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<div>And here, some conluding thoughts:</div>
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<p style="MARGIN: 0in 0in 0pt"><b><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">How can the human rights-based framework (HRBF) be incorporated into potential Global Governance bodies for them to more decisively address the SDH?<span> </span></font></span></b></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">1.The HRBF <u>can</u> be incorporated as a positive force into global health governance bodies for them to actually tackle the SDH. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">2.The institutions we think could/should effectively adopt the HRBF to tackle the SDH are, as a minimum, WHO, UNICEF, <font size="2">UNAIDS and<span> </span>UNFPA; </font>the WB, the GF, the Gates Foundation and other PPPs. <span> </span></font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">3.The process through which this may happen was delineated in the pieces of ysterday and two days ago on the HRBFapplied to Planning.</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">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).</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">5.So, how can the HRBF tackle needed changes towards addressing the SDH?</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">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 <u>claim holders that will have to generate the pressures</u> for this to happen.</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">6.What does WHO need to do specifically to keep in line with the UN mandate to apply the HRBF?<span> </span>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. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">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 <u>what is really needed is</u> concomitant<span> </span><b>'pro-health, poverty reduction</b> <strong>policies'</strong> and strategies that tackle preventable ill-health and malnutrition at is roots. Why continue to focus on what are health <u>outcomes</u> 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.</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">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!) <font size="2">(and not donor priorities...), </font>and b) that WHO needs to make needed internal administrative changes to (re)gain credence. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><font face="arial,sans-serif"><span style="FONT-SIZE: 10pt">9.Finally, w</span><span lang="EN-GB" style="FONT-SIZE: 10pt">hy does WHO (with its original core values and its very clear Constitution)<b> </b></span><span style="FONT-SIZE: 10pt">need to get back into a position of greater command and power in global health governance</span><b><span lang="EN-GB" style="FONT-SIZE: 10pt">?</span></b></font></p>
<p style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">Globally, <u>tackling the social determinants of health has become central</u> 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 <u>and</u> 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.<span> </span><u>Now, WHO has to use its leadership in tackling the SDH and more decisively adopting the HRBF</u> (which is the UN mandate anyway!). </font></span></p>
<p style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">10.This will surely more directly address the SDH --although using a HRBF does not automatically tackle the SDH.<span> </span>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.</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">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 </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">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. </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font face="arial,sans-serif">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).</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"></span> </p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><font size="1">ClaudioSchuftan, Ho Chi Minh City</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt"><a onclick="return top.js.OpenExtLink(window,event,this)" href="mailto:cschuftan@phmovement.org" target="_blank"><font size="1">cschuftan@phmovement.org</font></a><font size="1"> </font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 10pt">___________</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; TEXT-ALIGN: justify"><font face="arial,sans-serif"><font size="1"><span style="FONT-SIZE: 8pt">1.</span><span lang="EN-GB" style="FONT-SIZE: 8pt">'Making WHO Work Better: An Advocacy Agenda for Civil Society and NGOs', D<i>iscussion document produced by the Global Health Watch 2 Working Group,</i> July 2006<i>)</i>.</span></font></font></p>
<p style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: justify"><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 style="FONT-SIZE: 10pt"></span></font></font></p>
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