PHA-Exchange> Food for a short-sighted thought

[Claudio Schuftan]

Human Rights Reader 164



*FROM A HUMAN RIGHTS PERSPECTIVE, PUBLIC HEALTH STANDS AT A CROSSROAD.*



*1. The currently prevailing public health paradigm is suffering from
myopia. It mostly embarks in analyzing what really are only the symptoms of
the present public health crisis (i.e., non-performing vertical programs and
top-down goals setting); it holds these symptoms of the crisis under a
magnifying glass. Therefore, in its pursuit of specific solutions, the
overall picture of health-as-a-human-right is lost ('looking constantly
through a lens makes one short-sighted'…if you were not short-sighted t
begin with…). *

* *

*2. Moreover, under the same optic, malnutrition is more often than not seen
as a problem of micro-nutrients (iron, iodine, zinc, vitamin A) with the
causes of drastic declines in food security and even of starvation taken as
given and not being considered to be flagrant human rights (HR) violations.
*

* *

*3. We are further told that the resurgence of malaria is a matter of
concern requiring new anti-malarials. Yet the phenomenon of annual migration
of part of the poor population in many malaria-ridden countries --in search
of a livelihood and thus changing their exposure to the parasite-- is rarely
discussed. Or, occupational hazards in the informal sector of the economy
are only dimly perceived despite evidence of a deterioration in the already
bad working conditions in this large sector of the economy that is growing
as the world 'globalizes' and offers its cheap labor to transnationals so as
to become 'competitive' in the global market. *

* *

*4. As a corollary, the diagnostic approach that contemporary public health
only succinctly glosses-over (considering it as being neither 'practical'
nor 'respectable') is the search for the real-structural-causes behind the
symptoms of the public health AND health-as-a-human-rights crisis. *

* *

*5. Conversely, the HR-based framework not only entails a more systematic
and detailed analysis of the proximate causes (not just glossing-over them),
but also entails linking them with underlying, deeper social and economic
processes, ergo the much talked-about social determinants of health. This
brand of HR-sensitive public health offers concrete technical options to
tackle some of the existing public health problems, but also holds up a
mirror to society allowing society to understand that these problems are not
accidental, but arise as a foreseeable and systematic consequence of the
deliberate social and economic choices being made --which benefit a few and
marginalize the many. *

* *

*6. Just as good epidemiology accurately predicts the trends in the
development of a disease (given specific initial conditions), good
HR-sensitive public health focuses on alerting society to the consequences
of specific social and economic policy choices being made (by commission or
by omission), i.e., it also focuses on what is known as health impact
assessment or analysis. *

* *

*7. These consequences need to be assessed against the larger scale HR
violations at country level and thus against the undue suffering they cause;
they should not be assessed against promises, e.g.,  of a better access to
global markets and a raised per-capita GDP with an expected though
never-to-come trickle-down. *

* *

*8. Only a HR-sensitive public health will help society quantify the human
costs of the particular model of development it has adopted and to arrive at
the right decisions on how to change the failing model and its misguided
policies. [Remember: When there is political will, there is a policy way…
(S. Ostry)].*

* *

*9. …If you thought all of this is new, just read this:*

*"Palliatives will no longer do. If we want to take remedial action, we must
be radical. Palliatives in such cases are more costly than radical action …"
Rudolf Virchow, Report on the Typhus Epidemic in Upper Silesia, 1848.*

* *

*10. [Note: The model here criticized also ignores undeniable realities of
the under-funding of health care services in the public sector that are
being cleverly turned into a mantra through which the proponents and
supporters of the model attack public funding for health care. In this
process, the real achievements of the public sector in delivering low cost,
effective curative and above-all preventive health care services are swept
under a propaganda carpet. No wonder, then, that primary health care is
becoming a fee collection-driven exercise, and that user fees charged in
public hospitals are being couched in the usual sugar-coating parlance of
fees being introduced 'for-those-who-can-pay'. This all, while the global
experiences about user fees show that they serve only one purpose: to drive
out the poor and the indigent]. *

* *

*Claudio Schuftan, Ho Chi Minh City*

*cschuftan at phmovement.org  NEW EMAIL ADDRESS*

*______________________________________*

*Adapted from A. Shukla, Key public health challenges in India: a social
medicine perspective, Social Medicine, April 2007, and Review of Radical
Political Economics, Vol.38, No.3 , Summer 2006.*
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