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<div>As a corollary to the posting of yesterday, many of you may wonder how the human right to health relates to the Social Determinants of Health. Here is one vision: </div>
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<div style="MARGIN: 0in 0in 0pt"><font face="arial,sans-serif"><b><span style="FONT-SIZE: 10pt">The human rights-based framework: how is it related to the SDH?</span></b><span style="FONT-SIZE: 10pt"></span></font></div>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">1. <u>Human rights based planning: the new approach: What is it?</u> </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">To prepare long term plans of action, one has to go through detailed situation analyses that identify the most important causes of the problems to be solved.</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">Situation analyses are based on an Assessment and an Analysis of the existing situation that will then lead to decisions being made for Action; this has been called a<span> </span>triple A (AAA) process.<span> </span></font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">But the assessment and the analysis cannot be done in a vacuum --without previously having worked on a Conceptual Framework of the causes of the problems that are to be solved. Considering the SDH thus requires such a framework where these causes figure prominently as determinants.<span> </span></font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">This means that one has to have an in depth understanding of how those problems come about --what their determinants are (biomedical, social and economic) before one can decide what the best options are to take the most effective actions to solve them. In short: "One finds what one looks for".</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">The essence of a good situation analysis, then, is to carry out a Causal Analysis based on a pre-existing Conceptual Framework that includes the SDH --and to base all decisions for action to be taken on this analysis. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">Therefore, appropriate interventions for the main causes at <u>each</u> causal level (immediate, underlying and basic or structural) have to be found. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">Addressing each cause is necessary, but not sufficient to change the outcome (i.e., preventable ill-health,<span> </span>malnutrition and excess deaths). </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">One needs to act at all levels of determinants at the same time; this is why so many "selective PHC interventions" failed in the past.</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">The above, basically summarizes what professionals in the field were expected to be doing up to now when trying to solve health and nutrition problems. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">But the Human Rights Based Framework to Planning brings with it a new perspective to our work.</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">The essence of the Human Rights based approach is that it tells us that, additionally,<span> </span>we now need to carry out what is called a Capacity Analysis (or accountability analysis). </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">2. <u>What is a Capacity Analysis? </u></font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">To analyze any Human Rights situation it is essential to identify two main groups of actors:<span> </span><b>Claim Holders and Duty Bearers</b>. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">Claim Holders are the groups whose universally recognized entitlements are or are not being catered for by the societies they live in, and whose rights are thus being upheld or violated. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">Duty Bearers are those individuals or institutions that are supposed to uphold the specific right related to each entitlement. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">For example,<span> </span>in the case of a child as a claim holder, the first-line duty bearer is the mother; next are the father and other family members. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">But --forming a veritable pattern-- there also are duty bearers for children's rights further up the ladder: community leaders, district and provincial authorities, national and international leaders and institutions. (Some call this analysis of claim-duty relationships 'Pattern Analysis').</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><font face="arial,sans-serif"><span style="FONT-SIZE: 10pt">To recap, the end result of a good causal/situation analysis is a list of locally specific immediate<u>,</u> underlying and basic causes that determine the problems being addressed (arrived at through a participatory AAA process that identifies all </span><span style="FONT-SIZE: 10pt">those causes and comes up with the suggested solutions for each cause identified).</span></font></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">It is here --when potential solutions have been collectively identified-- where Capacity Analysis comes in.<span> </span></font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">Capacity Analysis takes what is being proposed to be done for each determinant at each causal level and looks at what is already being done or not being done (and why) for that problem. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">It then looks at <u>who</u> should be doing something about it [individual and/or institution(s) who is (are) the corresponding duty bearer(s)] and attaches the name of that (those) person(s) or institution(s) to each proposed solution.<span> </span></font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">This results in a list of the most crucial persons/institutions that have to be approached to push them to get the proposed solution(s) for each cause implemented. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">Note that, often --as a result of a pattern analysis-- a particular duty bearer is found not to be able to meet her/his obligations, because some of her/his rights are being violated by a duty bearer higher up (e.g., parents without resources to pay health user fees cannot be blamed…).</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">In a very simplified way, the end result of a good Capacity Analysis is a four or five columns table: </font></span></p>
<p style="MARGIN: 0in 0in 0pt 0.25in; TEXT-INDENT: -0.25in"><font face="arial,sans-serif"><span style="FONT-SIZE: 10pt; FONT-FAMILY: Symbol"><span>·<span> </span></span></span><span style="FONT-SIZE: 10pt"><span> </span>the first column lists the causes listed from immediate to basic; </span></font></p>
<p style="MARGIN: 0in 0in 0pt 0.25in; TEXT-INDENT: -0.25in"><font face="arial,sans-serif"><span style="FONT-SIZE: 10pt; FONT-FAMILY: Symbol"><span>·<span> </span></span></span><span style="FONT-SIZE: 10pt">the second column lists the respective right(s) being violated, for which group of claim holders (for example, children) for each cause (e.g., the human right to health care, to food and adequate nutrition, etc); </span></font></p>
<p style="MARGIN: 0in 0in 0pt 0.25in; TEXT-INDENT: -0.25in"><font face="arial,sans-serif"><span style="FONT-SIZE: 10pt; FONT-FAMILY: Symbol"><span>·<span> </span></span></span><span style="FONT-SIZE: 10pt">the third column identifies the gaps between what is being done and what still needs to be done (i.e., the actions still needed).</span></font></p>
<p style="MARGIN: 0in 0in 0pt 0.25in; TEXT-INDENT: -0.25in"><font face="arial,sans-serif"><span style="FONT-SIZE: 10pt; FONT-FAMILY: Symbol"><span>·<span> </span></span></span><span style="FONT-SIZE: 10pt">the fourth column --to be realistic-- identifies the most critical respective duty bearer(s) <u>by name</u> (individuals and/or institutions responsible, often at more than one level);</span></font></p>
<p style="MARGIN: 0in 0in 0pt 0.25in; TEXT-INDENT: -0.25in"><font face="arial,sans-serif"><span style="FONT-SIZE: 10pt; FONT-FAMILY: Symbol"><span>·<span> </span></span></span><span style="FONT-SIZE: 10pt">a fifth column may be added to specify who is going to approach those duty bearers and by when. </span></font></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">This table thus becomes an action plan to get the various Human Rights deemed to be violated redressed for each specific group of claim holders.</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">What this new Human Rights Framework to Planning does, then, is to couple the causal and the capacity analyses.<span> </span></font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">At first glance, this may not mean much to readers being introduced to this new concept; but it is a powerful combination. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">The coupling not only identifies what needs to be done, and at what level, but it also targets the person or institution that has to be lobbied/pressured, because they are legally responsible to do something about it under the Covenants of International Human Rights officially signed and ratified by most countries in the world.</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">The Human Rights-based framework (HRBF), therefore, gives advocates of children's welfare or of any other human right new powers: As advocates, we can now approach duty bearers as 'guilty of not doing what they are legally (and not only ethically) supposed to do'.<span> </span></font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">The Human Rights covenants currently in force are very explicit about this; we just have not sufficiently used this added power in our work so far.<span> </span></font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">Duty bearers have to be approached using the Human Rights violation justification, and have to be made accountable to comply!<span> </span></font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">Alleging a "lack of resources" is not a good enough justification by duty bearers not to uphold the rights being violated. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">They have to convincingly demonstrate that resources available (even if meager) are not being used for other less essential functions. A progressive realization of the violated rights has to be in place even in the poorest countries --including intermediate benchmarks for its realization. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">If we all do follow this new approach, we may set a growing precedent that will further the cause of those claim holders whose basic human rights are being violated worldwide. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">Issues are a bit more intricate than here reflected, but this is a good introduction.</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">Much of the HRBF is still in the making and not yet applied.<span> </span>UNICEF, before Ann Veneman, had been at the forefront of working on how to apply the HRBF to the planning, implementation and execution of health and nutrition programs. NGOs have also started to apply the HRBF. But many NGOs have not yet revisioned and remissioned themselves to apply the HRBF.</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">3. <u>So, how does the HRBF relate to the SDH</u>? </font></span></p>
<p style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><span><font face="arial,sans-serif" size="2">The HRBF gives us the possibility to advance a political agenda towards equity and towards the indispensable structural changes that need to be made for health and other social services to receive the resources they need to reverse the corresponding human rights currently being violated.</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">The HRBF is about a more equitable distribution of resources in society, and health is one of many entry points to achieve this goal. Human beings are born with a right to health and society has to proactively make the investments to prevent totally preventable ill-health and malnutrition and to treat those affected by the diseases of poverty. Being the UN mandate,<span> </span>the HRBF is thus the a prime approach to tackle the SDH. Focusing our efforts in anything short of this is a job half done, more so if we do not arrive at such a situation through the empowerment of claim holders themselves to relentlessly demand that the needed changes are implemented. This is not a task for an avant-garde only: it is a mass mobilization task.</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">4. <u>How does the HRBF address global governance (GG) in general?…how has it addressed it so far</u>? </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">GG leaders belong to the highest level of duty bearers the HRBF needs to approach and to hold accountable. But to address them directly, one has to know who they are and which are the key global health institutions they work for. A better capacity analysis is called for here. Right to health advocates have to address duty bearers at many levels, and should not miss addressing those in GG bodies. This requires high levels of claim holder mobilization and organization so they can be approached from a position of power. The People's Health Movement has successfully lobbied WHO at the highest levels and is now embarked in a global right to health care campaign which will include such<span> </span>global-level advocacy. GG institutions now need to be addressed more proactively since it is in them where more power lies on decisions being made on global health policy issues. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 8pt"><font face="arial,sans-serif" size="2">___________</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 8pt"><font face="arial,sans-serif" size="1">References:</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 8pt"><font face="arial,sans-serif" size="1">1) Jonsson, U., Human Rights Approach to Development Programming, UNICEF ESARO, Nairobi, 2003.</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><font face="arial,sans-serif"><font size="1"><span lang="DE" style="FONT-SIZE: 8pt">2) Schuftan, C., </span><span style="FONT-SIZE: 8pt"><a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.humaninfo.org/aviva%20No%2069" target="_blank"><span lang="DE">www.humaninfo.org/aviva No 69</span></a></span><span lang="DE" style="FONT-SIZE: 8pt"></span></font></font></p>
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<p style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 150%"><span lang="DE" style="FONT-SIZE: 12pt; LINE-HEIGHT: 150%"><font face="arial,sans-serif" size="1">Claudio Schuftan, Ho Chi Minh City</font></span></p>
<p style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 150%"><span lang="DE" style="FONT-SIZE: 12pt; LINE-HEIGHT: 150%"><a onclick="return top.js.OpenExtLink(window,event,this)" href="mailto:cschuftan@phmovement.org" target="_blank"><font size="1">cschuftan@phmovement.org</font></a></span></p>
<p style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 150%"><span lang="DE" style="FONT-SIZE: 12pt; LINE-HEIGHT: 150%"><font face="arial,sans-serif" size="2"><strong> </strong></font></span></p></div>