PHM-Exch> Hlth and HRs J. - Issue on Participation - A. Grover Special UN rapporteur on RTH (3)

[Claudio Schuftan]

Here are five more interesting responses received.


from Alicia Yamin, HHRJ, ayamin at law.harvard.edu :



I'm delighted that this issue of the Journal has sparked such an interesting
and important exchange.  Alison, if you have been reading the new Journal
since Vol. 10:1, you will of course know that the points you raise have been
made by various authors, including myself.  The issue of global architecture
is an extremely important one and indeed one that will be centrally
addressed in our forthcoming issue on international assistance and
cooperation/non-state actors. Alison, I would like to encourage you to think
about submitting a piece for that issue.



Additionally, as we have repeatedly stated to Claudio, we are very eager to
have a dedicated PHM blog perspective appear on the Journal site.  The
subject of how human rights addresses the transnational forces structuring
power relations could be a great one to start with.



from Wim Deceukelaire wimathome at gmail.com:

I get the point and share Alison’s concern. Of course you're right that we
have to insist that exploitation and oppression have to be addressed before
anything else. On the other hand it is but right to call for the
industrialized countries to pay and compensate for the havoc they've
wreaked. It is a maybe secondary point. But then, it is badly needed to
respond to the most immediate needs of the people. In that context, we
shouldn't be afraid to advocate the "duty to assist" that makes part of the
human rights instruments, as long as we make clear it is far from enough and
isn't even the start of a solution.

What bothers me more is the reference to "international systems of
financing", especially if it refers to global funds and other charity
initiatives. The human rights framework derives its strength from the fact
that it clearly identifies the State as the duty-bearer. All benefits that
working people have been able to get were the result of the struggle of
social movements that asserted people's rights vis-a-vis the State. European
social security is a case in point. Today, we see a discourse emerging that
is also claiming the human rights framework, but that is advocating
global-fund-like initiatives as alternatives. The struggle is not a matter
anymore of the people claiming their rights from the State, but it becomes a
matter of politely requesting alms from Bill Gates. You might call it the
privatization of the right to health. It's a pity that this kind of thinking
is passed as human rights framework. As activists we'd better be vigilant
about that.

In this light, I'd also be glad for phm-exch readers to read, comment and
critique our article on participation and empowerment that appears in the
same issue of the HHR journal.



>From George Kent kent at hawaii.edu :

I don’t agree with Alison’s position here, or maybe I just don’t understand
it well enough. In the book on *Global Obligations for the Right to Food*,
we argued that, under a concentric circles model of rings of responsibility,
there are many layers of responsibility for care for the needy, beginning
with the immediate family and community, and continuing on up to the global
community.

This implies that we are all responsible for all us in some measure. The
task is to figure out in what ways. To me it seems evident that those who
have greater resources have a greater responsibility to provide material
assistance to the needy.

Sometimes that assistance is managed badly, in various ways.  I discussed
this in *Freedom from Want*, especially in pp. 120-125 (available at
http://press.georgetown.edu/pdfs/9781589010550.pdf) I take this to mean that
assistance should be done well, not that assistance in general should be
ended.

In other words, I too am “STILL saying that if the poor countries can’t
afford it, then the international community must step in.”

Maybe the neediness is in fact there, largely because of the badly flawed
international architecture, as Alison suggests. But that is not something
that is going to be easily remedied. We can recognize that it is badly
flawed, and also at the same time recognize that the current world is one of
severe inequalities, one in which many needy people should be getting help
now from those who are not needy. We can’t ask the needy to wait for the
international system to get fixed.

I would say there are many sensible paths to take in working for greater
justice in the world, and we should not fault anyone for choosing a
different path.

Alison’s quotation, “When I give food to the hungry, they call me a saint.
But when I ask why the poor have no food, they call me a communist” is from
Dom Helder Camara. I have it on a poster that I used to use in lectures.



>From Ronald Labonte rlabonte at uottawa.ca :

This is an interesting exchange, and Alison makes some very good points. A
HR argument for international financing should not be made without a
critique, and recommendations for transformation, of the rules of the global
economic systems (trade, finance) that uphold gross economic inequities. At
the same time, the legacy of colonialism and other political histories has
carved the world into a multitude of countries, many of which are too small
and/or lacking in resources to have the capacities (assuming just
governments and a strong civil society to keep and hold them to account) to
meet basic health and human needs in any ethically reasonable time. Just as
federated states (and to some extent, the EU) transfer some residue of
wealth between ‘have’ and ‘have less’ regions to create more equity in
social infrastructures (creating more ‘equality of opportunity’), global
systems of wealth transfers must also be created, strengthened and removed
from the political vagaries of wealthier nations (i.e. rendered somewhat
more bureaucratic and needs-based rather than politically-based). In sum, I
don’t believe it is either/or; it is both/and. I also rather suspect that,
if the question was posed this way, both Alison and Anand would concur.



>From Matt Anderson bronxdoc at gmail.com :


I cannot help but agree with Alison.  I think that Anand's comments - and
admittedly I have only read this quote - are really quite confused.  Either
he believes his own rhetoric or he is being deliberately confusing.

Let's take the "global fund" question.  My comments here will be influenced
by my first-hand involvement in Guatemala.  HIV has always been an
exceptional disease with a very particular activist community behind it.  In
Guatemala there is not a "community" with activists interested in
tuberculosis and I don't see one forming, particularly in the highly
undemocratic context.  So where is this "organic" community that is going to
address tuberculosis?  Is it hundreds of independent Indian villages?

I think we would all agree that the "organic" structure that should be
addressing HIV, TB and malaria is the Guatemalan state.  The global fund's
end-run around the State, by financing NGO's just further discredits the
Guatemalan government (and political solutions in general) and promotes NGOs
(which you can call community if you wish, but I don't buy that).  It feeds
the widespread Guatemalan cynicism that all politicians are corrupt and
nothing good can come of government. This is the fertile soil for neoliberal
thinking.  Is Anand Grover promoting this model? Probably not.

On the ground in Guatemala we see that while we now have HIV medicines
available, we don't have any way of getting them to pregnant women since 40%
of women get no or very minimal prenatal care.  In other words, public
health solutions have to be at the national level, not at the disease level.

Finally, I would strongly endorse Alison's comments about foreign aid. With
what possible moral right does the US government which tried to overthrow
the Chavez government and actually overthrow the Aristide government (not
once but twice!!) talk about giving money to support international human
rights.  That money is - and has always been - a cover for promoting pro-US
political factions overseas.  "Development money" is never disinterested.
It is always about promoting the donor's economic interests.
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