DO WE DEFEND HUMAN RIGHTS OR DO WE DEFEND OURSELVES FROM THEM?
P. T. Delgado Palacios
This is not my text. The original is in Spanish. I have to confess though that, although in a small part fallacious, it raises some uncomfortable and disturbing questions for which I only may have some answers. At the risk of being accused of courting controversy I share this with you.
1. The Universal Declaration of Human Rights of 1948 assumes humankind agrees with the institutions of a bourgeois society. According to the Declaration we are entitled to protection under the law (Art.7). Of what law? Laws made by whom? Aren’t the owners of power and of money the ones who make the laws according to what is convenient for them? So, do those who question the law attempt against human rights (HR)?
2. The Declaration also says that every person has the right to property (Art.17). How necessary was it to insert that Article to protect the patrimony of those who already had amassed a fortune? So, do those who attempt to take something away from the latter attempt against HR?
3. People are needed to work for the benefit of the owners of capital. Then, we have to remember that every person has the right to work and to a salary (Art 23). So, does anyone who tries to set up an alternative and different system to neoliberalism attempt against HR?
4. What are we supposed to do so that everybody supports the ideology of those who organized our world in their own favor? Easy! Every person has the right to education….To that education that reproduces the system? Does s/he who does not accept this attempt against HR?
5. Can this all mean that oppression is actually used in the name of HR? Are we supposed to defend all the rights that justify and consolidate the neoliberal system? Are we going to defend these rights knowing that, in their name, the owners of power and of the money have invaded all spaces and have defended their own interests?
6. Where is the right to rebel and to resist to be found? Where is the right to live an alternative life without interference left?
7. These reflections and questions take us to think about drafting a proposal for a Declaration of HR from another angle, from the perspective of poor people, of the invisible, of the excluded. Actually, new rights are being proclaimed coming from different corners of the world: poor people’s rights, poor women’s rights, indigenous people’s rights, poor black people’s rights, people with special abilities rights, poor young people’s rights, poor children’s rights, the rights of nature and of the environment… What counts is to continue opening spaces in which all voices merge, and from which a new declaration can be proclaimed, one that brings together the common aspirations of the have nots.
8. We cannot turn away from the term Human Rights; what we have to do is to give it a new content, one that acts as a liberating force.
I pick material from here and there, i.e., those sentences that I agree with –not to store them in my memory, because my memory is faint –but to bring them to this Reader in which what you read is as mine or belongs to me now as much as it belongs to their original authors. (adapted from Montaigne).
The point of these Readers is to just present you with issues and let you arrive at your own individual conclusions. These conclusions should be discussed with your friends and colleagues. The ultimate purpose is to encourage everyone to think for her/himself. The Readers are ‘a source’; everything in them is to be taken as a cause for further elaboration. They do attempt to sway you towards human rights and thus present basic problems together with powerful arguments to enable you to think for yourself. This is what the Readers are ultimately about: letting you think for yourself about the basic issues of social justice. Most of us are concerned with the same basic problems, but do not necessarily use the same arguments. Readers give you varied arguments with the not unreasonable demand that you confront them with your own arguments. The Readers thus are an introduction to the problems of development and HR and the various ways in which they have been rightfully or wrongfully answered. Although the language of HR is specialized and sometimes difficult, the Readers clarify jargon and special terminology –terms are carefully introduced. The Readers are perhaps valuable to help you find your place in history. (adapted from R.C. Solomon)
So remember, some things you have for long considered evident turn to a doubt as you reflect deeper about them.
[All Readers can be found under No.69 in www.humaninfo.org/aviva under their respective numbers]
Many healthcare professionals see how social factors impact their patients’ health and ability to access health care. They have joined protests over the past weeks in NYC and around the world. Readers of the Portal are invited to participate in the following events organized by the group Healthcare for the 99%, the OWS healthcare working group:
Friday, October 21st 3:30pm, March on Verizon in solidarity with CWA and OWS! A group will meet at ZPark at 3:30 and will march to Verizon HQ at 140 West Street at 4pm to rally.
Sunday, October 23rd at 4pm, Healthcare Teach IN / Speak OUT at ZPARK. Bring your white coats and signs! Check out this powerful video from last week’s speak out at Washington Sq Park. Stay for our usual 5:30pm planning meeting right after.
Editor’s Note: This posting updates a 2004 article entitled How To Be a Street Medic, written by Juliana Grant. We are publishing this in recognition of the role played street medics in the Occupy Wall Street movement.
What are street medics?
The prospect of being on the receiving end of police brutality during political protests is not new for many activists. The Occupy movement has brought these concerns into particular focus as people who have never previously been involved in activist work start to engage in the movement. Additionally, the long-term nature of Occupy movements make the scope of medical and health needs broader than those associated with a single event.Dealing with the immediate and long term health needs of activists, including the effects of police violence, presents many unique issues that are not addressed by mainstream healthcare providers. Street or action medics are those groups and individuals who have stepped forward to help meet some of these needs by providing health care specifically to protesters and activists.
What do street medics do?
The health needs of activists are wide ranging and street medics attempt to meet these in a variety of ways:
For single actions or protests: Official EMS personnel are often barred from entering the scene of protests until police have determined the area “secure,” thereby creating delays in access to professional medical care for protesters. Street medics will often work on the ground during actions to provide appropriate first aid care to protesters and, if necessary, negotiate with police for the movement of injured persons to safe areas. Because the health effects of pepper spray, tear gas, rubber bullets and handcuffing are not understood by most health professionals, street medics have researched appropriate treatments for these and have learned how to provide acute and long-term care for these types of issues.
Health and safety training for activists:Many medic groups offer trainings for non-medic activists on staying healthy, including such general topics as remembering to bring water and sunscreen to events, and wear appropriate clothing, as how to handle issues such as what to do with clothes that have been covered in pepper spray.
Sub-acute care:Many Occupy sites have medic groups that have set up an area at the Occupy site where participants can seek care. The spectrum of care offered varies substantially among sites and depends a lot on who the medics are and their level of training. Care offered might only include basic first aid, or extend primary health care services. Some medic groups in the past have opened clinics specifically for activists and offering mental health support for those who are recovering from protest-associated trauma.
Disease prevention and public health:Occupy movements bring large numbers of people together in spaces that were not originally designed for that use. Disease prevention and public health activities supported by street medics can help keep participants healthy. These might include ensuring that hand sanitizer is available at all food stations and bathroom sites, arranging for free flu shot clinics, and working with logistics to help collect warm clothing for participants.
Mental health care: Being a victim of police brutality or misconduct is traumatic. Most of us will experience a heightened level of stress, anxiety or depression after an event. Some individuals might even develop long-term health problems, such as post-traumatic stress disorder. Mental health issues can also arise during regular Occupy activities simply due to the stress of being in a new and rapidly changing environment. Some Occupy participants may also have underlying mental health issues that are exacerbated by stressful situations. Street medics may offer mental health care to activists during or after an event. The level of care offered can range from basic peer support, to assistance identifying resources, to prolonged mental health treatment, depending on the resources available to the medic group.
Who are street medics?
Street medics come from a variety of health care backgrounds including herbalists, nurses, EMTs, NPs, health educators, physicians, medical students, and acupuncturists. In fact, a medical background is not actually necessary to be a street medic as most receive additional training in first aid, the management of activist-specific injuries and such topics as scene control and pre-hospital assessment. A large amount of formal medical training is not applicable to street medic work, so additional training is always necessary.
Being a street medic requires more than just medical knowledge. The ability to work in non-hierarchical affinity groups, value non-western medical knowledge and work in stressful, and at times dangerous, situations are all equally important to street medic work. For many physicians and nurses, developing these skills will be the focus of their street medic experience.
Why do we need street medics?
Political dissent requires more than individuals who willing to openly speak their mind. The success of political actions is, in part, based on the underlying support structure in place for those actions. Street medics are a vital part of this support and allow all types of health care workers to use their unique skills to help sustain political activism.
Where can I find more information?
The following websites are excellent resources for learning more about street medics. Most contain a links page to other street medic sites.
Street Medic Wiki
A great source of information about medics in general, as well as treatment protocols, recommendations for activists, and contact information for other groups.
How do I find a street medic group?
You may have a street medic group in your area already. The Street Medic Wiki has a list of street medic organizations, but it’s not up to date. Try going down to your local Occupy site and ask if there’s a medic tent. Go over, introduce yourself and ask if you can help!
Yesterday (Saturday, October 15th) saw the largest Occupy Wall Street event to date with estimates of participation running as high as 20,000 in New York City. But New York was just one of many cities across the globe that saw protests yesterday. Encouragingly, the protest movement may finally be taking on an international character which mirrors the international nature of the corporations that dominate our political processes.
It is unfortunate that much of the press coverage has focused on the number of people arrested. This makes it seem that this was some type of sporting contest between the protesters and the police. In fact, the overwhelming message was one of being respectful of the police (in part not to provoke arrests). This reflects the consistent message of non-violence and the broader theme that 99% of the people in this country have a common interest in a new social compact.
Doctors for the 99% has become the name for an informal group of health activists who have set out to support the occupation. We participated in a teach-in of sorts at Washington Square Park that started yesterday around 1PM. Since the use of megaphones or amplification equipment is prohibited in the park, we used the technique of a “human microphone” where the words of a speaker were repeated by the larger group. This lovely video by Jun Mitsumoto will give a sense of the meeting and how the microphone worked:
Meetings of OWS Healthcare for All take place on Wednesdays and Sundays at 5:30 PM at Zuccotti Park/Liberty Plaza “under the Big Red Thing.” (Right across the street from Empire Blue Cross/Blue Shield)
One of the speakers was New York Assemblyman Richard N. Gottfried (seen above) who was gently critical of the slogan Health Care for the 99%. He pointed out that we needed one health care system that would cover 100% of Americans. He also noted that a tax on the wealthiest 1% could pay for health care and for the things that kept people healthy such as housing and education. The OWS health organizer later passed around a petition supporting Assemblyman Gottfried’s proposal for a single payer health care system in New York.
Here is one of his videos from the end of the march in Times Square:
As we arrived in Times Square the massive police presence (dozens of cops walking in the middle of the streets with gloves on and big stacks of plastic hand-cuffs fastened to their belts) felt unnecessarily intimidating. It was also confusing that we were initially sent by the Police down one of the cross-street towards Times Square only to be told to leave (again by the Police). This effectively dismissed us from further involvement in the the protest. But, as noted above, no one wanted a confrontation.
Additional picture are available at this Flickr site.
At this time of social unrest and growing protests over corporate power and corruption, I offer this reminder that the public health and social justice website at (http://www.publichealthandsocialjustice.org or http://www.phsj.org) contains many articles and open-access powerpoints covering corporate malfeasance as it pertains to the U.S. and world economies, health care (including the insurance and pharmaceutical industries and health professions education), the environment, public education, drug laws, the tobacco industry, food safety (including GMOs, biopharming, the overuse of agricultural antibiotics, and obesity), and the military industrial complex.
Material in the slide shows can be shared with and presented to colleagues, activists, students, the media, and the general public (with appropriate citation).
The activism and education page contains contributions from Matt Anderson and colleagues/residents from Montefiore, Nick Freudenberg (whose website Corporations and Health Watch at http://www.corporationsandhealth.org/ is a treasure trove of material), Bill Wiist (author of the comprehensive The bottom line or public health: tactics corporations use to influence health and health policy and what we can do to counter them), Josh Freeman (writer of the Medicine and Social Justice blog at http://medicinesocialjustice.blogspot.com/), and many others.
One can also access links to many websites working to combat corporate corruption. New submissions are always welcome.
The long-overdue “occupation” of Wall Street began 23 days ago on September 17th. As it enters its fourth week, there is no sign that the occupation is slowing down. In fact, as of this writing, there are currently “Occupy Together” Meet-ups in 1,112 cities across the US with 83 confirmed occupations across the world.
This week saw significant representation by progressive doctors in the protests on Wednesday, October 5 and Saturday October 8. Many of us were associated either with the Physicians for a National Health Program, the National Physicians Alliance or a Bronx-based residency program in social medicine. [There were far more nurses at the protest largely because far more nurses are unionized.] Here are some pictures and video clips highlighting a protest effort which has come to be called: Doctors for the 99%:
Thursday, October 6:
A gorgeous fall afternoon in New York City. Cameron Paige of New York’s chapter of the National Physician’s Alliance sent out a message early in the day calling on physicians to show up at the afternoon’s rally.
The picture below links to Amy Goodman’s interview with Bronx physicians Dr. Arash Nafisi and Magni Hansel.
Here are some additional photos taken with our cellphones:
Dr Cameron Paige asks: What good is this, if you can't afford your medicines?
Also present on Thursday was one of our local hip hop duos, Rebel Diaz, offering a Bronx-style take on the protests for Amy Goodman’s Democracy Now.
More pictures from the Thursday’s demonstration have been posted on Flickr.
Saturday, October 8, 2011
Some 1,000 protesters moved from Zucotti Park in lower Manhattan to Washington Square Park. Here is the ABC report about the move. It includes a brief interview with Bronx family physician Dr. Daniel O’Connell:
Questions from Reporters (and various answers):
Why are doctors coming to this demonstration?
We are here to express our solidarity with this demonstration, this overwhelmingly peaceful demonstration.
We are here because our patients can’t get access to health care. They can’t afford their medications. And they can’t care for their health if they don’t have insurance and if they don’t have jobs.
Right now there are over 50 million people without health insurance in the United States. Medical costs are a leading cause of personal bankruptcy. Even with the new health care law, we will still have 21 million people without health insurance in 2019.
Health care should be a human right and everyone should have it.
What does Wall Street have to do with health?
There are great income disparities here in New York City. The mean income in the Bronx, it’s $17,000 a year. Here in Manhattan, it’s $64,000 a year. And how much money do the people in these buildings around us make?
These people here need to pay their fair share of taxes and obey the law.
If the economy is not good, people will not be healthy. Our patients need good jobs and benefits.
What is going to happen to these protests?
No one knows the answer. And, of course, the groups leading the protest is inexperienced and not sure what it wants. But this just reflects a political context where only the most conservative, pro-business ideas are allowed to be discussed in the media and in the political world. If progressive ideas are excluded from public debate, it’s inevitable they will burst forth in some spontaneous form.
Final comments
The occupation movement is still developing and we will keep readers of the Portal informed about local participation by health care personnel. Readers who would like us to post more materials can either email me (see below) are post a comment.
It is good that we have two strong local organizations - Physicians for a National Health Program and the National Physicians Alliance - who have spent thankless years organizing progressive doctors. These structures have helped create a cadre of activist physicians who were able to respond to the occupation. If you are not a member of one of these organizations, you should be.
Readers who would like more background on the occupation may consider the following sources:
Integrating human rights is not simply a technical matter resolved by adequate training; it requires negotiation, adapting and working within the local culture. Moreover, developing capacity in human rights will have little impact if, to start with, laws, institutions and policies fail to de-facto recognize human rights prerogatives.
Background
1. On December 10, 1948, 48 countries signed the Universal Declaration of Human Rights. The rest is history –history not to be taken lightly since human rights (HR) are just not any rights. They are specifically laid down in treaties. Treaties are contracts between governments. This means they are legally binding on the States that are party to them and call for compliance with the principles and standards contained in each instrument. Not so well known is the fact that signing these treaties already creates an obligation in the period between signing and ratification, i.e., states agree to refrain, in good faith, from acts that would defeat the objectives and purposes of the treaty.
2. Governments are actually required to harmonize their national legislation with international HR standards. For that, they need to examine their domestic legislation accordingly and carry out an analysis of existing policies; also, to refer to constitutional and domestic legal standards, as well as the government’s signed and ratified international HR obligations.*
*: We constantly need to remind governments that, at the 2005 UN World Summit. they did re-commit themselves to integrate the promotion and protection of HR into their national policies. As civil society, we can give them technical assistance to meet those commitments, but comply they must.
3. The above is often hampered by HR still being viewed with suspicion, as an external conditionality or the latest development fad or donor import. These concerns are not infrequently voiced in good faith (but out of ignorance) **, although sometimes they mask a desire to avoid HR obligations.
**: Just think how many of us have been or are unintentionally complicit with HR abuses committed by our or other governments. There simply is no such a thing as unintentional discrimination!
4. Therefore, to ultimately succeed, the challenge is to use HR in ways that people can identify-with and can internalize in the context of their own lives. Why? Because people have to reach a consensus on the causes of HR violations before they even consider demanding action to end the same.
Some further precisions are probably called for at this point:
i) On progressive realization
5. Often, governments use never-ending progressive realization tactics as an excuse for deferring or relaxing their efforts. ***
***: Remember: Civil and political rights have immediate effect (right to life, right of association, right to equal access to justice). Conversely, economic, social and cultural rights (ESCR) are to be implemented progressively, except for core obligations that have to be implemented immediately. In ESCR, of immediate implementation are: no discrimination, no regression, taking concrete steps towards the full realization of rights, monitoring progress and the availability of mechanisms of redress before a competent court or other adjudicator. [Key here is a) that aggrieved claim holders are to have the opportunity for recourse where duties are not met and b) that cultural claims cannot be invoked to justify HR violations].
6. One important way to keep track of progressive realization is paying attention to the impact of governments execution of budgets on different social groups. For instance, gender responsive budgeting does influence the rights of women.
ii) On General Comments
7. Treaty bodies have produced General Comments that clarify HR standards and give guidance on what these standards actually mean in practice for each specific codified right; they interpret the respective treaties and clarify their scope and meaning. ****
****: GENERAL COMMENTS ADOPTED BY THE COMMITTEE ON ESCR: General Comment No. 1: Reporting by States parties; GC No. 2: International technical assistance measures; GC No. 3: The nature of States parties’ obligations; GC No. 4: The right to adequate housing; GC No. 5: Persons with disabilities; GC No. 6: The economic, social and cultural rights of older persons; GC No. 7: The right to adequate housing; GC No. 8: The relationship between economic sanctions and respect for economic, social and cultural rights; GC No. 9: The domestic application of the ESCR Covenant; GC No. 10: The role of national human rights institutions in the protection of economic, social and cultural rights; GC No. 11: Plans of action for primary education; GC No. 12: The right to adequate food; GC No. 13: The right to education; GC No. 14: The right to the highest attainable standard of health; and GC No. 15: The right to water.
iii) On the roles of claim holders and duty bearers
8. During the identification of those with the role of duty bearers*****, we have to ask four key questions upfront: Who are they? What are their duties? Who of them is a violator? Is there a need for remedy?
*****: Duty bearer roles are always defined in relation to claim holders.
9. Identifying pertinent duty bearers depends on which rights are being violated or are not being fulfilled and who the claim holders are in that case.
10. For those with the role of claim holders, we have to ask: Who are they? What are their claims? Which of their rights is/are being violated?
11. Claim holders must have the triple capacity of exercising their rights, formulating claims and seeking redress. When formulating a claim, claim holders must know what they are entitled-to, know how to ask for it and know who to ask for it. Seeking redress includes seeking compensation for an unfulfilled obligation that can be either positive or negative. Remedies can be sought at either judicial, administrative and/or political level.
12. Processes that empower claim holders and duty bearers in their respective roles lead to more sustained results. For this to materialize, both claim holders and duty bearers must be ongoingly involved in monitoring and evaluation.
13. At the end of the assessment of these roles, we are left to identify 4-5 claim holders and 4-5 key duty bearers and 1-2 of the most important rights/duty relationships that need to be addressed as a matter of priority.
iv) On capacity analysis and gaps
14. Capacity gaps found both in claim holders’ and duty bearers’ respective roles have to be assessed, i.e., gaps: in knowledge, in responsibility, in motivation, in leadership, in authority and in access to and control of resources.
15. As pointed out above, the respective development of capacities to follow cannot only be a technocratic process; it also must entail engaging participants in needed social, political, legal and institutional changes.
16. The HR-based outputs aimed-at must thus, first and foremost, contribute to closing the capacity gap of claim holders, of duty bearers, as well as closing the gaps in the local legal, institutional and political frameworks.
17. Working with claim holders only, to empower them in their capacity to claim their rights, will not be effective if similar efforts are not made with duty bearers in an effort to muster their capacity and their commitment to ensure the right services are in place to respond to people’s entitlements.
v) On the human rights-based approach (HRBA)
18. The HRBA lifts intersectoral barriers and facilitates addressing common social and political hurdles that are behind capacity gaps of claim holders and of duty bearers in all the different sectors. It also shapes the type of relations with partners in other sectors by applying a holistic lens that looks at the big picture.
19. We do not deny the HRBA is time-intensive; it primarily requires devoting time to both claim holders and duty bearers capacity building; in other words, setting up ongoing, sorely needed, HR learning opportunities.
20. Furthermore, it is very important to gather information on good practices on the adoption of the HRBA so as to build up the evidence base needed to show effectiveness.
vi) On the HR results chain
21. As you know, the levels we aim-for in the development results chain are outputs, outcomes, impact and sustainability. In HR work, outcomes seek changes in development conditions and improvements in the performance of claim holders and of duty bearers (e.g., changes in their respective behavior). Impact is reached when the specific rights selected for fulfillment are finally realized. Processes are important, because, for us, the how is just as important as what is finally achieved.
22. Rights-based outputs close capacity gaps of claim holders and duty bearers; they create conditions for them to perform their respective roles.
23. Rights-based outcomes improve claim holders’ and duty bearers’ performance, i.e., they bring about positive changes in their individual behavior and that of the organizations they work in.
24. Rights-based impacts actually mean rights are realized and duty bearers are meeting their obligations.
vii) On HR principles and standards
25. The HRBA entails consciously and systematically paying attention to HR standards and principles in all aspects of development programming work.
26. Principles provide the playing rules for de development process.******
******: We talk about process principles (universality and inalienability, individuality, interdependence and interrelatedness) and content principles (participation and inclusiveness, equality and non-discrimination, accountability and rule of law).
27. Standards provide the minimum normative content of a right or entitlement, i.e., the types of claims and obligations that the right implies at the minimum, in practice. Standards correspond to the minimum level of policy an programming actions/activities necessary to make sure a right is being fulfilled. They are the minimum content of entitlements and obligations against which duty bearers, especially organs of the state, can be held accountable for. Examples of standards are articles in the HR treaties, in General Comments, in national legislation and in constitutions, as well as HR standards of the Right to Food that are found in Art. 11 of the CESCR and in GC 12. For the Right to Health, minimum standards are adequacy, access availability and quality of services (3AQ), as well as access to clean water, to food, to care and to shelter.
28. A key question to ask here is: Are national standards for positive discrimination or affirmative action recognized and applied?
In closing
29. Some tactical tips flow from all the above, namely:
If government officials resist, turn to religious leaders, to elders, to parliamentarians, to national HR institutions, to national civil society organizations, to international and local NGOs, to UN agencies, to labor unions, to women’s and youth organizations…leaving no stone unturned.
If the language of HR causes resistance, choose alternative ways of phrasing things without changing the content of what needs to be achieved. (Do not use HR language if it is not appropriate).
Knowing the opposition you are facing (where they are coming from) is key to successful negotiations.
30. Bottom line, HR stand to define the content of the development objectives. They delineate the playing field in which development is to take place. One would want to think that it is clear to development workers what this means. But there has been limited operational guidance as to how HR are to be best integrated into development programs –thus the challenge for a massive worldwide HR learning effort. [This Reader operates in this realm and contributes its grain of salt to that].
The GNP/capita ratio between rich and poor countries is 1:100; the difference in health expenditures among the same is 1:1000. (L. Chen)
1. While health and human rights advocates have, from the start, taken a global perspective on the causes of ill-health, social medicine and particularly social epidemiology have been slower to catch up. This is not an assertion to be taken lightly. This, simply because advancing global health and health equity against the odds of a wide variety of threats –including abusive non-caring actors, unjustifiable reasoning and procrastination, and plain complacency of those who have the power to make a difference– requires the adoption of a perspective that puts human rights (HR) and the human right to health at the center.
2. “Achieving health equity within a generation* is possible, it is the right thing to do, and now is the right time to do it.” This statement in the Report of WHO’s Commission on the Social Determinants of Health is not meant to be hollow rhetoric. Why? Because the human right to health presents a compelling case for action on health and on the social determinants of health. It implies that if individuals have a right to health, then they also have a right to the determinants of health being overcome.
*: What is meant by closing the gap in a generation is that the goal of social action is to flatten the social gradient in health by leveling up health outcomes across the social spectrum in the next 30 years.
3. There is a more than sufficiently plausible causal chain that links political decisions and social action geared at meaningful changes in the health of entire populations and especially on the health of the lower socioeconomic groups. Despite this plausibility, social epidemiology has chosen to primarily look at biomedical causality chains instead.
4. A social environment that does not respect, protect and fulfill the social, economic and cultural rights (to health, nutrition, education, shelter…) and to civil and political liberties can indeed be accused of having a role in the chain of causation and distribution of preventable ill-health, malnutrition and mortality.
5. So far, the problem with the social determinants (more formally so than in practice) has been on how to frame the rights associated with them if and when they are not explicitly identified in human rights law. In other words, how to reconcile an understanding of the dire health situation on the ground with the formal texts of human rights law has been a dilemma for hardnosed analysts. But, although it is true that HR law does not guarantee the right to be free of, for example, TB, a strong case can be made for it when interpreting the texts pertaining to the human right to health.
6. To carry things to an extreme: What if one believes, for example, that the provision of sutures is not only a reasonable and feasible means to prevent deaths, but that it should be seen as a human right? Although no explicit human right to sutures is stated in either the Universal Declaration of Human Rights, the Covenant on Economic, Social and Cultural Rights, or in the Right to Health’s General Comment No. 14, the existing language and rights in these legal human rights documents can be interpreted to provide individuals with a right to such essential health care supplies as sutures, sterile drapes, and anesthesia.
7. To insist that the full spectrum of international HR rights law must be respected, of course, requires not only its respect, but also the means to enforce it, and mechanisms to hold individuals and institutions accountable for its violation.
8. What I am aiming at here is at proactively deriving health-related standards from human rights law ** to infuse them into health programs and to direct them to govern actions of individuals delivering health care services on the ground.
**: Note that this rises arguments for advancing human rights not only in health, but also in social action in other areas.
9. Although we may be working in health, we need to apply the broader definition of human rights that encompasses all economic, social and cultural rights. A more vigorous enforcement of these human rights will improve people’s living conditions, i.e., tackle the social determinants, leading to better health outcomes.
10. When and where it is clearly visible that the social structure –i.e., the social, economic, and underlying political conditions– is condoning or, indeed, directly causing avoidable disease and preventable deaths on a large scale, the human rights framework emerges as the only currently available and viable mechanism to fight back; in such a setting, HR act as an empowering tool for those who suffer unacceptable violations of their right to health –a tool to help them bridge the gap of inequality and deprivation.
11. Moreover, in the present era of increasing globalization, international human rights law is the best available instrument to address the ill-health caused by transnational actors who, in many cases, are more powerful than many a government.
12. As Dr Jonathan Mann once said: “A society that realizes the full breadth of human rights will produce healthier individuals and populations”.
13. It is only when it is accepted that the absence of the right to health is the cause of preventable ill-health and mortality, that the causal role and the importance of the right to health will stand firm and unopposed.***
***: We are reminded here that human rights are not natural facts or objects, but ethical and political assertions about claims, privileges, liberties, immunities, and powers in relation to various human capabilities. (A. Sen)
14. Unnecessary and avoidable misunderstandings result from attempting to deemphasize the importance of HR as direct causal components of the pattern and distribution of preventable ill-health, malnutrition and mortality. Actually, the health and human rights framework as a necessity supplements the analysis of the social causes, the distribution, and the consequences of preventable ill-health and mortality as done by social epidemiology.
Are institutions and health care professionals agents for a sustainable social transformation?
15. We have got to get health practitioners to embrace the fight against entrenched orthodoxies in many health areas, as well as get them to champion the enforcement and the realization of people’s economic, social and cultural rights.
16. For the practitioner of social medicine, the primary aim thus is both to address avoidable ill-health, malnutrition and mortality through his/her healing art, as well as to contribute to the enforcement of economic, social and cultural rights, or any other right –for their own sake.
17. What is said here is that it is futile to try to reduce inequalities in health by acting on aspects of health care delivery only (i.e., acting on the supply side only).
18. In practice, what fellow practitioners need is to identify what is required in the form of social action to influence policies, regulations and laws, as well as actions on the ground. This invariably means addressing the social determinants of ill-health and health inequalities by influencing local and national deliberations so that decisions respect the human rights principles (i.e., universality and inalienability, individuality, interdependence and interrelatedness, participation and inclusiveness, equality and non-discrimination, and accountability and rule of law).
19. When HR standards and principles are incorporated into health-related disciplines such as epidemiology, medicine and operations research, they do provide a plan of action not only for practitioners, but also for communities and for states –in other words, the human rights discourse also ought to become a community health planning tool. (L. Freedman)
20. It is thus unacceptable today to continue maintaining that the causes that are directly and indirectly (and unnecessarily) killing people are not a human rights concerns.
Adapted from The Right to Sutures: Social epidemiology, human rights, and social justice, S. Venkatapuram, R. Bell, and M. Marmot, Health and Human Rights, Vol. 12, No. 2 (2010).
Food for a thought that does not represent the people
Human Rights Reader 271
Accountability in foreign aid
The international legal regime established through the various human rights treaties is the existing global accountability framework which we should be drawing upon much, much more.
1. Efforts to increase the type of foreign aid that strengthens human rights institutions and accountabilities should go in tandem with the actual disbursement of foreign aid funds. But is this the case?
2. As I had said earlier, mutual accountability is the least developed Paris Declaration principle that would definitely benefit from a human rights (HR) perspective so that civil society’s capacity to hold donors and their own (recipient) governments accountable needs to be strengthened.
3. A number of the deep-seated problems in the current foreign aid system stem from an imbalance of accountabilities –with ‘upwards’ accountability to donors prioritized over ‘downwards’ accountability to the poor countries and to the people aid is supposed to help. (ActionAid) Such an accountability towards the ultimate recipients of aid is simply missing.
4. Domestic accountability requires a certain level of democracy and of functioning institutions for individuals to be able to claim their rights and participate in decision making. In a democracy, this duty must be met by the recipient government. But, as long as many governments are far from democratic, it is legitimate to expect the donors to take up such a duty.
5. In the donor countries, citizens can better hold (and have a history of holding) their government to account for the way their money is spent and by providing leverage for the negotiation of HR issues. So, through demanding greater legal accountability of donor agencies, leverage can be used to demand the respect of HR standards and principles in foreign aid, as well as the setting of annual benchmarks to measure progress in that aid.
6. The ever-present pressure on donors of showing results turns accountability further outwards on them instead of supporting the national inwards processes necessary for achieving ownership and domestic accountability.
Aid darlings and aid orphans
-We have to recognize the existence of aid darlings and aid orphans and must, therefore, improve the unfair global allocation of aid resources.
-On the other hand, aid is not the route to development anyway; it creates dependency and erodes self-reliance.
7. Many of the bilateral donor agencies and development banks use the phrase ‘respect, protect and promote’ instead of the correct phrase ‘respect, protect and fulfill’. The omission of ‘fulfill’ is deliberate (!), reflecting these countries rejection of the Right to Development which is seen by them as an acceptance of an obligation to provide development assistance. (As much as the very uncritical acceptance of the ‘aid effectiveness’ dogma which is widely prevalent, other rhetorical terms are also often used to avoid blatant existing contradictions). Development today must be seen within the realm of the HR framework and, in so doing, development assistance must now be seen as a right rather than an instrument of solidarity.
8. Ultimately, human rights work exposes the political dimension of aid and of poverty. This being so, it is claim holders who have to ensure that the technical assistance on offer through foreign aid is truly demand-driven. For this, both donor and partner patterns of behavior must change; but this will only happen if the underlying incentives shift. I had said earlier that country ownership of development programs should not be equated with government ownership. So, for example, if gender equality is not an explicit national priority (and in many cases it is not), the incentive is not there. The rhetorical question here is: Will gender equality then be entirely excluded from donor agendas …as HR in general are?
9. The emphasis in current (and past) foreign aid is (has) simply (been) too much centered on the ‘plumbing’ or ‘mechanisms’ of the aid delivery system and not enough on reducing poverty and inequality as called for by the Right to Development.
10. Under the pretext of making aid more effective, the aid effectiveness paradigm has become a form of collective colonialism by Northern donors when engaging with Southern countries that, through weakness, vulnerability or psychological dependency, allow themselves to be subjected to it.* (Y. Tandon)
*: The explicit recognition of the importance of South-South cooperation is another important issue and is not explored here.
11. There is simply no aid effectiveness without development effectiveness and the gender equality, environment and human rights perspective must be crucially incorporated to even have a chance to achieve this century’s development goals. (J. Cedergren)
12. In closing: The lessons learned from this Reader are quite dramatic. There is a need for more training. The fact is that there is a fundamental misunderstanding in multilateral and bilateral agencies, governments, NGOs and other civil society organizations; it is about the real need for training. The move from a traditional basic needs or human development program thinking to an understanding of the human rights-based framework to development and to development programming requires a total mind shift. This cannot be achieved by one or two four-day workshops; it requires at least such workshops several times a year for 2-3 years! No agency or government has come close to that, and it is exactly this lack of serious training that has hindered an accelerated adoption of the HR-based framework.
Readers of the Portal may be interested in a talk this Friday (9/2/2011) at the CUNY Graduate School. Steve Brouwer, author of the blog Venezuela Notes, will be speaking about his new book, Revolutionary Doctors published by Monthly Review Press. He will be accompanied by the Honorable Jorge Valero Briceño, Permanent Representative of the Bolivarian Republic of Venezuela to the United Nations. The talk will take place at 7PM at the Elebash Recital Hall, The Graduate Center, CUNY, 365 Fifth Avenue, New York, NY 10016. Click here for a flyer.
Brouwer’s book begins with a discussion about the Cuban medical system and its programs of medical internationalism (either providing medical care directly overseas or training foreign doctors). It goes on to consider how Cuba assisted Venezuela to create a new public health care system, known as Barrio Adentro. Finally, Brouwer looks at the backlash against the Cuban model on the part of the US as well as the development of revolutionary medicine as part of the creation of a socialist society. It is always mind opening to read about serious attempts to construct socialist societies; there are real alternatives to our current social structure.
Brouwer notes that medicina integral (comprehensive or whole medicine) is built on Che Guevara’s idea that “individuals can liberate and develop themselves more fully when they are devoted to the full and revolutionary development of their communities and societies…” This conception of human development stands in stark contrast to current US political discourse where we are told that individuals develop most fully when they are disconnect from the broader social good and pursue their own selfish ends.
The talk is presented by Monthly Review Press; Bolivarian Circle Alberto Lovera; Cuba Solidarity New York; TheIndypendent; July 26 Coalition; Casa de las Americas; The Center for the Humanities at The Graduate Center, CUNY; IFCO-Pastors for Peace; The Center for Place, Culture and Politics, CUNY; and others.
