PHA-Exch> Food for an uneasy thought

[Claudio Schuftan]

Human Rights Reader 188



*WE HEAR ENDLESS APPEALS-TO AND LAMENTS-ABOUT THE LACK OF POLITICAL WILL TO
ADDRESS HUMAN RIGHTS ISSUES. AN ACTIVE ENGAGEMENT BY CIVIL SOCIETY MEANS WE
NO LONGER HAVE A NEED TO RESORT TO THE CONCEPT OF POLITICAL WILL!*

* *

An inability to exercise power means that poor and vulnerable people cannot
change the condition of their vulnerability and must remain dependent on
others to do so.



[Although this applies to human rights in general, we will here more
specifically look at the right to health]



1. Health planners are still uneasy dealing-with and focusing-on *claims and
duties* in their work. They also perceive there is a contradiction between
human rights (HR) and public health objectives; this flawed perception is
premised primarily on an individualistic notion of what HR entail --and this
is supposedly opposed to the collective focus of public health. How further
from the truth could they be!



2. The challenge for these public health policy makers is to, first,
acknowledge the above fallacy to then  identify how best to synchronize
health policies and programs with the HR framework --since *both* strive to
maximize human wellbeing.



3. The other fallacy often voiced is that HR are 'legalistic' and thus
mostly 'a-bunch-of-legalese-describing-a-utopia'. But, the truth is that
falling-back on the legal framework by itself is mostly not necessary
upfront for the day-to-day enforcement of human rights in general * and the
right to health (RTH) in *particular: most violations of HR are evident just
using common sense…*

*: But do not misconstrue: International HR law can successfully be used a)
to expose existing laws that violate HR principles, and b) to legislate at
national level along international HR law (i.e., new laws). There is plenty
jurisprudence on HR violations having successfully been brought to court and
having been won --including in the area of health.



4. As a matter of fact, the HR legal framework is necessary, but not
sufficient --and can actually, by itself, be disempowering. This, since, in
the absence of community mobilization, claims to human rights are easily
ignored, no matter how legally compelling. In other words, even if legal
frameworks make sense and are clear, this does not automatically mean poor
people will see their right to health respected, protected and fulfilled.

5. An important challenge here is to advance and broaden our work on seeking
*accountability* in the area of health and HR. We are aware that one form of
accountability is legal (judiciable), but there are others: In addition to
using judicial remedies, we can also use budget analysis, specific process
and outcome indicators, and other HR tools to monitor compliance).
Basically, we need to seek new ways of working to build accountability into
health systems *and* into the ways health workers work.

6. In practice, this means we need to identify the key features of the right
to health and teach them to make them better understood --as the only way to
make them more operational. There is thus currently a trend in the health
and human rights movement that is driving us away from a purely legal
analysis and more towards the actual operationalization of the right to
health (P. Hunt).

7. So far, HR work has been good at identifying legal requirements, but not
as good at identifying operational requirements. It is crucial to more
actively engage with health workers to find ways to translate/operationalize
the legal requirements in the HR covenants into operating
guidelines/parameters in health work overall, from planning to
implementation.



8. Bottom line: It is the process of civil society and health workers
participation at all levels that is instrumental to improvements in health.
Ergo, HR covenants and law(s) are important to fall-back-on but, alone, are
not enough; they need to be coupled with de-facto community engagement --and
the HR approach can, and indeed does, strengthen such community engagement!



9. But for this engagement to be jump-started, crucial information needs to
be channeled to communities for them to use it in their political action so
as to influence policy-makers to support a more equitable agenda. An active
civil society that actively negotiates its inclusion in the decision-making
system is the best guarantee of health equity. *  The lesson to be learned
here is that creating political space is about mastering relevant
information and about accumulating* power --not only to be heard, but to
influence**.*

*: Come to think of it: How thin is the line between negotiation and
imposition…?



10. Keep in mind that the HR framework directly addresses issues of power
and is thus the strongest guarantor we nowadays have to achieve
effective-equity-promoting-impacts. This is why we so often ruminate that we
need empowerment rather than mere 'participation'. The lesson to be learned
here is that, in the HR *framework, protesting is stronger than just
complaining…]*. *

*: A caveat: Top-down devolving of responsibilities to districts (as seen in
current decentralization efforts) risks absolving duty bearers in government
of their HR obligations.



11. Information about the 'whys?' of the current unfair situation thus
importantly serves to reverse the powerlessness underlying inequity; That
underpins why the role of information is so central in empowering community
partners to do their own advocacy for action *. On the other hand, organized
communities are, at the same time, generators of important information on
the shortcomings of the health system…and that underpins why information
from *all* sources is such a crucial *enabling mechanism to realize HR.*

*: As regards the consequences of unfair policies, you may have heard about
Health Impact Assessment as an important generator of key information; HIA
is a tool for assessing the health impact of policies in any sector; it
ultimately seeks accountability, not only from governments, but also from
transnational corporations, from multilateral and from bilateral aid
organizations. If applied before policy implementation, it attempts to
preempt the negative health effects foreseen.



12. Finally, the often forgotten strengths of the HR-based approach is that

a) it focuses the analysis on identifying *system failures* rather than
branding individuals as the problem, and

b) it provides a workable and accepted framework for managing conflict
between claim holders and duty bearers.



Claudio Schuftan, Ho Chi Minh City

cschuftan at phmovement.org

[All Readers can be found in www.humaninfo.org/aviva  under
No.69<http://www.humaninfo.org/aviva%20%20under%20No.69>
]

_________________________________

Adapted from London, L., Making HR Work for the Public's Health: Equity and
Access,  Global Forum Update on Research for Health, Vol. 4, 2007.
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