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Food for a borderless thought


Human Rights Reader 356

Despite the universality of human rights, many states still disregard their extra-territorial obligations and apply human rights only within their own borders.


  1. Human rights specialists have only relatively recently begun to give serious attention to the issue of extra-territorial obligations (ETOs), so the terminology relating to it has not yet sufficiently sunk-in. In the past, we have mostly referred to the external obligations of states. But the key point now is that states have responsibility for actions taken by themselves and also for actions taken by others –e.g., corporations– outside their borders, especially but not only, when they have actual or potential control over them. (G. Kent)


  1. We already know states have a broad variety of moral and international legal responsibilities. Some of them are enshrined in international human rights law and have thus become legal obligations. References to the extra-territorial or external human right obligations of states inherently emphasize the roles they have neglected pertaining certain other actors. Why? Because human rights law is state-centric, since it is only states that sign and ratify international human rights agreements. But corporations or other agencies sometimes are complicit in states’ violations of human rights (HR) meaning that, so far, such non-state actors have not been made de-facto direct abusers (violators) of HR.


  1. Over the past 20 years, the attempt to limit obligations territorially has led to gaps in HR protection that have become more severe particularly in the context of globalization. Some of these gaps are:
  • the lack of HR regulation and accountability of transnational corporations (TNCs);
  • the ineffective application of HR law to development, financial investment and trade agreements and policies;
  • the absence of HR accountability of intergovernmental organizations, e.g., the EU (and their respective member states) and the lack of implementation of governments’ duties to respect, protect and fulfill HR abroad in their international cooperation and assistance.


  1. States must thus be reminded that, without extra-territorial obligations, HR cannot assume their proper role as the legal base for regulating a globalization process that ensures the universal protection of HR. States must fully integrate these obligations into their policies and practices and ensure that they are the central terms of reference in international and global policy-making and that remedial/recourse mechanisms are put in place as needed: food for thought for the drafters of the post 2015 development agenda here.


  1. National, regional and international HR mechanisms must equally address extra-territorial obligations in their respective reporting and monitoring systems, including the call for remedial actions; they must further strengthen the application of extra-territorial obligations in jurisprudence and law. In particular, states must ensure that these mechanisms guarantee the right to an effective remedy for breaches of extra-territorial obligations.*

*: The Maastricht Principles on Extra-territorial Obligations of States, adopted in 2011 by international law experts from all regions of the world, including members of international HR treaty bodies, regional HR bodies, as well as former and current Special Rapporteurs of the United Nations Human Rights Council, reflect existing current legal standards and norms. They clarify the extra-territorial obligations of States with a particular focus on economic, social and cultural rights. The Maastricht Principles are applicable to HR in general and inform the HR obligations of intergovernmental organizations. States and HR mechanisms are called to apply the Maastricht Principles and the norms and standards on which they are based when acting unilaterally, multilaterally and through intergovernmental organizations. (M. Gibney and R. Kunnemann, Accountability for violations beyond borders, Chapter 7, pp.54-57, in Right to Food and Nutrition Watch – Claiming Human Rights: The Accountability Challenge, FIAN et al, Heidelberg, October 2011)


The common misconception that human rights are strictly territorial in their application easily leads to results that are the antithesis of human rights


It is only a simple-minded approach to jurisdiction that identifies jurisdiction with territory; this plays into the hands of those politicians and businessmen who still feel they can do abroad what they must not do at home.


  1. It is clear: Only by carrying over HR obligations from state-based treaty law to the activities of intergovernmental organizations and TNCs will open the door to accessing more effective accountability mechanisms to end HR abuses/violations attributable to these actors-made-duty-bearers and thus to potentially receive the reparations due from them.**

**: I note that accountability for breaches to extra-territorial obligations will, of course, not be higher than the existing accountability for breaches of domestic HR obligations. I also note that existing HR mechanisms of the UN are under-applied as refers to ETOs. This fact allows HR abuses and violations by foreign actors (including intergovernmental organizations) to continue even under the current HR treaty laws. [It is not that the International Covenant on Economic, Social and Cultural Rights (ICESCR) does not emphasize the duty to realize these ETOs in HR in cases of overseas development assistance (foreign aid). ICESCR always meant to overcome territorial limitations].


  1. What flows from the ETOs is that:
  • home states of TNCs will have to allow for legal remedy once companies they headquarter abuse HR abroad;
  • a state violates HR not only when it destroys, for instance, people’s access to food in a foreign country, but also when it condones others (on whom it has influence) doing so. (Take, for example, the case of land grabbing by corporations operating from outside a territory, or the example of the European Union being responsible for violating the subsistence rights of sugar farmers in poor countries);
  • the obligation of governments of the North are unfulfilled, because they do not take up their responsibility to regulate and monitor the work of their respective TNCs overseas;
  • the focus on economic, social and cultural rights abroad, now provides us with additional tools to (re)gain democratic control over policies that are violating HR.


  1. Important to keep in mind here is the fact that ETOs also vie not to interfere with states’ efforts to implement their own territorial obligations, but in fact facilitate such policies. But states also have to use their influence in international political decision-making processes they participate in.


  1. Bottom line: Being international, ETOs are not yet being global! They stand not only for morals, but are grounded in law. (R. Kuennemann)

A lot more for us to do still.


Claudio Schuftan, Ho Chi Minh City



Postscript/marginalia: International law has not plainly established the ‘legal personality’ of the entity we describe as the global-community-taken-as-a-whole


As far as I know, most ETO discussions focus on the obligations of single countries, not the global community as a whole. That limited perspective weakens the entire human rights project. (G. Kent)
There are colleagues that have introduced the term global community to highlight that there are some moral responsibilities that rest with the collectivity of all people, and at least some of them should be raised to the level of legal obligations. The codification of these obligations would be based on a broad consensus regarding a host of underlying moral responsibilities. The idea is that the global-community-taken-as-a-whole should be viewed as carrying certain obligations. The UN Charter and the Universal Declaration of Human Rights clearly acknowledge the responsibility of the global community for the realization of human rights. Under international law, the primary obligations of states are internal, but they have external obligations as well. There are thus global obligations that go beyond –collectively. There is a need for clarity though, not only about what the global community may do, but also about what it must do and to what depth, i.e., what the obligations of rich countries are and what the obligations of international agencies are collectively with regard to human rights in poor countries.* (G. Kent)

*: There have been many global plans, but they propose only to work around the edges of the many HR problems, but not to end their violation. We have had no breakthrough solutions. Moreover, it should be acknowledged that the global community also has an obligation to support the efforts of the people of those states whose governments fail them. (G. Kent)



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Food for an exhausted thought


Human Rights Reader 355


  1. An era can be said to end when its basic aspirations and illusions are exhausted. (Arthur Miller) Take neoliberalism: Disenchantment with neoliberalism as an ideal has grown to a dangerous (or hopeful?) point.*  (J.C. Juncker)

*: I read somewhere that for people these days it is easier to imagine the end of the world than the end of Capitalism. (Albino Gomez)


  1. Neoliberalism has not just been a set of bad attitudes. It has been the unrestrained exercise of corporate power with its human rights (HR) violations, taking advantage of the working class’s lethargy.**

(W. Podmore)

**: Capitalism does not only generate capital; it also creates a working class kept content with an unjust system they are made to believe to be natural. (N. Shepper)


  1. You see? In our world, transnational corporations (TNCs) have rights backed by hard laws (treaties, free trade agreements, bilateral investment treaties…)*** and strong enforcement mechanisms; they can sue states even beyond national jurisdiction. But TNCs obligations are backed only by soft laws, codes of conduct and voluntary guidelines, deprived of any enforcement mechanism; the HR situation is no exception. Above all, it is weak and poor states that suffer most from this situation. Only powerful states are able to regulate and control the activities of TNCs and hold them responsible for the damage they do and the HR violations they perpetrate; but most other states are not able to do so. (M. Khor)

***: For instance, the latest WTO Bali deal is ultimately ‘a battle between food for the poor and trade for the rich’. (R. Sengupta)


  1. So, perhaps more than rhetorically, are we rushing forward to the past, to the times of Queen Victoria, when an obscure German philosopher and economist by the name of Karl Marx was working in the British Library in London on his denunciation of exploitation, and preparing his Communist Manifesto? (R. Savio)


Neoliberalism is but a moment in the history of capitalism


  1. Neoliberalism has done away with many State functions; it has not destroyed the State, but has put it at the service of the neoliberal project, the capitalist project. Capitalism has existed and exists as an economic, political, cultural and military hegemonic power.


  1. How we relate to the essence of capitalism actually also leads to quite serious consequences for our environment. From a theoretical point of view, the reason is that the rate of reproduction of capital is very different from the rate of reproduction of nature and, as the injection of capital imposes its own rhythm, not surprisingly, it is destroying nature.****

****: Who will forgive us if we let the planet die while we just bare witness? (J. Koenig)


  1. For capitalism, nature is a source of ‘natural resources’, i.e., capitalism commoditizes the planet because, if natural resources are not dealt as commodities, they cannot contribute to making a profit and to the accumulation of capital.


  1. This fact calls for a thorough revision of the capitalist model so as to serve particularly urgent ecological and social demands. Instead, the tinkering we have seen is short term, i.e., applying social policies largely of the welfare type, such as subsidies and other. This may (have) allow(ed) poor people to escape from misery, but not become the active social subjects they need to become –perhaps, at best, just the system’s customers. (F. Houtart)


  1. In this, believing in a utopia is very necessary to aim at our human rights (HR) goal –not in the sense of an unreachable illusion, but in the sense of something that we do not have today, but that we could have tomorrow. It is thus worth fighting for this utopia, at the same time being specific and concrete.


  1. The principle is that we should leave a system that concentrates real power in a few hands –a system where it is the individual that prevails over the common good and over the rights of others. There is nothing less democratic than the monopoly capitalism that characterizes the current economy, with its domination over the political organization of nations and of international agencies.


  1. As a matter of principle, also sport, culture, religion and other areas of the human endeavor will have to introduce democratic processes in its respective structures. Developing these democratic processes everywhere is a very important immediate step (for example fostering participatory, direct democracy) and also a longer-term step (e.g., reforming the United Nations). Just be reminded that the Security Council, the World Bank and the International Monetary Fund are very undemocratic with the right to pass resolutions or to veto vested in only a handful of world powers.


As the Mayan Indians in southern Chiapas say: “Human beings are the consciousness bearers of nature”.


  1. Capitalism tends to impose a single culture, a single lingua franca, a way of consuming, of eating, of dressing …all as a function of submission to the law of value. It is all about imposing a dominant culture that has undoubtedly contributed much to mankind, but that was ultimately absorbed by the very logic of capitalism, i.e., as an instrument for its global dissemination leading to its hegemony.


  1. There already exist in the world thousands of initiatives, both advocating for the respect for nature, as well as for a social/non-individualistic and more solidary economy and for the defense of HR and of fairer democratic mechanisms. These initiatives do indeed exists, but are still very scattered. The problem is how to bring all these forces together to a joint political project aimed at arriving at a stronger correlation of forces in the struggle to transform ingrained practices and economic and political structures.


  1. From the end of the 1970s, capitalism regained momentum launching the era of neoliberalism that further imposed its values and gradually chipped away at the achievements of past social struggles thus resulting also in the weakening of social organizations (trade unions in particular).


  1. History teaches us that capitalism is fierce and vicious when it can, and ‘civilized’ when it must. The economic logic of the system requires it to adapt whenever the accumulation process is affected. This is why, in the second decade of the 2000s, global capitalism is trying to go ‘green’. Before that, ecological aspects were simply considered externalities, i.e., they did not enter in the calculations the market made. Consequently, damage to nature was not paid by capital, but by the people and nations. The same applies to the severe social damage that has been done.


  1. It is not enough to only regulate capitalism; we must impose a new paradigm of collective organization of humanity on this planet. This is neither an easy process, nor is it short term.


  1. HR ethics and politics, in the sense of being social constructs, do not fall from the sky, but must be built from the bottom. It is about establishing rules that allow the construction, production, reproduction and the improvement of life on the planet with dignity, justice and social responsibility.


  1. Introducing the ethical and political dimensions in the organization of the economy is also a requirement of the processes of change needed, starting as early as during the period of transition towards the new paradigm.


  1. Social structures do not change by themselves. It is social actors who build permanent social structures clearly influencing what existed before. It is us humans who build our societies, and this is why we speak of a ‘new wo/man’, of the need to transform human consciousness to be able to build new social relationships firmly anchored in HR.


  1. What is today called ‘the decolonization of our values’ pertains not only to our economic or political, but our mental decolonization. Capitalism has had a huge role in the colonization of our minds, influencing the type of consumption and the desire of large majorities of the population of the world to have a type of consumption as the one the United States has.


  1. Bottom line: There are no road problems to get to Rome; there is a need of a different Rome. (All the above quoting the late Andres Carrasco)


Claudio Schuftan, Ho ChiMinh City




-Capitalism is not a dirty word. It is a dirty system. (A. Katz)

-Capitalism systematically brings about violence which it then must combat through repression. Since violence is a constant feature of capitalism, the need for a police apparatus arises to control it. As a result, we end up adding State violence to social violence. (A. Badiou)


SocMed Uganda – Health Worker Campaign

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We’ve just returned to Minneapolis after an invigorating month in Gulu, Uganda together with medical and nursing students from Uganda, Rwanda, Zimbabwe, Argentina, Lebanon, and the U.S. As part of our SocMed curriculum, we shared an intensive month together studying the social determinants of health and developing strategies to constructively address these factors. It was a transformational month for all of us.

In a remarkable and hopeful demonstration of the power of a committed group of passionate individuals to effect change in the world, our students rapidly (in 7 days) developed a campaign to address the current health worker shortage in Uganda called ‘Focus 15 For Health.” They wrote an open letter to President Museveni of Uganda, which will be delivered to his office this week by our Ugandan medical students and they put together a video to accompany their letter.

They have requested that we spread the word far and wide to highlight the issues they are addressing. Please see the Facebook link https://www.facebook.com/pages/Focus15ForHealth/585394781605521 for more details (and “like” it if you feel inclined). You can also learn more by visiting: http://focus15forhealth.tumblr.com/

Many thanks,
Mike Westerhaus and Amy Finnegan
Co-Directors, SocMed


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Food for a multiply-by-dividing thought


Human Rights Reader 354


-Like slavery and apartheid, poverty is not natural. It is man-made; it can thus be overcome and eradicated by man-made actions, i.e., by a far greater resolve on the part of states.

-Poor people don’t ask for much; they don’t invade others’ spaces; but given no choices, they will. (J. Koenig)


  1. Most of the current discourse on poverty alleviation I see in development work is just a modern return to charity…  Therefore, poverty persists; its victims remain vulnerable and are endlessly trapped below ‘the line’. (J. Koenig)


  1. As I endlessly repeat, poverty reduction is unachievable without disparity reduction. This means that the structural relationships between the richer people and people living in poverty must be understood, exposed and addressed.* (U. Jonsson)

*: http://werdiscussion.worldeconomicsassociation.org/?post=incrementum-ad-absurdum-global-growth-inequality-and-poverty-eradication-in-a-carbon-constrained-world


  1. Given that the widening gap between the ‘have-lots’ and the ‘have-nots’ is one of the key factors driving poverty and deprivation around the world, it is essential that the human rights framework is adopted universally so as to actively promote the twin principles of equality and non-discrimination in practice, as well as in law. People living in poverty, i.e., those rendered poor, generally view their lack of voice and of power as probably the most stigmatizing elements of their de-privation (or privation since they never were non-poor and never had voice or power). (CESR)


  1. Poverty comes in ever new ways, now including the impoverishment of human, community and ecological values.** (A. Fazal) It therefore is the driving factors behind poverty –the factors that entrench it, bar the exits from it and drag people back down into it– that we need to tackle. The less visible driving forces include, across all societies, various forms of discrimination, unequal treatment by service providers and legal systems, social exclusion and many forms of violence and insecurity. Pro-active and sustained policy, legal and administrative measures are needed to redress this and enable the inclusion and fair treatment of marginalized groups and people. (Note: I am not talking about should or can; I am talking about must; ‘vive la difference’!)

**: Poverty also entails a lack of relationships; not only a lack of resources.


  1. We are only now beginning to look seriously beyond the aggregates and beneath the averages, to try to understand the inequalities and de-privations that large sections of many societies –including those making rapid progress overall– still face. A fair and level playing field is therefore not enough; it is only a beginning. Policies and interventions that aim to improve the lives of disadvantaged people are undermined, because they address chronic poverty as charity, not addressing its structural drivers. The poverties that these drivers address are perpetuated, and they accumulate. (R. Morgan) Our human rights (HR) work goes beyond the aggregates, below the averages.


  1. We can no longer speak of communities ‘suffering’ from extreme poverty. (It is true though that the consequences of poverty are suffered). Why? Because communities are actually rendered poor by the existing economic and political system with its widely uneven and unfair power relations. It is thus critical for us to understand how such power dynamics lead to poverty, to violence and to HR violations and what we must do to do-away with the respective imposed vulnerabilities and choose doing it together with whom.


  1. This leads me to a small set of iron laws in which I believe firmly:

(i) To bring poor people into prosperity, the wealthy will have to be moved out of their excess prosperity.
(ii) What the wealthy often receive without working comes from what another person must work for receiving a pittance.
(iii) The government must ultimately take concrete steps to redistribute to the have-nots what it, in great part, does not take from the wealthy.
(iv) You can multiply wealth by dividing it!
(v) When most of the people work hard to make a meager living, and a minority plays in the casino economy and makes way more than they need, that is the beginning of the end of any nation and of the planet.

(vi) Any policy for the poor (or pro-poor) is by definition a poor policy.**

**: There is something called the Palma Ratio. It stands for the ratio of the top 10% of population’s share of gross national income (GNI), divided by the poorest 40% of the population’s share of GNI. It provides a more policy-relevant indicator of the extent of inequality in each country and can be particularly relevant in shaping disparity reduction policies.


  1. Finally, an old sound piece of advice: Study the rich and powerful, not the poor and powerless…Let the poor study themselves. They already know what is wrong with their lives and if you truly want to help them, the best you can do is to give them a clearer idea of how their oppressors are working now
and can be expected to work in the future. (Susan George, 1974)


Claudio Schuftan, Ho ChiMinh City




-To err is human, but to blame somebody else is even more human.

-Note the common root in dignity and indignation.

-Everyday dramas of dignity: People who work in the grey market or do not work; people who live on welfare that can never hope having a job; people who survive picking on trash bins; children who must choose between studying and going out there to make a living at a very early age; those who graduate but cannot make a living; those who receive a totally insufficient pension; those who cannot buy; those who travel in overcrowded buses and trains; those who wait for months to have a needed surgical operation; small businessmen that cannot pay their taxes; small industrialists that cannot import what they need and cannot fight against transnational corporations’ penetration; battered women who remain defenseless; those who seek justice and cannot find it… (Albino Gomez)




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Food for mobilizing around a thought


Human Rights Reader 353


  1. In this Reader, let me add some key ideas about empowerment, i.e., about people gaining mastery over their lives, community members assuming greater power or expanding their existing power from within so as to forcefully demand and achieve the changes they desire.


  1. Empowerment entails enhancing the capacity and the ability of communities to identify, to mobilize-around and to address their burning problems; it aims at community members participating actively in their community life gaining leadership skills, setting up tight social networks and, as a result, amassing social and political power.


  1. We are talking here about engaging community members as equals, about developing their leadership skills, about increasing their knowledge of what empowerment strategies work and about how they actually can access the resources needed through their active involvement.


  1. To be relevant, community organizing and empowerment have to start from where the people are, with community members setting their own agenda based on their very felt needs. In such a process, as they move along, they are to achieve greater awareness and power, as well as gain control over the resources accessed.


  1. In their selection of the priority issues to address, they will first (not too ambitiously) identify the more immediate, specific and realizable targets for change that, after some small victories, will further unite them thus adding more and more community strength. All community members will be given the chance to participate in identifying issues and targets will be jointly selected as part of adopting a shared human rights-based strategy.


  1. Slowly, a shared critical consciousness will emerge, particularly an awareness of the social, political and economic forces responsible for the many accumulated social problems they face.* At this point, community members discuss what really are the root causes of their problems and plan commensurate actions to address them.

*: For example, quoting WHO: Advancing health as a human right (HR) means making people conscious of both their challenges and the concrete possibilities for change.


  1. These, then, are the guts of the process of empowerment –empowerment basically to build counter-power to face the powers that be. …And which are these?


Types of power  


Visible power: This level includes the visible and definable aspects of political power –the formal rules, structures, authorities, institutions and procedures of decision-making. (Strategies that target this level usually try to change the ‘who, how and what’ of policymaking so that the policy process is rendered more democratic and accountable so as to serve the needs and the HR of people, as well as the survival of the planet).

Hidden power: Certain powerful people and institutions maintain their influence by controlling who gets to the decision-making table and what gets on the agenda. These dynamics operate on many levels to exclude and devalue the concerns and representation of other less powerful groups. (Empowering strategies that focus on strengthening organizations and movements of those rendered poor can and do build the collective power in terms of numbers and of new leadership that will influence the way the political agenda is shaped, on top of increasing the visibility and legitimacy of their issues, their voice, their influence and their demands).

Invisible power: Probably the most insidious of the three dimensions of power, invisible power shapes the psychological and ideological boundaries of participation. Significant problems and issues are not only kept from the decision-making table, but also from the minds and consciousness of the different players involved, even those directly affected by the problem. By influencing how individuals think about their place in the world, this level of power shapes people’s beliefs and people’s sense of self and of acceptance of the status quo –even of their own sense of superiority or inferiority. Processes of socialization, culture and ideology perpetuate exclusion and inequality by defining what is normal, acceptable and safe. (Change strategies in this area must target the prevailing social and political culture or system, as well as address the individuals’ consciousness so as to transform the way people perceive themselves and those around them, and how they envisage their future possibilities and alternatives. (Veneklasen and Miller).


Empowered people need to progress from individual to collective and from local to global action. (K. Glanz)


It is power differentials between the actors in global governance that have invariably led (and lead) to the imposition of development agendas. I fear that post 2015 will be more of the same.


  1. If we want to unite a block of countries behind a global HR strategy, it is essential to mobilize social movements to build counter-power within each country first.** Therefore, consolidating a strong, independent social movement for HR must be the priority for all of us. Why? Because our objective has to firmly be to apply pressure from the base of each of these social movements. That is and will be decisive in our struggle for HR. For the time being, we cannot see any grouping of countries cohesively and collectively confronting the major HR issues of the reigning neoliberal ideology; we can only find a few countries that, mostly independently, support certain demands emanating from the HR framework. Much is to be done here still. (La Via Campesina)

**: Counter-power does not, by itself, automatically lead to the best solutions. Context and some technical knowhow do play a role. Undisputable progression towards the realization of HR is always to be the horizon to aim-for though.


  1. The accident of birth is the principal source of inequality for most people. While we celebrate equality of opportunity, we live in a society in which birth is most of the times fate. This powerful impact of birth on life chances is bad for individuals born into disadvantage. And it is bad for society. But it does not have to be this way. We cannot ignore failing social institutions that condone and take as a fait accompli poor children’s disadvantage and the violation of their HR. On these issues, outside interventions too often impose rich-country, middle-class norms. We have to denounce these. Ergo, we must empower people to be what they want to be. (J.J. Heckman)


Claudio Schuftan, Ho Chi Minh City




-When we see a giant, we have to look carefully at the position of the sun; it could well be that the giant is nothing more than the shadow of a dwarf. (Novalis)

– Slow progress is progress.


Most HR Readers can be found in www.humaninfo.org/aviva under No. 69


Slide shows on Public Health and Social Justice Website Updated for 2015

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pshj website picture

The major topical Powerpoint slide shows on the Public Health and Social Justice have all just been updated to include the most recently available research and policy information. They range in length from 50 slides to 700 slides (yes, seven hundred, for the Environmental Degradation and Social Injustice Powerpoint). All slide shows are open access, meaning that anyone can use all or part of one, with appropriate citation. See http://www.publichealthandsocialjustice.org or http://www.phsj.org .
Topic areas are listed below. Submissions are always welcome and can be sent to martindonohoe@phsj.org.

You can also order a copy of the Public Health and Social Justice Reader (2013, Jossey Bass/Wiley) through the website at http://phsj.org/public-health-and-social-justice-reader/. Click phsj book discount flyer pdf for table of contents, endorsements, and discount code to use to receive 20% off.

The website and I have no disclosures, I/it receive(s) no external funds, and I have not made any money off the book…..my goal is to just to get the word out and hopefully help motivate and train people.


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Happy New Year.

Martin Donohoe


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Food for a wrongly set up thought


Human Rights Reader 352


Health is a political challenge.


#: Adapted from the analytical section of the University of Oslo Commission on Global Governance for Health: The political origins of health inequity: prospects for change. The Lancet, Volume 383, Issue 9917, Pages 630 – 667, 15 February 2014.


It is the existing global set-up and norms that ultimately limit our range of choices and constrain our actions in health at the local level.


The present system of global governance fails to adequately protect and cater to the needs of public health the world over.


  1. Many institutions of global governance –set up in the immediate post-World War II era– have come under scrutiny as being outdated and anachronistic, having undergone almost no formal institutional reform to make them more relevant to the 21st century. As a result, rules that govern us are heavily biased in favor of the status-quo. The anachronistic structure of the international financial institutions (IFIs)*, the UN Security Council, as well as, the reluctance to open the governance of WHO to a wider range of claim holders are but three examples. Changes in the existing rules will be tough, but are a must –with those who de-facto control global governance simply having to cede power.

*: International decision-making processes often do not operate on the principle of ‘one nation state, one vote’. In the IMF and the World Bank, the wealthiest countries have far greater influence over policy making than do less wealthy countries –and in the Security Council, veto power is vested on just a couple states.


  1. Global governance processes outside the health sector are also not working and must be made to work better for health. Is this important? Indeed! It is global governance processes outside the health sector that must work more pointedly towards fairer and more just health systems that are in compliance with the fulfillment of the human right to health. For this to happen, it is primarily global health activists empowering claim holders that will have to more decisively push for the needed and unpostponable reforms.


  1. In the current set-up, the main missing factors for a fairer global health governance** are: (i) political empowerment, (ii) non-discriminatory inclusion in social and political interactions, and (iii) the conditions for legitimate claim holders to stake claims.

**: A point of clarification: Global health governance (GHG) refers to governance of the global health system –defined as “the actors and institutions with the primary purpose of health”. Global governance for health (GGH) refers to “all governance areas that can and do affect health”.


  1. The implications of applying fairer rules in global health governance can and will be controversial and unwelcome to some, simply because it requires a candid assessment and a rebalancing of power structures.


  1. Expressed as disfunctions, five systemic dysfunctions hinder the realization of a better global health governance:


  • First, democratic deficit: Participation and representation of claim holders in decision-making processes, is insufficient. (We are talking about claim holders in civil society, in social movements and in expert health bodies).
  • Second, weak accountability mechanisms: The means by which power can be constrained and made responsive to the people that it affects are weak or inexistent and are insufficiently supported by transparent governance processes.
  • Third, institutional stickiness: Norms, rules, and decision-making procedures are inflexible and difficult to reform (especially when they maintain entrenched interests); they therefore reinforce harmful health effects and inequalities.
  • Fourth, inadequate policy space across sectors: The means by which public health can be protected and promoted both nationally and globally are inadequate, meaning that in global policy-making arenas outside of the health sector (GGH), health can be and often is subordinated to other objectives, such as economic or security interests.
  • Fifth and finally, missing or only nascent and weak institutions: International institutions to protect and promote public health are either totally absent or still grossly ineffective (e.g., treaties, funds, courts, and softer forms of regulation such as norms and binding guidelines monitored by public interest civil society and human rights (HR) commissions).***

***: In apparent contradiction of this is the fact that the number of international bodies, conferences, and multilateral treaties grew from about 2900 in 1981 to 4900 in 2003. This trend has produced a system of overlapping, conflicting and nested sets of rules (sometimes called regime complexity) that blurs obligations and responsibilities and complicates accountability. (A hidden intention in this…?). [Note, however, that States can preserve their policy space for health by renegotiating, withdrawing from, or refusing to sign-up to international rules that will undermine the human right to health in their territory –but do they?].


  1. To the above five dysfunctions, we can add some more found in the overall global governance system, namely: (i) the paucity of rules and codes of conduct that go beyond the realm of voluntary guidelines that do not work; (ii) weak or inexistent mechanisms for accountability of transnational corporations particularly to the people whose lives and health are most directly affected by their actions; (iii) weak institutions for enforcing international norms, laws, and standards when they are violated by transnational corporations; and (iv) the absence of institutions to ensure that competition for foreign direct investment between states does not lead to outcomes contrary to public health interests.


  1. Bottom line here: It is the political determinants of health that basically ought to shape global health governance in order to frame the types of solutions that are proposed –solutions that more often than not currently exclude the consideration of alternative bottom-centered options. ****

****: One way to get at the political determinants is to mandate international organizations and donors to carry out health equity or right to health impact assessments –a measure that should also be included as an explicit goal in the post-2015 agenda. Why? Because inequalities in health are not, in any sense whatsoever, a ‘natural’ phenomenon, but the result of a toxic combination of poor social policies and programs, unfair economic arrangements, and bad politics all skewing the distribution of health benefits. Another way to get at them is to demand that trade and investment agreements never again be negotiated between governments behind closed doors. The same is true for the adjudication of investment disputes between states and corporations that are shrouded in secrecy, even when major questions of public interest (such as tobacco control legislation or drugs patents) are at stake.


In principle, states are political equals in the global system. In reality, power disparities remain vast.


It is the politics of it all that generates and distributes the power and resources at local, national and global levels and that ultimately shapes how people live, what they eat, and, ultimately, their health.


  1. Yes, power asymmetries and the norms and policies these bring about do limit the range of our choices and do constrain our actions in health. [But beware, this state of affairs also sometimes provides opportunities –if we succeed to mobilize the powerless to stake concrete claims against injustice]. The resulting disparities and discrimination pervade all aspects of life, e.g., relations between men and women, between old and young people, as well as relations between countries, corporations, and people’s organizations. But somehow the situation still remains hostage to the above norms and policies clearly maintained by those actors with the most power. (Do not forget that the media also exert power –only seldom though to outrage the public and to inspire political mobilization).


The power of the market consistently supersedes the power of human rights principles, including in the area of health.


The internalization stage of human rights principles and standards, including in the human right to health domain, remains weak and woefully incomplete.


  1. No single global political authority exists to hold states accountable when they violate the human right to health or fail to comply with internationally agreed-upon HR rules, principles, and standards. Nor do adequate accountability mechanisms exist for transnational corporations that move between jurisdictions with relative ease and are more powerful and better resourced than the governments that should regulate them. TNCs thus end up de-facto exerting what is an illegitimate and undemocratic influence in global and national policy processes.


  1. The problem called the ‘democratic deficit’ pertains to the lack of an equal right participate in decision-making, i.e., of fair representation with voice and influence, of transparency, and of accountability. As said, public interest civil society organizations, social movements, marginalized groups, and health experts are inadequately included in international decision-making processes. By comparison, corporations have more privileged access to national delegates to UN agencies, who can bring the TNCs’ self-interested proposals to the negotiating table. The democratic deficit thus remains a central feature of most global governance processes including health.


  1. Much of the pressures of the corporate sector pertain to them pushing for privatization and/or market access. They do so really lacking the evidence to show that the market logic improves access to health or cuts costs. The arguments the ‘privatizers’ use read like this: “Public services provide poor health care”, and “the state does not have the means to invest in public health services”. Both arguments are flawed, are relative and respond to a neoliberal ideological interpretation of what a health system ought to be.


  1. Moreover, as you may know, Intellectual Property Regimes are increasingly focused on protecting business and corporate interests and investments. (UN Committee on ESCR) These regimes have effectively demonstrated that they have the ability to block the optimal development of, and greater access to new appropriate technology solutions to essential human problems such as in primary health care, in the provision of adequate nutrition and of clean water, as well as in the attainment of higher levels of quality of health care, of drug effectiveness and safety, of chemical safety, and the achievement of climate change. (CETIM)


Private corporations have an unwarranted influential role in contemporary global and health governance.


When health is compromised by transnational corporations’ ulterior global pursuits, our response must simply be changing the inner workings of global governance.


  1. Let us not be fooled: Large TNCs wield tremendous economic power which they can and do deploy to further their interests in global governance processes and global markets. But they are not alone. Other ‘non-state actors’ such as foundations also wield substantial economic power. You know the philathrocapitalist Bill & Melinda Gates Foundation has become the most influential players in global health.


  1. In the realm of nutrition, the speculative bubble, i.e., the increased trade in futures food commodity markets has been the main underlying cause of excessive food-price volatility. TNCs, mega family owned corporations and financial speculators are increasingly expanding their influence in these global decision-making processes, with no accountability whatsoever with respect to the international laws protecting the myriad populations being rendered vulnerable. Some firms exploit cross-country differences in regulations to maximize their profits. *****

*****: With their increasing power, a few powerful corporations dominate the ultraprocessed junk food sector. This results in a globalized food market in which consumer welfare is measured by price rather than by nutritional value or health effects.


  1. Deplorably, the existing multilateral global governance structures do not allow the Special UN Rapporteurs to impose the respect of HR beyond exerting a mere normative moral force. We must call for a strengthened use of HR instruments in health policy making, such as those the UN Special Rapporteur for Health has been calling for –among other, calling for stronger sanctions against a broader range of violations by corporate actors by more proactively using the national and international judicial systems.


How far are we from an era where health will be adopted as a universal value, as a human right and as a shared social and political objective for all?


  1. Economic globalization has outpaced the political reaction to its negative effects, i.e., the development of institutions and the mobilization of forces that can more fairly govern the global market and protect societies against past market failures and those surely yet to come. Mechanisms to do exactly that remain pitifully isolated and thus weak. New and/or drastically retooled institutions and mechanisms, as well as strong regulations are needed when the operations and interests of some of the state and non-state actors seriously conflict with people’s health and wellbeing.


  1. Furthermore, the UN Human Rights Council should expand the mandates of the Special Rapporteurs to include HR audits of the decision-making processes of global governance organizations. Moreover, having the Special Rapporteur for health report directly to the World Health Assembly would help as would strengthening the mechanisms for imposing sanctions and arranging for reparations in cases of demonstrated violations of the human right to health.


  1. Getting there will require agents of change (us) and a determination for change, within social movements, inside the UN and among the political leaders of the world.


  1. The sad truth is that we still do not have adequate means to ensure the accountability of states and of the private sector for the health consequences of their actions. Only weak institutions exist in the health sector itself, as well as in other sectors to protect health as a HR –especially in the politically powerful sectors of finance, trade and security. Major hurdles remain for a fairer and better global governance of health regime. So the era we yearn-for is still in the distance. Each of us can play a role in bringing it closer.


Claudio Schuftan, Ho Chi Minh City



Support the Peoples Health Movement

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phm logo

This November the People’s Health Movement published the fourth edition of Global Health Watch which has become a recognized “Alternative Health Report.”  I am reaching out to ask your support for the important work done by the People’s Health Movement.

The People’s Health Movement (PHM) is active in about 70 countries, primarily in the global South. PHM has led the global fight for health justice since 2000 when it drafted the widely endorsed People’s Charter for Health. Its large network of activists, academics, and organizations works on every level to realize the right to health for all through advocating for global social justice and the need to address the social determinants of health.

PHM works toward our goal for a healthier world through four core programs: 

A staff of only seven highly dedicated individuals in India, Egypt and South Africa coordinate the organization, but volunteers do the bulk of PHM’s work.  Historically, PHM has been able to obtain funding from international funding agencies, but this has been particularly difficult since the global financial crisis.  

There are many ways you can support PHM

If you haven’t already, please read and sign the People’s Charter for Health

Consider making a tax-deductible donation to support the core PHM programs. Globally, the average donation to PHM is $100. But donations in any amount are gratefully accepted through the Hesperian Foundation website.
Become a member of PHM’s Global Solidarity Network. Through the Global Solidarity Network, you can support PHM with monthly or annually reoccurring donations.
You can stay informed and involved via our PHM Exchange list serve and at the PHM website.

Consider buying a copy of Global Health Watch 4 through Hesperian’s website (outside of North America purchases at Zed Books).

​If you have any questions about any of this information or about PHM global, PHM-North America or PHM-USA, don’t hesitate to contact me. And if would like to learn more about, get involved in, or connect with PHM in another way, you can send a message to this list or to me personally.

 With gratitude and continued commitment,

Leigh Haynes
PHM Global Steering Council Co-Representative
North America Region


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Food for an out of context thought


Human Rights Reader 351


In the right context, human rights are relevant to all dimensions of sustainable development. They must shape the purpose and content of all its goals, its targets and the metrics used to measure progress, as well as the way duty bearer commitments are implemented and accounted for. (CESR) But is this the case in the post 2015 development agenda under discussion?


Development blues


Inequalities are pressing at the seams of our social fabric. (Christine Lagarde)


  1. At present, in the development arena, the so-called ‘international community’ has proclaimed itself as a replacement of the UN. Media of dominant powers keep repeating the phrases: “The International Community believes this or that, decides this or that”. Looking more closely, we discover that the ‘international community’ they refer to is made up of the United States, the European Union and two or three handpicked countries such as Saudi Arabia and Qatar. (Or, as P. Craig Roberts says: What is the international community? Is it the assemblage of US and Europe’s plus its vassal states?) Actually what is required is the resurrection of human rights in the UN, the only acceptable frame for the expression of the international community. (Samir Amin)


  1. More and more today, in-the-distorted-way-things-are, higher growth rates correlate with increasing inequalities, increasing sections of the population being rendered vulnerable and no decreases in discrimination. International summits end up reiterating the same problems rather than identifying new solutions that break with the ruling paradigm. Governments and international NGOs seem to be celebrating not the achievement and follow through of any decisions, but the fact that a certain summit took place and the fact that ‘it provided opportunities for encounters and for networking’. The most central of issues are over-and-over systematically left to be addressed en passant, with no really relevant break-through resolutions and decisions made. Equity, equality, political issues, structural change, empowerment (especially of women and youth), the need for more policy space for developing countries, debt forgiveness*, issues of global economic governance, and the need for a new economic order and financial architecture are rarely touched upon. (SID) No surprise that only shy and woolly recommendations come out. In sum, we live in a stage of development where promises are deceivingly stimulating, but achievements in human rights (HR) are, at best, worrisome.**

*:   Debt is considered manageable for poor countries if it remains below 40% of GDP. (F+D 47:4, Dec. 2010)

**: Most people who work in development jobs do not have much commitment to HR and lack real de-facto political clarity about them; so the world keeps turning and only little, non-quantum changes are achieved. (Adapted from the poet Jerome Koenig)


Looking with hindsight should instill in us a greater sense of urgency


  1. The first generation of development economics (1950 onwards) stressed state-led development. The second generation (1970s onwards) stressed a greater market orientation. Now the focus (of the ‘international community’…???) is on communities. Or is it? But the problem is that when inequalities become too great, it is claimed the idea of community cohesion becomes more elusive. (R. Arons) So, just claiming the obvious, namely that greater equality is needed, simply does not fit the bill of what is really needed. The times call for less rhetoric and more action. (A. Arora)


  1. No more taking advice! Advice pitched mainly by technocrats in the capitals of the North to technocrats in the field in the South –with little or no concern for how such advice may be applied (and less so communicated) to citizen as claim holders.***

No more centralization of development functions! Functions that keep chaos and instability (decentralization at least offers the hope of greater incentives leading to more stability).

No more development merely as a relief effort! Development is a human right –one that is too often violated primarily by not engaging actively with communities.

***: Many community members, long away from the classroom, will lack the patience (rightly so) to digest a lecture from somebody who does not live the problems of underdevelopment first hand. They favor crafting the content of development messages themselves so as to ensure they spread and achieve real grassroots ownership. (F+D 50:4, December 2013)


Grandiose top-down policies mostly do ruin initiatives born at the local level


-Top-down mostly means normative, i.e., such policies seek to align value systems and standards of multiple technical actors and build consensus. But do they really align and build …or do they impose…?

-There is a danger in top-down policy making when ‘reason’ does not represent an intelligence that understands, but only an ignorance that refutes and argues baselessly. (Albino Gomez)


  1. Over the years, economic development policy making, because it has been imposed from the top, has mainly been an exercise in the-theory-of-second-best-social-policy-making. Policies might have had some kind of an internal rationale but, by different agencies not really communicating with each other, they were applied differently. As a result, not only delays have occurred, but work has been implemented at cross purposes –and still the urgent social improvements they were supposed to address are not being addressed, particularly because proper participation and representation was not considered. (F+D 50:4, December 2013)


  1. Because of this, we have been hearing more and more calls for policy coherence. The question is coherence for whom and for what? Often this has meant government/private sector coherence. And this is not what is needed! Actually, the lack of coherence is not the main problem. The main problem is that we, in public interest civil society, are not the owners of policy making –we are not even participants. More frequently than us, the private sector has been influencing policy, often contradicting policies put forward by us so we end up being the jedis fighting Dart Vader, i.e., Luke Skywalker fighting The Force. (Well, in the film, The Force is actually defeated…).


  1. We all know that moves to give the private sector an increased role in ‘delivering development’ are not being matched by efforts to, once and for all, holding businesses and corporations more accountable to their HR responsibilities. (CESR)


The lingering questions


  1. How then are the people to remain, or become, sovereign if they are in no position even to identify who, or what, is making the decisions that affect their lives? Democracy has in no way kept up with the pace of globalization. Whether nationally or internationally, authority is exercised without the consent of the governed. The people are given few tools and close to no information to understand who is actually running what. Corporations exercise power without taking up corresponding responsibility. Whereas voters can eventually sanction governments and throw them out of office, corporations are not only beyond popular reach through votes, but collect spurious privileges such as ‘personhood’ in the USA or full status in the United Nations. (Susan George)


  1. So, no more feeding into the governmental processes? In good part the answer here would be yes. Instead, feeding into the grassroots processes has the greater potential to bring us right where we want to be, i.e., to put HR at the center. As an un-postponable starting point, then, massive HR learning efforts are needed so as to build the capacities of claim holders and duty bearers for the path to be urgently pursued to use the appropriate process-centered metrics/measurements to assess progress towards the progressive realization of HR. The focus simply needs to shift to ‘where the rubber hits the road’. A change of paradigm is needed for this –a new paradigm that will be a true tectonic shift and that absolutely requires understanding HR beyond being only a new legal paradigm. It is much more than this!


A call to action


  1. The post 2015 development agenda preparation process shows us how little we, in public interest civil society, are able to influence the overall ‘international development community’ to embark in the so badly needed change of paradigm. Over and over, we face resistance from powerful nation states influenced by the interests of the corporate sector.


  1. This resistance is at work despite the development agendas at local, national and global levels having been increasingly marked by a series of failures attributable to decreasing social cohesion and processes of social disintegration. Religious, linguistic, historical and ethnic dimensions of identity are becoming not only a dividing element, but provide the motivation and justification for social segregation, discrimination and violence. Apart from the identification of these issues, there has been no discourse evolving on development strategies countering these challenges. This is one urgent reason why we need to work towards the affirmation and understanding of HR globally as the key element of urgently needed inclusion, as well as a means of everybody internalizing the impact and costs of non-action for the future of our grandchildren. I repeat: As an un-postponable starting point, massive HRL efforts are needed so as to build the capacities for the path to be urgently pursued at both national and global level. (W. Lichem)


  1. Making us aware and repeating over-and-over that the problems we face are complex and difficult to solve is not helpful. We have what we have and we are all expected to come up with solutions. Let the time not pass, for now is the time to act. The times definitely do not call for procrastination or despair, but call for action. I make an impassionate call for colleagues to become more literate in (and take up) the HR framework to development.


Claudio Schuftan, Ho Chi Minh City




-The concept of ‘paradigm’ involves the interrelated concepts of ontology, epistemology and methodology. [Ontology –What is out there to know?, Epistemology –What and how can we know about it?, Methodology –How can we go about acquiring knowledge? (What procedures should we use to acquire more of the needed HR knowledge…)].

-In line with the old adage, in HR work, you should never let a good crisis go to waste.

-There is light at the end of the tunnel: “The arc of the moral universe is long, but it bends towards justice”. (Dr. Martin Luther King, Jr) or “Facing the old society, with its economic miseries and its delirious politics, a new society is on the rise”. (Karl Marx, 1870)

New issue of Social Medicine Journal Published

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We are pleased to announce that Social Medicine has just published its latest issue at
http://www.socialmedicine.info/index.php/socialmedicine. We invite you to review the Table of Contents here and then visit our web site to review articles and items of interest.  A Spanish version of the journal is avaialable at www.medicinasocial.info

Social Medicine
Vol 8, No 3 (2014)
Table of Contents


Bolstering the Biomedical Paradigm (99-100)
Frank Thomas Houghton,  Sharon B Houghton

Original Research

The Chilean AUGE healthcare guarantees from a patient perspective: a survey of access to healthcare in rural central Chile (101-112)
Caitlin Schrepel, Eric Tanenbaum, Gerald Paccione, Roberto Belmar

Revisiting Bandoeng (113-128)
Socrates Litsios

Social Medicine in Practice
Shaking Off Our Lassitude: Creating a Global Health Service-Learning Program
Founded in Social Medicine (129-138)
Francis Xavier Coughlin

Themes and Debates
Mainstreaming social determinants of health (SDH) terms into the PubMed
database would facilitate effective scrutiny of SDH (139-142)
Sivan Y.S.

Exploring the Hidden Curriculum of Global Health (143-146)
Kelly Christine Anderson, Jane Philpott,  Danyaal Raza