of accountability mechanisms will also have to be made eminently participatory if we want to greatly improve the credibility, ownership and effectiveness of the HR movement. Why? Because this monitoring accountability makes processes more responsive to people’s needs and thus facilitates the potential for real transformation.


Claudio Schuftan, Ho Chi Minh City




Caveat: Have you noticed? Holding back from providing your own answer when you ask a focus group a question is ‘more difficult than trying to suppress an oncoming sneeze’. (Jerry and Monique Sternin)



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Human rights: Food to right a distorted thought


Human Rights Reader 422

  1. Here are a bunch of questions that have for long puzzled other critics and me


  • Why is it that those who have chronicled history have not felt the chains of injustice and oppression? Is it thus made-up-dreams that fuel history’s recount? (Albino Gomez, Julio Monsalvo)
  • Are historians bound by circumstances, condemned to whatever partial, (sometimes distorted) view their sources grant them? Is it their only recourse to keep on-and-on looking hoping to get it so that the facts they gather ‘make historical sense’? So what are they actually seeing when they look? Do historians sometimes perhaps deliberately describe what never was? …or claim more than there was?*

*: Tolstoy once wrote that, in his writing, he could not be governed by historical documents, because they did not reflect the truth. (as quoted by Richard Taruskin)

  • Why have historians decided for us which forms of popular upraisings prevailed and where and which were to be chronicled into history textbooks?
  • Why does the history of power struggles and of the consequences of its exercise continue to be so often totally hidden and unexplored? (Michel Foucault)
  • Is it true that the struggle against ‘evil’ has resulted in the greatest atrocities of history? Is not the banner of ‘the good’ always used to exercise violence against the defenseless? (A. Gomez)
  • When chronicling social violence, why do historians not add chronicling violence of the state?
  • Is the history of economic development more about great men (and they are almost all men), or is it primarily about the broader processes that create widespread wellbeing and stronger, more protective human rights (HR)? (Simon Johnson)
  • Do we live under the-tyranny-of-simple/simplistic-historical-explanations? (Philip Ball)


Conventional history is in part made up of fallacies, forgetfulness and sophisms (i.e., apparently clever, but flawed arguments) (Ernesto Sabato)


  1. Here is a sampler:
  • What happens in conventional history is that it is dotted with disasters, and goes from one disaster to the next, i.e., the narrative crumbles under the weight of these endless stories of bad news for the HR victims. (Philip Roth)
  • What the science (?) of history has too often done is turning disasters into accounts of epic glories.* (Philip Roth)

*: Never forget: History is not a science, in the conventional sense, it is the art of showing a clean face and hiding a sinister ass. (Leopoldo Marechal)

  • Contemporary conventional history has lost its capacity to suggest solutions for the future.* (Marc Auge)

*:We simply have to refer to the past fairly, precisely because it is absolutely relevant for the present; the future depends on it. (A. Gomez)

  • Conventional history often dramatizes what has been called ‘somebody else’s reality’, e.g., that of the nobles of Europe. There is nothing wrong with rectifying and ‘defatalizing’ this past –if such a word exists –i.e., showing how history may have been portrayed differently about things that did happen, e.g., the harsh life of serfs in Europe, echoing their feelings voiced as what it meant to be vulnerable and abused. So, what we schoolchildren studied as ‘history’ (or harmless history) –where everything is chronicled in its own time by the winners– has been inevitably biased. (Moreover, as an aside, when you study history, you memorize dates and ‘facts’ …and then you pass the exam). (Philip Roth)
  • Standard historical accounts have privileged the role of western actors, and their perspectives on historical causalities. The reason for this state of affairs lies in a complacent approach to historical research that itself is too often focused on a celebratory or commemorative approach to the historical evolution instead of a more critical approach. (Steven Jensen)


  1. So, what it is all about is to question the many versions of ‘official (conventional) history’ that have in-visibilized the conditions of power and that have rationalized and maintained inequality, the inferiorization of whole peoples and the ingrained discrimination against them. The call is for resurrecting and re-interpreting the true historical roots especially of resistance and liberation processes leadered by social movements that never gave up building the societies they yearned-for –in short, struggling for universal justice and HR. (Jorge Osorio)


A bit of true history


  1. The first point to acknowledge is that HR came-in from the South. The year 1962 was a major turning point, because of an important redefinition of the HR project around race and religion, and the emergence of an unprecedented momentum and leadership during the decolonization period. The legal and diplomatic breakthrough was brokered by a key group of countries, namely, Jamaica, Ghana, the Philippines, Liberia, Costa Rica and Senegal. These countries pushed the HR agenda and built alliances at the United Nations for a vital period during the 1960s. They fought for and delivered a stronger HR system, including its legally binding components. Jamaica was the global leader in HR diplomacy within two years of the country’s independence in 1962. The global South’s contribution was, therefore, foundational with long-lasting legacies that are still with us today.


  1. From 1963-1968, a core group of these states initiated a diplomatic effort to develop an international HR system with mechanisms at the global, regional and national level. They believed such mechanisms were necessary if the United Nations was to function as an organization for collective security in the post-colonial world. They therefore placed issues such as fact-finding missions, national human rights commissions, treaty body monitoring and regional HR mechanisms on the UN agenda. Ghana and the Philippines led the process that laid the foundation for the treaty body system in the mid-1960s. They faced much resistance and progress was slow, but this agenda-setting would have a lasting impact.


  1. Global South actors from 1962 also redefined the international HR project around racial discrimination and religious intolerance. They challenged the major Western powers to engage more fully with the emerging international HR diplomacy. The evolution of HR was never just a Western project. It was a pluralist project emerging through a multitude of historical processes with a diverse set of actors involved. This is what conventional historians have failed to acknowledge. This is a paradox that remedy we must. (Steven Jensen)


Claudio Schuftan, Ho Chi Minh City


all 400+ Readers are available at www.claudioschuftan.com under ‘Readers’


Let’s face it, most great nations in history owed their existence to conquest. They then established themselves legally and economically as the privileged class of the conquered nations. They secured for themselves the monopoly of the ownership of the land and appointed priests from among their own. These priests then controlled education fostering the division of society into social classes making this a permanent feature and, through that, inculcating a value system through which, in a way, social behavior could be controlled. We have not really overcome the ‘predatory phase’ of human development. For too long we assumed that historians are the only ones who have the right to tell us all questions that affect and have affected the organization of society. Looking back in time, they make it seem that there were periods in which groups of individuals fully enjoyed their privileges; those times are gone forever though. Individuals are now more conscious than ever of their dependence on society. But they do not see this dependence as a positive fact, like an organic link, like a protective force, but rather as something that threatens their human rights or even their economic existence –and that needs to change. (Albert Einstein)



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Human Rights: Food for a thought from the horse’s mouth


Human Rights Reader 421


[Excerpted from F&D, the IMF quarterly publication, 53:4, December 2016 (with human rights issues added)].


Setting the stage


  1. The two decades following the Cold War were celebrated and decried as the era of globalization. Critically speaking, the long-term trend of globalization masks a frank deterioration. As opposed to poor households, high-income households have been able to save a lot but, relative to their incomes, consume too little. Economists have simply not given much attention to the income polarization this has been brewing. [Income polarization measures the move from the middle of the income distribution out into the tails. Income inequality measures how far apart incomes at those tails are, i.e., the income distribution between the low and high-income groups]. Since 1970, polarization has grown faster that inequality with alarming consequences for human rights (HR) and for the economy overall. (Ali Alichi)


  1. What the above says is that globalization has continued to enrich the few at the expense of providing a decent livelihood and a respect for the HR of the many. There is a long tale of foreign interests undermining domestic controls of the economy. It has importantly been bilateral trade instruments, treaties and free trade agreements (FTAs) promoted by the rich countries that have entrenched their dominance and have generated the uneven bargaining environment under which we live. Industrialized countries are the rule makers –poor countries are rule takers. Rich countries go for growth, but an inequality-entrenching growth, together with HR violations and poverty. Bottom line, globalization is a story of very few winners and billions of losers, a story of unequal partners, of inequality, of suppressed development, of continued exploitation and of exclusion. The rules are not working for the many; they never have. (Kumi Naidoo)


What is claimed


Point 1: Corporations are effectively using data to influence public opinion and behavior. They tell we must focus on stronger growth first. “A larger slice of the pie for everyone calls for a bigger pie”.


Point 2: For long, the deliberations and decisions of the IMF have not fully taken into account the political (and certainly not the HR) ramifications of globalization, true. But now it does see that politics and economics are a two-way street. So they now are calling into question the legitimacy of the political and economic elites the world over. (David Lipton)


Point 3: Globalization has allowed a quantum jump going from strengthening safety nets to calling for ‘trampolines’(springboards), for instance, for creating new jobs. Better international coordination against tax avoidance to prevent the bulk of globalization’s gains from accruing disproportionately to capital is called for. (Maurice Obstfeld)


Point 4: As the world economy becomes richer, it shifts from manufacturing to services –and that is good. So, globalization is purportedly changing the economy rather than stagnating it or retrogressing. That the distribution resulting from globalization has so far been inadequate is a failure of politics rather than of globalization per-se. (Sebastian Mallaby)

Point 5: There is no evidence that immigration exacerbates inequality within the bottom 90% of earners. Immigrants need help with language training and job search support; recognition of their education and work experience, all easing the way to entrepreneurship. Eventually, economic reality can overcome cultural resistance to migration.* (Florence Jaumotte)

*: Prince Parsis fleeing from Iran to India was received by the local ruler with a cup of milk full to the rim implying there is no more room. He responded by adding sugar to the cup to show how immigration can enrich local communities, dissolving into society.


What is countered (and closer to the truth)


Counterpoint 1: In many developing economies, income inequality and the violation of HR have clearly increased over the past three decades especially in Asia. Free trade affects earnings unevenly across local labor markets within a country. Lower export costs affect workers differently across provinces –the poorer provinces ones carrying the brunt. Provinces that benefit more are richer to begin with. So, as trade goes up so does regional wage inequality. International trade generates an earning wedge across regions. Poverty decreases less in rural districts disproportionately harming households rendered poor. Ultimately, households in the bottom 10th and 20th income distribution percentiles experience the largest decline in per capita consumption. Many have to find jobs in the informal sector. (Nina Pavcnic)


Counterpoint 2: Discriminated losers have been fighting globalization before it had a name; they still are. Economists thus have to pay more attention to these groups’ plight. For the losers to lose their job is something crucial to plead about. You may think they want to stack the deck in their favor, but if they do not, technology and trade under globalization will stack it against them. Nothing new here: The over-privileged generally benefit from globalization more than the under-privileged. Thus there is both a fairness case (less inequality, greater respect for HR) and a politico-economic case (fairer trade) for supporting much more the losers of free trade. (Alan Blinder)


Counterpoint 3: Globalization has actually resulted in greater income inequality, HR violations and disrupted lives. Most governments have not ensured that gains from the purported economic growth are broadly shared. Inequality has worsened most in Asia and Eastern Europe; it had declined in Brazil, but now, who knows. There has been a decline in labor union members and influence and a related rise in businesses’ willingness to shift production to low wage venues offshore. There is no guarantee the potential of globalization will be realized, absent decisive government action to support those who suffer from its negative effects. (Maurice Obstfeld)


Counterpoint 4: The right response to the inequalities brought about by globalization is taxing policies and spending policies that redistribute the overall gains to those who are hurt by an unfair economic system.


Counterpoint 5: Trade liberalization is very attractive to the kinds of people who go to Davos and talk about global affairs. The overall effect has been big gains for the third-world middle class and the global top 1%. It is surprising that he backlash against globalization has been so long in coming. Globalization may well be a finished project. (Paul Krugman)


Counterpoint 6: Trade, like technological advances can and does skew the distribution of income and often threatens HR.


Counterpoint 7: Viewing the downgrade in workers’ jobs and pay over the past 30 years as solely the result of globalization risks letting national governments off the hook. Domestic politicians have often given the impression that they are powerless. In the face of globalization trends this hardly confirms this claim. It is their policy choices that have had a huge detrimental effect on the prospects of working people’s jobs and pay. Most important for trade unions, attacks on collective bargaining rights progressively weakened one of the most important protections against inequality. Countries with a higher coverage of collective bargaining agreements enjoy lower wage inequality, including between high and low skilled workers, between women and men, and between workers on regular and temporary contracts. We must remind our respective governments that they have the power to improve working people’s lives and can enable and encourage trade unions to continue their vital work in protecting workers human rights and pay. (Frances O’Grady)


Counterpoint 8: We thus need policies that address the needs of those who lose out from technological change and globalization. Otherwise our political problems will only deepen. (David Lipton)


Claudio Schuftan, Ho Chi Minh City




It is said that Voltaire so much enjoyed annoying stupid powerful people that he kept forgetting that stupid people who had gained power were never stupid about threats to their power.



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Human rights: Food for a not-so-private-matter thought


Human Rights Reader 420


Religion and Science


  1. Insofar as religion makes claims in the area of science –which it does, because it talks about creation, about the nature of the universe and about the nature of life– to that extent, all scientists should be involved in it. (Richard Dawkins)


  1. Scientists are clear though that science is an evidence-based system and religions are primarily faith-based systems.That is the difference for them to ponder given that when a scientist finds that the evidence disproves a hypothesis, the hypothesis is rejected. Religious beliefs are not rejectable. (You do not have to have faith in science or believe-in or know-about the science of immunization for your vaccines to work –and early childhood immunizations are part of the Rights of the Child).


[Caveat: No denying, many scientists continue discussing about the lack of proof about the existence of God. But the absence of evidence is no evidence of absence. (Albino Gomez)].


Religion and human rights


  1. There are the frequent propositions that religion merits protection because it is a public good. The extreme expression of this view comes in the form of blasphemy laws, in which it is no longer individual or collective human rights that are protected by the state, but rather the religion as such.


  1. Actually, proponents of the ‘defamation of religion’ laws have, for over two decades, tried hard to impose the view in the United Nations Human Rights Commission and then Council that the defamation of religion should be condemned as a violation of the human rights of believers,* arguing that no clear line can be drawn between offending a religion and offending a person professing it. (D. Petrova)

*: Not being facetious, with so many million believers and atheists, God must be tired of being personified by religions and sects and would rather prefer that people be treated more like her, i.e., be respected and loved. (A. Gomez)


  1. Furthermore, according to the United States Declaration of Independence, its citizens’ inalienable human rights (HR) were given to them by the ‘Creator’. But, from the perspective of modern political science, this appeal to God is, of course, futile. Conversely, it is deceiving to think that simply disregarding the Almighty will be sufficient to achieve more secular humanist ideals such as HR. The truth is that we have never managed to vouch and advocate for HR in sensible and convincing modern terms.


  1. One common strategy has been to appeal to Nature rather than to God. On this view, human beings have inalienable natural rights. But in order to accept this alternative one must ascribe ‘human nature’ something it does not have so that it cannot be the source of binding, inalienable rights.


  1. Kant claimed that the rights of humanity are grounded in our capacity for rational deliberation. However, in order to uphold this position one must defend a metaphysical conception of reason, so, no good outlook there either. Actually, current political thinking prides itself for being ‘post-metaphysical’** arguing that without a theory of justice there is no theory of the state. (the above, from O. Boehm)

**: I ask: Can, under some circumstances, a metaphysical question make a come-back as an urgent political one? Religion may, after all, merely be a subject for philosophical speculation. Although this is the way many persons think, no one takes the first step to relegate religion to that realm perhaps for fear of being called irreverent. (Paulo Coelho)


[Caveat: No denying, historically, religion has both helped tame or avoid popular upraisings, but has also been an ethical motivation/motivator for important revolutionary engagements –including in the realm of HR. (Francois Houtart)].


What comes/does not come from religion?


  1. It is further argued that the state is supposed to be an instrument for defending the interests of its citizens. But is it? Does the state really defend justice or universal human rights? Do Northern governments not often ally with many despotic, HR-violating regimes? What is here evaded is the more general, but urgent question of the peoples’ actual entitlement to political claim. While it is a fact that history shows us many examples of commitments to HR (true, sometimes coming from the realm of religion), the problem is precisely that, also historically, we have not yet been able to translate these commitments to HR into political action.*** (O. Boehm) What do religions have to show in relation to this translation?

***: In the world, we do have plenty of ‘identity politics’ which is about group interests, often defined by tribal allegiances and/or religious belief, i.e., communities often organize according to ethnicity and/or faith. Depressingly, faith-coded fanaticism can still exploit widespread frustration with corrupt and dysfunctional governments. The clear-cut ideology of simplistically pitting good against bad attracts alienated, frustrated and deeply confused youth internationally (with HR falling flatly through the cracks…). (Hans Dembowski)


Is religion just a private matter?


Man has the innate and indomitable desire to judge before understanding, and in this desire is where religions have thrived. (Milan Kundera)


  1. Do we need to get involved, not just in an education about facts, but a de-education in faith –the form of belief that replaces the need for evidence with simple emotive commitment? Is our challenge to win people away from faith-based living to evidence-based living? I ask, because an open alignment with irrationality makes accepting the implausible a virtue. There are literally thousands of religious sects (44,000 Christian alone). So the odds against children choosing freely from all these to follow the same faith as their parents are pretty high. (J. Coyne)


  1. Commitment to one’s faith has nothing to do with the available evidence, but is importantly about social pressures. Science has learned through experience that assuming the existence of gods and divine intervention has been of no value in helping us truly understand the universe. Why does all this matter? Unfortunately, religions can and do have not always positive public and HR implications. Do countries need to do something about this? Take, for example: Forty eight states in the USA allow religious exemptions for vaccination, endangering the children who do not get immunized and also the community in general, for even those who are vaccinated do not always acquire full immunity. (J. Coyne)


  1. During the French Revolution, the goals of equal rights for men and women, plus the setting aside of unreasonable Church influence**** in favor of secular governance and human fraternity were some of the aspirations that mobilized the common people to rally against the old regime and to strive to build a new order.***** (Jose Luis Vivero)

****: Voltaire’s intolerance of religion was nothing like religious intolerance; it was directed at institutions –the Church– not individuals. It is thus refreshing that, at a time when many people pay great deference to faith, one can make measured criticism of religious institutions acceptable. But be reminded that this kind of open free thinking is rather rare to find in our world.

*****: Chauvinistic, HR-denying pathways by right wing parties use and have used every conceivable instrument and media in an attempt to reach out to the masses in churches, mosques, temples, pagodas and other bases for social gatherings. (S. Chachra)


Religious leaders can and do influence. So, yes, religion defines many people’s values (B. Felmberg)


  1. Very generally speaking, it seems to me that religions can (and have) typically have (had) a few functions: the control of women’s fertility* (men want to know who their children are); the protection of property/rights of ownership (though shalt not steal, etc); the promotion of commerce; wielding political power over large numbers of people; giving financial power to the leadership; mobilizing military force (rallying the troops behind a cause); fostering a sense of community, of belonging; offering a common narrative and rituals; providing relative safety among people of the same group mostly through a social behavior contract; validating a set of assumptions regarding behavior that can be used to navigate transactions with people of another group; enabling networks and intra-group trade; setting rules often enforced through fear and coercion and sometimes violence.****** (Sarah England)

******: Religions, at their best, are not about punishment. But unfortunately, when it comes to women, women’s rights and sex, they are rarely at their best.


  1. Religion is merely a matter of consensus, that is, it can make a lot of people think some thing is right (good or bad, fair or unfair) –and so, that thing becomes right. (Paulo Coelho) But when men think they only fear their God, they do not stop at anything… (Baron von Hobach)


Claudio Schuftan, Ho hi Minh City



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



– The co-existence of gods and humans was one of the most effective achievements over the ages. All it took was to trade and sell the many demi-gods in the three existing celestial markets: the market of the future that lies beyond death, the market of charity and the market of war. Many competing religions sprang up, each criticizing the faults attributed to their rivals, but still, all alike, being what they most vehemently claimed not to be: a market for emotions. Religions were markets and the markets were religions. (Boaventura de Sousa Santos)

– Religious people are sometimes further away from their fellow beings than what atheists are far from God. (A. Gomez)



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Human rights: Food for a more than convincing thought


Human Rights Reader 419

-Human rights activists cry out, not just to rescue others from their oppression, but to preserve what is left of their own dignity. (K. H.)

I do not do this to change the country. I do this so the country does not change me. (A. J. Muste)

-Although individually, none of us activists can save the world, all of us can serve the world. And together, we can have impact.’ (Commissioner Zeid, UNHCR)


Political theory is useful to change consciences –and that is what human rights activists do


To will the (political) ends is to will the means. (Emmanuel Kant) Human rights activists thus use the means in their power. They do not feel despair; they get angry. (Jan Eliasson)


  1. Solidarity is, by far, not yet the development goal most commonly pursued. The mercantilistic-logic-of-individual-accumulation actually works in the opposite direction and this forces us to act politically, particularly because the conservative ideologues desperately try to invisibilize politics. Our challenge thus is to resist so we can protect what we have already won, at the same time that we build convergences for the political struggle that we simply have to embark-on. Processes in this effort are pendular; when the pendulum swings to the right (like in this day and age), as it comes back, it never returns to the point where it started out the swing from the left. What this means to us is that some of the achievements won do stay, if nothing but in our collective memory, and this we have to take advantage-of as we struggle for more solidary human rights-abiding social structures. (Armando deNegri)


A defining property of the prevailing human rights situation anywhere is complexity


  1. Because of the sheer number of relationships and feedback loops between the human rights (HR) discourse’s many elements, these relationships cannot be reduced to simple chains of cause and effect. Those of us engaged in seeking change need to identify which elements are the most important and understand how they interact. It requires an iterative and endless testing of assumptions about right and wrong, a constant adaptation to the evolving nature of what is happening and exploring the key relationships.


  1. Human rights activists thus need to adapt their analysis and strategy according to the stage that their political surrounding most closely resembles. They have to question linear approaches to the campaigning they promote and engage-in. ‘Critical junctures’ force activists to question their long-held assumptions about what constitutes ‘sound’ policies, and make them more willing to take the risks associated with innovation, as past tactics suddenly appear less worth defending.*

*: Would you agree? The danger of taking a risk is worth a thousand days of ease and comfort. (Paulo Coelho)


Because of the complexities involved, the best activists are the most insatiable learners


– As an old English poet wrote: Be like the fountain that overflows, not like the cistern that merely contains. (P. Coelho)

– You cannot defend what you do not believe-in and you cannot love what you do not know. (adapted from Erich Fromm)


  1. This is wrong:** Some among us live like fish in an aquarium, contented because whenever they choose-to they can see the world outside through the glass. The same glass allows nothing strange to trouble their ordinary existence; they do things because they are used to do them. They watch the news on TV, as we all do, as a confirmation of their happiness in a world full of problems and injustices, carefully avoiding all knowledge of what lies beyond the glass walls of the aquarium. (P. Coelho)

**: This is also wrong: In the struggle for HR, it often feels that much of our efforts are expended on responding to attacks or crises instead of actually proactively preventing the violation of HR principles and the erosion of HR standards. (Phil Lynch)


  1. Ongoing learning allows effective activists to make timely, constructive critiques and proposals and to do so based on ideas and facts that ‘touch’ and motivate claim holders. They are expected to do so with great humility, yet also very forcefully,*** because it is absolutely necessary for claim holders to make governments understand they are missing the opportunity of regaining the lost trust and support of its citizens. (Alejandro Navarro)

***: Activists cannot be shy: Those who are born as a whistle never makes it to trumpet. (Albino Gomez)


  1. From an unorthodox source comes to me something that applies precisely to the point above, namely what I call the effective activists’ credo: I am responsible for taking action, for asking questions, for getting answers, and for facilitating collective decision-making. I will not wait for someone to tell me. If I need to know, I am responsible for asking. I have no right to be offended that I did not get-this-sooner. If I am doing something others should know about, I am responsible for telling them. (Harvard Business Review)


  1. So, because an idea only comes to life when someone stays behind putting it into practice, good recommendations require the active engagement of the activist so as to lead to actions that eventually bring about the changes planned together with the claim holders. (P. Coelho)


A crisis –actual or perceived– produces real change, no matter what


  1. When such a crisis occurs, activists are to quickly develop alternatives to existing policies and are to keep these alive and available until the politically impossible becomes politically inevitable. [Note that International NGOs are not always quick enough in spotting and seizing such opportunities (if at all)].


  1. Conversely, crisis or not, robust public interest civil society organizations (PICSOs) active in the HR domain can and do fulfill eight essential functions. These include:

producing compelling moral arguments for action,****

building coalitions beyond, in our case, the HR sector,

introducing new participatory, workable policy alternatives,

enhancing the legitimacy of HR initiatives and institutions,

strengthening systems in the social services sector,

enhancing accountability systems,

mitigating the neoliberal determinants of maldevelopment, and

ensuring rights-based approaches are followed.

****: HR activists do not yet hold power, but they are here to forcefully set limits. (Ricardo Lorenzetti)


  1. Given that PICSOs’ activism has reached tremendous progress in HR work, there is a need to invest-in and support this work as a global public good to ensure that the 2030 Agenda for Sustainable Development can remotely be realized. (Adapted from Julie Smith, Kent Buse and Case Gordon)


  1. Human rights activists also need to build trust and connections between key claim holders and duty bearers who, together, are able to push through the desired changes. Everybody involved must understand and take advantage of the windows of opportunity (crisis or no crisis). These are critical junctures for HR constituencies-for-change to transform attitudes and norms, so that the impossible can suddenly come to happen.


  1. HR activists need to become better ‘reflectivists’, taking the time to understand the prevailing system (its opportunities and constraints) before and while engaging to change it. They need to better understand the stop-start rhythm of change exhibited by complex systems and adapt their efforts accordingly. They also must avoid becoming arrogant and be more willing to learn from accidents, from failures and from other people. Finally, they have to make friends with ambiguity and uncertainty, while maintaining the energy and determination so essential to changing the world. (much of the above from Duncan Green)


  1. As Groucho Marx said: Am I right or am I right?


Claudio Schuftan, Ho Chi Minh City



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



For activists to pretend to always be consequent in each and every one of their actions is a utopia; the same is true for pretending that all marriages have 100% smooth relationships. (Pablo Simonetti)

Evils once recognized are half-way on towards their remedy. (Elizabeth Gaskell)

– Q: How are you? A: Busy. How did we end up living like this? When did we forget that we are human beings, not human doings? This disease of being ‘busy’ (and let’s call it what it is, the dis-ease of being busy, when we are never at ease) is spiritually destructive to our health and wellbeing. (Kyle Westaway)

Hope is a paradox. To have hope means being permanently prepared for that that has not occurred yet. But in so doing, do not despair if that does not happen in your lifetime. (Erich Fromm)

– Confucius already knew that it is better to light a candle than to curse darkness.

– Do not ever say that your future depends on your dreams, …because they will send you to sleep. (A. Gomez)

For activists, to shake hands is supposed to be a sign of solemn agreement. To shake hands is testimony of an open, honest and frank attitude. (Franz Kafka)

– When we want to involve young people in HR activism work, we have to face the issue of power. To give young people a real say in decision-making, we older people need to hand over at least part of our power to the younger generation. (Jannemiek Evelo)

– As a put-down, PICSOs leadered by HR activists are purposely and mistakenly called ‘unorganized’ and ‘informal’ by the enemies of HR. (Vandana Shiva) So keep in mind: Activists receive affection from their friends; their actual importance though is given by their enemies. (A. Gomez)



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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



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



– 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?



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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



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



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)



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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



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