PHA-Exch> How can the human rights-based framework be incorporated into potential Global Governance bodies for them to more decisively address the SDH?

[Claudio Schuftan]

And here, some conluding thoughts:


*How can the human rights-based framework (HRBF) be incorporated into
potential Global Governance bodies for them to more decisively address the
SDH?     *

1.The HRBF *can* be incorporated as a positive force into global health
governance bodies for them to actually tackle the SDH.

2.The institutions we think could/should effectively adopt the HRBF to
tackle the SDH are, as a minimum, WHO, UNICEF, UNAIDS and  UNFPA; the WB,
the GF, the Gates Foundation and other PPPs.

3.The process through which this may happen was delineated in the pieces of
ysterday and two days ago on the HRBFapplied to Planning.

4.We are not naïf. Nothing short of these global institutions active in
health revisioning and remissioning their charters will do. The shift will
not come without a shift in paradigm and the same can only come from the
pressure exerted by civil society (CSOs).

5.So, how can the HRBF tackle needed changes towards addressing the SDH?

>From now on, the incorporation of capacity analyses to identify,
characterize and target duty bearers that are not doing what needs to be
done will have to be key to WHO and to these other organizations' work. This
process in itself empowers individual and institutional *claim holders that
will have to generate the pressures* for this to happen.

6.What does WHO need to do specifically to keep in line with the UN mandate
to apply the HRBF?  It must revision and remission itself denoting a shift
towards more proactively tackling the SDH and the worldwide violations to
the human right to health.

7.When WHO looks to see how things might be done differently, it should not
limit its gaze to health. WHO tends to give too much attention to narrow
'pro-poor' health approaches and policies when *what is really needed
is*concomitant
*'pro-health, poverty reduction* *policies'* and strategies that tackle
preventable ill-health and malnutrition at is roots. Why continue to focus
on what are health *outcomes* and not their social determinants? Don't we
have sufficient evidence that the sectoral approach has not worked?  At some
point, instead of just trying harder, it is time to try something else,
e.g., supporting proposals for new health system reforms that are themselves
SDH- and HR-oriented, and are indigenous and truly participatory rather than
top-down imports. It is mainly up to developing countries themselves to say
no to Western, top-down, biomedical approaches that do not serve their
interests. In today's world, only more committed and focused civil society
organizations pressures have a chance to make these changes.

8.The lithmus tests are a) that extra-budgetary donations to WHO (an
important part of its budget) must be made to follow agreed overall
WHO priorities (and its Constitution!) (and not donor priorities...), and b)
that WHO needs to make needed internal administrative changes to (re)gain
credence.

9.Finally, why does WHO (with its original core values and its very clear
Constitution)* *need to get back into a position of greater command and
power in global health governance*?*

Globally, *tackling the social determinants of health has become central* in
the effort to improve global health. This makes the choices made by global
public health institutions in this respect of far greater priority concern.
While there are many health institutions global in scope, there is only one
multilateral institution with the political legitimacy and dedicated mandate
to promote and protect health: WHO. Ergo, it needs to regain its position of
global governance in health --no less than to preside over a revival of the
principles of the Alma Ata Declaration (which put the SDH *and* the human
right to health in their right place to begin with!). WHO continues to
embody our best hope for a social and political conception of health
embedded in a developmental, human rights and social justice framework that
is not always shared by other health-related institutions such as the WB. In
addition to this historical legacy, WHO has a past proven track record in
providing technical leadership on a range of issues that is
unsurpassed.  *Now, WHO
has to use its leadership in tackling the SDH and more decisively adopting
the HRBF* (which is the UN mandate anyway!).

10.This will surely more directly address the SDH --although using a HRBF
does not automatically tackle the SDH.  But the HRBF is more likely to do so
since it empowers claim holders to demand their rights. Herein lies what the
CSDH thinks is one of the greatest challenges for the Director General of
WHO.

11.However, the emphasis here on a WHO reform and its regaining global
governance powers may be misplaced. Instead of looking to WHO re-visioning
its role, perhaps more should be done to get the governments of member
nations to make decisions that serve the interests of their own people whose
human right to health care is being violated on a daily basis --and this
will require empowering claim holders globally to demand these decisions are
made: indeed not an easy human rights learning task

11.All this will require massive lobbying and training both of CSOs staff to
push WHO in this direction, as well as of the staff in the global health
institutions mentioned above --WHO included.

12.For this effort to go anywhere, the HR Section of WHO in Geneva will need
to be strengthened and given a regional presence --a 180 degrees turnaround
from what is happening now (mainly due to pressures from the USA, we
understand).



ClaudioSchuftan, Ho Chi Minh City

cschuftan at phmovement.org

___________

References:

1.'Making WHO Work Better: An Advocacy Agenda for Civil Society and NGOs', D
*iscussion document produced by the Global Health Watch 2 Working
Group,*July 2006
*)*.

2. Schuftan, C., www.humaninfo.org/aviva No
69<http://www.humaninfo.org/aviva%20No%2069>
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