PHA-Exch> Food for a thought with an added value (2)

[Claudio Schuftan]

**

Human Rights Reader 208



*HEALTH CARE AS A RIGHT: WHAT YOU NEED TO KNOW*. (Part 2 of 3)

*The Right to Health: A holistic overview of its components and tasks for
the global health movement.*

* *

8. The right to health has been defined as the *‘**right to the enjoyment of
a variety of facilities, goods, services and conditions necessary for the
realisation of the highest attainable standard of health’* (General Comment
14, CESCR). (
http://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.En?OpenDocument)



9. This right includes both the *right to all the underlying determinants of
health besides health care* (such as* *water, food security, housing,
sanitation, education, a safe and healthy working and living environment,
etc.), and the* right to health care *(i.e., the right to the entire
spectrum of preventive, curative and rehabilitative services plus health
education and promotive activities*).*



10. In practice, this suggests two types of tasks for the global health
movement:

*a) Tackling the* *right to all the underlying determinants of health:
*Supporting
and even co-initiating, campaigns or initiatives addressing key health
determinants* *(e.g., campaigns for water, for food security, or for
housing) is important and justified by itself.* *There are initiatives
already* *working on behalf of these rights, not necessarily spearheaded by
health activists. The focal points for each of these initiatives should be
the organisations with the most experience and commitment to that particular
issue (e.g., water, food security, housing, the environment). This
recognition places an obligation on health activists to actively support and
strengthen such initiatives though not necessarily to take up the
responsibility of primary leadership of such groups. When liaising with
these groups, health activists will bring-in the health perspective into
those campaigns. An additional important role that has to be played by
health activists is to help document violations of the right to the
underlying determinants of health, for instance., showing how denial of food
security and appropriate care of mothers and children leads to worsening
malnutrition, increased morbidity and mortality. Health-based arguments can
indeed significantly strengthen the demands of claim holders to tackle these
* *determinants from a RTH perspective.



*b)* *Strengthening the* *Right to Health Care: *The global health movement
has a primary and unquestionable responsibility to take the lead on this.* *The
urgent need for action within the health care sector has already been
pointed out. We are all witnesses to the often catastrophic consequences of
the lack of economic access to adequate health care and the poverty trap
associated with serious illness.



*What is the added value of adopting the human rights-based framework (HRBF)
to tackle the problems described? *

11. In every development process, there are three types of actors: *claim
holders, duty bearers and agents of accountability*. When the State does not
respect human rights, claim holders have to demand their rights directly
from the duty bearers in government plus interact with agents of
accountability (e.g., HR commissions, ombudsmen, HR-oriented NGOs) who
overlook the procedures being put in place by government and make sure duty
bearers fulfill their obligations (including remedies and restitutions). If
claim holders do not do it, it is in part their fault. One can thus say that
it is also the duty of those of us who are aware of human rights to generate
awareness about the bases of these rights, in partnership with  the
marginalised and underserved groups we work with.

12. The RTH is thus violated, when the poor, the marginalised and the
discriminated, as claim holders, do not have the capacity to effectively
demand (claim) their rights; rights are also violated because duty bearers
do not have the capacity or the will to fulfil their obligations
(technically called ‘correlative duties’).



13. Therefore, in the HRBF one has to carry out three types of analyses: a)
*situation analyses* in which one determines the causes of the problems
placing them in a hierarchical causality chain of immediate, underlying and
basic causes or determinants, b) *capacity analyses* in which one determines
*who* are the individuals/institutions that bear the duty to do something
about the above causes calling them then to fulfil their duties as per their
country’s obligations as signatory of the United Nations HR covenants, and a
c) *analysis of and liaison with accountability agents.*  Herein lies the
call for HR activists to carry out rights awareness work, i.e., to educate
and inform the broader society about what these rights mean and what
*accountability
mechanisms* should be put in place and made to work.



14. These three types of analyses have to be carried out with the
representatives of the local community and the beneficiaries of the health
system so that the rights being violated can be identified jointly and those
responsible also be jointly confronted --for them to do something about the
problems identified.



15. As a corollary of the above, note that, the rights activists’ ultimate
goal is NOT to look for health policies that favour the poor… What is sought
is significant poverty reduction policies that directly address the social
determinants of health!



*Claudio Schuftan, Laura Turiano and Abhay Shukla, People’s Health
Movement,Right to Health Campaign (see
www.phmovement.org ).*
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