PHA-Exchange> Food for challenging a conventional thought

[claudio at hcmc.netnam.vn]

Human Rights reader 157


Exploring a critical, systemic approach to health rights
Summary of a paper by Abhay Shukla* (part 1 of 4)

Pathologies of power, as well as social class formation are the motor forces 
behind most human rights violations which are themselves embedded in 
entrenched historical structural violence trends.

1. Many previous and existing social struggles have demanded specific rights --
without necessarily having used the international human rights framework. When 
discussing a ‘rights-based approach to health’ we should --but often do not-- 
proceed from acknowledging this larger historical precedent of struggles for 
people’s rights and social justice. These struggles predate, as well as 
coexist with the use of modern human rights instruments. In practice, today’s 
international human rights law has codified old and new claims to a set of 
social arrangements that are thought to be capable of best securing the 
enjoyment of all inalienable human rights.

2. It is possible, for example, to argue for the ‘right to health’ (RTH) on 
primarily public health grounds and on the basis of old social justice 
arguments, without making any reference to the international human rights 
framework. Nevertheless, the use of the human rights framework does complement 
the public health and social justice perspectives and thus strengthens the 
argument for the RTH.

3. The right to health actually encompasses the ‘right to health care’ and 
the ‘right to the underlying determinants of health’. The distinction between 
both can pose a dilemma to health activists since it does not lead to a clear 
focus of action for them when working towards the attainment of the RTH. But 
the focus should not be blurred.  It remains an important role of activists to 
document violations of the right to health care, as well as the right to the 
underlying social determinants of health. 

4. So, on top of working on health care issues, health activists have a 
critically important responsibility to co-initiate and participate in the 
promotion of the right to the determinants of health which are often  
primarily led by other allied, non-health movements. While doing the latter, 
they have a special role in pointing out the negative health effects of 
existing bilateral trade agreements and of detrimental globalisation-
privatisation policies. Because of their dual responsibility, these activists 
may be uniquely placed to help initiate ‘social sector alliances’ which could 
build a powerful united movement as a counter-power to the onslaught of 
globalisation and the privatisation of various social services including 
health care. 

5.This implies that the progressive health movement must lend its strength and 
voice to movements struggling to improve health-related entitlements such as 
nutrition services and food security, clean drinking water, sanitation and 
safer environmental and working conditions, among others. 

6. The struggle for health rights must thus move-on to link with several other 
struggles (for the rights to food, water, education, housing, livelihood and 
social justice) in their various forms. Health rights work must become one 
strand of a much larger struggle to challenge the unfairness of the dominant 
social order. 

The international human rights framework and the underlying global power 
structures

7. Within countries, dominant classes have historically been forced to concede 
certain rights in a formal manner to maintain their legitimacy (although they 
are not always serious about implementing these rights, especially the full 
range of economic, social and cultural rights). [It is true that “hypocrisy is 
the homage paid by vice to virtue”]. 
In fact, in the case of dominant actors like the U.S. government, a particular 
version of human rights (mostly focused on rather narrowly conceived civil-
political rights) is often used as a cover for policies that result in large 
scale denial of social and economic rights.

8. To the extent that improvements do not take (or have not really taken) 
place, we have to question the legitimacy of the dominant system. So, we 
should also be keenly aware of the limitations of the dominant human rights 
framework, especially its failure --as often applied so far-- to analyse and 
confront the underlying political economy of neo-liberal globalisation and the 
exploitative socio-economic system responsible for large scale denial of 
economic, social and cultural rights. In short, we can and should functionally 
use human rights to counter the social injustices of the globally-constructed-
political-economic-system, without having any illusions about the nature of 
this global power structure, which plays with the language of human rights 
while perpetuating the systemic basis for their violation.

Pitfalls and strengths of the rights-based approach

9. A potential pitfall that can be encountered when using the rights approach 
to health --and that we need to be aware of-- is the often seen primarily 
local focus it uses. We need to take our demands for health care rights beyond 
just local demands and targeting the immediate providers; continuously 
pointing out the larger links will increasingly bring the main decision makers 
into focus. 
10. On the other hand, some strengths of the rights-based approach to health 
are:
•	The rights approach can help us link somewhat complex issues of health 
policy with very concrete demands that can be taken up by people anywhere,
•	the rights approach talks in terms of obligations and violations thus 
placing the responsibility to deliver on the different agents of the 
prevailing system, 
•	the rights approach can also form the basis for a comprehensive policy 
critique that exposes detrimental neo-liberal health policies, and
•	the rights approach allows us also to pursue and institute legal 
action to revert violations and to seek redressal for those wronged.

11. As regards the fight for health care rights, the same begins primarily as 
a form of resistance
•	against the shrinking and weakening of public health services, 
•	against the denial of health care to the most needy through the 
application of user fees, as well as 
•	against the often found poor quality of care both in the public and in 
the private health sector. 
(contd).

Claudio Schuftan, Ho Chi Minh City
claudio at hcmc.netnam.vn 
________________________________
*:Adapted from Abhay Shukla’s “A compiled review of the rights approach to 
health and health care”, submitted for publication to ‘Beyond the Circle’, 
India, 2007. This summary includes adaptations of certain quotations from 
other authors, references for which can be found in the full article.



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