Los Angeles. My main topic this month is the significance of the ‘new philanthropies’ and their impact on global public health, and in particular population nutrition in less resourced and impoverished countries. My context is this month’s UN Summit on the prevention and control of non-communicable diseases, which are now rampant in Asia, Africa and Latin America. A vital source for this commentary is an analysis by scholars from the Harvard School of Public Health and the London School of Hygiene and Tropical Medicine (1).
My pictured example is the biggest philanthropist in the world, whose interest is public health, and his foundation, whose budget is greater than that of the World Health Organisation, and which after the US government is the biggest funder of WHO. This is the Gates Foundation, about to become the largest single shareholder in the Coca-Cola company and in Kraft Foods (1), which, as stated on its website, is ‘driven by the interests and passions of the Gates family’. Bill Gates, above, is speaking on the theme of ‘the new drivers of development’ at the 2008 World Economic Forum meeting in Davos.
People’s Health Movement
On to its world assembly in Cape Town
At the end of July I attended the annual meeting of the USA circle of the People’s Health Movement in Los Angeles. The setting was bucolic: the Loyola Marymount University campus, seen above in term time. It was good to be with grassroots activists in the US who, suffice it to say, are having a hard time, because of the financial turmoil the US is going through. I brought with me the solidarity of the global People’s Health Movement.
Discussions were fertile and we all shared plenty of ideas on where the movement wants to go in its domestic US work over the next two years. Attention was also given on how to best contribute to the organisation of the Third People’s Health Assembly, to be held in Cape Town in July next year. This coming event is creating a great deal of excitement the world over, particularly among grassroots organisations working in health. What a great job they are doing in the US. Defending the right to health in this great nation is certainly not an easy task – let alone working against militarism and against big time polluters, as some militant groups here do.
The new philanthropies in world health affairs
Masters of our universe
Bill Gates is currently the world’s second wealthiest person. Among all the new philanthropists I have picked him because the Gates Foundation, with assets of $US 30 billion, is by far the largest foundation whose main interest is population health (1). He has become devoted to the UN Millennium Development Goals. Above (left) he is advocating them at the UN General Assembly in 2008. Also in 2008 he is (right) upholding them with colleagues UN secretary-general Ban Ki-moon, the late Nigerian president Yuma Yar-Adua, former UK prime minister Gordon Brown, Queen Rania of Jordan, and (far right) Bono. No people of the type shown in the photographs being held up were, as far as I know, present in Davos.
When we consider the significance and impact of the ‘new philanthropies’, it is fair and reasonable to think of Bill Gates and his foundation, because of its scale and his presence. But there are others.
FOUNDATIONS
HAVE YOU EVER WONDERED WHERE THEY
AND THEIR PEOPLE COME FROM?
AND WHETHER THEIR INTENTIONS
ARE REALLY PRISTINE?
Institutional relationships in global health are a growing area of study, but few if any previous analyses have examined private foundations. It is almost as if analysts feel that foundations are beyond criticism or even appraisal. Bill Gates certainly thinks so. The intentions and policies of the directors of foundations are rarely considered. This is now beginning to change (1-4).
There are broadly three different types of private foundation whose declared purpose is to protect and improve public health, including nutrition. Some were set up a long time ago, often by vastly wealthy US industrialists and which, over decades, have sought distance from their founders. These include the Rockefeller and Ford Foundations, for example. Some are similar, except that the founders are themselves alive and active in pursuit of influence on internal affairs in ways they see as akin to their view of the world. The Gates Foundation is the outstanding example, but there are others, for instance the Fundación Carlos Slim Helú, named after the world’s currently wealthiest person. Other foundations are obviously different; they are set up by and controlled by transnational and other giant food and drink companies. These include the Coca Cola Foundation, the PepsiCo Foundation, the Kraft Foods Foundation, and many others.
As I see it, the similarities between these types of foundation are actually greater than their differences. Corporations set up or fund foundations that support the corporation’s direct or indirect, tactical or strategic policies. Foundations that are historically or constitutionally distant from their founding funders still work within an ideology that is consistent with big business, particularly as seen by US industrialists. They rarely transfer money and resources to organisations that are independent, democratic, and accountable to their members, or to voters and taxpayers.
The funders and directors of private foundations may well have altruistic motives, but it is also true that there is financial benefit in setting up a foundation. It also stands to reason that the policies of any foundation will support or at least be consistent with the corporate policies and personal ideology of the people who control the foundation. Tax-exempt private foundations and for-profit corporations increasingly engage in relationships that can and do influence global health.
Where do foundations invest their money?
Many public health foundations have associations with private food and drug corporations. In some instances, they are invested in the stock of such corporations. Here below, for example, is a list of the main stockholdings of the Gates Foundation, taken from (1).
What this shows is that when the stock of Hathaway donated by Warren Buffett and now being transferred to the Foundation is taken into account, the Gates Foundation will be the largest single stockholder in Coca-Cola, the biggest manufacturer of sugared soft drinks in the world, and of Kraft Foods, the biggest manufacturer of confectionery in the world. Does Bill Gates think about this, when he makes decisions, or is on platforms with executive from transnational food and drink processors? Probably not, but it seems likely that they think about it, and it also seems likely that there is a basic community of interests here.
Does this help to explain the zealous attachment of the cash-strapped United Nations system to ‘public-private partnerships’ where in our field of nutrition and public health the private partners are mostly transnational food and drink processors, otherwise known as Big Snack? This also seems rather likely to me.
Personnel move between food and drink industries, pharmaceutical houses and academia and to and from public health foundations. Foundation board members and decision-makers also sit on the boards of some for-profit corporations benefiting from their grants. While private foundations adopt standard disclosure protocols for employees in order to mitigate potential conflicts of interests, these disclosures do not always apply to the overall endowment investments of the foundations or to board membership appointments.
The extent and range of relationships between tax-exempt foundations and for-profit corporations suggest that transparency in grant making alone may not be preventing potential conflicts of interests between global health programmes and their financing. The question of whether and how financial and institutional relationships shape foundation decision-making has yet to be properly addressed, let alone answered.
Further, it is surely fanciful to suppose that industrialists who are alive and active now, and who maintain control over foundations, are likely to change the core beliefs that made them immensely wealthy. The basic ideology that drives transnational corporations is going to be the same basic ideology that drives their foundations. Does this seem to you to be a cynical view? Surely it is common sense. But the implications are vast. It means that the strategic policies and practices of transnational corporations are pursued, albeit in a different guise, by the foundations set up in their name. Technological fixes ensue. But medical technologies make a relatively small impact on the broader social and economic determinants of health and nutrition; and the efficacy of technology cannot be guaranteed so that an over-emphasison technology has been and is problematic.
As David McCoy says, the ways in which much private philanthropy works are hugely inefficient. For example, there are many transaction costs related to vertical top-down initiatives, and there is much collateral damage along the way. We could achieve better long-term health and nutrition improvements using an approach that tackles the social determinants.
Foundations are not all bad
David McCoy also thinks the issue is less straightforward than ‘condemning private philanthropy out of hand’. For example, he asks some important questions:
Private philanthropy can include some expressions and actions of social
solidarity for ordinary people, but we do not condemn that, do we?
Do we need to make a distinction between post-tax and pre-tax private
philanthropy?
Many of us work for organisations that are funded in part by private money –
do we condemn all that private money as well?
Is all private philanthropy worse than public aid? Are US government aid and
the World Bank loans and grants associated with structural adjustment programmes better than all examples and sources of private philanthropy?
Are there better and worse forms of private philanthropy – in terms of the source and the spending of that wealth?
Is there a need for us to differentiate a moral/political position from a
tactical/strategic position on private philanthropy?
Given the pre-eminence of Gates in the global health field, what is our strategy towards the Gates Foundation? Have we ever called for a debate or discussion with the Foundation? And should we?
Do we seek to reform, or to lead a revolt on all of the above?
Much philanthropy used in ways that prevent the radical and structural
changes required to set up a fairer and more progressive economic system. What is our stance here?
Aren’t private foundations not only unaccountable, but hasn’t their power grown through the ‘capture’ of other institutions, including the UN?
Their rise is linked strongly to the relative reduction in public financing with a concomitant rise in the public-private partnership paradigm. Is there any monitoring of the revolving door syndrome between United Nations-foundations-corporate sector-governments?
Are there adequate checks and balances to prevent the capture of public
financing and policy making by the private philanthropy/corporate sector?
I think there is much agreement on the historical analysis of the rise of these institutions, their minimising the tax liabilities of their corporate funders, and their capture of the UN (and many other public bodies). But the issues are complicated, and are only beginning to surface and to be understood (1-4).
CHARITY
FOUNDATIONS ARE PART OF THE
PRIVATISATION OF PUBLIC HEALTH AND
THE EROSION OF PUBLIC GOODS
My friend Alison Katz, on the other hand, thinks philanthropy is never positive. Her view is that the right to health and to nutrition are incompatible with private philanthropy. Private philanthropy and the diseases of poverty go together: They result from, and characterise, gross economic inequity – the root cause of preventable malnutrition, ill-health and deaths.
She believes that as nutrition professionals, we must fight for economic justice as the precondition for the right to nutrition. This implies denouncing private philanthropy.
I am on her side. These things were clear already over ten years ago when philanthropies became prominent. Since the 1980s, most of all, big corporations have successfully fought to pay very little tax and even no tax at all. In doing so they have succeeded in destroying the tax base which is the basis for public services of all kinds, including health and nutrition.
Of course they prefer not to pay taxes, but instead to ‘give’ money (even lots of money) to health (much less to nutrition). In doing so, they open up the area of health and health services to privatisation. They thus make what should remain public goods actual tools of capital with all that implies. The implications include rapidly widening gaps in equity, and the terrifying prospect of destitution when chaotic fluctuations in the money markets occur, such as those we are once again experiencing as I write this column.
Please, do not tell us that health services in faraway lands would collapse, were it not for private foundations. It is not a question of abandoning services in Africa and leaving people adrift. It is a question of what we are fighting for in the long run, and a question of values, principles, equity and justice.
.
Box 1
A letter to Margaret Chan
In 2007, Alison Katz sent a letter on this to Margaret Chan, director-general of WHO. She wrote it at a time when she worked for WHO, but under notice of dismissal. Nothing has changed since and conflicts of interest are still pervasive. Here is part of the letter. It never received a response. You can access the full letter here.
‘It has become fashionable to focus attention on the poor, but to meet and establish partnerships with the rich. In order to address the fundamental problem of inequality, this pattern must be reversed. It is time to focus attention on the rich and powerful, because they are the experts in the mechanisms of unequal power relations and the architects of policies and strategies which produce, reinforce and accelerate inequalities. Those systems must be closely examined by WHO and opened up to public scrutiny and democratic control. To clarify, this is not a discourse on good and evil; the issue is one of antisocial and sometimes violent systems manipulated by a handful of individuals.
‘Poor people do not attend G8 summits, board meetings of the latest Global Fund or philanthropic foundations, let alone the World Economic Forum – where Chief Executive Officers of transnational corporations are offered even more privileged access to political leaders than they already enjoy. But poor people also hold meetings and they are represented – if imperfectly – at the World Social Forum (and in national and regional social fora), in trade unions, social and political movements and elsewhere.
‘As Director-General of WHO, you are committed to “the people of Africa who bear an enormous and disproportionate burden of ill health and premature death” and you have made this “the key indicator of the performance of WHO”.’ Katz goes on to say that the presence of the WHO director-general at meetings of the World Social Forum ‘would represent real hope and inspiration for the world’s people and an essential counterbalance to high level meetings with government leaders and their corporate backers/advisors – who are increasingly one and the same’.
‘You have gone on record saying that “the landscape of public health has become a complex and crowded arena for action with a growing number of health initiatives” and you reminded us that WHO is “constitutionally mandated to act as the directing and coordinating authority on health”. As you know, public-private partnerships have become the policy paradigm for global health work despite the evident conflict of interest which would have outlawed such arrangements thirty years ago. Agencies and organizations with public responsibilities are partnering with the private sector for one reason: It (appears to have) become the only source of funds. This situation has arisen, because under neoliberal economic regimes, public sector budgets have been slashed and tax bases destroyed. Those developments are themselves the result of the influence of transnational corporations (TNCs) and the international financial institutions on governments’.
‘The solution to this problem is not for public bodies to go begging to the private sector, nor to the foundations of celebrity philanthropists with diverse agendas. The solution is economic justice, including an adequate tax base, both nationally and internationally, to cover all public services, as well as proper funding of public institutions such as WHO through regular budgets so that they may fulfil their international responsibilities unimpeded by corporate interests’.
‘You have further argued that “the amount of money being made available by foundations, funding agencies and donor governments is unprecedented”. This will be entirely positive if you are able to use these funds to pursue your vision and priorities, as is your right and your duty. It can be argued that, if WHO had operated exclusively on a regular budget, even with a significantly smaller workforce, but one that was dedicated to WHO’s constitutional mandate, far more progress towards Health for All would have been achieved’.
‘As you have said “Primary Health Care (PHC) is the cornerstone of building the capacity of health systems. It is also central to health development and to community health security”. PHC will remain mostly rhetoric if it is not supported by a solid, equitable tax base and other forms of redistributive justice (debt cancellation and reparation, fair trade, abolition of tax havens, democratic control of TNC activities, etc.). WHO itself needs to set targets for the level of core funding, starting perhaps at 70% of total expenditure, and increasing annually until undue influence is removed. The private sector has no place in public health policy making at global or national level. This does not, of course, exclude responsibly designed interactions as in the past. But it does exclude partnerships, because partners must share the same goal’.
THE NEW PLUTOCRACY
PHILANTHROPY IS THE ANTITHESIS
OF THE RIGHTS-BASED APPROACH
TO NUTRITION AND TO HEALTH
Private philanthropy is always interested in something. Does it seem that I am being facetious when I suggest that this is furtherance of its own interests? Private philanthropy exists because of gross inequities. Diseases of poverty and philanthropy in health and nutrition will always go hand in hand. When the right to health is achieved – even partially – who will need philanthropy? Philanthropic giving is the antithesis of the rights-based approach to health and nutrition.
Private philanthropy has no place in a social justice approach to human rights, including the right to nutrition. A right cannot depend on charity, or even on expressions of top-down social solidarity. That is the nature of rights. Private philanthropy only exists because of large inequalities. It almost always confers yet more power on the giver and thereby further widens those inequalities. It is truly a vicious circle and our aim ought to be to move out of it.
This does not mean abandoning people to their suffering. It means working on a transition to a human rights-based approach at all times. In all our strategies we have to move towards the standards and principles of human rights and away from charity.
The People’s Health Movement position
The People’s Health Movement has had lengthy debates on public-private partnerships, and has protested Bill Gates opening the World Health Assembly in 2005 and again speaking there in 2011. We have vehemently and vocally opposed the privatisation of health services and have denounced the UN Global Compact. Our entire raison d’être relates to issues of conflicts of interest, the rule of money, and the capture of WHO by industry.
We do not condemn private philanthropy action as a temporary measure to stop immediate and medium term suffering. As a way of achieving our aim of health as a human right, yes, we do condemn it. It has no part to play in the structural processes to achieve the human right to health and to nutrition. We are about creating the conditions for human rights, not to dole out goodies to salve consciences, quelling popular uprisings, and preventing real change.
My own reflections
Here is what I think, based on working for over 30 years as a nutrition and health professional mostly concerned about impoverished people in all continents apart from Europe.
Ordinary people understand well that charity is an integral part of systems of inequity. If it is to be effective, and in order to improve the situation of people, social solidarity has to take the form of political action. Hence the famous phrase of Dom Hélder Câmara the Brazilian archbishop of Olinda and Recife: ‘When I give food to the poor they call me a saint, when I ask why they are poor, they call me a communist’. When impoverished people protest in the streets, you do not hear them calling for more philanthropy. They are demanding their rights.
A solid tax base, redistributive tax systems, and economic justice are the answers. Transnational corporations are skilled at avoiding tax. Some pay little, some pay none. Rich people generally pay far less proportionately than poor people. Over the past 30 years, the tax burden, like every other burden, has shifted massively onto the backs of the poorest.
Do we really want to put nutrition decision-making in the hands of the wealthy much of whose money comes from avoidance of taxes, which is to say not contributing to the public purse, so that the public has to come begging for money that is rightfully theirs in the first place? Or, do we want decision-making to be public and democratic including those who pay taxes? That’s the choice: rule by money – plutocracy – or rule by people – democracy. We already condemn the ability to pay as a criterion for access to health care and to good nutrition. We should also condemn the ability to pay as a criterion for access to decision making. When we work in health or nutrition or any public service addressing human rights, our funding should be public; we should not depend on private funding.
The more I think about this, the more it seems to me that private philanthropy provides a respectable front to the much larger hidden face of powerful and exploitative forces. We want health and nutrition for all through social justice. It is a matter of appreciation whether social justice is a revolutionary project. Compared to the current neoliberal dogma, it probably is.
People are naturally compassionate, and empathy is a human trait. When ordinary people are told the truth about how international aid or private philanthropy works, they understand very well that human rights and charity are not the same thing. People will always need to help out other people in emergencies, because human beings are like that. But in a fair world, it would be just as likely for Haiti to help out Belgium, as it would be for Australia to help out Mali.
Private philanthropy’s espousal of ‘creative capitalism’ or ‘responsible capitalism’ or ‘win-win capitalism’ or ‘markets that benefit the poor’ (there are many more warm phrases) surely is obviously absurd at a time of chaotic market failures. Such phrases are surely fatuous when we find that foundations are doing nothing or little to stop systematic corporate tax evasion, and are aware that international property rights laws now promote monopolies and hinder innovation and scientific development. The very least that private foundations could do, is to address the many inequities and causes of market capture, market failure, barriers to market entry, and so on and on. These issues are crucial in the health and nutrition sector, because of its particular susceptibility to market failures. If families are thrown out of their houses, or have no money to buy shoes, usually they manage somehow. If they have no food, they die.
As Alison Katz so eloquently argues and David McCoy rightly concludes, private philanthropy has become a powerful and insidious presence in our midst. Ventilating this topic now is timely, in the month of the UN Summit on prevention and control of non-communicable diseases.
Transnational corporations and foundations are deeply implicated and involved in this global pandemic. Soon, I predict, private foundations, some directly controlled by transnational food and drink companies, others with less direct links with that part of industry whose products are a cause of the pandemic, will enter big-time, into the prevention of non-communicable diseases arena. But why am I saying ‘soon’? This is already happening now. At the very least, we professionals need to become more aware of what is going on, where philanthropic stakeholders are coming from, and why.
References:
1 Stuckler D., Basu S., McKee M., Global health philanthropy and institutional relationships: how should conflicts of interest be addressed? PLoS Med 8(4): e1001020. doi:10.1371/journal.pmed.1001020
2 Anon. What has the Gates Foundation done for public health? [Editorial]. The Lancet 2009; 373, 9675: 1527.
3 Piller C, Sanders E, Dixon R. Dark clouds over good work of the Gates
Foundation. The Los Angeles Times, 7 January 2007.
4 Wiist B. Philanthropic foundations and the public health agenda. Corporation
and Health Watch, 3 August 2011.
Acknowledgement and request
You are invited please to respond, comment, disagree, as you wish. Please use the response facility below. You are free to make use of the material in this column, provided you acknowledge the Association, and me please, and cite the Association’s website.
Please cite as: Schuftan C.The new philanthropies in world health affairs. [Column] Website of the World Public Health Nutrition Association, September 2011. Obtainable at www.wphna.org
I owe the analysis in the commentary to many years’ experience and many discussions with countless friends and colleagues in the People’s Health Movement. Many thanks to David McCoy and Alison Katz; and also to David Stuckler, Sanjay Basu and Martin McKee, whose extensive review cited above is a vital resource. This column is reviewed by Geoffrey Cannon.
A contingent of about 40 doctors in crisp white coats, carrying signs that read “Bronx doctors for Wall Street Occupation” and “My patients need jobs, education, healthcare for all, not just prescriptions, definitely not bank bailouts,” joined the throngs of activists at the Occupy Wall Street protests at New York’s Times Square two weeks ago.
Members of the umbrella group “Healthcare for the 99 Percent,” they are one of a growing number of OWS constituencies that view their particular cause not as a stand-alone issue, but integrated with other social grievances represented by the movement.
These doctors care for the people who live in the poorest congressional district in the country: the South Bronx’s 16th district. They see large numbers of patients each day who are hungry, who don’t have jobs or stable homes, who can’t afford their prescriptions. Widespread poverty means that Motrin and Lipitor won’t do much to help these New Yorkers; their health problems have much deeper socioeconomic roots. Not surprisingly, the Bronx is the unhealthiest county in the state of New York, according to a recent University of Wisconsin study. Dr. Cameron Page, who completed his residency in the Bronx and now works at Manhattan’s Beth Israel Medical Center, says that what he calls “upstream problems” have to be addressed first, because by the time patients get to the exam room, “it’s too late.”
Our colleague Dr. Rob Roose forwarded this announcement of a fundraiser for the El Punto en la Montaña Syringe Exchange Program in rural Puerto Rico. He noted that: “injection drug use and its related sequelae continue to be massive public health problems in Puerto Rico. There is very little political will or interest to support prevention efforts or offer treatment for substance users. Over the past several years, some colleagues of ours and friends of mine in the harm reduction field have been doing some very excellent work providing syringe exchange for rural users in Puerto Rico. However, and unfortunately, their work is in jeopardy of ending due to lack of funding. ” A podcast describing the work of the clinic is available from the Harm Reduction Coalition.
HELP US STOP A DRAMATIC AND AVOIDABLE HUMANITARIAN CRISIS IN PUERTO RICO
Julia Burgos Latino Cultural Center – (1680 Lexington Ave, between 105 and 106 streets) -Thursday, November 10, 2011 – 6pm to 12am
Education +Access = Power
The AIDS crisis in Puerto Rico is out of control. Over 35,000 people live with HIV/AIDS and at least 50% of these are due to the (avoidable) sharing of contaminated drug injection. It has been proven that when free sterile syringes are made available to injection drug users (IDU), they stop sharing syringes and HIV infection rates go down dramatically. Moreover, HIV and Hepatitis C (HCV) infections are the direct result of the lack of syringe availability. Despite the epidemiological crisis in the island, the needs of these populations continue to be overlooked. While a syringe that literally costs cents can save hundreds of thousands of dollars in HIV and HCV medication treatments and unnecessary human pain, there are almost no monetary allocations to decelerate the progress of these epidemics. In fact, while HCV treatment is virtually nonexistent in Puerto Rico, studies have found that over half of PR IDU may be infected with HCV. This governmental negligence has caused a major and unprecedented human rights’ crisis. We are determined to take matters into our own hands by bringing life-saving services to PR IDU via activism and philanthropy. But we need you. Puerto Rico needs you.
Concerned NYC-based activists are asking you to support El Punto en la Montaña, a rural Syringe Exchange Program (SEP) that operates in the municipalities of Cayey, Cidra, Comerio and Aguas Buenas. While the HIV/AIDS epidemic is island-wide, drug users in rural municipalities have even less access to drug treatment services and sterile injection supplies than those IDU living in metropolitan areas, where syringe exchange, methadone treatment and other services are (somewhat) available. This is what makes El Punto unique. Since 2007, with a yearly budget of approximately $40,000, it has provided access to sterile injection supplies, education and nutritional services to over 600 rural IDU. 98% of these IDU had never received these services in their lifetimes prior to El Punto.
El Punto has been able to operate thanks to funding from private foundations such as TIDES, National AIDS Fund-now AIDS United, NASEN and MAC AIDS Fund. CitiWide Harm Reduction (a Bronx-based SEP) and the Harm Reduction Coalition have also supported this program administratively, and with trainings and supplies. While these funders and institutions have helped El Punto throughout the past 4 years, the financial panorama for 2012 is grim. We need to raise $30,000 to guarantee full program operation during 2012.
Join our efforts to face an unprecedented humanitarian crisis. Join as at the fundraiser PUERTO RICO´S HUMANITARIAN CALL to be held on Thursday, November 10 at the Julia Burgos Latino Cultural Center (1680 Lexington Ave, between 105 and 106 streets). You can also send check donations by mail to 226 East 144th Street, Bronx, NY 10451. Please make checks payable to “CitiWide Harm Reduction/El Punto en la Montaña”.
Questions? Contact El Punto Chair Camila Gelpí-Acosta at 718-581-3983 or camilagelpi@gmail.com
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].
