The Social Medicine Portal

HUMAN RIGHTS EMBRACE THE NON-ECONOMIC DIMENSIONS OF DEVELOPMENT. THEY PROMOTE AND CONSOLIDATE SOCIAL SOLIDARITY. THEY ARE NOT A DISPLAY WINDOW; THEY ENTAIL A DISTINCT PROGRAM, A FULL-BLOWN MOVEMENT.

Human Rights Reader 247

HUMAN RIGHTS EMBRACE THE NON-ECONOMIC DIMENSIONS OF DEVELOPMENT*. THEY PROMOTE AND CONSOLIDATE SOCIAL SOLIDARITY. THEY ARE NOT A DISPLAY WINDOW; THEY ENTAIL A DISTINCT PROGRAM, A FULL-BLOWN MOVEMENT. (P. Drucker)

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*: The truth is that there are no purely or primarily economic solutions to human rights problems.

-Human rights is an unapologetic project for social emancipation in which suffering is related to powerlessness and freedom to living in dignity. (A. Yamin)

-A dose of religious altruism, of non-religious generosity and just a vague adherence to human rights will simply not be able to overturn the current mal-development paradigm.

-It is the shifting from needs to socially and legally guaranteed entitlements, and from charity to duty and to dignity that underpins human rights work. (A. Donald, S. Koenig)

1. For each of us human rights activists, the challenge is: How can the rules of the new human rights (HR) movement replace our routine? Innovations are fiercely resisted by some of our peers, precisely because they redefine the rules they are comfortable operating under.

2. At present, these peers rather try to bring attention to ‘their’ story and present sufficient arguments to defend ‘their’ role in the fight against poverty –and eventually against injustice. What we want them to understand is that the HR-based framework de-facto unites them/unites us! (P. Develtere)

3. In the hands of only a few of us activists, the HR-based approach (HRBA) is limited and not endlessly elastic –and its implementation will only reach so far. This is why this Reader is a perennial recruiter of new strategic allies.

4. In our hands, HR interventions pursue equity, equality and ultimately social justice.  But most governments are not at all (or sufficiently) motivated (yet) to pursue the same by reasons that are linked to their simplistic or misguided (or absent) HR thinking. Therefore, only a handful of these governments have set up accountability mechanisms to protect HR.

5. We are thus left with the fact that it is the actual functioning of contemporary societies that does not facilitate the job of those of us who are seeking to tackle and defuse HR violations.*

*: I am often left to wonder: Do states ratify HR treaties gambling on the fact that they will experience little pressure to comply with them?

6. Despite this difficulty, and because the strategies of the oppressors are becoming more evident by the day, we have to move forward swiftly and be inflexible about the fundamental tenets of HR.

7. Fortunately, HR is no longer the missing word from many a UN meeting or negotiation; after initial neglect, HR have made their way onto the respective agendas. Yes, more and more, HR are being invoked to justify a variety of fundamental claims; yes, they are playing an increasingly important role in shaping public policies. But does that mean that HR (with their specific claims of individuals on governments) are  moving to center stage right along power politics? (P. Farmer)  Not really, I would say, even if HR are embodied in legal instruments which are formally binding on States.

The stark reality is that people with the least power to contest the denial of their rights are constrained in their ability to enjoy those rights, precisely because they do not participate in shaping public policy.

8. Although not yet center stage, the HR-based framework, for instance as applied to health, makes explicit reference to HR from the outset of its assessment of the health situation; it does not only name the relevance of human rights in retrospect; it does not use HR standards and principles as a way of naming violations after they have occurred, but as a way of preventing violations from occurring in the first place.

9. As we have said many times, the HR-based framework is based on international HR standards (i.e., desirable outcomes); it recognizes claim holders and duty bearers; it focuses on discriminated and marginalized groups; it aims at the progressive achievement of all HR; it gives equal importance to the outcomes and to the processes of development; and it upholds HR principles (i.e., criteria for the HR processes to be set in motion, namely, indivisibility, inter-relatedness, non-discrimination, participation, accountability, transparency, human dignity, rule of law, equality). **

**:  Do keep in mind though: Human rights do allow diversity, but not inequality.

10. Ultimately, when using the HR-based approach (HRBA), we both observe and judge; we both present and contest evidence; we both apply morality and legality! (D. Tarantola, U. Jonsson)

11. Some say that we are sowing-in-the-ocean as we try to introduce the HRBA. But it is by considering the political economy as a whole, that the HRBA shapes more meaningful, indeed not utopian, interventions. *** (J. Bourdon)

***: As a matter of fact, the HRBA is stern with those who get stuck in old dogmas.

12. As HR activists, we thus have to act differently depending whether our recommendations are being either ignored, contested or eventually mainstreamed. (Health Insights, IDS, Issue 78, Oct 2009)

13. Bottom line, despite all the difficulties, we can neither loose hope nor the desire to find a rational solution to the HR problems at hand. New ideas, cultural restlessness and new world visions are often born simultaneously in various places…and this is reassuring. In HR work, what we need is to build and to share a true intellectual and ideological armour –transcending borders.

Claudio Schuftan, Ho Chi Minh City

cschuftan@phmovement.org

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Partially adapted from Development in Practice; D+C, 36:2, Oct.2009; and A. Gomez, Tiempo de Descuento, Editorial El Fin de la Noche, Buenos Aires, 2009.

HUMAN RIGHTS ARE ABOUT PEOPLE BEING IN CONTROL OF THEIR CHOICES. (A. Yamin)

Food for a negotiated thought

Human Rights Reader 246

-Ultimately, by using the human rights-based framework, we strive to negotiate a new social contract                                                                or class compromise from a position of strength and power.  (T. Schrecker)

1. The process of globalization with its progressive accumulation of economic and political capital sees human rights (HR) as a threat, because the HR-based approach (HRBA) emerges as an alternative to neoliberalism by focusing on divergent and rival imperatives and justifications.  Conversely, the HRBA sees neoliberalism as a threat, as an economic system out of control, as bringing uncertainty, as dependency-creating, as excluding. It sees it bringing about fear, aggression, fundamentalism, as well as creating ever-expanding spaces for private interests. Despite all these self-serving attributes, neoliberalism survives as the dominant way of thinking in development. Its economists push more for individual rights (e.g., property), for limited state activity and for a free-wheeling market; they say the poor are responsible for their own poverty. (Development in Practice)  Put another way, hidden in the unacceptable current social differences and social injustices is the neoliberal economic model with much money, much poverty, much silence, much omission, much disdain, much disillusion.

2. Often, there is at least an implicit complicity of rich donor countries in opposing HR activists; they argue that they rather focus on issues of bad governance in poor countries –which often ends up being more cosmetic than substantive (if not unrealistic).  We counter-argue that political outcomes are not only determined by the interaction between content matters (policy) and institutional structures (polity), but by raw political interests (often post-colonial interests in the case of donors). We all know that:

• in policy circles, concepts tend to be discussed a lot, but they rarely become implemented in reality, and
• the crux of the matter remains one where those that have the power to define what poverty is, also have the power to define its causes and thus to decide what solutions to implement.*

* : Ideologically, rich countries act as if only the small cut-out they make of reality is the real valid one; they deny other dimensions of reality –in our case, the way the HRBA sees things. (L. Weinstein)

3. In opposing this latest manifestation of Capitalism-gone-to-extremes, what is missing is an integration of the multiple international HR obligations in the process of negotiating, among other, debt relief and free trade agreements. Existing arrangements are the result of poorly negotiated either multilateral or bilateral compromises. There is an asymmetry in the bargaining power that rich and poor countries bring to these negotiations.  It is thus urgent to carry out HR impact assessments in the contexts of debt and trade, especially its effects on women and on other vulnerable groups. (T. Schrecker)  Additionally, we must confront the unequal structure of representation within government, i.e., the intra-governmental distribution of power.

4. In other words, globalization, unequal representation, free-wheeling markets, dependency, the neoliberal economic model, the debt crisis, and international free trade agreements all limit national HR policy space. So, we simply have to ensure that HR priorities are not compromised by these agreements. But are we doing this…? (M. Koivusalo)

5. So, here is the deal: If one carries out a class analysis, one can determine who really benefits; if one analyzes the power relations involved, one can determine who is in control; and if one analyzes the exact role of the state, one can determine who is accountable.

6. You see? In HR work, when mapping the big picture, one already identifies the points that will require social pressure, that will require aligning interests, identifying champions, and going for early wins to reach key tipping points; …one also ponders the social cost of delaying key decisions.

Claudio Schuftan, Ho Chi Minh City

cschuftan@phmovement.org

Partially adapted from L. Weinstein, Ed. Multiversidad, Editorial Universidad Bolivariana, Coleccion Nuevos Paradigmas, Santiago, Chile, Mayo 2009; FAQs about the HRBA to Development, Sida, 2009; The Broker, Issue 16, October 2009; D+C, 36:5, May 2009; and Globalization and Health: Pathways, Evidence and policy, R. Labonte, T. Schrecker, C. Packer and V. Runnels Eds, Routledge Books, 2009.

HAVING RIGHTS DOES NOT PRESUPPOSE A SIMULTANEOUS ABILITY TO CLAIM THEM.

Food for a ratified yet non-realized thought

Human Rights Reader 245

HAVING RIGHTS DOES NOT PRESUPPOSE A SIMULTANEOUS ABILITY TO CLAIM THEM.

-There is a clear difference between having a right and having a right realized. Slaves in the US had the right to freedom before President Lincoln and native Africans in South Africa had the right to freedom before Apartheid was abolished.

-If a country (state party) has ratified a treaty, individuals move from being just right-holders to being claim-holders –with valid claims on others, i.e., the correlative duty-bearers. This forms a ‘claim-duty pattern’ in society, in which the state, most often, is the ultimate duty-bearer. (U. Jonsson)

1. Ratification is a binding act in international law. The extent to which human rights (HR) can be enforced through litigation acknowledges that: they must indeed be taken seriously. But we are all aware that court verdicts are not self-executing; popular mobilization is still essential to overcome state resistance to implement such judgments. Implementing entities responsible for the adoption and actual implementation of HR policies indeed too often enjoy unwarranted impunity. (T. Schrecker)

2. We are also aware that most countries cannot change decades-long (or centuries-long?) situations of HR violations overnight. The answer is to come up with indicators that tell us a country’s readiness to accelerate action on the progressive realization of specific HR*. We can then classify countries according to this readiness after a HR impact assessment is carried out (even if a quick one). (SCN News No. 37, early 2009)  This readiness should be measured as a function of both the government’s commitment and its capacity. Commitment corresponds to willingness to act at scale (with commensurate allocation of resources). Capacity corresponds to a country’s ability to act at scale (i.e., available staff, institutions, training opportunities). (C. Nishida)

*: It is the UN Economic, Social and Cultural Rights (ESCR) Committee that has the role as the ultimate arbiter in determining what progressive-realization-of-HR-measures are deemed appropriate, i.e., their being implemented in a reasonable short time frame; the steps being sufficiently deliberate, concrete and targeted so as to meet the respective HR obligations in default. The evidence they look for to point in that direction are: legislation passed, judicial remedies applied, and social measures or policies adopted.

3. Traditionally, capacity has been equated with training, but the HR-based framework has expanded the concept to encompass acceptance-of-responsibility to meet a set of respective duties, namely

• to have the authority to do so,
• to have the access-to and control-over the economic, human and organizational resources necessary to meet the respective HR obligations,
• to have the capacity to communicate and the capability to make rational decisions, and
• to have the capacity to use the human rights-based framework in monitoring and evaluating development projects. (U. Jonsson)

4. It is regrettable that, as countries try to (or pretend to) enforce internationally recognized Economic, Social and Cultural Rights (be reminded that the US signed, but never ratified the ESCR covenant)**,

they often fail

• to give the necessary weighted attention to the currently ongoing violations of ESCR in their midst,
• to make reference to the absence of ad-hoc legal remedies,
• to pinpoint clear, specific obligations of duty bearers,
• to critically review trade and taxation policies negatively affecting ESCR,
• to address women’s rights issues***,
• to question why disempowered segments of society do not have the right to be heard****, and
• to give due attention to issues of accountability, non-discrimination, full participation and empowerment –while they tend to focus instead on recommendations that attempt to fix or to set-up social protection nets which carry a high risk of excluding many of those most in need. (FIAN)

**  :    Note, importantly, that it was due to the Cold War dispute that we ended up with two separate covenants. Civil and Political Rights, and Economic, Social and Cultural Rights. There is no formal reason for this otherwise. (U. Jonsson)

*** :   For instance, the realization of  the women’s right to health requires the removal of all barriers interfering with access to health services, to education and to information –including sexual and reproductive health and contraception. Mind you, the obligation of not discriminating against women also requires very specific measures to redress gender inequality overall.

****: The system we are trying to change is one that keeps people silenced –not even asking questions; one that keeps the judged from judging, and keeps individuals from joining together. (E. Galeano)

5. Bottom line here is that, without the monitoring by the UN Human Rights Council***** (i.e., without any follow-up), the UN Human Rights Strategy carries the risk of contributing more to the problem than to the solution of HR violations, because it would denote a UN Strategy with ‘no teeth’. (A. Paasch, Contact, WCC, Issue 186, Nov 2008)

*****: The Human Rights Council, in existence since 2007, is made up of 47 states. It takes a broad overview on human rights issues. It is the successor to the earlier Commission on Human Rights. In contrast, the Committee on ESCR is a committee of experts, acting in their personal capacity. It oversees implementation of ICESCR.

Progressive realization and priority setting:

6. Human rights activists do not like to address the issue of choice and priority, because all rights are indivisible and interrelated, i.e., each and all of them are inherent to human dignity. There cannot be any hierarchy of rights and thus, strictly speaking, rights should not be prioritized. But because resources are limited, development programming simply requires prioritization.

7. So, in HR programming, one can indeed think of incremental solutions –provided they are arrived-at through participatory methods, i.e.,  the prioritization should be done with full participation of, at least, the relevant claim-holders. Outsiders’ should not decide on priorities of any kind! What we can and must prioritize are actions that will contribute to the realization of rights currently not upheld. (UNICEF) ******

******: We note though that minimum or core human rights are part of what Amartya Sen calls ‘moral-global-minima’ and are thus not part of this discussion. As per the ESCR Committee, failure to satisfy minimum core obligations imposes a fairly strict burden on states to justify their non-action or compliance.

8. Therefore, the fact that all human rights should be accorded the same respect does not preclude priority setting during the planning and programming process.

9. Bottom line here is that actions for development must be prioritized in any development approach, because resources are always limited. But no priorities should be set out-of-context, a-priori, or ‘in-general’. Better still, prioritization should be the result of a negotiation between claim-holders and duty-bearers in a participatory manner. (U. Jonsson)

Claudio Schuftan, Ho Chi Minh City

cschuftan@phmovement.org

WHEN YOU DREAM ABOUT HUMAN RIGHTS ALONE, IT IS JUST A DREAM; WHEN YOU DREAM WITH OTHERS, IT PRE-EMPTS REALITY

Food for a preemptive thought

Human Rights Reader 244

WHEN YOU DREAM ABOUT HUMAN RIGHTS ALONE, IT IS JUST A DREAM; WHEN YOU DREAM WITH OTHERS, IT PRE-EMPTS REALITY. (R. Pereira G.)

-Martin Luther King did not say “I have a nightmare”. (L. Stoddard)

-Our future may be beyond our vision, but not beyond our control. (Senator Edward M. Kennedy)

1. History is not a good predictor of the future. Our institutions and our ethics come from a different historical era and have not yet been updated to knit together a globally stable society. (J. Sachs)  So I’d say that, for human rights (HR), we can safely conclude we find ourselves at a watershed of history.

2. Moreover, since in politics one should never let a serious crisis go to waste, this is the (belated) time to take bold steps. It is not by pushing for more control, more purity of intentions or more money that deepening HR violations will be avoided; to pretend being able to do more through these ‘pushes’ is to commit a sin of ignorance. (N. Boesen)

3. But is there the needed sense of urgency to take the necessary much bolder steps? If so, who feels it and who does not? Who cares about the serious HR problems affecting us the world over? Only a creative anger about the world crisis we have just lived through will lead to a renewed commitment to work towards change in the HR direction.*

*: In the realm of taking such a direction, the question then is: Does this mark a paradigm shift or is it mainly happening on the fringes of the mainstream paradigm? (We want to make sure it is shift!).

4. Unfortunately, still much is needed to more decisively embark in the HR direction: Without HR expertise**, “we are flying blind into a complex and harrowing future” –and that is a challenge. (J. Sachs)  Without a vision, our efforts will likely be little more than a pipe dream.***

**  : The challenge here is: Can people be made to care about HR if they do not already? People and systems need to be ready for change. Change happens through learning and learning happens only when people decide they want to learn.

***: The question is: Whose vision are we talking about here? The wider the gap between the vision of the outside interveners and that of the local people, the more unlikely it will be to achieve lasting results.

5. HR activists are well aware that the HR-based framework goes against the grain of the current uncaring system; but ‘our’ system is fragmented and an ‘international HR community’ does not really exist yet; therein lies the second challenge to embark-on in the HR direction: much networking and coalition-building is still needed. Currently, the international community lacks an appropriate framework and influence to guide HR interventions aimed at changing the structures and processes within a country, as well as at changing individuals’ perceptions and values related to HR. It is such a framework that is needed to contribute to individuals asking the right questions thus making interventions more effective. (J. de Lange)

6. One of the catch-phrases of recent years has been that we should use ‘existing mechanisms’ to solve problems rather than using new ones; this, to us, is a recklessly reactionary point of view. The dominant paradigm has had at its core a horrible simplification of what poverty reduction entails. It has been mixed with an arrogant belief that money and good intentions can fix the problems. Sadly, this has been said for years, with little to show for.

7. Current efforts are simply not serving Poverty Reduction goals; they actually never have been –if we consider the real need to rather be Disparity Reduction. So, in the case of foreign aid, for instance, (i.e., elite-driven processes between international actors and local elites) stop being concerned about the amount of aid as if it matters; what really matters is the social, political, institutional and environmental challenges that aid is willing to tackle.

8. In HR work, this Reader has repeatedly insisted, direct support to the realization of HR in essence entails a power struggle.  Since, through pressure, powerful interests can change their positions and fast action can ensue, herein lies the third challenge, one pointing towards social mobilization to stake long overdue claims. **** The challenge here is to translate the ‘whats’ and ‘hows’ we see happening into practical guidelines for people working in countries where HR violations are rife.

****: Because those who hold property and assets from the outset largely shape policy and market outcomes, market forces need to be confronted through politics, social ethics and a strong and vibrant civil society. (P.H. May)

9. Far from being Machiavellian, HR activists see the world in terms of power, conflict and interests. (Even Margaret Thatcher was of the opinion that we do not have neighbors as much as rivals). That is why they bring all their arguments together to use them in a political process of negotiation *****; for that, they build coalitions for change. Sooner or later resistance to the changes they propose emerge; some groups will oppose them. That is why being strategic is better than being haphazard and why it is important to know when to act and when not to, as well as why it is important to move forward incrementally trying out what works, and ensuring inclusiveness in the political mobilization.

*****: The political nature of the HR struggle becomes clear when we realize how very far from podiums and negotiation tables real HR experts are.

10. Bottom line, the conflicts we face cannot be resolved simply by doing transfers, but imply a fundamental rethinking of the precepts of HR, of equality, of equity and of social justice.

Claudio Schuftan, Ho Chi Minh City

cschuftan@phmovement.org

A reminder: All HR Readers can be found in www.humaninfo.org/aviva under No.69.

Mostly adapted from The Broker, Issue 18, February 2010.

WE ARE REALLY IN CLOUD CUCKOOLAND IF WE ACCEPT THAT NEOLIBERALISM IS A BENIGN SOCIAL IDEA THAT BACKS THE HUMAN RIGHTS FRAMEWORK. (Theodore MacDonald)

SOCIAL MEDICINE AS A PRAXIS IS PROFOUNDLY LINKED TO THE PRAXIS OF EMANCIPATORY HUMAN RIGHTS.

Food for an emancipatory thought

Human Rights Reader 242

Time was when we could; we’ve come to the time we can; we do not want to come to a time when we’re out of options. (adapted from Haiku #1533, J. Koenig).

1. As HR activists working in health, we face a double challenge. We must work for fundamental economic, social and political changes underlying what we know as the social determinant of health and, at the same time, we must work on changes in the specific field of health where additional localized resistance (often by doctors) is to be reckoned with. We thus need to set-up networks –not forgetting the health workers, organized or not– to integrate our health and our human rights (HR) aims in what will inevitably become a political challenge. (As this Reader has repeatedly said, HR are a powerful idea which should be spread, starting with concerted efforts to launch more and more HR learning activities).

2. Actually, it is the HR-based framework that contains the powerful ideas; ideas that are at odds and counter neoliberal ideology, ideas that are a counter-power to the prevailing market forces –and, let’s face it,  that is why the spreading of the HR idea is opposed. The powers-that-be fear HR as they entail an emancipatory praxis, a praxis that eventually is a counter-hegemonic force against globalization. The HR-based framework legitimizes power in the hands of claim holders, away from male, adult, middle and upper-class property owners. In so doing, the HR framework confers on rights holders a legitimate claim on the resources necessary to fulfill specific HR –and that is feared. HR are ultimately the legal expression of a collective will –and that is feared. Moreover, the HR-based framework prioritizes dignity and solidarity over accumulation, over competition, and over the market, as well as the inclusion of environmental rights –and that is feared. (I think I am not being harsh in my analysis here; I am just calling a spade, a spade).

3. A ‘decent minimum’ cannot be set on inalienable human rights. There is thus no such a thing as ‘basic rights’ or ‘low intensity human rights’ (the latter seeming to be what is, at most, acceptable to the powers-that-be as they relentlessly foster the process of globalization with its ‘low intensity democracies’ the world over). (B. de Souza)*

*: Fact: Strong democracies encourage claim holders and shield them from drastic reprisals. (T. Schrecker)

4. “Things have a price,” says Emmanuel Kant, “but man, in contrast, has dignity”. Things that have a price are interchangeable, can be sold, and/or can be used as tools. Human dignity, on the other hand, implies that human life is an end in itself, irreplaceable and never exchangeable; it cannot be made into an object or thing, and it cannot serve as an instrument or a commodity. Dignity is violated when something associated with life acquires commodity status and becomes –either directly or indirectly– an object of profit; we see this all the time in processes that subordinate life (and nature) to the interests of accumulation: health is regrettably no exception.

5. Capitalism has made health too much into an economic concern. The right to maintain and restore health (mostly the latter) thus became dependent on a business, and a new corresponding morality came into being with it –and for HR, as much as for social medicine, this has become a nemesis, an issue central to their respective raisons d’etre.

6. Some feel that the emphasis on individual rights (as sanctioned by UN human rights treaties) has created an obstacle for social medicine which is all about collective or community rights. **

**: Allow me an unorthodox metaphor here. Conventional wisdom would suggest that ‘In HR work, the I is a We or it is not at all; united, we are part of a choir; outside it, our music is atonal’. (C. Fuentes)  But then, conventional wisdom can sometimes be wrong…

7. In the unequal societies of Capitalism, health policies have medicalized health problems; we all know that much. The human right to health (RTH) presupposes a right to the non-medicalization of life –since medicalization is inherent to the commodification of health. (That has made health a topic of what has become known as bio-politics). The RTH arose within the context of the social welfare state, true; so it is, in principle, since then that the RTH fell in the realm of bio-politics. But real action to defuse the many violations of this right and to start staking claims against pertinent duty bearers took a good 40 or more years to gain momentum.

8. Take, for instance, the 1993 World Bank’s World Report which was devoted to health; it has guided most of the neoliberal reforms we find today all over the world –and it was conspicuously silent-on and did not even mention the RTH. Instead, we got DALYs. DALYs legitimized the denial of access to services essential for survival to those unable to pay for them. We were thus left with the damage and with the social exclusion that has resulted from our planners using this neoliberal WB indicator to measure progress.

9. But back to social medicine as a praxis linked to the praxis of human rights: Its strong egalitarian emphasis is one of the most important reasons to consider HR as central to efforts to advance health equity. (T. Schrecker) In other words, HR-based action on health is essential for health equity. Yet, still today, this action is more often talked about than practiced.

10. Since changes in health will only come about by collective action (M. Marmot),  at the community level –given appropriate and ample HR learning opportunities– the HR-based approach creates the prospect to innovate and to implement new ways of addressing the-processes-of-health-disease-and-care in a collective, mutually supportive manner. Therefore, as borrowed from the concept of food sovereignty, health sovereignty has come to mean communities themselves deciding what they need and want.

11. Bottom line, the introduction of HR not only preordains how public health work is to be done (i.e., processes), but also what its ultimate outcome should be in terms of dignity and solidarity. (D. Tarantola)

Claudio Schuftan, Ho Chi Minh City

cschuftan@phmovement.org

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Mostly adapted from A. Stolkiner, Human rights and the right to health in Latinamerica: the two faces of one powerful idea, Social Medicine, 5:1, 2010.

ONLY WHERE AND WHEN HUMAN RIGHTS ARE RESPECTED CAN WE SPEAK OF DEMOCRACY BEING STABLE.

Food for a resounding majority thought

Human Rights Reader 241
 
The human rights framework provides a normative base for poverty reduction, while democracy organizes political and social life to this end. (Sida)
1. Ratification of UN Covenants and Conventions (has not) and does not require(d) any type of democracy. Actually, the reasons for why so many non-democratic countries have ratified many UN treaties include:
·      gaining international legitimacy;
·      attracting donor funding; and
·      having accepted them with Reservations (which is when states accept most of the text of a covenant, but with some reservations).
Although ratification of a UN Convention is legally binding, there is no real enforcement mechanism, especially if there are no active monitoring bodies (which a true democratic regime calls for). (U. Jonsson)
 
2. In their ODA, more often than not, donors fund recipient countries to focus primarily on human rights standards (i.e., on desirable outcomes –classically these days the MDGs*); human rights standards do not require democracy. In their aid, these same donors conveniently overlook their recipients’ adherence to human rights principles (i.e., the required criteria for human rights-based processes to be set in motion on a solid base); human rights principles do require a working democracy for their enforcement. This is a crucial point to keep in mind.
*: A single-issue-focus is applied to the achievement of each individual MDG –without due attention being paid-to through which processes each goal is to be achieved. Moreover, no attention is paid to whether the same are rights-based processes –as mandated by UN covenants and as clearly stated in the Millennium Declaration where the MDGs actually come from! (U. Jonsson and  D+C, 35:6, June 2008).  
 
3. The mere fact that elections are held, does not mean that democratic rules are firmly in place. Actually, the representative institutions of so-called-democracies are widely perceived as being controlled  by the dominant economic and financial groups in society. (V. Navarro) So, democracy is not only about elections –and not even a tradition of uninterrupted ‘free’ elections means there is democracy…or that human rights (HR) are respected.
 
4. Would a jobless family from Marseille, Frankfurt or Antwerp have any reason to swap places with a family in Managua, Phnom Penh or Nairobi? Probably not. Put the question the other way around, and the answer is quite likely yes. The reason is not just that France, Germany or Belgium are richer than Nicaragua, Kampuchia or Kenya. But, within its confines, democracy in Europe works better. *
*: On the other hand, look at the OECD countries: With all their democracy, they have, at best, been lukewarm towards HR violations in poor countries. 
 
5. People who happen to be poor can only be given guarantees they can assert their rights where states pass laws that protect HR and that ultimately enforce and observe them. Democracy is thus not simply a function of voting; it is a matter of HR as well –and this is mostly forgotten. A true democracy secures physical and economic access to all social services with no discrimination and implements fair rules of compensation for HR violations.
 
6. Even in so-called democratic countries, many times the bureaucracy is too hierarchical**, is arrogant, aloof, despondent, dismissive, arbitrary and corrupt in its behavior… and does not care for HR –being absolutely ignorant about HR standards and principles. (One often wonders if civil servants really give a damn…).*** What we find is that civil servants have different levels of moral standards and work ethic.
**:   Thinking loud, one wonders, would organizing the civil service in trade unions change their culture of blind obedience?
***: Administrations have to serve society and not themselves, right? But too often we see them using the law to make arbitrary decisions –not in the direction or interest of HR.
 
7. Many societies function along the lines of patronage systems –where who you know matters more than what you know. This is one reason why bureaucracies should not just be seen as a machine –they are an important, but unpredictable component of any governing system and are thus not to be taken for granted.
 
8. Under this guise, would it seem somehow patriotic to subvert a bureaucracy uncaring about HR…? In our eyes, a good public administration is to serve development and to provide impetus to the implementation of the HR-based framework.
 
9. So, to what a position does all of this lead us? The problem with democracy is that organized greed always wins over disorganized egalitarianism. We thus either need more checks and balances on the greed (but that requires challenging the power of the greedy) or we need to strengthen the organization and the mobilization of the ‘egalitarians’ (which also requires challenging power). So, no easy solutions, leaving us to do what needs to be done perhaps in small steps (…?). (L. London)
 
10. Ergo, can the current world political structure be “reformed”? It is run by the rich and powerful and they are not going to voluntarily cede their privilege, are they? **** It is acknowledged that there is always a tension between reformism and revolution –and that cannot be resolved by this Reader. Our role is to point to the most progressive solution to the political problems we have inherited in the 21st century. (M. Anderson)
****: Do not dismiss it lightly: i) Democracy is seen as an obstacle, a barrier to the operation and the unbridled ambitions of neoliberalism. (T. McDonald), and ii) Dictators are the proxy facade of the owners of the wealth.
 
11. This leaves us with the question: In this context, what are HR activists to do? We will promote a firm pro-democracy stand with an unmistaken HR base! We will use HR as a decisive contribution to a bottom-centered-direct-democracy! *****  
*****: Direct democracy is the collective action that has historically allowed poor and excluded groups to make their voices heard; it is a way in which the condition of being relatively powerless can become internalized and linked to the  ability to forcefully negotiate and influence decisions by actively engaging in the political system. (D. Green).
 
12. Bottom line: Knowledge about all of this alone, or democracy alone for that purpose, will not improve HR.  Already centuries ago, Francis Bacon, said that knowledge is power. But knowledge is not automatically followed by action. Strengthening capacity is important, but without power, it is not sufficient.
 
Claudio Schuftan, Ho Chi Minh City
cschuftan@phmovement.org 
______________
Partly adapted from D+C, 35:6, June 2008; D+C, 35:7-8, July/August 2008; D+C, 36:5, May 2009; The Broker, Issue 15, August 2009; The Broker, Issue 16, October 2009; L. Weinstein, Ed. Multiversidad, Editorial Universidad Bolivariana, Coleccion Nuevos Paradigmas, Santiago, Chile, Mayo 2009; and Development and Practice, 19:8, 2009.
 
Postscript: In the alleged ‘democratic discourse’, not all opinions affecting outcomes are backed by the same power. Am I thus being ‘HR-facetious’ if I paraphrase: “All opinions deserve the same respect” is a very harmful idea and falsely democratic. (Albino Gomez, Tiempo de Descuento, Editorial El Fin de la Noche, Buenos Aires, 2009).

THE DOZEN HATS WORN BY HUMAN RIGHTS ACTIVISTS.

Food for an eye opener thought

Human Rights Reader 240

Activists do not need to be original thinkers as much as they need to be original listeners.

They are not only witnesses, but doers, particularly social mobilizers.

1. As a starter, a random list of desirable attributes can be an eye opener.

Human rights activists are expected to be: agenda setters, catalysts, promoters, conveners, finders of seed money, collectors, disseminators, advocates, educators, linkers, sponsors, defenders, observers, judges, presenters of the proper and contesters of the faulty evidence, pushers of changes-people-can-believe-in (D. Gwatkin), visionaries that see tomorrow when others only see today, active opponents of corporations that violate social and environmental standards in their operations, vectors/promoters/ announcers of the new human rights (HR) paradigm…

2. But realistically, on the one hand, HR activists cannot be omnipresent –granted. So they have to opt to carry out certain roles more effectively and rule out other. (J. Cloke, Development in Practice) But on the other hand, HR activists do not usually operate in conventional give-and-take terms; they have an agenda in which some elements are non-negotiable: HR are non-negotiable.

3. Since there is no point any longer to abide by the several myths entrenched by the hegemonic Northern-led development paradigm (which still treats its perceptions as if they always were the product of objective facts), HR activists have to undo old hierarchies and undo myths that come from it. They also have to undo myths that come from the obsolete overseas development assistance (ODA) model that comes with it …a particularly odd model indeed (a remnant of colonialism?). The model reminds us of the absurd of a court allowing a thief to spend some more of the money he has stolen before passing sentence. (U. Avnery)]. 

6. HR activists have a big task in front of them: a task much deeper, more complex than a public visibility campaign; a task that is more than just the physical bringing together of likeminded people. They cannot lower their guard; they have to unlearn and change much of what they learned about how society works –since the glass is already full and they need to make room for new, HR-based concepts… Ergo, they cannot advance without being all-encompassing in their work, i.e., work with both  the powerful and with the still unorganized poor and marginalized people that have, for too long, been relegated to (…or opted to?) live in a state of resignation. It is for activists to raise consciousness thus widening the scope of people’s alternatives, opening a whole new cosmo-vision to which they need to be introduced-to.

7. HR are obviously a global theme, but less obvious is the fact that HR are ultimately a theme that is resolved at the individual and community level –at the conscience of each individual and member of that community. Thus the important priority role of HR activists in pioneering human rights learning.

8. When faced with a given reality, HR activists have to ponder the action alternatives that that reality calls for; but these actions become viable and sustainable only when the-more-global-scenario is taken into consideration; it is the latter that opens the doors for the mobilization and solidarity work needed to bring about the switch to the new HR paradigm that will eventually lead to the concrete worldwide changes needed to effectively counter the relentless process of globalization with its negative HR consequences.*

*: A paradigm is somewhat similar to group-thinking, mindset or discourse, or an explanatory conceptual framework, or a world view or cosmo-vision. Paradigms lead to thinking inside the box. (U. Jonsson)

9. An example of how the ‘bigger picture’ needs to be taken into account is here given for activists working in the field of health. In their case: 

• the WHO Constitution provides them with an overall umbrella of what the human right to health (RTH) is;
• the text of the  UN RTH and General Comment No.12 (#) –and, of course, HR standards (i.e., the desirable outcomes pursued as, for example, some of the MDGs) and HR principles (i.e., the required criteria for the HR-based processes to be set in motion: indivisibility, inter-relatedness, universality of HR, respect of human dignity, right to life and to development, equality, rule of law, non-discrimination, empowering participation, accountability) — are the documents that provide them with the advocacy and the political framework for their activism;
• the principles of comprehensive primary health care (PHC), as set in the 1978 Alma Ata Declaration (consistent with HR standards), acquaint them with the basics on health care and with the basic and underlying social determinants of ill-health, malnutrition and preventable deaths;
• WHO’s Report on the Social Determinants of Health (SDH) provides them with guidance to assess both HR violations and the effectiveness (or not) of ongoing interventions to reverse those violations.

The knowledge generated by these documents points them to what issues need addressing in each specific locality. Therefore, everything they do in their work in health must incorporate these four elements. A campaign for the RTH has thus to integrate these elements when focusing on the ‘HR-worthiness’ of existing health systems. In short, RTH work must tap into the ongoing global efforts to drastically change health systems using the human right to health as a framework. (L. Turiano) **

**: These are also the four legs on which the People’s Health Movement Charter for Health stands, and the basis of PHM’s Global Right to Health Care campaign. (www.phmovement.org)

10. As can be gathered, in general, it is HR activists that come from the non-academic sphere that have to play the greater protagonists’ role. Among all other roles, they also have to expose local leaders (or academics…) that speak of programs, needs and injustices but, in their speeches, writings or actions, rarely address what is behind HR violations.

11. Bottom line, we expect HR activists to be competent directors who oversee the putting into action a collectively arrived-at, well-written script. It is for the players though to act-out that script as the main protagonists. ***

***: Caveat: The power to act is different from the ability to act; in an effort to achieve results, we often give responsibilities to individuals and/or institutions with the ability  –and not with the power– to act. (U. Jonsson) This is at the very core of the HR-based framework, namely, activists’ work with claim holders and duty bearers is to precisely go from the ability to the power to make needed changes.

Claudio Schuftan, Ho Chi Minh City

cschuftan@phmovement.org  

______________

A few aspects adapted from Aravind Adiga, The White Tiger, Free Press, N. Y., 2008; L. Weinstein, Ed. Multiversidad, Editorial Universidad Bolivariana, Coleccion Nuevos Paradigmas, Santiago, Chile, Mayo 2009; and D+C, Vol.36, No.9. Sept. 2009.

Postscript: Remember! You may be small, but if the light is positioned right, you cast a long shadow.

(#):General Comment 1, Reporting by States parties.

General Comment 2, International technical assistance measures.

General Comment 3, The nature of States parties’ obligations.

General Comment 4, The right to adequate housing.

General Comment No. 5, Persons with disabilities.

General Comment No. 6, The economic, social and cultural rights of older persons.

General Comment 7, Forced evictions, and the right to adequate housing.

General Comment 8, The relationship between economic sanctions and respect for economic, social and cultural rights.

General Comment 9, The domestic application of the Covenant.

General Comment 10, The role of national human rights institutions in the protection of economic, social and cultural rights.

General Comment 11, Plans of action for primary education.

General Comment 12, Right to adequate food.

General Comment 13, The right to education.

General Comment 14, The right to the highest attainable standard of health.

General Comment 15, The right to water.

General Comment 16, The equal right of men and women to the enjoyment of all economic, social and cultural  rights.

General Comment 17, The right of everyone to benefit from the protection of the moral and material interests resulting from any scientific, literary or artistic production of which he or she is the author.

General Comment 18, The equal right of men and women to the enjoyment of all economic, social and cultural.
General Comment 19, The right to social security (art. 9) (Thirty-ninth session, 2007), U.N. Doc. E/C.12/GC/19 (2008).
General Comment No. 20, Non-Discrimination in Economic, Social and Cultural Rights.

HAVE YOU ASKED YOURSELF: WHERE IS THE POLITICS IN POLITICAL WILL?

Food for the politics of a thought

Human Rights Reader 239

Politics often is the art of knowing how to choose between two      equally bad, unpopular measures. (R. Aron)

In politics, the power of the purse is the most undemocratic power of all.

In this Reader, we often refer to the politics-of-it-all in human rights (HR) work. From a general perspective, it is fitting we explore what lies beneath the surface:

1. In front of my own eyes and over the years, the ideas and political allegiances of many of my friends and teachers have changed much –not always for the better. Therefore, frankly, I do not feel any guilt anymore when I have become an activist for the cause I strongly believe in. For too long, soft, reformist, band-aid approaches have led us nowhere on HR issues. Sixty years after we should have, belatedly adopting the HR framework without a political plan, to me, risks simply more of the same.

2. In my adult life, development work has, pretty much, swung to the right (…and away from HR principles) so that it does not take a real effort to link immorality with some of the politics behind the neoliberal principles being applied. As it stands, neoliberal parlance continues to be the default language among development policy makers. * (W. Bello)

*: A fair caveat would be: In left-wing politics, one can also build a successful career full of empty promises and cozy accommodations.

3. It is the system in neoliberalism that we mainly object to, primarily the ideological identity and course-of-action adopted by its proponents and implementers. More pointedly, the real underlying associated question is not primarily whether the system works, but for whom it works. (J. Blaylock)

4. In our effort to re-embed the economy in society –instead of having society driven by the economy– it is the “social invoice” or the “social legacy” of the rulers-that-happen-to-be-in-charge what we look-at in HR work. (K. Polanyi) We simply cannot let lifelong politicians and rulers-on-duty come to tell us stories any more…It is facts that count –in our case, facts about HR violations. **

**: Be reminded here that the common belief of all tyrants is that they are the quintessence of the country they rule over.

5. Politicians are prone to twist reality to fit their needs, aren’t they?: “Find me some scientists that share my views”, we may find them asking for. (South African ex-president Mbeki rings a bell here…). But recommendations from such scientists risk being theoretical and having an ideological conservative undertone. ***

***: To be clear: Ideology does not entail cognitive distortions of reality, as some claim. It rather shapes the moral judgment on what pattern of wealth distribution is fair. It influences peoples’ perceptions about that which is fair and, therefore, about HR. (A. Alesina) Take, for instance, the language increasingly used in health: “purchasing or buying services for clients” and tell me if that does not have a clear ideological undertone.

6. We do not often enough address and denounce the rhetoric-action-gap of our leaders, the gap where those-who-decide-over-HR-issues do not take needed decisions or take the wrong decisions; this, because we probably fear questioning or challenging the power of their political position. (U. Jonsson) So that is why we say that HR work is about reconsidering the fundamentals of decision making.

7. What we ought to be asking is: What are the vested interests of decision-making individuals? What are the political constraints they face? What is the hidden process of informal politics behind the façade of good intentions?

8. Bottom line, in HR work we are faced with the challenge of starting changes while still trapped in a system that is skeptical about (if not outright opposed to) HR-friendly needed changes. It is not ‘politics or policies’; it is ‘politics and policies’ (or politics as manifested in policies). **** (V. Navarro)

****: Often overlooked is the fact that pro-HR policies must not be overridden by policies on trade and commerce or by any action that will cement existing power structures which, let’s be clear, are the main source of HR violations.

9. Moreover, because international organizations find it difficult to be confrontational, they often also end up being complacent on HR issues. Their capacity and willingness to address the issues of structural inequality behind flagrant HR violations face-on is limited at best. As much as we as individuals should be doing, these organizations simply need to wield their economic and political clout (which individuals do not have) as a means to contest these social injustices.

10. Globally, the current powers-that-be pay only lip service to the concept of social justice. The leadership of the global political system ‘somehow’ still has a HR-blind-spot: An unlucky coincidence? or An inconvenient truth? The global political discourse is replete with clichéed references to HR and to the role the international ‘global community’ should play in the international HR arena. But we all know that these references are made only as utopian ideals. (R. Labonte)

11. Most importantly, the term ‘political will’ (or lack thereof) is another one of those clichés frequently used. Suffice it to say: It is utterly superficial and ultimately meaningless; it is ultimately used as an evasive euphemism (i.e., a term used in place of a term that might be considered too direct, harsh, unpleasant or offensive). Be honest: We use ‘lack of political will’ when, with a sigh of relief, we shift the responsibility of doing something for HR to someone else, don’t we? That is why it is so popular (or fashionable). Political will really is about the obligations of states. Making no choices is a choice! (A-E. Birn) It is like saying: “I said maybe! …and that’s final”. Political will does not fall from the sky. It has to trickle up/permeate upwards from society. (A, Shukla).  Political will is expecting something from top-down when it is bottom-up accountability in a political struggle that we are really after in applying the HR framework! But political struggle (e.g., labor solidarity,  community activism, and work on redistributive reforms with social-justice-oriented political parties. (R. Luxemburg)) is never mentioned as central in the process of doing away with HR violations. (A-E. Birn)

12. Not presuming that this vast topic is hereby closed, perhaps a fitting closing remark here is: One cannot be a pessimist and hope that, in the end, everything will turn out OK. What this means to each of you, I leave up to your interpretation.

Claudio Schuftan, Ho Chi Minh City

cschuftan@phmovement.org

______

Partly taken and adapted from Bryce Echenique, Permiso para Sentir, Editoria Planeta, Buenos Aires, 2005; Contact, WCC, Issue 186, Nov., 2008; Aravind Adiga, The White Tiger, Free Press, N. Y., 2008; D+C, Vol.36, No.5, May 2009; D+C  Vol.36, No.9, Sept. 2009; The Broker, Issue 16, October 2009; Development in Practice Vol.19, No.8, November 2009; R. Labonte, T. Schrecker, C. Packer and V. Runnels Eds, Globalization and Health: Pathways, Evidence and Policy, Routledge Books, 2009.

Postscript: Words do carry political weight. Once released into the world, they have a life of their own. Unlike dogs, they cannot be called back. (U. Avnery)

IRON LAWS ABOUT PARTICIPATION IN THE CONTEXT OF HUMAN RIGHTS WORK.

Food for a thought elites will have to abide by

 Human Rights Reader 238

 - If the people will lead, the leaders will follow. (M.  Gandhi)

- Changes in human rights are hardly ever achieved in a simple straightforward way –they bring about interior power struggles and resistance which need to be dealt with people’s counter-power. (F. Holtmeier) It is thus people’s counter-power that has to create demand for change.   

- In human rights work, participation is not about pointing our fingers, but about raising our hands to be counted. (S. Koenig)

I have gathered many statements about participation and empowerment (by far not all my own) that I think qualify for the status of ‘iron laws’ in our human rights (HR) work. Here they are:

1. Participation is not just a consultation process; we understand it as an empowerment process. (Reminiscent of the principle of magnetic resonance, empowering participation seeks ‘social resonance’).

2. People need outlets to voice their complaints about the injustices and HR violations they are subjected to.*

*: For instance, community-based health committees attached to health facilities should be able to hold doctors and health staff accountable and, if necessary, request they be replaced.  (P. de Vos)

3. In HR work, we must guarantee that the voice of those whose HR are being violated is heeded. But it is not only having voice: It is getting to the position of having influence.

4. The challenge of actually ‘taking part’, is thus ultimately the challenge ‘to be counted’. Ergo, making decisions is what makes people’s participation effective; only then can their informed participation be used to counter- power.

5. Civil society definitely has the capacity of making the arrangements for participation to become empowering. The power gained is to make a measurable difference in public service provision as service providers are to be made accountable at multiple local levels. (G. Kendra)

6. Since laws and policies are mostly instruments for the arbitrary discharge of office holders’ power to make solo decisions (rather than a means to help hold these officials accountable), the prevalent local notions of the HR-fairness-of-laws-and-policies can only be changed by engaging the active participation of local communities. It is them who have to proactively demand laws, policies and regulations be changed, be scrapped or be put in place to make sure they are fair in a HR sense. (In this process, using the pertinent UN Covenants and General Comments should be the basis).**

**: In defusing HR violations , new/amended laws will, most probably, be necessary to define new duties and obligations of institutions and of actors. As HR workers, the problem we face is the current lack of a moral-political framework for solving social justice- and HR-related problems. (H.P. Ruger); the introduction and widespread dissemination of such a framework will have to antecede actual legal work –hence the importance of HR learning.

7. The difference between participation and empowering participation is the latter’s explicit orientation towards social and political change.***

***: We note that, for instance, the World Bank-hijacked concept of empowerment does not consider increasing the capacity of individuals to make their own choices in relation to the actions and outcomes they long for.

8. The HR-based approach (HRBA) actually evolved from the concept of empowerment. It adds to the concept of empowerment the attributes of being entitled to the universal-right-to-seek-accountability through varied mechanisms and of having equal-rights-to-claim, to-demand-and-to-seek-redress. (P. de Vos) 

9. The type of empowering participation the HR framework fosters starts with claim holders understanding how final decisions are made (who? when? using what criteria?)

10. In empowering participation, calls for fairness that do not, early on, name who-is (i.e., the pertinent duty bearers) and what-the-forces-are behind the perpetuation of inequities and HR violations, are not really empowering. (A-E. Birn)

11. Achieving an empowering participation in the HR sense is ultimately going to be a block-by-block, household-by-household seven-days-a-week job.

12. Empowering participation processes are not cost-free; they need sustained funding. Moreover, keep in mind that empowerment processes are not linear; they evolve in quantum leaps.

13. When fostering empowering participation in HR work, we will face both contingent and organizational barriers that will attempt to prevent us from introducing the HR framework as the basis of our work.****

****: In the health professions, the biomedical training students get fosters hierarchical attitudes that act as further barriers to participatory approaches. (L. Morgan)

14. To tackle the organizational barriers, we have to start by identifying what impacts and worries people so as to link and translate those worries to concrete violations as related to the precise wording of UN HR covenants’ clauses.

15. Also early-on in empowering participation, it is necessary to talk about the ‘HR debt’ of governments and about the need for a change of paradigm that introducing the HR framework is all about. (M. Ovalle) 

16. Thereafter, still using the HR framework, the sequence of activities to follow will be: to inform, to educate, to empower, to set an agenda and to mobilize.

17. Genuine people’s empowering participation is that in which the most disadvantaged social classes and groups –those underrepresented in society– are duly represented in leadership; only this ensures the active engagement of marginalized and discriminated groups in gathering and achieving the needed  counter-power. (Caveat: This representation does not automatically decrease the risks of paternalism, patriarchy and bureaucratic overpowering).

18. As regards adapting women’s participation to make it empowering, you will have to read between the lines…since there rarely are more than a couple lines in conventional development plans when it comes to women’s issues. (I. Allende)

19. Participatory-Budget-Analysis, Participatory-Village-level-Social-Auditing and Citizens-Report-Cards are relatively new working tools with immense potential in HR work.

20. Monitoring is also an activity to be made participative; it entails embarking, jointly with beneficiaries, on monitoring the overall direction in which development interventions are being steered, their performance, the processes being applied and, last but not least, the outcomes.

21. Bottom line, empowering participation fosters enough collective strength to influence power relations. Ultimately, the process seeks to challenge the powers-that-be responsible for the status-quo of which HR violations are  part and parcel.

22. Genuine people’s participatory processes also beg for solidarity. Solidarity work is a) to be seen as a further political and HR task that supports the development of a strong democratic citizenry, and b) to be used to support, replicate and multiply citizens organizations and to mobilize them around HR principles so that a wide HR movement can be consolidated.

23. HR work thus capitalizes on the ethical sense of solidarity as it promotes a new image of a fair and just society by opening the doors to a new reflection about the transformative power of the application of the HR framework.  And finally,

24. Since there are a host of new possibilities for political participation and solidarity, internet communications have become an important political factor in HR work –a factor to reckon with and to take advantage-of.

Claudio Schuftan, Ho Chi Minh City

cschuftan@phmovement.org   

______

Partly taken and adapted from D+C 36:2, Feb 2009; D+C, 36:5, May 2009; H. Potts, Participation and the Right to the highest attainable standard of health, HR Centre, University of Essex, 2008; Campania 2007 por el derecho a la salud en Uruguay, diciembre 2008; and L. Weinstein, Ed. Multiversidad, Editorial Universidad Bolivariana, Coleccion Nuevos Paradigmas, Santiago, Chile, Mayo 2009.