PHM-Exch> [ESCR-Right-to-Health] ACTIVISM AS A SOCIAL DETERMINANT OF HEALTH

[Claudio Schuftan]

EQUINET NEWS is designed to keep you informed about materials on
equity and health in east and southern Africa, focusing primarily on
EQUINET's principal themes. It includes news about EQUINET activities,
policy debates or theme work to keep you updated on work taking place.
Further information on EQUINET activities is available from the
EQUINET secretariat at Training and Research Support Centre (TARSC)
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1. Editorial

ACTIVISM AS A SOCIAL DETERMINANT OF HEALTH
Mark Heywood, SECTION27, South Africa

We are living during a time of unprecedented threat and opportunity
for the right to health. We are seeing cutbacks in the funding for
prevention and treatment of HIV, retreats from commitments to
‘universal access’ to HIV and TB treatment, attacks on human rights
and new threats to national and global health, including through
climate change and food insecurity. At the same time there are new and
better technologies available for health, new medicines and
diagnostics for common diseases like tuberculosis, and an array of
interventions that could improve health and reduce malnutrition. Some
states, particularly South Africa and Brazil, are seriously seeking to
improve health on the principle that health is a human right. But it
is questionable whether they have the resources to do it. There are
examples of growing global co-operation and legal agreement around
social challenges, such as climate change, although not yet around the
most immediate social challenges that face the poor. Activist
movements exist around AIDS, health and around social justice.

The Commission on the Social Determinants of Health pointed to the
demand for a response to this moment of contradiction between threat
and opportunity from a leadership and governance that is driven by
social justice. It stated: “In order to address health inequities, and
inequitable conditions of daily living, it is necessary to address
inequities – such as those between men and women – in the way society
is organized. This requires a strong public sector that is committed,
capable, and adequately financed. To achieve that requires more than
strengthened government – it requires strengthened governance:
legitimacy, space, and support for civil society, for an accountable
private sector, and for people across society to agree public
interests and reinvest in the value of collective action. In a
globalized world, the need for governance dedicated to equity applies
equally from the community level to global institutions.”

This is not a new call. It resonates with the recognition of the right
to health as a human right found in the 1946 World Health Organisation
Constitution, the 1966 International Covenant on Economic Social and
Cultural Rights (ICESCR), the 1978 Alma Ata Declaration and the 2000
UN Committee on Economic, Social and Cultural Rights ‘General Comment
14’ on Article 12 of ICESCR. Increasingly it is also reflected in the
incorporation of the right to health into the national constitutions
of over seventy countries in the last decade.

Nevertheless good health and access to adequate health care services
remains out of reach to billions of people. Nearly two billion people
(a third of the world’s population) lack access to essential medicines
and about 150 million people suffer financial catastrophe annually due
to ill health, while the costs of care pushes 100 million below the
poverty line.

The world is well aware of these facts. They are published by the WHO
and others. When these facts are raised in international forums, it
has led states to make bold promises….that they later do not keep. In
Africa, 19 of the African countries who signed the 2001 Abuja
Declaration to spend 15% of their government budget on health
al¬locate less now than they did in 2001. Yet the WHO indicate that
low-income countries could raise an additional US$ 15 billion a year
for health from domestic sources by increasing health’s share of total
government spending to 15%. Neither are high income countries meeting
their promises. According to the ‘Africa Progress Report 2010’,
published by a unique panel chaired by Kofi Annan, when the $25
billion Gleneagles commitment comes due at the end of 2011, the
resources allocated by G8 countries will have fallen short by at least
$9.8 billion. The panel calls this a “staggering shortfall.”

Does this mean that the right to health has no value? No. Has the
right to health been sufficiently popularised or used? No. Are the
state and United Nations institutions who have a duty to protect and
realise the right to health fulfilling their obligations? No.

In the last decade AIDS activists have established in practice the
principle that states must fund treatment as a right, with the
organisation of resources globally to meet this obligation. Currently
we are seeing a reversal of this basic entitlement, as the right to
these resources are being challenged by arguments over cost
effectiveness, a retreat from funding treatment in middle income
countries, despite the fact that three quarters of the poorest people
in the world live in middle income countries; and a claim that too
much money is going to AIDS treatment, despite the fact that an
estimated ten million people still need treatment globally. Some
states in low income countries claim to have inadequate resources for
health even while their political and economic elites grow visibly
wealthier, and even states who have met the Abuja commitment try to
fairly distribute unfairly inadequate amounts of money for health.

The Commission on the Social Determinants of Health called for
conditions that would enable civil society to organize and act in a
way that promotes and realises the political and social rights
affecting health equity. It seems that we should go further than this,
given the reversals in progress and growing inequalities in health. We
need to see the level of activism by civil society as a key social
determinant of health. The fight for health should be a central pillar
of all movements for social justice and equality, not in the abstract,
but for the specific goods, institutions, demands and resources that
will realise the right to health.

Please send feedback or queries on the issues raised in this briefing
to the EQUINET secretariat: admin at equinetafrica.org.This is an edited
extract of a speech given at the Southern African Regional Dialogue on
Realising the Right to Health in March 2011. For more information on
the issues raised in this op-ed and for this and other presentations
made at the conference see: www.section27.org.za.


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