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Food for a spreading thought


Human Rights Reader 336
In political terms, the birth of human rights was a non-trivial achievement. The human rights principles about development have now become a firm part of the framework of the modern study of social systems.


1. Human rights (HR) give us the intellectual strength to defend what we do and what we believe-in, as well as giving us tools on how to hold and defend those beliefs. Therefore, criticism and argumentation are part of the HR discourse. As such, HR do not really intend to pull us away from our lives; they rather enlighten our lives. (R.C. Solomon)


2. Worldwide, one can indeed talk of a ‘united-league-of-HR-violators’. It is the role of an existing and upcoming ‘united-league-of-HR-defenders’ to more systematically begin to set up a counter-power and, as so needed, blame-and-shame the violators. One way could be the yearly ranking of violator countries. Because this is a worldwide challenge, cultural relativism is not acceptable to HR, i.e., HR apply universally. The most widespread cultural-relative pattern is patriarchy which manifests itself the world over as different versions of the same problematic pattern that so importantly conflicts with HR principles.


3. Adapting an axiom of Baruch de Spinoza, I feel comfortable saying that everything happens necessarily because of its causes. The knowledge of an effect depends-on and involves the knowledge of its causes. Everything in HR has a structural cause behind it. In the absence of that (those) cause(s), there would be no negative HR effects; the knowledge of these causes depends on our actively looking for the always underlying structural causes. In Thomas Kuhn’s words: We find what we look for.


4. Consequent with the above, it is high time that the symptoms of an ideological shift towards HR begin showing and manifesting themselves more clearly. Even if, while preparing for the post 2015 era, one sees the simultaneous emergence of new competing ideas in many places, the needed cultural turmoil these create in debates has not yet really bridged the existing gap. One has yet to see the crystallization of a new-cosmovision-centered-on-HR as a new coherent global system. We thus still must come up with the needed determination and conceptual toolbox that will allow us to overcome this period of turbulence. …A role for HR Learning here! (Alain Minc)


To accept the future, we must renounce much of the past


5. Shifting paradigms, in practice, means transforming our way of thinking. On certain occasions in our lives, such a shifting is needed as a way for us to retain dignity while throwing up our hands. (L. D. Landau) The old paradigm’s progressively shallower ideas begin to conflict with the new ideas, prominently so with those that call on us to recognize our own HR vision of the world.


6. In the end, to understand, one has to ‘change gears’.** One has to reassess and reassemble how one conceives-of the important things that are going on. Anything else is a wasted effort, because what is really happening has nothing to do with fancy, stale social theories.  It then is not an academic question any more to ask what is really going to happen in the future.

**: Not surprisingly, very often, it is non-specialists who think out-of-the-box as needed, who find the new ways, ways that completely change what it means to know something.


7. What we miss today are ‘terribly’ ethical women and men that do not concede anything, that go in search of the truth wherever it is to be found and that do not fall for the slogans of the prevailing development paradigm. (A. Castillo) For instance, as I have many times quoted: charity robs people of their dignity. Or: imposed ignorance is a HR violation. (S. Koenig)


Human rights organizations are far from homogenous


8. What is here implied does not mean, of course, that all HR organizations should be addressing the full range of human rights. It is perfectly valid for organizations to focus on aspects of the agenda suited to their competencies and traditional modus operandi. Note though that methodology can adapt to mission, rather than vice versa! Belatedly, not necessarily after 2015, it is necessary for civil society organizations to develop and apply more effective and rigorous methods to document abuses of the economic, social and cultural rights they witness to, then, attribute responsibilities for specific breaches of HR standards and principles and press for accountability. Exposing the injustice behind the more systemic discriminatory and retrogressive policy failures requires developing new methods for rights-based monitoring and advocacy. These include quantitative tools (marshaling certain statistical evidence using indicators, benchmarks and indices) and techniques such as budget and tax analyses to assess whether resources are being generated and allocated in line with HR principles. (I. Sainz and A. Yamin)


9. These approaches have to be married with various forms of empowering social mobilization. There is considerable evidence that HR research, policy advocacy and litigation, particularly when associated with social movements mobilization, have been successful in many different contexts in challenging economic and social injustices: from the denial of access to life-saving medical treatment, to deaths resulting from dysfunctional food chain systems. Experience has shown that for HR advocacy to bring about change in the sphere of economic and social policy, accountability must be pursued in a variety of different forms and venues, from courtrooms to boardrooms, to newsrooms, to classrooms, to living rooms and on the streets.***  For this reason, economic, social and cultural rights organizations have made it a priority to forge links with social movements and grassroots groups, working with them to devise tools and strategies for accountability and to support their efforts to localize and ‘vernacularize’ HR claims.                                                      ***: Sensibly, a growing number of HR workers are asking to subject the World Bank, the IMF, the WTO, USAID, the European Commission and other development organizations to the HR Universal Periodic Review process of the UN HR Council which, so far, every four years, reviews the HR performance of all UN member states. Furthermore, States simply have to be made to open up an adequate domestic policy space to meet their HR obligations when pursuing business-related policy objectives with other States or business enterprises, for instance through investment treaties or contracts.  Bilateral investment treaties and free-trade agreements may create economic opportunities for States. But they often also affect the overall domestic policy space of Governments. They can, and often do, constrain them from fully implementing new HR legislation, or put them at risk of binding international arbitration if they do so. Therefore, States should ensure that they retain adequate policy and regulatory powers to protect HR under the terms of any such agreements. (C. Herman)


10. What this debate drives home is that HR organizations vary greatly in mission, methods, approaches to partnership and levels of resources. While each organization is at liberty to define its mandate based on where it perceives it can make a difference, those with the greatest reach and profile must guard against undermining the efforts of others to promote a more comprehensive and transformative understanding of what human rights mean. (I. Sainz and A. Yamin)


In human rights there is a message that is not being heard


Breaking through the vicious cycle of humiliation means that the oppressed must confront their oppressors.


11. In our struggles, we uphold HR and justice for all since, else, we run the risk of perpetuating humiliation and we become the new oppressors, i.e., we become victimized violators. Why this risk? Because the prevailing structures of society socialize us to dominate and to exclude others. It is the learning about HR, directed to how to use them in practice that will help us see how the patterns of oppression shape our ideology and behavior. Everyone has to take-on some responsibility for these ingrained oppressive behaviors. (S. Koenig).


12. Yes, we live in a culture of domination and submission, of indifference (where ‘the other’ has virtually no presence). The question is: Why is there no aggression in indifference? But actually, there is, whenever the indifference is intentional. In that case, silence is aggression (and let’s keep in mind that not changing behavior can be a type of aggression). When I defend myself, I am responding to some kind of aggression, that is, I am treating my circumstance as an aggression and that treatment can, in some circumstances, be remaining silent.(H. Maturana)****

****: Franz Kafka calls this a combative silence; one that makes those who keep silent actually participants. (F. Kafka)


13. Bottom line: One day, our multiple and multiplying, unresolved and accumulated global HR problems will become insurmountable barriers to a paralyzed society. By then (should we wait…?), the stupid –in the Latin sense of stupere which means staying quiet, unmoved, bewildered– will either become resigned or become violent. (M. Denevi) “Fear the slave who breaks his chains!” (F. Schiller)


Claudio Schuftan, Ho Chi Minh City



- There is a frontier we do not dare to cross; the frontier of the struggles within ourselves. (C. Fuentes) Yes, we meet in the street, discuss world problems at length …solve nothing. (J. Koenig)

- Reality cannot be concealed; it is us who negate it. The real danger is that what we do not see, what we refuse to see, what we underestimate or refuse to believe. (C. Fazio)

- When many things seem to us so unfair, we must bare in mind that it is not Justice that best serves women and men. (Albino Gomez)  Bottom line: Closed minds make excuses to avoid facing the truth. Justice is denied. (J. Koenig)


Damaged Care back in NYC: The Musical Comedy about Health Care in America

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Damaged Care

When: Saturday, April 5th and Sunday, April 6th both shows at 2PM

Where: Don’t tell Mama: 343 West 46th Street (Restaurant Row)

Cost: $15 Cover, 2-Drink Minimum (Cash Only)


The Singing Doctors Greg Lagana and Barry Levy are back in New York City this weekend to perform Damaged Care: The Musical Comedy about Health Care in America. The show, now in its 18th year, has been presented tomany different types of organizations and institutions, including hospitals and state medical associations, medical societies and public health associations, medical specialty societies and nursing organizations, educational institutions, and pharmaceutical industry organizations.

For a taste of the show, check out these You Tube Videos:

Health Care Business

Another Outbreak of Us Superbugs

Doctors in Cyberspace

Send in the Dogs

The Spare Parts Blues

posted by Matt Anderson


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Food for an eco-systemic thought


Human Rights Reader 335

-Human rights are philosophical; they are holistic; they are a secular religion with its own commandments. (Shula Koenig) But does the philosophy behind human rights depend on science? It does not. Nevertheless, human rights cannot and do not ignore scientific facts. As they do so, human rights cannot and do not build a philosophy-of-the-spirit like in the times of Descartes. Human rights advance when their practitioners dialogue with their peers and with human rights’ very own history, as well as when they ask relevant questions pertaining to other related domains. (Albino Gomez)

-It is not enough to write the word HUMAN RIGHTS in upper case or in color font in a document, or make any other kind of linguistic acrobatics to make it stick. What is at play is the deep meaning and action-orientation of human rights.


1. The human rights (HR) framework transcends the narrow confines of the accumulation-driven capitalist model that benefits only a few to the detriment of the majority. It proposes a new notion that looks beyond the narrow domain of economic growth that has dominated the world’s ill-balanced policy agendas over the last decades.


2. The human rights-based approach* ultimately helps generate the political will and a culture of resources allocation that places the needs of groups and individuals rendered vulnerable on an equal footing with the interests and prerogatives of those who are better off. As such, it adopts a HR language** that makes the participation of citizens in the overall work in the development sector a reality. This is why the HR framework is clearly a political tool –a fact disregarded by many in the left. (U. Jonsson) What is political about HR? Everything, it turns out. We did not know this before. Now the words ‘human rights’ and ‘politics’ have become inseparable. (M. Pollan)

*: Think of it like this: HR are a home where the dignity of all people is celebrated; we see it as the ultimate habitat of and for humanity. It is a space where people can be free from fear and want –and often a refuge from persecution. It is often the first home people have had and owned. Enjoying HR, people are protected, they learn how to walk towards a new horizon, to restore or build a better home as they internalize the HR language as a path to dignity for all.  A big chunk of the world’s population is actually aimlessly searching for ways out of their problems, doing it in many directions; they need such a real home. (S. Koenig)

**: With the exception of Marx, no other public or official language is available that provides the same range, power, and precision as the human rights framework. (C. Archer) Keep in mind that choosing words is important. Words have to speak to the ultimate meaning of our purpose. For instance, I contend we need to stop talking about the human rights-based approach. HR is not an ‘approach’… one of many. It is a guiding ‘framework’ –a worldview, a holistic vision with a very concrete mission. (S. Koenig) Using the concept of a ‘Human-Rights-Informed-Approach’ instead of a HR-based approach is perhaps an option to consider.


3. The HR-based informed approach as a process calls for adhering to the HR principles of equality and non-discrimination, inclusion and participation, and accountability and the rule of law. At the same time, as an outcome, it calls for meeting specific human rights standards, for example adequate housing, access to water and sanitation, health and education services, work, freedom of speech, etc. or any other civil, political, economic, social and cultural right as codified in the respective human rights treaties ratified by the vast majority of countries. (U. Jonsson)


4. Rich and powerful countries have a long history of violation of HR, in some cases within their own territories, in other countries, in their ex-colonies and/or surrounding territories. In too many cases, they have for decades installed and kept in place dictatorships elsewhere. What moral lesson do they pretend to give the rest of the world? Perhaps preaching from their permanent seats in the Security Council of the United Nations…?*** (A. Gomez)

***: Friedrich Engels spoke of ‘social murder’, and accused rich and powerful countries of perpetrating this crime perpetually. Just like a small rip in a dike can end up in it caving-in, being condescending on minor HR violations only gives license to States to embark in even greater violations. (V. A. Beker)


5. Even as we face the challenge of the century of giving the post 2015 development agenda its ultimate center, unfortunately, the HR framework risks going from neglect to rhetoric. (A. Eide) In this struggle, I think we have to go for broke as needed and be both brave and angry.


Braking away from the iron chains of the routine in our work


6. Let me share here with you some suggestions of our friend Anwar Fazal in Malaysia:

- What about setting up a project on Crimes Against HR?: The project would select and expose annually 500 crimes against HR and rival the Fortune 500 that celebrates the much less worthy achievement of corporate enterprise.

- Or a project on the State of HR?: This would entail an annual report, national and global, with an audit in the spirit and image of IBFAN’s State of Violation of the International Code of Marketing of Breastmilk Substitutes.

- Or a project for a HR Gateway?: Here one would set up a digital library documenting past work on HR. (Information and inspiration cannot be allowed to vanish!).

- Or a project for a HR Lifeline?: Here one would run a global news feature service that generates discussion (written and radio), as well as run ad-hoc courses on HR journalism.

- Or a project on HR Champions?: This would recognize our heroes from all over the world and could give HR awards.

- Or a project exposing corporate accountability?: This would have HR exposée pieces and audits once a year.

- Or a Project Dignity that would highlight the dignity factor in HR work?

- Or a Project HR Interpol that would expose gross HR violations through a systematic internet-alert-system called ‘HR Interpol’ that would condemn gross violations wherever in the world as they occur?

- Or a Green Project that would denounce environmental practices affecting HR, would combat consumerism and would create ‘green consciousness’?

- Or a project called HR Transformation**** that would change the way we work letting the periphery of what we do be the center, e.g., be more participatory and action oriented? And would strategically locate HR incubators, catalysts, multipliers and accelerators. It would let us all become more passionate HR drivers actively resisting HR-adverse top-down commands and control. It would also help set up active networks of claim holders and would foster more volunteerism. It would call you to move your office to where the action is.…Or all of the above?

****: What Project HR Transformation means is that most of us will more consistently and regularly have to come to terms with the risk-averse nature of our system, and the detrimental impact this has on our willingness to actively challenge HR abuses or problems face-on. The view of HR as being ‘sensitive’ could not be more misguided.  Our habit of gagging ourselves –of using ambiguous language or deferring response until it is effectively without relevance betrays the people we portray to stand for, i.e., common people.  No matter what we say, this fact is clearly with us. (C. Cahn) The result of such an attitude adds to the fear I so often have, namely that many well-intentioned colleagues end up bureaucratizing HR.


7. Human rights are not a lighting rod, but a magnetic force to change the unfair rules of the development game and of the rather routine work we mostly do. HR and social justice aspirations are inseparable, but are not synonymous. They both, in themselves, do lead to more just societies accompanied by fairer social and economic governance. But beware: justice that comes too late is not justice. (R.C. Solomon)


8. The reality that we are faced with every day is that globalization and the chronic persistence of poverty and a widening social injustice, excuse the repetition, persist. Therefore, in breaking away from the iron chains, the HR movement cannot just concern itself with countering the abusive interference by the State in individual civil liberties. Protecting HR further involves bolstering the state’s capacity to rein-in the unbridled power of market forces, as well as ensuring its institutions are equipped to protect the enjoyment of HR from infringements by private actors. It also involves having the State fulfill a series of positive obligations, all necessary for people to live their lives in dignity.


9. Ultimately, HR have the goal of transforming the national and international social order in which all HR can be fully realized. They address the unfair distribution of resources that fuels deprivation and inequality within and between societies. HR advocacy must thus be concerned with distributive justice, as well as palliative, retributive justice.

Claudio Schuftan, Ho Chi Minh City


Postscript: Whenever you feel powerless about what human rights work has thrown at you, just remember this: A single of your pubic hairs can shut down an entire restaurant.



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Food for a sovereign public thought


Human Rights Reader 334
If children were reared for profit (like young farm stock), giving them a diet below requirements-for-health would be financially unsound. (Boyd Orr)


Food sovereignty in perspective


1. Food sovereignty entails shifting the focus of our discussions from commodities to diets; it entails seeing biodiversity as indispensable for livelihoods, for health and for the environment; and entails coming-up with sustainable dietary guidelines, because varied diets also positively affect the ecosystem. Human rights-based development policies must thus be reoriented to more sustainable diets (because standard and ‘simple’ solutions are not sustainable). These policies must also learn from traditional food systems (i.e., from agri-culture) and must put action-learning in a prominent place. Bottom line, food sovereignty calls for a reorientation of institutional set-ups at all levels which most still fail to see.

Public-Private (for profit) Partnerships (PPPs) in perspective

In the last decade, PPPs have become a vulnerable flank of serious contradictions.

2. Mixing science and public health nutrition with the influence of powerful corporate interests in foods and beverages is not the recipe for healthy eating and sustainable diets. Here is a call, then, for public sector actors and the UN to reconsider PPPs as a default paradigm for engagement with the private sector. Such partnerships are often portrayed by participating corporations and by other proponents alike as being a ‘win-win-win situation’: for the public sector actor, the private sector actor and the general public (or relevant publics). However, the ethical and human rights implications of PPPs are more complex than either of these positions may initially suggest. The systemic effects of PPPs tend to be insidious and include an erosion of the mission and integrity of participating public institutions –on top of an erosion of the trust and confidence placed in those institutions.  For them, it is problematic to restore lost trust and confidence without also addressing the underlying loss of integrity. What is of concern are both the corporate influence over policy making at the expense of the public good, as well as the loss of the public partner’s legitimacy with key constituencies due to perceived co-option by commercial interests.

3. More often than not, PPPs ‘sanitize’ the reputation of the corporate actor that hopes to increase its brand loyalty. If the predictable effects of a PPP are to create loyalty for a brand that it markets, for example, energy-dense foods and sugar-sweetened beverages, it can be argued that such an arrangement undermines the mission and integrity of the public partner, especially when that partner is a government official or agency responsible for public health.

4. Moreover, partnerships related to the conduct of health or nutrition research raise a variety of further concerns. One issue here is the systemic distorting effects of corporate sponsorship of research, whether or not such research is framed as a PPP. Much of this research, e.g., in nutrition, is conducted in academia with the financial sponsorship of industry and, not surprisingly, this research is often enough designed to explore mostly the potential benefits of consuming these foods and ingredients. Such a research: (a) reinforces an industry-favorable framing of social problems (for example, emphasizing individual responsibility for obesity rather than the social, marketing and environmental determinants of malnutrition and health), and (b) introduces a systemic bias favoring technological solutions that may be readily commercialized.  Therefore, the potential these partnerships have to undermine the public’s trust and confidence in policy makers, in policy processes, and in the resulting policies is great. Despite these concerns, a number of governments –including those in the U.S., the U.K. and Australia– have expressly invoked the rhetoric of ‘partnership’ to describe the role of industry in the development and implementation of policies related to health promotion. The ethical and human rights implications of this kind of industry participation in policymaking include concerns about the preclusion of policy options (most notably, increased regulation), the marginalization of claim holders, the discounting of relevant evidence, and a distortion in the development and implementation of policies.

5. Allowing the private partners to influence the strategic priorities of the public sector actor –through ‘quick combustion friendship deals’ with policy making officials (A. Berg)– distorts the latter’s agenda, because it prioritizes goals that are favorable to the industry.* So, literally, the corporate mask must thus be unveiled and, as necessary, stripped off their faces before sanctioning the partnership. The latter means that public partners must explore and assess the ethics of PPPs before considering any proposed partnership. They must also seriously consider disengaging from existing partnerships for similar or related reasons. To further our example above, if the partnership threatens to distort the research agenda of the public partner by focusing on research in the interests of the industry partner, the public partner must consider imposing a condition that matching funds be found elsewhere to support related research that can be contrary to the interest of the industry partner. Counterbalancing is an essential component for any ethical approach to PPPs that would be capable of addressing the systemic effects of such partnerships. It is the cumulative effects of partnerships that must inform the ongoing monitoring and evaluation of any partnership, as well as thorough ex-post analyses.  Thinking creatively should involve the exploration of other modes of interaction with the private sector that do not involve partnerships.  (What’s the Big Deal?: The Ethics of Public-Private Partnerships Related to Food and Health by Jonathan H. Marks Edmond J. Safra Research Lab  Working Papers, No. 11 Harvard University, 2013)

*: The fact is that no (or very few) colleagues criticize the recommendations made by PPPs. Why? I think it is because they basically are non-threatening to the current affairs in our neo-liberally controlled world. No matter how much these recommendations push the respective envelope, things that really matter, as the social determinants of so much ill-being, still merely stay unaddressed and thus unmoved. So when it comes to PPPs, it is better for the public sector to step backwards than to get lost on the way.


Corporate behavior in perspective

6. Given the so frequently-occurring premeditated corporate behavior, let me quote: “Next time you hear of a big food or beverage company sponsoring an after-school physical activity program in your community, you can be sure they’ll say: It is to show ‘our company’s concern for our kids’ health. But the real intent is to look angelic while making consumers feel good about the brand and drawing attention away from the unhealthful nature of the company’s products”.** (Michael Mudd, former Executive Vice President of Global Corporate Affairs for Kraft Foods)

**: In our crazy present-day world, s/he who is not afraid of hunger is afraid of too much food. So we can divide the world among those who do not know what to eat and those who do not know what they eat. More and more it looks like Big Food’s motto is “fill them up” and less and less “feed them”. (C. Fernández-Vega)

7. Therefore, from a civil society and a human rights perspective, accountability is more than just a word. Collectively, we need to reflect about what kinds of accountability will create a working environment’ that includes both (mostly) regulations and incentives for the private sector to behave responsibly. This requires always asking:

-Accountability from whom (parent companies, subsidiaries, retailers, all of the above)?

-Accountability towards whom (employees, public authorities, local communities? the most nutritionally vulnerable)? and

-Accountability on what issues (on how to make companies more accountable on their impacts on the right to food and nutrition? or on their contribution to tackling the social determinants of health and nutrition, such as access to land, water, sanitation and hygiene, healthcare services, decent work, quality education and above all affordable, diverse, nutritious foods –including adequate and transparent information on the latter)? (E. de Vachat).


8. Bottom line, the right to nutrition is inseparable from social justice. It requires the adoption of appropriate economic, environmental and social policies including corporate regulation, at both the national and international levels. It is ultimately oriented to i) the reduction of poverty through disparity reduction; and ii) contextualizing poverty in the process of exploitation, domination and power imbalances. This leads to the question: Why do some people live/are kept in poverty? …and this, in turn, linked to: What about the fulfillment of all human rights for all? Ultimately, availability, access and adequacy are key –and these must be isolated from corporate influence. (U. Jonsson) The times do not call for procrastination or despair, but call for action. To stop (or not to start) is to go backwards. The tiger is not going to become vegetarian.


Claudio Schuftan, Ho Chi Minh City



Every day there are more people that speak of serious things in a silly way and about silly things in a serious way.  It actually looks like many people rather prefer to ignore than to apply what they know and conveniently forget what they remember. (Albino Gomez)


It is said that only the pessimists can change the world since the optimists are always content with the world they live in. But certain pessimists are so pessimistic that they believe that in-no-way can our existing ill-functioning world be fixed.


As regards mediocre people, they never pass judgment about themselves or others; they rather stay trapped in their limited refuges. Mediocre people reject engaging in polemic dialogues, they do not dare confronting those who think differently; they are fundamentally insecure and look for excuses that are mostly based on disqualifying the other; they lack courage to publicly express or debate their ideas, purposes and projects; they primarily communicate by monologuing and by clapping when they agree –which is most of the time. (J. Ingenieros, El hombre Mediocre, 1913)



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Food for a thought in all policies


Human Rights Reader 333

Over 2.300 years ago, the Greek philosopher Aristotle said that “if we believe that men have any personal rights at all as human beings, they have an absolute right to such measure of good health as society, and society alone, is able to give them.”


1. We used to say that health is too important to leave it to the doctors. Then some said it was too important to leave it to the state. Now, we forcefully say it is so important that we must leave it to, nothing less than social movements. (A. C. Laurell) Why? Because effective action to address the social determination of health (SDH) and the concomitant health inequalities and violations of the right to health* will have to primarily come from civil society actions and pressures. Think of the history of your country…does this apply?

*: According to WHO, the right to health is not the same as the right to be healthy. A common misconception is that the State has to guarantee good health for everybody. However, good health is influenced by several factors that are outside the direct control of States –although human rights-based health legislation is indeed a priority. An individual’s right to health cannot be realized without realizing other rights, the violations of which are at the root of poverty, such as the rights to work, to food, to housing and to education, and to the principle of non-discrimination. This is very much the result of the fact that ill-health is a symptom or an outcome of much broader and deeper problems in society.  Therefore, health practitioners must have some knowledge about the key human rights, in particular the economic, social and cultural rights. This is required to carry out very ambitious and indeed needed Causality, Capacity and Pattern Analyses as required when applying the human rights framework.  (U. Jonsson)


Focusing on the ‘Health Have-Nots’ (A. Fazal)


2. All the time, ministries of health tell us human rights activists “we may have formal differences of opinion with you but, substantially, we all have the same objective”. Nothing could be further from the truth. We simply come from different, or even opposed, schools or frameworks of thought. Those of us who defend the right to health go well beyond technical issues in health, i.e., for us, nobody should lack access to comprehensive health care because s/he cannot pay for the services or lives in more remote places. If we would agree on this, yes, anything else is amenable to negotiation –but being very clear that no existing norms and policies can ignore that the aim is for progressively attaining equality in health. For instance, the respective ministry cannot call universal health insurance a progressive-public-policy when, in reality, it does not offer the same coverage for everybody; it cannot call comprehensive insurance what, in reality, may reimburse for health care that is not comprehensive, but is rather based on different health care packages –different for different groups, only trimmed-down-ones for the health have-nots.

3. The framework from which human rights activists come-from is based on reforming the health system based on three inseparable principles: Universality and Comprehensiveness of public health care and Solidarity (to each according to her/his needs and not her/his means). Only the application of these three principles can guarantee equality since they are the basis of all human rights (HR). Furthermore, in shaping equitable health systems, it has to be together-with-claim-holders that one decides and prioritizes the actions to be taken.** (A. Saco)

**: Unfortunately health services have often become places of deprivation, inequality and exclusion. Therefore, it is claim holders that must demand a better position to respond to the challenges this brings about. In this context, it is important to recognize that the human right to health actually means the-right-to-command-the-whole-health-planning,- implementation-and-monitoring-process, i.e., establishing a democratic management of health care. The aim must be a people-centered, sustainable development in health. Health, within the economy, must be changed from being considered an engine of growth and productivity to fostering truly active HR agents of change. (U. Jonsson)


4. The above is not, as far as I know, what ministries are talking about in their plans for health system reform. It needs emphasizing that, for the most part, States are not channeling resources to claim holders that need those resources the most thus securing and guaranteeing the fact that all human beings are assigned the same rights. The public health sector can simply not (but is) deny(ing) services to somebody, because s/he is living in poverty and/or is marginalized. We are not talking about ministries having to have social programs; we are talking about them having to have human rights-based programs. (Those who can afford it are free to pay for private services, but that does not deny their right to use the public services). You can thus see the differences are not formal only. We do not deny that there is plenty room for ministries to implement operational, organizational and administrative measures to improve services, but these are not in the direction of the human right to health, because they ignore the three principles above. They actually have, for long, been responsible of a further denial of universal health care coverage, have offered minimum basic packages for people rendered poor and have ignored any notion of solidarity. (A. Saco)


The road to fulfill the right to health for all the health have-nots implies the setting up, the strengthening and the development of Tax-Based-Universal-Public-Health-Systems. This position contravenes the campaign currently being launched by international financial institutions, UN agencies and by neoliberal donor governments to address the under-discussion concept of Universal Health Coverage which they base on the widening of different insurance schemes, on limited basic health services packages for the people rendered poor and on the promotion of private investment in the health sector. But health cannot only be conceived as the provision of curative services. We know that health implies looking after a whole set of interdependent HR since health is, among other, ultimately determined by the de-facto access to an environment free of toxics, to healthy production models, as well as to decent housing and quality education, to clean water and sanitation, to land redistribution… Along the same lines, the recognition of the right of the people and of communities to a free and informed consultation and participation in the formulation of health policies has been a clear unfolding historic achievement.

We are keenly aware of the negative effects the extractivist model of natural resources and the predatory behavior of the agro/food/beverage industry both have on health and on the livelihood of communities –not forgetting the ecosystem. Numerous studies have rigorously demonstrated the fact that health is socially and environmentally determined. Therefore, from the social medicine point of view, it is alarming that much of the current discussions have been focused on the right to health care of a minority disregarding what literally is the HR to life of vast majorities. (We are talking about a class-based differential risk exposure to premature preventable deaths). Related to this, we consider that the debate on tax and fiscal reforms is crucial (and realistic) so as to come-up i) with redistribution of wealth policies (= disparity reduction), ii) with the universalization of HR, iii) with citizens participation and iv) with ‘healthy’ public health policies, as well as v) with seeking alternative production models that are not ecologically destructive and are equitable. (Asociacion Latinoamericana de Medicina Social, ALAMES)


A birds-eye view of the conditions necessary for health systems to be equitable and universal


The right to health is far more than the individual liberty to access health services and resources: it is a right to change ourselves by changing the health system. Moreover, it is a collective rather than an individual right since this transformation inevitably depends upon the collective exercise of power specifically acquired to reshape the processes of how health services are delivered. (H. Lefebvre)


5. Universal Health Coverage (UHC), even if considered a HR in the ongoing debates, does not per-se address the actual determinants of health outcomes (which include the usual indicators of the many deprivations of marginalized groups prominently including household poverty). Therefore, UHC must also, among other, include affordable access to medicines and an effective and performing domestic health care system.*** (M. Montes)

***: Sir Michael Marmot introduced the concept of ‘Proportionate Universalism’ in the UHC debate. By it, he meant that actions to achieve UHC must be universal, and of a scale and intensity that is proportionate to the level of disadvantages in health in different countries. ‘Benchmarking tables and figures’ have been used in this context to compare a country’s progress in health with that of its peers, called ‘comparator countries’.


6. Four key ingredients have been said by some to be necessary for the successful financing of UHC: i) removal of direct payments and other financial barriers; ii) compulsory pre-payment; iii) large risk pools; and iv) financing from general revenues to cover the uncovered.  But conventional insurance schemes –whether private, community-based or European-style social health insurance– come up short when measured against these criteria. Since UHC is about access to quality care for everyone regardless of ability to pay, governments must move away from relying on employment-based and contributory insurance models.  Instead, health care must become a right of citizenship (or actually of residency so as to include migrants), financed in large part through general government revenues.  Equality must be built into the system from the beginning, rather than starting with those easiest to reach in the formal sector. (Oxfam)


A quick peek into the non-communicable diseases debate


7. The case of non-communicable diseases (NCDs) is an example of how profitable solutions are applied to potentially profitable problems. In this regard, it is striking that problems that should be addressed through binding legislation are being timidly addressed as requiring industry ‘cooperation’ or ‘voluntary’ codes of conduct. (A. Katz)


8. The 1993 WHO World Health Report (the ‘Sachs Report’) made health-as-an-input-to-increased-productivity a respectable concept. Since then, a myriad of documents promoting action on NCDs have gone and go even further: they alert the private sector to see health as a market opportunity.  The ‘hard sell’ of actions to tackle NCDs overwhelmingly removes their social and economic determinants from the debate and focuses instead almost exclusively on risk factors relating to individual behavior, e.g.: “If you smoke you do so at your own risk” or “It is you who are responsible for your excess overweight”.**** This is the typical victim-blaming-approach of the neoliberal era taken to the extreme! (A. Katz)

****: Keep in mind: i) obesity is a normal response to an abnormal environment; and ii) tobacco, alcohol, sugar/transfats & fast-food big transnational corporations are to be seen as ‘vectors of disease’ that need national monitoring in the same way as other vectors. (R. Moodie)


9. The structural root causes of disease and of poverty are of no interest to the rich and powerful. On the contrary, the highlighting of these causes represents a threat to the status-quo as they address extreme and growing inequalities which bring this privileged group so many rewards both in geopolitical and economic terms. It is time to question the use of the term ‘risk factors’ and indeed the whole concept of risk. The term tends to imply individual agency and responsibility, i.e., as if people had the ability to fully control their lives and their environment. It ignores the critical distinction between risks taken and the risks imposed by the different manipulations of the market place that result in the skewed corporate power relationships we all know about.***** The terms ‘contributing factors’ or ‘determinants’ are more neutral than ‘risk factors’ and allow the real causes to be identified and analyzed without prior assumptions (or subtle suggestions) about the individual or structural origin of the causes. (A. Katz)

*****: Risks taken align four or more individual risk factors (especially for NCDs), but do so aligning them like in a Swiss cheese so that remedial arrows cannot really pass.


Claudio Schuftan, Ho Chi Minh City



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Food for a fetishized thought


Human Rights Reader 332


George Bernard Shaw said that statistics is a science that demonstrates that if my neighbor has two cars and I have none, both of us have one.


1. In the language of statistics, uncertainty is a latent variable*  (N. Bloom) …particularly when it is mainly statistics that lead to policy-induced uncertainty. In policy making, it too often boils down to ‘2b or not 2b’.** (M. McGrath) One can ask: Where then are human rights (HR) policy considerations relegated-to?

*: We walk many roads, all paved with uncertainty; so, choose: But do so wisely as you walk (J. Koenig) and be aware that the omnipresent ‘omitted variable bias’ is at the very center of much empirical social sciences research. The fact is that nothing plus nothing does not give nothing, but sometimes gives a little something. (Julio Cortazar)

**: Many researchers who have been prominent in identifying a certain problem say that getting involved in the solution of the same is none of their business. Deplorable. (F. Monckeberg)


2. You have to agree with me that the ‘p values’ of biostatistics are no substitute for human values, especially HR values. (Jonathan Mann) Why?, because wisdom is being reduced to knowledge which in turn has become to mean reducing knowledge to information*** –or, as we are now supposed to say, data. I posit that statistics are deliberately positioned as objective by the forces of status-quo, i.e., in the sense that statistics are ‘free from context’. But such a position is utterly reductionist and even naive. (G. Cannon)

***: Where is the word we lost in words and where is the knowledge we lost in information. (T. S. Elliot)


3. On their own, statistical indicators are inconclusive. They say nothing without clear reference points against which to judge performance and to assess the adequacy of achievements or progress over time …and the reference point, in our case, I dare say never is human rights.


4. Together with others, I am especially weary of the prevailing tendency to ‘fetishize’ particular techniques, especially the quantitative techniques that are so tempting to many. I see in them a number of unintended risks and consequences. There is, for instance, a risk that ‘perfecting’ the particular tool or technique becomes an end unto itself –the danger being that the tool becomes overly complicated and inaccessible to the intended user. Another risk of fetishizing quantitative tools and techniques is that these tools can and do narrow the lens of analysis, reducing a complex reality to simple, verifiable numbers, and thereby making invisible otherwise relevant factors. As a result, ‘the multi-dimensional can be easily confused with the two-dimensional’. So, beware of the risks of reducing assessments to a technocratic exercise that analyzes the trees while missing the forest –and masks the value judgments that are inherent to choosing particular indicators and collecting specific data –HR always being the looser here. (CESR’s OPERA approach)


5. But it does get worse: Observations derived from correlating statistical data are all too often mistaken for causal relationships. The effects of single factors are easier to pinpoint and trace than the interaction of several factors, yet these interactions are often the key that unlocks outcomes. Selecting manageable indicators to capture concepts such as empowerment, HR violations or greater democratic engagement is a struggle that HR workers often lose (the preparation of the post-2015 development agenda being only one current example). **** One key factor here is the capability of citizens and their organizations to influence the information to be gathered and making it available in a transparent manner. The latter requires the mobilization of rather vast masses of citizens who must become involved in some type of HR learning.

****: In the context of HR, we should keep in mind three types of indicators: (i) structural indicators that capture the acceptance, intent and commitment of states to undertake measures in keeping with their HR obligations; (ii) process indicators that assess states’ efforts, through its implementation of policy measures and programs of action, to transform its HR commitments into desired results and (iii) outcome indicators that assess the result of states efforts in furthering the fulfillment of HR. ( ;


6. The rather mechanical correlation of data –and the use of many other old and new statistical techniques– fits the current obsession with counting. Numbers may be fine as far as they go, but they can neither explain our behavior nor how we experience the motivating power in our search for HR and dignity for all. In the words of the note that Albert Einstein kept on his wall: “Not everything that counts can be measured, not everything that can be measured counts”.  (The Broker, Issue 25, June 2011)


7. In general, development practitioners, as it is now conventionally posited, seem to assume that the inductive method, which is to say the accumulation and ordering of facts, i.e., data, into evidence, using increasingly sophisticated statistical techniques, will of itself generate objective findings. This is just plain wrong. For a start, the very ordering of facts, the equivalent of brick-laying, implies a plan, an idea. But in any case, the purpose of evidence is to support or refute a theory. The theory comes first. This is the deductive method. True, the theory may emerge or be refined in the course of the organization of facts, just as a master mason may change the architect’s mind. Induction is comfortable. It implies that information will generate objective measured quantified conclusions: Job done! These days the inductive method is mostly worked out by computers and is becoming increasingly detached from thought. By contrast, deductive processes require constant thought. By their conformist, middle-of-the-road nature, old theories and indeed stale ideologies and systems of ideas can be and indeed should be challenged, as needs arise and, in our case, HR circumstances require. This may feel dangerous to some ‘with an axe to grind’. Indeed, but this is the way of the real world and we see no more room for HR ideas to be resisted. (G. Cannon)


8. Bottom line: We should be careful to avoid interpreting the idea of a ‘data revolution’ too narrowly, i.e., as only being about statistics.  Data, as defined by the Oxford Dictionary, is “facts and statistics collected together for reference or analysis.” But facts, especially HR facts, can also come from testimonials, videos, story-telling and other participatory research approaches. Furthermore, these methods can give an important and often critical context to an issue far beyond what the numbers alone may or may not reveal. Numbers are useful, but only as long as they do not master us.


9. If we are truly serious about effective means of monitoring progress on the next set of post 2015 development goals, these approaches must be part of the ‘revolution’.


10. Keep in mind that, in an effort to bridge the digital divide between the knows and the know-nots (A. Fazal), innovations in technology can assist greatly (e.g., SMS-based polling, low cost video capturing) alongside more traditional, ‘low tech’ solutions (e.g., particularly open town hall meetings). (S. O’Shea) The ultimate effort I guess I am actually calling for is for us to increasingly step out of the exclusive ordinary range of statistics (S. Spender) and complement the use of data with the use of testimonies. [Am I talking of statistimonies or testictics?].


Claudio Schuftan, Ho Chi Minh City



-Every newspaper should be carrying HR complaints. But this carries its risks. The powers-that-be may start attacking the journalists posting such complaints and then end up closing newspapers… (Albino Gomez)

-Julian Assange has gone on record saying that justice, if it really deserves that name, must put brakes on power. If a government purports to defend its people, it must guarantee that politicians never have full control over information.

-I always say that certain forms of simplification may denote a lack of sophistication. (A. Gomez) As a matter of fact, it is easier for all of us to build a microscope than to build a macroscope. (Ch. F. Hebbel)




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Food for a feminine thought


Human Rights Reader 331


-In our land of Oz, hypocrisy is without shame. Patriarchy rules. (J. Koenig)


-Women are not ‘men of the feminine sex’. (J. F. Sarmiento)


-Gender relations are a form of organizing society …as is income.


1. While sex refers to biological differences between men and women, gender refers to the roles and responsibilities that society constructs, assigns and expects of women and of men on the basis of their biological and physical characteristics. The bad thing about this is that these expectations create stereotypes.




2. Gender thus refers to the attributes and opportunities associated with being male or female and to the relationships between males and females which, in-last-instance, are socially constructed and learned through socialization processes. Therefore, gender roles change over time. Ergo: society can change the gender roles!




3. As regards gender equality, this does not mean that women and men should become the same, but rather that women and men should have equal access to opportunities and to achieve equal results. Furthermore, gender equality is not a woman’s issue, but must concern and engage men as well as women.




4. Women have traditionally been relegated to the household sphere and to a subordinate status in society –on top of being generally excluded from recognized interpretations of human rights (HR). It is the UN’s Convention on the Elimination of all Forms of Discrimination against Women (CEDAW)* that sets out the measures for the achievement of equality between men and women –regardless of their marital status, in all aspects of political, economic, social and cultural life. It is thus no longer about just achieving equality and about eradicating gender discrimination, but rather about empowering women so they can become full and equal partners in all policies and decision-making processes in their communities.


*: Surprisingly, CEDAW did not include anything about violence against women. It was only fourteen years later, in 1993, that the Declaration on the Elimination of Violence Against Women (DEVAW) proposed ways in which governments should act to prevent such violence, and to protect and defend women’s rights.




5. An important ad-hoc note here: It is said that not all inequalities are inequitable and not all equalities equitable: Indeed a very important and correct (although not that easy to understand) statement. We can use an Outcome/Process example relevant to women to put things in perspective and to explain this: Take the use of Affirmative Action in ensuring gender-equal outcomes in employment. The same can be defined as: The use of a morally defendable unequal (i.e., equitable) process in order to achieve a morally desirable gender equality. (U. Jonsson)




6. We have to be aware of three additional things. Gender discrimination:


(i) is an issue that affects the realization of several HR; (ii) is an issue that ultimately relates to women’s autonomy; and (iii) both these issues call for the de-facto empowerment of women at all levels worldwide. (UNFPA)




7. What is meant by the immediately above is that women-must-propose, society-must-respect and the-state-must-guarantee. (C. Santamaría) The role of the state in this respect is paramount; among other, it needs to create enough equally paying jobs and social services that allow men and women and their families to live in security and in dignity. But this is not going to come without a struggle: in-dignation must grow from dignity being denied. Therefore, in order to eliminate the discrimination against them, women must forcefully advance the fostering of equality and of their rights.




8. In every-day terms, this means women have to fight for their right to more and better standards of living, for their sexual and reproductive rights, for their labor rights, for their right to participation and representation, as well as many other rights. What women do not want is that their achievements be measured by maternal mortality rates, by rates of violence** and of poverty only; much more is involved in their emancipation.


**: Keep in mind that there also is what is called symbolic violence against women defined as that form of violence that is perpetrated against women with their accepting it. (P. Bourdieu)




9. In last instance, using the HR framework, women seek to address the specific disadvantages and oppression that they face through discriminatory laws, policies, allocation of resources and many, many different ingrained practices of social institutions. Their empowerment entails a process of change towards them gaining greater control over their work, their mobility, their access to resources, their reproduction, their bodily integrity and their political participation.




10. The time has come to move away from the development debate focused on all encompassing growth –where marginalized groups grow invariably slower than the rich (and women amongst them slower than men!). (R.K. Murthy)




11. Let us all remember and ponder:  We are born into a world of privileged and under-privileged people, of powerful and powerless people, of a patriarchal system in which injustice is justice, a world where women exchange their right to equality for mere survival. (U. Baxi)




12. Patriarchy, and many different forms of women ‘belonging’, so widespread in the East and the West, the North and the South causes mostly women (but also men), as said, to exchange their right to equality for what is mere survival. This, in an attempt to feel safe and protected in situations where, too often, injustice is the true pattern of the prevailing system of justice. (S. Koenig)




13. As a matter of fact, gender equality needs to be understood and practiced as something that increases the size of the pie. By this I mean that gender equality is not a zero sum game; the path to equality should not be one that takes from men and gives to women until the two positions are equally constrained. Gender equality is about creating conditions where both men and women have the ability to realize their full human potential and HR. Too often, men think that the gains of women come at their expense. This is simply not true and such thinking is a real barrier to genuine progress.  The case for gender equality needs to be –and is– a mutually beneficial story.




14. Agreeing with the poet Jerome Koenig, I contend that governments must protect women, certainly no less than what they protect corporations. Does that not make sense to you? Is it in any way acceptable that values governing states bend to special interests and do not address social imperatives?




15. Bottom line: Women are fighting back. Yes. But what we mostly see in the battles women have slowly won is not yet peace between women and men, but only a truce. (A. Rossi)




Claudio Schuftan, Ho Chi Minh City






-I can think of a number of reasons for gender discrimination, but I cannot think of a good one. (J. Waterlow)


-A lot of powerful men still have much to learn from the dialogue of those who think differently on gender issues. (D. Panzeri)


-There is, of course, a need for an explicit focus on income inequality, however one should strongly disagree with any suggestion to subsume the current gender equality goal under a broader inequalities goal. A stand-alone goal on gender equality and women’s empowerment is indeed needed. (Gender and Development Network)


-Women who undertake ambitious enterprises ought to act as if they were already accomplished, and thus impose upon themselves a future as irrevocable as the past. (J. L. Borges) Remember: Life goes on and a lot of good and beautiful things still happen (even in women’s affairs). Never forget though that, often, the loveliest flowers grow in the dung heap. (David Werner)


-When are problems solved? Better sooner then later… While p’s are still small. (J. Koenig)



A party to celebrate Einstein’s ECHO clinic turning 15!

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In 1999 students at Albert Einstein College of Medicine created the ECHO clinic (Einstein Community Health Outreach) to provide free care in the Bronx.  The clinic, run in collaboration with the Institute for Family Health is now 15 years old and there will be a celebration on Thursday, February 13th, 2014.  All of the proceeds will be used to pay for referrals to specialty appointments and health screenings for our patients.

The clinic came at the beginning of a wave of free clinics created by New York City medical students and others who saw the unmet health needs of those without insurance. Sadly, the need for such clinics will continue under the Affordable Care Act which does not cover undocumented workers.

The clinic relies heavily on volunteers. Premedical students and volunteer faculty preceptors are always welcome.

Einstein is one of the only schools in the country that has its students rotate through the free clinic as part of their family medicine clerkship.  This unique component of Einstein’s clinical curriculum is critical in shaping socially conscious future physicians.  

To purchase a ticket or make a donation, please click here. Since the ECHO Free Clinic is a 501(c)3 non-profit organization, all donations are tax deductible.



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Food for a myth-buster thought


Human Rights Reader 330


The others “R” us.
Never forget we “R” them.
Human Rights “R” ours. (J. Koenig)


Actually, there is still much to do about nailing certain old and already stale myths in the human rights domain. Among them:


1. Not even waiting for the expected post-2015-push, our challenge is to concentrate our efforts on actively tackling disparity reduction rather than concentrate our efforts on poverty alleviation alone. (The cake is only so big; we have to slice it more fairly…).


2. Targeting interventions to ‘the poor’ is nothing but depersonalizing them and throwing at them a crumb of bread to feed them today. Targeting does nothing to address the structural determinants that perpetuate poverty, generation after generation, i.e., in thirty years we may still find ourselves ‘targeting the poor’…. (Please, also mind that it is not about ‘the poor’…it is about ‘those-being-rendered-poor’ by an unfair and unjust economic system with its clearly differential enjoyment of human rights (HR) and ultimately differential exposure to premature and preventable ill-health and deaths).*

*: Furthermore, the populations we purport to be ultimately serving are not really ‘vulnerable’; they are also rendered vulnerable by the same unfair and unjust economic system. The same is true for inequality; inequality is not our problem: it is the individuals/structures and forces that perpetuate inequality that are our problem. (V. Nabarro). In other words, looking at vulnerability this way points us towards identifying and addressing/opposing those forces, individuals and institutions responsible for it.


3. In our work in HR, our challenge thus really goes beyond tackling the social determinants of, for instance, preventable ill-health and malnutrition; the challenge rather is about tackling the social determination of the grossly unfair differential enjoyment of HR. (The latter concept points us much more directly towards the structural social, economic and political determinants really at the base of HR violations as seen worldwide).


4. A lot is being said about HR-sensitive interventions. For us HR activists, this is a deliberate way to water-down the more precise language of the HR-based framework. I ask: Do we need the (softened) new term ‘HR-sensitive’?


5. Also, much is said about safety nets and targeting, i.e., zeroing-in on the most affected (at great cost) and, as said, ‘throwing them a crumb of bread’ (or ‘giving them a fish to feed themselves for a day’**) without changing the structures of the system that perpetuates their condition of ‘most affected’. Targeting is only ethically tenable if, concomitantly, we put in place drastic measures to address the structural causes of the unfair economic system.

**: Teaching them to fish to feed themselves, as is so often repeated, is not a solution either …as long as those who control the lake where to go fishing are those vested with economic interests they resist to relinquish…


6. Given the magnitude of the problems at hand, shouldn’t we then be making a difference in our daily work between what is only interesting and what is really important? That is, aren’t the trees not letting many of us see the forest?  Is it enough for us to contribute to solving the myriad problems of, again in my example, ill-health and/or malnutrition by just doing what we do everyday? Or isn’t it? New commitments are needed (beyond the so often pushed multidisciplinary/multisectoral approach) to resolve said problems; we cannot disregard the political implications of what really needs to be done: political we must become if we are to avoid the doom scenario that lies before us and threatens our common future.


7. How much does each one of us have to realign her/his priorities? We always need to keep in mind that much of what we each do, day-in-day-out, may be necessary, but is it really sufficient? For instance, to solve the global problem of malnutrition, shouldn’t we be playing a more proactive vocal role in opposing commodities-futures-markets that set prices of commodities to the whims of speculators? Or, to more forcefully oppose agricultural subsidies in the rich world?  Additionally, are we forceful enough to demand a switch in our emphasis from food security to food sovereignty as an emerging competing and more correct concept? Or, will we pay more attention and act on the important issue of land grabbing? We cannot fail to address these issues. Everything technical we get involved-in fades in the light of these macro constraints.


8. Be mindful that the delaying tactic that undecided or opposed decision-makers (or many of us as well) more often than not use is to call for yet another task force or committee to ‘further study’ the issue(s) at hand.


9. The era of recommendations that start with “The government should…” is finished. The pertinent questions are: What will I do? What will you do? What will we do? What will the government actually do? The era of nice documents and nice declarations without ‘teeth’ is also finished.


10. With the UN having already accepted HR as the kingpin of the post-2015 agenda, it baffles me how little we –in the development community– are collectively acting on this needed change-of-paradigm so far. I here make an impassionate call for colleagues to become more HR literate. HR learning is an imperative!…at  a massive scale.


11. Furthermore, we must face it: the era of addressing Basic Human Needs has also come to an end; we live in the era of development as a human right and that forces us to focus our attention on the violation of HR the world over and on the role of empowering claim holders and duty bearers to get rid of these violations. Will the post-215 debate finally center around this accordingly? If this is to happen, we all have to play an active role in it. Period.


Some important calls


12. Because of the above, the challenge for the post-2015 agenda is not really to set yet new outcome indicators or goals to track either progress or regression.  In the era of development-as-a-human-right, the much more important focus is to be on process indicators being achieved progressively and ultimately leading towards the desired HR outcomes. (This was a big shortcoming of the MDGs).


13. The implication of this is that, post-2015, all countries should be called to prepare long-term progressive realization of HR plans in all areas; plans that specify annual benchmarks that need to be achieved to be ‘on course’. The latter can/should be monitored by watchdog civil society organizations so as to keep governments on track and accountable. This is the core of the change of paradigm we need.


14. Already these days, we hear and read too much from prophets of the post-2015 development agenda that I feel are preaching nothing but a ‘politics of the extreme center’….and this is not what we need given the cumulative evidence we are exposed-to about the multiple threats to our common future.


15. Again and again we are reminded that the problems we face are complex and multidimensional; so, calls are made for what?: for further research. This is not helpful at this point as so much of the evidence is already in. These are times of action. Details can be solved on-the-go.


16. Complex or not complex, we-have-what-we-have and we are all expected to come up with solutions. I am afraid the solutions needed will have to go quite a bit beyond the politics of the extreme center. What this implies, I will leave to you to figure out. But for us, HR activists, the challenges and needed lines of action are clear.  Let the time not escape, for yesterday was the time to act!  (Don’t our deliberations these days give you a slight sense of deja-vu?).


17. Calls are being made to feed our planned actions into the governmental process. Fair enough. But what about making concrete suggestions on how to feed into the myriad grassroots processes the world over? It is this that will bring us back to the centrality of adopting the HR framework and will bring us back to what metrics to select –a metrics more skewed towards process and participation indicators showing us the way to the progressive realization of HR. Therein lies the needed change of paradigm.


18. Reaching a ‘common vision’, as so often is called for, is in last instance an ideological problem. We are not primarily dealing with an inter-sectoral or multidisciplinary problem; sectors called-on to collaborate that have individuals with a conservative ideology will come up with conservative technocratic solutions.  Am I very wrong?


19. Therefore, in the next 12 months, we must hold honest discussions and negotiations not only on the substantial technical issues, but also on the substantial political issues of our future development agenda. Anything short of this will …I leave it up to you to complete the sentence.


20. Last but not least, we do not really need the myriad justifications given of why health, nutrition, education, water… are important, because they improve productivity or educational performance. They are all important, because they are undeniable human rights. Period. They are all more an ethical and a political imperative, not a foremost economic imperative. We need not search for more justifications and fall prey to the game of the politics of the extreme center. That is the change of paradigm we need.


Claudio Schuftan, Ho Chi Minh City



Debate 1/14/2014: “Single payer is the best way to achieve universal health coverage in the U.S.

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Health Policy Debate

Tuesday, January 14 at the Price Center Le Frak Auditorium, Albert Einstein College of Medicine, Bronx, New York

Motion: “Single payer is the best way to achieve universal health coverage in the U.S.”

The debate will be moderated by Dr. Patricia (Tia) Powell.
Wine, cheese and heroes will be available in the Block Pavilion (right outside of LeFrak Auditorium) at 6:30pm.  The debate will kick off at 7pm.

Dr. Peter Carmel MD Former AMA president;Professor in the Department of Neurological Surgery at NJ Medical School
Dr. Oliver Fein MD, Former PNHP President; Professor of Clinical Medicine and Public Health, Weill Cornell Medical College
Dr. Alieta Eck, MD Former president of Association of American Physicians and Surgeons; Co-founder, Zarephath Health Center
Dr. Mary O’ Brien, MD Faculty at Columbia College of Physicians; Surgeons and co-author of the book “10 Excellent Reasons for National Healthcare.”