This course is offered through SocMed, an organization that advocates for and implements global health curricula founded on the study of social medicine. By engaging medical students though careful examination of the social and economic contexts of health and immersing them in partnership with a diverse group of students from around the world, we aim to foster innovative leaders who are ready to tackle challenging health problems in communities around the world.

SocMed utilizes a curriculum that places great importance on building personal partnerships and encouraging students to reflect upon their personal experiences with power, privilege, race, class, gender, and sexual orientation as central to effective partnership building in global health. In the spirit of praxis (a model of education that combines critical reflection with action) these components of the course give students the opportunity to discern their role in global health and social medicine through facilitated, in-depth conversations with core faculty and student colleagues. Please feel free to visit our website, www.socmedglobal.org, for more information about the course, to view the course prospectus and application, its directors and guest lecturers, and SocMed. We have attached the 2013 Course Prospectus to this posting below for your convenience. Applications are due by June 30, 2012.

Please do not hesitate to contact us with any questions you have at inquiries@socmedglobal.org

Sincerely,

Michael Westerhaus, MD, MA
Amy Finnegan, Ph.D.
Course Directors

Foood for an allergizing thought

Human Rights Reader 288

-It seems our peers have an allergy to enforcing   human rights accountability. (J. Alday)

-To be effective, accountability needs to be demanded; therefore, effective mechanisms to demand accountability are badly needed. Are we fostering such mechanisms?

1. Monitoring and evaluation (M&E) both serve accountability purposes, but must be directed towards human rights standards and principles if they are to have even a chance to improve the human rights (HR) situation. (So beware: Monitoring does not automatically lead to demanding accountability!). In HR work this means we need to foster bottom-up monitoring systems. Examples of the same are: citizens report cards, social audits, HR impact assessments, public hearings and active complaints mechanisms plus direct interaction between service users and providers. All these empower poor and marginalized citizens and make the needed naming and shaming possible. If this is not achieved, accountability risks becoming just another development buzzword. (The Broker)

2. As this Reader has said many times, the human rights-based framework emphasizes both processes and outcomes; it draws attention to marginalized populations; it works towards equitable service delivery; it extends and deepens people’s rights; it ensures local ownership of the development process and, last but not least, strengthens the accountability of all actors by addressing the common weaknesses of the accountability systems.

3. HR work departs from the premise that the process of demanding accountability improves fiscal transparency towards HR in good part through independent civil society organizations keeping a vigilant eye. * There are thus obvious links between transparency, accountability and participation. In last instance, implementing effective accountability measures involves challenging the state. As a result, accountability measures also transform the state.

*: Human rights accountability is actually more than the purely civil-society and popular movements accountability described here though. It is also to include accountability demanded by parliamentary committees, ombudsmen and national human rights institutions.

4. As a corollary, HR work insists that the socially marginalized must muster collective power to carry out autonomous accountability checks through collective action –action that ultimately pursues shifting the existing power balance between state and society.

5. At the end of the day, mobilization for accountability must lead to the building of coalitions between the marginalized social actors and allies to be found both within and outside government. (J. Fox)

6. Note that, procedurally speaking, accountability greatly benefits from having data as disaggregated as possible so as to establish reasonable benchmarks for those-in-any-way-marginalized and thus measuring progress. (One can actually think of setting up and following something like an ‘Index of Fulfilled HR Obligations and Commitments’).

The idea that economic, social and cultural rights (ESCR), as a whole category, are not fit for judicial adjudication is seriously misguided.

7. Apparent obstacles-to and difficulties-with* justiciability, as one of the important alternative accountability mechanisms, equally affect ESCR and civil and political rights. But such difficulties have never deterred the international community to seek justiciability for violated civil and political rights. The question is: Have national and international actors to an equal extent sought justiciability for ESCR?

*: Real difficulties can be overcome, it is only the imaginary difficulties that are unconquerable…

8. Massive and serious HR violations perpetrated by political authorities (be it by commission or by omission) do indeed require firm judicial interventions in order to (re)establish the rule of law (nationally) and/or the rule of international HR law.

9. But let me be clear here: Justiciability is not the only means of enforcing ESCR. A great number of the tasks required for the full realization of ESCR depend primarily on actions by the executive and legislative branches of the State.

10. Denying judicial intervention in the realm of HR seriously reduces the remedies victims of economic, social and cultural rights violations can claim. ** It also weakens the accountability of the State and erodes deterrence, consequently perpetuating impunity for ESCR violations.

**Be reminded here that ESCR litigation can also refer to collective grievances and can demand collective remedies.

11. Furthermore, international and regional experiences can offer valuable arguments and examples to help overcome prejudices in those jurisdictions where there are still limitations on the possibility of enforcing ESCR through litigation. Both domestic and international good practices in this field have shown to be mutually reinforcing.

12. The ways in which civil and political and economic, social and cultural rights are intertwined and interact with one another makes it impossible to declare the latter category non-justiciable without undermining the protections granted by both categories of rights (actually artificially classified separately!).

13. Evidence shows that ESCR claims have many times played a constructive role in promoting more inclusive and responsive policies and programs. Some of these have saved thousands of lives.

14. But let us be realistic: In the context of, for example, widespread hunger and homelessness in both affluent and impoverished countries, the number of ESCR cases brought to court may seem quite insignificant. *** Clearly, resolving the justiciability debate will not solve the systemic poverty and social exclusion that are the primary causes of ESCR violations. What is cause for hope are the signs of a newly invigorated court adjudications for HR cases at the domestic, regional and international levels. After too many years of delay, we are beginning to see the emergence of fair hearings into violations of all human rights, not just a selective few. These developments reflect the emergence of a new human rights movement that is more and more fully inclusive of those whose dignity, security and equality is assaulted by poverty, homelessness, hunger or violations of other economic, social and cultural rights. (A. Nolan, B. Porter and M. Langford)

*: Note that, while judicial redress systems seem to work best in Latin America, they

are largely lacking in most African, Asian and Middle-Eastern countries.

15. Bottom line here then is that concerns about the justiciability of ESCR are thus generally ill-conceived and run contrary to an already sizeable positive experience.

Corporate Social Accountability vs Corporate Social Responsibility

16. Because corporations use such a myriad of tactics to get away with ‘their way’ in, for instance, the realm of health, food and nutrition, demanding corporate accountability (and not only the so-far-mostly-toothless version of corporate responsibility!) is key to HR work. Why? To illustrate what I mean, let me give you some selected examples of strategies used by pharmaceutical, food and beverage corporations to get ‘their way’ in their daily business. They:

• Embark in public relations campaigns that emphasize consumers’ personal responsibility, moderation, free choice, and enjoyment.
• Use the government-versus-personal-freedom and the get-government-off-our-backs arguments.
• Vilify their critics, health advocates and public health and nutrition scientists as policing their actions and accusing them of seeking to impose a controlling state.
• Hire a public relations firm to develop and help carry out their plans to create a favorable image, to combat negative reports, or to repair damage to their credibility or image.
• Set up or fund ‘front groups’ with consumer-advocacy-sounding names to promote the corporate agenda and messages.
• Distort any science to divert the attention from the negative health effects of their products or practices to other matters.

They also:

• Publish journal articles and book chapters, make presentations at scientific meetings, host conferences and workshops for professionals that give the appearance of objective science in order to convey an image of credibility, but do not present the entire dataset, or misrepresent or distort data about the corporation’s harmful operations, products or policies.
• Pay scientists or physicians or other professionals to serve as spokespersons to represent the corporation’s position.
• Use their lobbying power to buy political influence, to gain a competitive advantage and to avoid or minimize regulation and taxation.
• Contribute funds to election campaigns of politicians in positions to influence legislation favorable to the corporation and to obtain favorable rulings from the judiciary.
• Participate as delegates in the policy-making or standard setting process to ensure the lowest or most lenient possible standards for corporate products and operations.
• Work to reduce government budgets for scientific, policy and regulatory activities deemed contrary to the corporations’ profits.
• Set up or fund foundations that support the corporations’ agendas rather than funding priorities determined through independent democratic processes.
• Externalize as many costs as possible (e.g., dumping chemicals into rivers or in Third World countries; not providing their employees medical coverage).
• Use assorted tricky legal and regulatory tactics.
• Work to get corporate officials or industry lobbyists appointed to government regulatory agencies with authority over its own industry.
• ‘Shop’ for alternative judiciary venues or levels of government when rulings or decisions are unfavorable to them.
• When deemed necessary to ensure profits, they even employ illegal means.
• Emphasize technological solutions to health problems mostly to generate profit.
• Use both direct advertising and indirect methods such as product placement and integration into the story line of entertainment products.
• Connect image of product or corporation with human emotions and values.
• Financial tactics they use include contributing funding to community and neighborhood organizations in order to create dependency, gain allies, and influence or manipulate the organization’s agenda. (D. Stuckler et al)

17 . Does more need to be said…? Does all this sound familiar to you? What this list does is to reinforce the need for our own tactics to select and use accountability mechanisms that confront face-on the shrewd operators that use the above tactics.

18. So, after all is said and done, as you see, the intention of this Reader is to reinforce our calls for pursuing all possible mechanisms to demand accountability in an effort to contribute to change the current balance of power between state, corporations and citizens –primarily towards the latter.

Claudio Schuftan in Ho Chi Minh City

cschuftan@phmovement.org

_____________

Adapted from UNFPA  A HRBA to Programming: Practical implementation manual and training materials, 2010; F+D 47:4, Dec. 2010; Courts and the Legal Enforcement of Economic, Social and Cultural Rights, Comparative experiences of justiciability.  International Commission of Jurists, Geneva, 2008; and D. Stuckler et al, Global Health Philanthropy and Institutional Relationships: How Should Conflicts of Interest Be Addressed? PLoS Medicine | www.plosmedicine.org 1 April 2011 | Volume 8 | Issue 4.

Postscript

Today’s Reader speaks the truth to power; it does not, for a moment, timidly ask the powerful to justify their truth to us. Actually, most Readers intend to make you uneasy, to shake state structures that have become too rigid, excluding and deformed; they attempt to be wake-up calls. (Ortega y Gasset)

This effort of mine to ‘moralize’ readers has gotten to me; I have now began to convince myself. (Facetiously quoting Charlie Chaplin)  But, seriously, what I really ask myself every time I send out a Reader is if all this is worth, if it helps at all; or will it either be deleted or stacked in a folder somewhere in your computer?

Joyce Wong, LCSW

Ousara Sophouk

Joyce Wong LCSW , Social Worker and Ousara Sophouk, Family Health Worker at the Montefiore Family Health Center were recently interviewed by Pete Pin for a photodocumentary project - Displaced:The Cambodian Diaspora through the Magnum Foundation Emergency Fund. Mr. Pin, a fellow at Magnum Foundation, spent 5 months last year taking photographs of the Cambodian Bronx community. Joyce and Ousara speak about their 20 years of experience serving the Southeast Asian community in the Bronx. A link to the interview and photographs can be found on the Emergency Fund’s website.

Here is the text of the interview:

In early November, 2011 Pete Pin, EF Fellow, spoke to Joyce Wong, a licensed clinical social worker, and Ousara Sophuok, a Cambodian family health worker who immigrated as a refugee from Cambodia in 1986. Joyce and Ousara work together at Montefiore Hospital in the Bronx, New York where they provide mental health services to the Cambodian and Vietnamese Bronx community.

PETE PIN: Can you describe the clinic and the work you do here in the Bronx?

JOYCE WONG: We have been providing out-patient mental health services for the last twenty years as part of a collaboration between the Department of Psychiatry and Family Medicine. We are part of an urban medical center but we actually modeled our program after the Harvard Program in Refugee Trauma who were pioneers in the identification and treatment of torture and mass violence. With the program, mental health care is integrated in a community healthcare setting as a truly collaborative model of care.

Cambodian refugees were resettled in the Bronx in the mid-1980′s and came to our clinic for healthcare. However, physicians were not equipped to deal with a lot of the medical and psychiatric problems the patients presented. Not only were medical problems associated with lack of access to medical care—as many refugees were living and languishing in refugee camps between five to ten years—but many patients suffered from psychiatric trauma from the Khmer Rouge Regime (1975-1979).

In the mid 1980′s, we partnered with the departments of psychiatry and family medicine at Montefiore and developed a collaboration with a small mental health program to attempt to address some of these problems. At that time non-governmental organizations, especially abroad, addressed the problems of food, clothes and shelter for persons who had undergone mass violence, trauma and natural disaster. But the NGOs did not usually address their mental health needs. My colleagues at Harvard were one of the first to conduct scientific research studies when Cambodian refugees were living in refugee camps in Thailand, and found that high levels of depression existed within the refugee camps. When the refugees were resettled here in the Bronx , the focus on the mental health care needs of refugees was very progressive for that time. It was a holistic approach. This was over twenty years ago.

But how do you present mental health to someone who does not have a western frame of reference or worldview? A lot of the work in the first years was getting to know the community and going out to the community because you’re not going to expect someone to come to your door even if they are living across the street from your clinic. We established a motto of “Eat, Work and Play”: eating with the community, working with the community, and playing with the community. It meant attending weddings we were invited to, attending important religious holidays at the local Buddhist temple, conducting home visits to get a sense of the social issues that the people in the community were facing, walking up and down Fordham Road in the Bronx.

PIN: Were there things unique about the Cambodian community in regards to their trauma and their history that compounded the difficulty of providing services and hindered their ability as individuals and a community to assimilate and to make that transition from the camps to America?

WONG: It was very difficult for Cambodians because during the genocide between one to three million people were killed from a population of seven million. Much of the educated population of Cambodia was killed. Many of the surviving Cambodians that were able to flee and escape to refugee camps were rice farmers who didn’t have high levels of literacy in their own language or education. In contrast, many other immigrant groups came from countries where there was a solid infrastructure, where there’s a high level of educational attainment, and this really influences their experiences when they come to the United States. It affects their ability to navigate in their new home country and what opportunities are available to them on a day to day. The refugees that came to the Bronx from Cambodia were already a disenfranchised community and further marginalized because they were resettled in a physically and economically distressed community. To compound this, not being able to read and write, not having access to resources because of the language was a barrier on all levels: education, work, and health.

PIN: Sarah can you discuss your work in the community and how you became involved in the clinic? It’s important to stress to readers that you are yourself a member of the Bronx Cambodian refugee community, that you immigrated here under the exact circumstances as the people you have been providing services to.

OUSARA SOPHUOK: Joyce Wong had mentioned that during the war a lot of educated individuals were killed and the majority of our patients, especially the ones that came for care at our clinic, didn’t have a lot of formal education, including myself. During the war I didn’t have a lot of education, I only finished a few years in school. I escaped to a refugee camp where I studied English for six months. When I arrived to New York there was a temple three blocks from this clinic I went to regularly. That’s how the community got together. I arrived 1986 and I went to the temple where they had a Cambodian women’s program where I studied English.

One day there was a person from Adelphi University who was recruiting people for training in human services and a job program. They wanted us to go for field placement. At that time I didn’t know what I wanted so I said, “I want to work on something that relates to the community and I can help people” although I could not even help myself at that point. It was what I wanted to do, so they said “Ok you can do your field placement at the temple.” When I was doing my field placement my English was not great and I was so nervous to be doing the work. Then I looked at the people that were going to the ESL class at the temple, and I realized I knew more English than them because I studied it in the refugee camp. I said to myself, “These community members need more help than I do.” That’s what gave me a lot of courage to go to school. I went to the training for six months and at the time when I graduated from the program they were looking to hire someone to work in the mental health clinic for Cambodian and Vietnamese refugees at Montefiore.

I grew up in a family that served the community, which is where my desire to help others comes from. My father used to be a Buddhist monk in the Bronx temple and we went to the temple all the time. We prayed and ate together there so I really knew the community before I started working here. Like Joyce had mentioned, we had to eat and play so I went to the temple and I recruited people. I explained to them what I was doing and the services we had here. The people trusted me because my father was the monk in the temple and people trusted him.

PIN: When you approached people to talk about the services here, how did you phrase it, how did you talk to people? You obviously played a very pivotal role in the outreach.

SOPHUOK: At that time it was very difficult to translate from English to Khmer. The word psychiatrist, psychiatry or mental health literally translates to “crazy.” It’s a very strong word so I used the word “emotional health.” Instead of physical health I said emotional health and I explained to them that we have the clinic here and the doctor will take care of your physical health and we will take care of your emotional health. You have to educate the people that emotional and physical is the same, that they’re very connected to each other. This is critical because we went through a lot of trauma during the war.

At first, it was difficult for people to understand. Traditionally we didn’t talk about mental health and our feelings; we always suppressed this during the war. You didn’t say anything during the war, you kept everything inside to survive; you acted as if you were dumb. There’s a Cambodian word a ting mong meaning a scarecrow on the farm. We called ourselves a ting mong because we acted as if we didn’t know anything. We hid our intelligence to survive.

WONG: The Khmer Rouge had a slogan: “To destroy you is no loss, to keep you is no gain.” If you’re constantly told that you’re not of any value and disposable, something happens to your psyche which has ramifications for survival at that time but also psychological consequences in the future.

PIN: Is this something that you see manifesting itself decades after?

WONG: It was a coping mechanism during the war for survival, but as you said it had repercussions for the future. The a ting mong mentality became so ingrained during the genocide and the refugee years, that even after immigrating to the U.S. many Cambodians continued to wear that cloak. If you don’t bring the trauma into consciousness, then it continues to manifest itself and weigh on you every day.

PIN: You carry the weight of that with you. For me I think that’s very critical, the residual affects of trauma; that’s something the academic and resettlement community doesn’t widely recognize. There hasn’t been a lot of work on residual trauma, and this perspective is brand new in regards to the need to provide holistic, culturally sensitive mental health services to refugees that takes into account their unique circumstances.

SOPHUOK: We had to get people to understand that the clinic was a very safe place to talk about our emotional health. I had to convince them that if they said something wrong here they were not going to get killed and that here in the clinic we take care of their emotional needs. And then the people started to open their minds a little bit and began to trust us. After a few years, the program expanded by word of mouth, the doctors, and self referrals.

PIN: Please describe the community within the first year or two here in the Bronx, how their experiences were, even your experience, during that transition in the first several years of resettlement?

SOPHUOK: It was very difficult even for myself. I encountered a lot of difficulties even though I spoke a little bit of English. It was very scary to go outside and it was very difficult to go somewhere because of the culture shock. The culture was different. The living situation was different. The first years were difficult because we couldn’t go anywhere. We were like children learning how to walk step by step. We learned how to walk block by block. At that time we could only go to the temple and a Cambodian store that opened in the community. So people were not able to take the train or bus to travel outside of the neighborhood. We were both scared to get lost and confined. I’m of course talking about myself—that I felt confined—but I know that other people felt confined too. Imagine the older Cambodians who didn’t speak English. The first year was very difficult. Even now there are a lot of Cambodians who are ill and remain confined.

PIN: Yes. A lot of people don’t realize this. When I talk outside the Cambodian community the usual response is “that’s just the immigrant story,” that it’s the normal transition for immigrants when they resettle. As if all these issues can be generalized for all immigrants. However, obviously there are very unique circumstances that are endogenous to the Cambodian community as a result of the specific historical circumstances of their displacement and the resultant demographic outcomes as a result of the genocide.

WONG: Exactly. And refugees are disproportionately affected because of the multiple past trauma events of undergoing a war and genocide. The average number of trauma events a Cambodian refugee has undergone is 16. From torture, starvation, separation of family and friends, witnessing of killing, rape, and slave labor. So it’s not just acculturation, but the refugee’s past traumas and the resulting possible psychiatric distress and disability. Furthermore, these refugees were situated in economically distressed communities.

PIN: Please talk about the outreach in terms of strategies you talked about; eat, work and play?

WONG: Like our colleagues at Harvard, our approaches were a little unconventional and off-the-beaten path in trying to recruit and present ourselves in a way that community members would trust us. That really meant getting out there in the community and talking to people. Advocating for social changes, injustices. Challenging slum landlords in housing court, accessing social services, creating art programs that community members could participate in to beautify there community. The best forums usually are established places or places of faith, which play a very large role in community members’ lives. As Sarah said we often visited the temple on major holidays, made home visits, and attended weddings, funerals, religious ceremonies. We have always had a big component of also providing social services to meet the psychosocial needs of the community. We’ve had the privilege of being here for twenty years so we have followed people through the lifecycle; many of the patients grew up with us. We have been there through their marriages, through having children, through having teenage children, pregnancies, domestic violence, alcoholism, poverty, discrimination, deportation, etc. We really have run through the gamut in regards to problems and scenarios that community members have faced.

But one thing I think was pivotal for us during our time here is the realization that although mental health is very important, it’s important to stress economic and social sustainability. That comes from building community and empowering it through self-determination. So our approach has always been holistic. It was crucial when we partnered with the Committee Against Anti-Asian Violence in the Bronx, a grassroot organization in New York in the mid 1990′s. I just felt that at some point maybe six years after we started providing services, doors were closing on our community members. I didn’t feel they were progressing socially or economically; not because they didn’t want to but because of lack of investment of the US government and other institutions. So we partnered with The Committee Against Anti-Asian Violencethrough their youth leadership development project to organize and advocate for economic, social and health justice on behalf of the refugee community. We began to organize the community around other issues such as welfare rights, education rights, immigration rights, language rights, and accessing comprehensive healthcare. Witnessing the community mobilizing themselves and taking action was a highlight of my career. It was liberating to actually see the community developing consciousness and building its confidence.

If you ask me, as you’ve said before “how is it different?” I would say old models of recovery aren’t really effective anymore, and the humanistic/holistic approach to recovery is crucial. I really do feel hopeful with our community. I’ve seen that people really can recover from mass trauma and violence and can live very productive lives and can begin to trust other people again.

PIN: How have your patients progressed over this life cycle?

WONG: It’s a reality that some things may never really go away. Patients and community members still suffer from major depression; they still suffer from post-traumatic stress disorder. It doesn’t go away. But even if you have these psychiatric conditions, you can learn how to cope and live a fulfilling rich life. That’s huge. And that gives me hope. Our patients can still enjoy life, can still have positive healthy relationships with other people; you don’t have to be so isolated. I tell them they are not experiencing these things because of bad karma but because they underwent genocide and that it’s a normal reaction to terrible horrific events. I think it’s very reassuring and relieving for suffering people.

PIN: Sarah, can you elaborate on that?

SOPHUOK: I just want to add a point – about patients learning to cope and learning the result of the war was no fault of their own.  For some patients with severe psychiatric problems, the process was very slow.  We had to work very hard period. We encouraged them to do things that relieve them of suffering such as exercising, walking daily, socializing at the Buddhist Temple, engaging in meaningful activities, being of service to others.

WONG: This patient Sarah is referring to goes to the gym two to three time a week.  This was somebody who was completely homebound and confined when we started treating her 15 years ago.  She was paralyzed with her story and with her pain.  So she’s still limited in many ways but now she feels she has some control over the quality of her life and pain.  She can do things for herself; she can lead a more productive life. For us, progress doesn’t always translate into a job and although we feel work is a great value, being productive could also mean going to the park three times a week to meet your friends, or going to the temple on a daily basis. All of these activities are of great value and have a lot of healing qualities.

PIN: Again, that’s one of the issues: the old models of treatment are limited to the idea of providing English instruction and jobs.

WONG: Yes, it’s short-term thinking and a residual form of social welfare.

PIN: Yes, and what’s great about this is the fact that you have been providing services for over twenty years and it remains an ongoing process. You have acknowledged the reality that severe trauma does not magically go away.

WONG: Yes, it doesn’t go away but the way they see their lives, and the way they live their lives can still change. They are survivors, not victims anymore.

PIN: There’s a generation of Cambodians who immigrated here as teenagers or children, who came here when they were 14 or 15 and started high school here in the Bronx, or like myself were born in refugee camps but were raised in the inner-city; their experiences are very different because of their age. For the young Cambodians I met in the Bronx—and I think this goes across the board for all Cambodian diaspora communities in America—they have experienced their own unique forms of trauma inherited from their parents and compounded by the social ills of the inner-city.

When we started this interview, I played an audio clip of a teen I photographed in the Bronx who was speaking about her experience in regards to her parent’s trauma. You can hear a hint of trauma in her voice. For me it’s very profound how trauma can be passed on generationally. This is something I see in my own life. Have you treated people like this?

WONG: Yes, definitely. Within the last year there was a young Cambodian woman in her thirties and she was severely tortured during the Khmer Rouge.

This particular woman is a single mother with a seven-year-old daughter. She is one of the more traumatized and depressed patients that I have seen in a long time. It was just so clear how her depression and post-traumatic stress was affecting her relationship with her daughter. The little girl was taking care of her mother. Her mother was usually very depressed, very angry, and not able to parent her daughter in a consistent way. When I would ask, “Are you able to cook for your daughter or spend time with your daughter” she would respond, “No, I buy Chinese food or my daughter cooks her own meals.” Her daughter was going to sleep after eleven o’clock because her mother was not able to set boundaries and limits. The daughter was put in the role of an adult and that clearly affected the mother’s ability to be a parent.

Most of our patients are on psychotropic medication because it decreases their flashbacks, depressive and anxiety symptoms. This has helped her. Once her symptoms were relieved a bit, we were able to start talking about the importance of creating a secure and loving attachment with her daughter. When you’re that depressed it’s difficult to have an understanding of how your mental health problems can or are affecting your child and make the necessary changes.

PIN: What is your assessment of the community now? You’ve told me that you feel very hopeful, can you elaborate on that?

SOPHUOK: I feel very hopeful because our patients have received services and medication to help relieve them of their symptoms from trauma. They can now participate in community organizations like the Committee Against Anti Asian Violence and Mekong. With community organizational support, plus the temple our clinic that makes me very hopeful for the future. But still we need more. We do not have enough services for our community, which limits our progress but we have been actively working on Mekong.

Joyce Wong: I just feel hopeful to hear Cambodian youth say, “We want to be in charge of our community, we want to promote culture and dignity and we want to heal our community.” This makes me feel very hopeful. With these ideas we began to envision Mekong an emerging organization in New York City that will serve Southeast Asians by trying to improve the quality of life through community organizing, promoting arts, culture, language, and social services. It is a holistic approach to community organizing. Since last year we have been working with CAAAV to transition the Youth Leadership Project into an independent organization after a community needs assessment of Southeast Asians was conducted by emerging local leadership. On March 29, 2012 we will officially launch Mekong and that is something to celebrate and embrace. I would like to think that I’ve contributed a little grain of sand that creates hope and power.

RESOURCES:

• Harvard Program in Refugee Trauma
• Committee Against Anti Asian Violence
• Mekong
• Magnum Foundation Emergency Fund

ABOUT THE EF FELLOWSHIP:

EF Fellows are recent photojournalism school graduates who work as editorial assistants for the Emergency Fund and simultaneously create New York City-based photo stories on a topics consistent with the EF mission to “address critical issues that have not received the attention they deserve, or budding crises that are still over the horizon.”

posted by: Matt Anderson, MD

Street medics are a community of health workers who are specifically trained to respond to the health needs of people at demonstrations, in progressive social movements, and at encampments.

Street medics are called upon to deal with a wide variety of illness and injury: crowd-control, chemical weapons decontamination, weather and temperature-related illness, altered mental status, sexual assault, and handcuff injuries, all in resource-scare, unsecured environments. Street medics also provide preventative care and public health promotion in protester encampments. Street medic care is ethical, empowering, and do-no harm.

Those who already have advanced first aid or medical training will want to take this course as we cover many topics that are specific to protest healthcare. People with no healthcare background will learn valuable skills that can be used anywhere, not just at protests. In this highly participatory training, you will learn to use your skills in complex, high-tension, low-resource situations. Expect to have fun!

Location: Manhattan. Address and subway information emailed upon registration.

Cost: $50 with a sliding scale. No one will be turned away for lack of funds. Please explain your needs when registering. Payment in the form of cash or check can be made on the first day of training on May 19th.

For registration info, please email streetmedicnyc@gmail.com.

If you have further questions, please contact streetmedicnyc@gmail.com for more information.

Instructors from Common Ground Health Clinic, Latino Health Outreach Project, Medical Activists of New York, Black Cross Health Collective, Mutual Aid Street Medics, Katuah Earth First!, Mutual Aid Disaster Relief in Haiti, Mountain Justice 2005 Medics, and The Union of Palestinian Medical Relief Committees (Ramallah).

posted by: Matt Anderson, MD

Human Rights Reader 287

-Je participe, tu participes, il participe, nous participons….. ils profittent. (1968 Paris Revolution poster)

-For human rights processes to be truly participatory, representation has to be timely, truly active, free and meaningful, i.e., “you come; you buy the land; you make a plan, you build the house…and now you ask me what color I want for the walls of the kitchen?” is not really participation.

-For human rights, participation is both a means and a goal. (Stamford Common Understanding)

1. Oppressed people that lack the capacity for collective action are historically doomed. That is where empowerment comes-in in human rights (HR) work. Actually, for us, the very meaning of participation is empowerment. It pursues a significant input in decision making processes rather than mere consultation. In our case, among other, empowerment implies that, to make progress, claim holders have to use tools such as legal* and political action, i.e., we see participation as exercising a painstakingly earned political right. As someone said, the problem is that: “Part of being powerless is that people are always speaking on our behalf”. Are we those “people”…?

*: Seeking a redress for HR violations, access to justice and justiciability constitutes one of the tools for strengthening community empowerment initiatives; another is organizing the de-facto, vocal expression of community demands through active mobilization.

2. As the Occupy Movement around the world has shown, the voices of protest become insignificant and devoid of power when they are contradicted by the media and the computers of officialdom (…and of the secret service). As Amartya Sen rightfully reminded us, some of the real progress that has happened in recent years has come from public discussion –and from agitation.

3. From a HR perspective, a country can be doing well or bad. But in order to be doing well it has to want to do well. Do most countries want to do well? I have my doubts. If they do not really want to (beyond the lip service of their too often undemocratic leaders), it shows, because community efforts in them are thwarted and vanish before becoming a-political-force-to-reckon-with. Social cohesion, pragmatic solidarity across social classes and ultimately moral and political power are key ingredients to see change materialize in any society.

Participation as exercising a political right

4. To exercise this right, the new form of participation we foster in HR work is not ‘reactively-problem-oriented’, but ‘proactively-solution-oriented’.

5. As mostly applied at present, participation has been ‘fetishized’ and applied reactively, blinding its potential to foster needed structural changes. But when powerful enough to be heard, the collective voices of people can make themselves heard, can reform local institutions and can open access to wider avenues of action. So, how power is negotiated and finally allocated provides either incentives or disincentives for social actors either to become involved or remain apathetic. ** Let us not forget that self-supporting empowering participation begets further participation.

**: Let us also not confuse tolerance with indifference here; they are distinctly different; tolerance is the product of  a choice (that can be changed) to coexist with what is eminently unfair.

6. So, as you can gather, I am here talking about active and meaningful participation –not token, not just bringing-in the strongest groups among the marginalized.

7. Finally here, be very clear that, when fostering real grassroots participation, one cannot overlook the need to accommodate to poor people’s time availability (poverty of time); it may be necessary to compensate poor community members for their time spent in participating (with food, small per-diems or sitting allowances). Participation and representation do not simply come about on their own; they have a cost and, therefore. require some funding.

A critique of ourselves is overdue:

8. Whether local people open their mouths or not has not mattered much since, so far, we have quite routinely not considered them. Be honest: we do not really take them into account. (We too often have the tendency to want to teach others too much, no?). The worst is that we often are not even aware of local people’s quite desperate plight, so we do what we normally do –over and over again. Sorry, but this is akin to post-colonial arrogance.  Moreover, if we accept the position of the government, we are in practice, more often than not, turning against the plight of the most marginalized people.

9. Empowerment is still possible for those-who-have-nothing-to-lose, but their social and political consciousness has to be raised first and foremost.  They have to be convinced that there is no reason for them to remain bound to a feeling of impotence. In last instance, their failure is ours!

10. Furthermore, we too often underestimate the force and power that is exacted against poor people; this is a reality. We also too often fail to accept that the power of the people is/can also be real.

11. You re as aware as I am that we like to complain and to blame others; but the truth is that we do not show the necessary constant zeal about HR; we are short-winded-enthusiasts, quick to compromise, short of tenacity… Don’t we need less pretension and more ambition on this issue?  (Am I overstating my case to you here?).

12. Bottom line for HR work: it is crucial to ensure the participation of all marginalized groups taking into account all that is said above. In that effort, being transparent in how claim holders are selected to face relevant duty bearers, e.g., involving communities and their legitimate spokespersons in this process, ensuring gender balance and a deliberate focus on the most marginalized groups, is key.

Notes:

i) A thought to be reckoned here, when we speak about participation and representation, is in Albino, Gomez’s words: “Sometimes it is better to be included, but outside, than it is to be excluded inside…” (Does this make sense to you?).

ii) Beware that not only pioneers for change and genuine HR change agents are with us fostering participation; enemies can also be within –thus our need to help develop good leadership attributes to produce enlightened and vigilant HR change agents.

Claudio Schuftan in Ho Chi Minh City

cschuftan@phmovement.org

_____________

Adapted from Albino Gomez, Despojos y Semillas, Editorial Belgrano, Buenos Aires, 1997;  A. Gomez, Tiempo de Descuento, Editorial El Fin de la Noche, Buenos Aires, 2009; A. Gomez, Ultimo Patio, Ed. Turmalina, Buenos Aires, 2009; Development in Practice, 19:8, 2009; Z. Acevedo Diaz, La Dama de Cristal, Fondo Editorial Casa de las Americas, La Habana, 1999; D+C Vol.37, No.5, May 2010; D+C, Vol.37 No.10, Oct 2010; Susan George, Sus Crisis, Nuestras Soluciones (Leur crisis Nos Solutions), Icaria Editorial, Intermon Oxfam, Barcelona, 2010, 267 pp. (Editions Albin Michel SA,Paris, 2010, xxx pp.);  Getting the MDGs right: Towards the founding of an operational framework for the MDG-Human Rights Nexus. Copenhagen, Nov. 2010; and UNFPA, A HRBA to Programming: Practical implementation manual and training materials, 2010.

Postscript: Human rights are not so much a subject as they are a-way-of-thinking, a-way-of-life; a way that can be better appreciated by participating and joining-in. While reading each Reader, do not hesitate to do your own thinking and writing about the topic(s) covered.  For example, think about how you would develop your own view of reality. When a Reader confronts you with an argument, consider how you may argue –for or against– the same position. Attempt to answer the key questions in your own terms. Your own answers may be just as legitimate as those given in these Readers; that is what will ultimately make them personally valuable to you. (adapted from R.C. Solomon)

Human Rights Reader 286

Does the title imply that human rights then bypass the philosophical debate by simply imposing a set of universal positive moral and legal norms in an effort to preserve individual freedoms and collective rights? No. Not really.

Relativism in no way precludes the possibility of cross-cultural universals.

1. Moral and cultural relativism have indeed affected the human rights discourse, but on the philosophical level only.

2. Unfortunately, the challenge that relativism has presented to the human rights movement has not only been theoretical, but also politically motivated. It remains a fact that the claim of relativism, that diversity must be recognized, in no way destroys the existence of an international moral community. * (A.D. Renteln)  Despite this recognition, relativism is still employed as a political device; this reflects the underlying tensions between those who place primacy narrowly on their own individual rights as opposed to the human rights of theirs and of others in the national and international community.

*: Take notice, for example, that some twenty moral precepts are already accepted as  transcultural. These include the prohibition of murder or maiming; economic justice; reciprocity and restitution; provision for the poor; the right to own property; and priority for immaterial goods [such as freedom]. (R. Beis)

3. There is further compelling evidence that refutes the anthropological dogma that distinct cultural practices and beliefs represent an inviolable set of diverse truths and, consequently, are immune to outside criticism. Entire societies can be wrong, i.e., pertaining the systematic and unjust treatment of certain of its members (such as women, minorities and slaves). Such social structures that do affect decision-making serve no other purpose than to institutionalize inequality and injustice! Therefore, the mere fact that differences across cultures exist does not mean that all variations in social and cultural practices are right or acceptable.On these grounds, relativism itself has been critiqued as immoral.  (R. Edgerton)

Taking a relativist position is often intended to insulate governments from international criticism regarding the treatment of their citizens.

4. I contend that relativism itself would have to look beyond itself for a philosophical justification. In particular, the very claim of a ‘right to difference’, whether cultural or moral, implicitly implies the idea of a universal principle…

5. Although the human rights struggle is certainly motivated by passion, it is also influenced by argument. Simply put, human rights without reasons are vulnerable to denial and abuse. (M. Freeman)  The use of reason can thus not escape the influence of particular cultural codes.

6. In general, philosophers have identified the following sources for human rights (HR): divine authority (the Ten Commandments), natural law, or considerations concerning human nature. None of the major international human rights documents refers to God, because the existence of a supernatural authority is not subject to objective proof. Furthermore, except for the Universal Declaration of Human Rights, natural law –the system of moral imperatives accessible by human reason alone– is also dismissed by human rights…

7. For HR, it is demonstrably apparent that certain actions are wrong; there is widespread evidence that human beings have an aversion to violations of their dignity and well-being. Rational individuals anywhere do embrace standards and social arrangements that promote their autonomy, their security and their dignity.

8. Bottom line here, each human being has the right to equal concern and respect; this is simply a compelling moral axiom and a universal legal obligation.

The right to resist oppression is found in the tradition of many cultures.

9. Although existing international human rights instruments have an unmistakable Western imprint –both in terms of origin and methodology of implementation– this does not in any way invalidate the moral and legal content that they embody. For instance, any suggestion that freedom of expression is a luxury of the West insults the historic struggles of individuals and communities anywhere. (W. Soyinka)

10. In short, HR cannot be considered “a self-evident expression of Western culture” or of modernity alone. Comparable concepts of human respect, dignity and duty can be found in all parts of the world. The right to resist oppression is found in the traditions of many cultures in Africa, Asia and the Americas. In fact, some societies may possess the concept of rights without having an explicit vocabulary that expresses or codifies it.

11. Human rights are thus not arbitrary in nature, overwhelmingly because they are grounded in the universal realities of the human experience and they embody values presupposed by a wide range of cultures; they are features of humanness that lie beneath all local traditions –and actually are there to be seen– whether or not they are in fact recognized in local traditions. This being said, HR can then be regarded as a vehicle-for-shaping-social-conditions. (M. Nussbaum) They provide a mechanism for people of divergent convictions to learn about each other, resolve particular disagreements, and arrive at new understandings of what is possible for human beings giving rise to a new ethos of human solidarity and collective responsibility; it is this global dialogue that must be intensified manifold!

12. The international human rights regime thus has still much to gain from an ongoing process of moral, cultural and political dialogue among diverse nations and peoples. This, because there is no moral bond with others unless individuals choose to concern themselves with the interests of the community.

13. But the concept of HR goes beyond basic communitarian notions of mutual obligations; it not only embraces human diversity, but calls for a definite framework of rights and duties in the context of globally diverse societies.

14. Consequently, individuals remain universally weighed down by moral and civic ties even if they have not chosen them. The institutions of civil society are thus necessary, precisely because the separate interests of individuals inevitably often do interfere with each other.

15. Even though Article 29.1 of the Universal Declaration of Human Rights specifies that “everyone has duties to the community in which alone the free and full development of his personality is possible,” the brevity and less than prominent location of this statement hardly does justice to the notion that human rights must and do have correlative obligations –and we know that the creation of an “equilibrium of responsibilities” among all members of society has been a long sought-after and elusive goal.

16. Let us insist: HR have the power to transform and to fuse diverse and contending peoples into a universal community. Without such a universal identity, there can be no basis for universal moral action. **

**: Furthermore, let us not underestimate: HR play a pivotal role in freeing humanity from the shackles of religious fundamentalism.

17. Whether the precepts, laws, institutions, and provisions for a new international order provided by the HR discourse offer a distinct and comprehensive approach to the establishment of justice in world affairs is for humanity itself to decide. The burden is on our shoulders and time is of the essence.

18. Human rights indeed represent an invitation to freedom–freedom from want, freedom from war, freedom to unite, freedom to progress, freedom in peace and joy. HR call for a society that asserts the priority of fair procedures over selfish, self-serving particular ends.

Claudio Schuftan in Ho Chi Minh City

cschuftan@phmovement.org

[All HR Readers can be found in www.humaninfo.org/aviva under No. 69]

_____________

Adapted from The Human Rights Discourse: A Bahá’í Perspective, M. Weinberg, 1996-97 edition of The Bahá’í World, pp. 247-273.

Postscript: How do we really know what we think before we have written it down? Those who write need a master reader to give them honest feed back. (F. Stern)  I only occasionally get such feedback from you…

Human Rights Reader 285

Inequality is at the root of human rights (HR) work. Should I thus find it cynical that only in 2011 has the IMF ‘come out of the closet’ in a big way to say that inequality is bad… for Capitalism? The IMF’s F+D (Finance and Development) Volume 48, Number 3 of September 2011 carried feature stories under the title “All For One: Why Inequality Throws Us Off Balance”.

Here below is what I found. Although probably in some cases out of context, I quote or paraphrase and I annotate:

Only so much disparity is ethically and politically acceptable.

1. For decades, ‘trickle down’ was the unspoken bargain of the market system. (But it does not seem to have worked; instead, economic growth brought us growing inequalities).

2. Growing inequality breeds social resentment and generates political instability; it also fuels populist protectionism and an anti-globalization sentiment. (Is this what worries the IMF?).

3. Globalization, on the other hand, can be blamed for rising inequality. (A vintage IMF contradiction here?).

4. It is thus a big mistake to separate analyses of growth and income distribution since, over longer horizons, reduced inequality and sustainable growth may be two sides of he same coin.

5.  More equal societies have a greater likelihood of sustaining longer-term economic growth. (Or is it here that the IMF shows its real colors?).

6. Individual-centered social norms are enforced by the dominant class as their members have internalized them early-on in life; it is collective social norms that are the missing matter. (Thank you, IMF. This is particularly applicable to HR work; something additional is thus needed for duty bearers to start cooperating in a HR spirit).

Let the Gini out of the bottle. (The Gini Coefficient is an index of income inequality between different income groups ranked by income in a population; an index of 100 denotes maximum inequality).

7. After declining in the first half of the 20^th century, income inequality has made a come back particularly in the last quarter century. (We knew this, didn’t we?)

8. In 2005, global inequality had a high Gini coefficient of 70 which was 10 points higher than the Gini Coefficient of the most unequal country in the world. The richest 1% of people in the world receives nearly 14% of the global income while the poorest 20% receives just over 1%. In the US alone, the top 1% earners captured more than half of the overall economic growth experienced between 1993 and 2008. (They said it, not me…).

9. Inequality has risen both in China and in Vietnam (non-capitalist states), as well as in 16 out of 20 rich OECD countries. China’s inequality has surpassed that of the US. (Good tables and graphs on these distributions are found in this issue of F+D).

A bigger slice of the growing pie.

10. One traditional way to splitting the economic pie in favor of the haves against the have-less has been to cut wages to increase profits. The poor are ill prepared to deal with any income decline…. (Oh!, really?)

11. Budgetary spending cuts (as the ones the Republicans are asking for in the US Congress), ultimately slice the portion of the pie that goes to wage-earners, i.e., they hit wage earners more than others.

12. The reduced power of trade unions is responsible for the rising skilled-unskilled wage gap. Also a lack of unemployment benefits and a lack of guaranteed rural employment greatly contribute to inequality. (No news to most of us here either).

13. Inequality is not the product of impersonal forces though; it widens when society permits it and can be limited through conscious government policies. (Really?…an IMF late discovery?).

14. In other words, inequality matters in itself, not just as a proxy for other factors. ( I am flabbergasted…)

15. Failure to redistribute income is the result of the disproportionate influence of the rich over policy since they contribute more to politicians. Political decisions thus coincide with the preferences of the rich. The political system has moved to a ‘one-dollar-one-vote’ system away from the ‘one-person-one-vote notion. (…This said by an IMF publication!).

16. The top groups never reduce their consumption (there is only so much a person who ‘has it all’ can consume), but they increase their wealth accumulation. The bottom group receiving lower wages can only continue consuming by indebting itself…from loans given by the top group (as has been shown in the mortgage crisis in the US). Budget interventions do not directly confront the sources of inequality (such as declines in the collective bargaining power of the bottom group or shifts in the tax burden towards the bottom group), but are rather supplemented by policies that cut the cost of borrowing… so that the rich can continue lending at a profit. (Nice ‘catch-22’ situation, isn’t it?).

Decreasing global inequality is an epochal urgent imperative. (The IMF says it. Not this Reader!).

17. Are social justice and a focus on economic growth at war with one another?  Is there a trade-off between equality and efficiency? (You bet! x2).

18. As a social justice issue, universal access to health services and to education, for example, is difficult to achieve unless society has a more even income distribution.

19. Because too much inequality is destructive to growth, countries will find that improving equality will improve economic growth efficiency. (…The IMF’s neoliberal drive for economic growth shows trough here).

20. In the long run, there is therefore simply no way to avoid addressing the income inequality problem head-on. Financial liberalization buys time, but at the expense of an eventually much longer debt problem. (Again, their words, not mine).

Claudio Schuftan, Ho Chi Minh City

cschuftan@phmovement.org

Postscript:

Intelligent movements need time to gestate. Such is the movement –for justice, fairness and equality– we actively pursue in human rights work. Metaphorically speaking, a new intelligent edifice has to have a roof before people will abandon the old one en masse; it requires a critical mass of new formulations that give practical insight into current burning problems. Generating this critical mass, we stand with John Maynard Keynes who tells us that sooner or later, it is ideas, not vested interests which are dangerous… for good or for evil. We stand with John Stuart Mill’s Collective Utility that tells us that we need to pursue the greatest good for the greatest number. And we stand with Adam Smith who tells us that human society is held together by principles of benevolence and self-restraint. (Should I say “Amen”?).

Human Rights Reader 284

-Reason alone does not convince the violators of human rights (or their acolytes and protectors) to change course. (M. Vargas Llosa)

-A comprehensive understanding of the human rights framework inevitably implies taking political sides.

A few lose ends will benefit from some further clarification; this is what this Reader attempts.

On obligations:

1. The obligation to respect, protect and fulfill the human rights of groups in situations of vulnerability refers to the state’s obligation of conduct, i.e., its obligation to adopt concrete actions and measures in those three parameters (and no less!) thus decisively moving towards the realization of human rights (HR) by creating an enabling environment and by allocating sufficient resources.

2. Sustained HR progress will take place only if/when all parties involved believe that the above state obligations of conduct will be honored. Ultimately, only governments –through the active claiming of claim holders– can ensure that the protection of HR is not only a promise, but is carried out effectively. Claim holders must, in due course, make sure that the political situation they create will give those in power the needed push to enforce the specific HR being addressed. Conversely, governments must themselves demonstrate they are strong enough to effectively respect, protect and fulfill HR and must be willing to apply their own power to prevent abuses. What this means is that they have to accept to submit themselves to a system of checks and balances. Ergo, the open and transparent commitment of a country’s political institutions to HR is the ultimate determinant of progress in HR work. Countries with checks and balances in their political system, i.e., more democratic regimes, are more likely to show sustained results in the realm of HR. But a commitment to equal treatment must move-on to an emphasis on equal outcomes and/or benefits for the vulnerable if such sustainability is to materialize.

On covenants:

3. By now we know that civil and political rights (CPR) and economic, social and cultural rights (ESCR) were codified in two separate UN covenants. The separation of these human rights into two covenants was merely symptomatic of the Cold War era; Eastern countries prioritized ESCR * (ratified by 155 states) and Western countries prioritized CPR (ratified by 152 states).  CEDAW, on women’s rights  has been ratified by 182 states.  CRC, on children’s rights, has been ratified by 192 countries; both the latter have an optional protocol addressing mechanisms on how to handle complaints. ICESCR has a new optional protocol which has not yet been ratified by enough countries to enter into effect.

*: Never forget: ESCR are not just the poor step-sister in human rights work! (P. Alston)

On international HR law:

4. International human rights law is a valuable legal and conceptual framework in our work for many reasons. Among them:

(i) for bringing strategies to improve the HR of poor and excluded social groups under one common umbrella;

(ii) for improving equality in health, in nutrition, in education, in housing, etc.;

(iii) for clarifying responsibilities and accountability issues in a whole host of social services, and

(iv) for evaluating progress in meeting the MDGs.

5. The mechanisms used to apply international HR law, among other, include:

(i) Strengthening the technical capabilities of government agencies and human rights organizations to monitor, assess, and oversee social services’ compliance with international human rights instruments;

(ii) facilitating needed technical cooperation in the design, review, and reform of social security legislation, plans and policies so that they include the international human rights provisions;

(iii) strengthening social services workers’ competencies as relates to knowledge-about and application-of international human rights instruments;

(iv) adopting legislative, administrative, educational and other measures to disseminate international norms and standards so that HR are de-facto applied in national legislatures, courts, and other pertinent government entities;

(v) strengthening civil society organizations in their strategies for HR

learning, awareness creation, education, and information, as well as taking action to combat stigmatization and discrimination against groups affected by HR violations;

(vi) training all staff of development agencies so that they incorporate HR in their programs.

6. However, beware: the potential to apply these mechanisms is one thing; reality is another. The moral and legal strengths of human rights are a fact beyond doubt, but they risks becoming a dead-body-of-international-law if they are not actively claimed by those whose basic HR are denied, and if the human rights framework is not actively used and pushed to its full potential by agencies working with those living in poverty and those that are part of marginalized groups and communities. (Dignity International)

On dignity:

7. As this Reader has said many times before, rights are different from human rights. There are other rights like property, contractual and consumer rights –all of them with precise connotations. Only HR relate to dignity; and that makes them special. (G. Kent)

8. While human rights have often been interpreted in individual terms in some intellectual and legal traditions, notably in the Anglo-Saxon tradition, human rights guarantees also concern the collective well-being of social groups and thus can serve to articulate and focus shared claims to assert the collective dignity of marginalized groups and communities.

9. Dignity ultimately represents the deep desire by people to run their own lives… to be treated as citizens with both obligations and rights such that the state cannot just give and take their rights by whim. The quest for dignity is “Dignity Before Bread “. The spark that lights the fuse is always the quest for dignity. (L. Aron) Therefore, HR are the principal tool of a just struggle embracing the dream of justice and dignity for all. (M. Vargas Llosa)

On accountability:

10. With no effective complaint mechanisms there are no effective HR. Period. Rights are enforceable claims, but simply need an authority to which claim holders can appeal. To make sure those that have duties carry them out, agents of accountability (i.e., those exerting such a role) have to be engaged.

11. Durable democratic regimes –those that offer a combination of stability and responsible political institutions with players subject to checks and balances– offer the most fertile ground for the fulfillment of HR. This requires specific measures though to secure accountability, supported by a political environment that instills trust.

On HR violations:

12. The imperative to protect local populations from ongoing HR violations outweighs the moral objection of ‘engaging in dialogue with the devil’. Talking with duty bearers already implies engaging and having some initial clout; such a talking makes sense even if it sometimes initially takes place in the sidelines. (K. Colijn)

13. Ongoing HR violations rightfully destroy confidence in the protective function of the state. Not persecuting the perpetrators is a direct violation of one’s own obligation to defend and support HR.

On HR and justice:

14. A lack of popularity is not always a good indicator to decide on the justice of a good cause –especially the HR cause. HR is not about a popularity contest! In the HR-based approach, justice is pursued as an individual, independent goal.

15. Be reminded that fairness and justice in social arrangements includes budgetary allocations that enable individuals not only to access opportunities, but actually lead them to better HR results.

On claiming:

16. To claim is to search. ‘Searchers’ are those who actively claim to get  solutions to their problems. There thus needs to be a shift from treating victims as recipients to treating them as rights-endowed claim holders. In short, passive recipients simply must become active claimants. Furthermore, this means we have to become part of the mobilization that provides communities with the moral grounds to claim their HR.

17. Claiming has to go beyond the stage of asking for mere palliative solutions and, instead, demand the root causes are addressed so that solutions are sustainable. So, as experience is gained from HR work, we learn from the actual practice of claim holders and duty bearers and we get better at it –and what we learn in our struggle for HR also enriches HR theory.

18. As a practical tip, in the HR-based Framework’s Capacity Analysis, we always start with the claim holders, not the duty bearer. This is key in human rights law, as opposed to humanitarian rights law, where it is the other way around. ** (U. Jonsson)

**: On the other hand, we have to stop accepting what many call ‘Vulnerability Analysis’, in which ‘targets’ are identified to subsequently serve them with ‘packages’ of aid! The focus must be to address the processes that create and perpetuate vulnerable groups to begin with!

19. What I want to highlight here is that HR offer more than a conceptual armature connecting health, social conditions and broad governance principles. They provide an instrument for turning diffuse social demands into focused legal and political claims, as well as providing a set of criteria by which to evaluate the performance of political authorities in promoting people’s wellbeing and creating conditions for an equitable enjoyment of the fruits of development.*** (PHM)

***: Note that we are not saying the HR-based approach is necessarily the solution to the problems at hand, but it is indeed a totally different way of looking for  solutions. (G. Kent)  Furthermore, we should not consider HR theory as a dogma, but as a guide for action (Mao) or, in a more facetious mood: “If they hit you, yell; if they hit someone else, come up with a theory”. (I. Bashevis Singer)

20. Let us not forget that aggrieved claim holders are entitled to institute proceedings for appropriate redress before a competent court or other adjudicator.

Having a right is different from having a right realized. (G. Kent)

-Think about a big hotel in which all guests keep complaining about the services without realizing that they are the owners of the hotel… But also beware that every defeat we can impose in our HR work should not always be construed as a moral victory. (A. Gomez)

21. It is to be appreciated that any serious effort to reduce inequities and to challenge and change the unfair distribution of social resources will necessarily involve changing the distribution of power within society. Doing so is not in the interest of those currently holding power. **** The alternative is to turn to civil society actors to serve as the drivers for positive social, political, and economic changes that will demand greater equity. Closing the gap entails using the HR principles of empowerment through active participation, i.e., incorporating the conceptual foundations of the

human rights approach to offer a compelling alternative rationale for action. However, the effort to graft community empowerment onto a project or program that focuses primarily on top-down initiatives is bound not to be  successful. (A. R. Chapman) Therefore, I contend that, if HR work does not address the issues of power, the implementation of HR actions risks being mechanical, anonymous and purely quantitative. If this is difficult for our peers to grasp, remember that HR work always brings with it a revision of y/our points of view… In times of change towards HR, the limits of the possible stretch a thousand times.

****: Important in our struggle is to have enemies that respect us. (A. Dorfman)

22. Finally, one additional overriding message about power that I want to stay with you, the reader, is that there is a tremendous gap between the purported potential contribution private business could make to HR and the actual contributions made so far by the private sector to address HR issues; I remain pessimistic that this gap will diminish in the future.

Claudio Schuftan, Ho Chi Minh City

cschuftan@phmovement.org

________________________

Adapted from Understanding Human Rights: Manual on HR Education, W. Benedek Ed., ETC, Graz, 2006; D+C, 37:10, Oct. 2010; D+C, 37:12, Dec. 2010, The Broker, Issue 23, Dec. 2010/Jan2011; The Broker, Issue 24. Feb./March 2011; F+D 47:4, Dec. 2010; PAHO 50th Directing Council, 62nd session of the regional committee, Washington, D.C., 27 September -1 October 2010. Provisional agenda item 4.8: Health and Human Rights Concept Paper; and CSDH framework for action, Last version, Discussion paper for the Commission on Social Determinants of Health, draft, April 2007.

Postscript: I am not interested in picking up crumbs of compassion thrown from the table of someone who considers himself my master.  I want the full menu of rights. (D. Tutu)

Note from the Editor: Pfizer offers a especially outrageous case of a company which committed massive crimes and did not face the full penalty. Here, briefly is the story:

In 2009 the US announced a $2.3 billion dollar settlement with Pfizer’s for the marketing practices related to several drugs including Bextra, a drug taken off  the market in 2006 because of concerns over cardiovascular safety.  In their statement on the case the FBI noted that Pfizer: “promoted the sale of Bextra for uses and at dosages the Food and Drug Administration (FDA) specifically declined to approve for safety reasons.”   The settlement involved the largest criminal fine ever imposed in the US.

Both HHS and the FBI emphasized that this was (to use the FBI’s words): “a clear message that the FBI and our partners will not stand by and let any manufacturer peddle their prescriptions or products for uses beyond their intended—and federal government-approved—purpose.”

But the back story is not so simple.  If a health care company is convicted of fraud it is automatically excluded from the Medicaid and Medicare programs for several years.  This is the law.  But CNN later reported that prosecutors felt an exclusion from Medicare and Medicaid would bankrupt Pfizer, a company they deemed “too big to fail.” So the Feds found a way to help Pfizer avoid this penalty.  They allowed Pfizer to create a shell company - Pharmacia & Upjohn Co. Inc. – which would plead guilty to the fraud and be excluded from Medicare and Medicaid; for the rest of the company it was business as usual.  It was – in the words of CNN – like having an imaginary friend who takes the rap for you when you do something wrong.

In short this was a “clear message” that when corporations are too big, they are above the law.  When this happens something is very wrong with our democracy and it is time to take to the streets.  For us in NYC the exact time is 2/29/2012 @ 10AM.

Protest against Pfizer’s profiteering and support for ALEC (American Legislative Exchange Council)

When:   Wednesday, February 29, 10 AM

Where:  Assemble at 42nd Street and First Avenue (Robert Moses Playground)

In fighting corporate greed and corruption, Occupy nationwide is holding actions on Wednesday February 29 to raise awareness about the destructive political activities of the American Legislative Exchange Council (ALEC) and the corporations, Pfizer among them, that run it.

The two main targets in New York City are Bank of America and Pfizer, and Healthcare for the 99% is leading a protest at Pfizer, which sits on ALEC’s Board, to highlight how its business practices as well as its role in ALEC reveal excessive corporate greed at the expense of human needs.

This is in essence a march along 42nd Street from 1st Avenue to 6th Avenue:

9:30-10:00 AM:   Meet up at Fitst Avenue and 42nd Street (Robert Moses Playground at the north side Tudor City);

10:00-11:00 AM: March to and protest (moving picket) outside Pfizer at 235 East 42nd Street between 2nd-3rd Ave;

11:00-12:00 PM: March to Bryant Park, join other feeder marches, staging for…

12:00-??:?? PM: Step-off for roving actions at Bank of America branches and ending at BOA Tower.

Download the Call to Action for this Protest here: ALEC-Pfizer_SDTC_Call-To-Action

For more on NYC OWS F29:  http://www.nycga.net/events/event/national-day-of-action-shut-down-the-corporations/

For more on ALEC: http://alecexposed.org

For more on nationwide F29 Action: http://www.shutdownthecorporations.org/

posted by Matt Anderson, MD

Human Rights Reader 283

[The following is a constructive critique I received from Dr Abhay Shukla in India regarding the contents and the tone of the Human Rights Readers. The text is verbatim.]

1. As a general comment on the Readers, I would contrast two possible styles of dealing with the issue of health rights:

a. Taking the human rights (HR) approach as the starting point, deducing one’s arguments mainly from the HR framework, using this as the principal justification for action, and appealing for an active use of this framework as the main form of action (moving mostly within the HR framework). Several of the Readers fall in this category despite referring to a political perspective in an abstract manner.
b. Taking people’s experience of real life deprivation of basic health care and unhealthy living conditions as the starting point. In other words, taking the massive and avoidable suffering, inequalities and ‘unjust’ social situations as a major justification for change so that arguments for change are developed coming from the people’s aspiration for a qualitatively better life, including better health as a key social aspiration. This means drawing upon the HR framework as one important justification and anchoring point but not the only one for social action. It also means discussing a variety of small and large social actions and struggles that are actually taking place on the ground –with or without using human rights language– as an exercise to provide new hope and direction. The use of the HR framework as one of the tools for further struggle can sharpen and politicize existing efforts, along with various other forms of mobilization (as said, starting from real life experiences and moving to various strategies for change, including the use of human rights, thus ending up with suggestions for realistic forms of struggle on the ground).

2. This may sound like an oversimplification and perhaps ‘stereotyping’ the situation, but the Readers seem to me to fall more in category ‘a’ than ‘b’ and seem to rely very heavily, almost exclusively on the HR framework, rather than referring to it as one useful tool in a broader range of strategies and forms of struggle. Also, there seems to be a major emphasis on international HR covenants and instruments which are of rather limited use in the actual struggles of grassroots activists, even though they have some place (based on our experience in India, I would argue rather peripheral and limited) in a local-to-national spectrum of strategies. Furthermore, there is usually a lack of reference in the Readers to actual struggles, movements, initiatives, which make them sound rather delinked from ground realities. Hence several of the Readers read like ‘moral’ arguments, expressing distress at violations of HR in a generic way, indirectly placing excessive and undue expectation that such a (mostly international, universal) framework would, in and of itself, in a major way fulfill and promote people’s access to healthy lives and health care –a fact that is at great distance from the real ground situation. As a matter of fact, people often, or perhaps usually, struggle without explicit knowledge of  the ‘human rights framework’ as such; instead they protest against perceived injustice, exploitation and deprivation, and may use human rights language as part of a wider repertory of struggles and strategies. Our task as activists is to support such struggles, and help sharpen them with various tools which include, but are not limited to, the human rights framework.

3. Keeping this in mind, I would strongly suggest that the Readers carefully look at how actual struggles on health rights have developed in various countries and places, how the HR framework has or has not been used, what broader perspectives and strategies have been used in social struggles, and then revisit what the HR framework has to offer in this larger scenario. This neither means abandoning the HR framework, nor being completely subjugated to it, but rather having a sense of its appropriate use as one tool in a wider spectrum of struggles in social movements.

4. These comment are not a ‘critique’ of the Readers which have several useful insights, it is just that I feel they need to move a bit beyond ‘moving within the HR framework’ and then critically look at it and use it in a significantly broader socio-political context. I repeat, HR can be one useful tool in a spectrum of strategies. However excessive reliance on it as the principal perspective and justification, “overshadowing political analysis and in-depth understanding of social situations and actual struggles” might constrain our vision.

__________

Your comments are welcome at

cschuftan@phmovement.org