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<p><span class="Apple-style-span" style="border-collapse: collapse;font-family: arial, sans-serif;font-size: 13px;"><br><br>EQUINET NEWS is designed to keep you informed about materials on<br>equity and health in east and southern Africa, focusing primarily on<br>
EQUINET's principal themes. It includes news about EQUINET activities,<br>policy debates or theme work to keep you updated on work taking place.<br>Further information on EQUINET activities is available from the<br>EQUINET secretariat at Training and Research Support Centre (TARSC)<br>
(email: <a href="mailto:admin@equinetafrica.org" style="color: rgb(0, 0, 204);">admin@equinetafrica.org</a>).<br><br>/\/\//\/\/\//\/\/\//\/\/\//\/\/\//\/\/\//\/\/\//\/\/\//\/\/\//\<br>1. Editorial<br><br>ACTIVISM AS A SOCIAL DETERMINANT OF HEALTH<br>
Mark Heywood, SECTION27, South Africa<br><br>We are living during a time of unprecedented threat and opportunity<br>for the right to health. We are seeing cutbacks in the funding for<br>prevention and treatment of HIV, retreats from commitments to<br>
‘universal access’ to HIV and TB treatment, attacks on human rights<br>and new threats to national and global health, including through<br>climate change and food insecurity. At the same time there are new and<br>better technologies available for health, new medicines and<br>
diagnostics for common diseases like tuberculosis, and an array of<br>interventions that could improve health and reduce malnutrition. Some<br>states, particularly South Africa and Brazil, are seriously seeking to<br>improve health on the principle that health is a human right. But it<br>
is questionable whether they have the resources to do it. There are<br>examples of growing global co-operation and legal agreement around<br>social challenges, such as climate change, although not yet around the<br>most immediate social challenges that face the poor. Activist<br>
movements exist around AIDS, health and around social justice.<br><br>The Commission on the Social Determinants of Health pointed to the<br>demand for a response to this moment of contradiction between threat<br>and opportunity from a leadership and governance that is driven by<br>
social justice. It stated: “In order to address health inequities, and<br>inequitable conditions of daily living, it is necessary to address<br>inequities – such as those between men and women – in the way society<br>is organized. This requires a strong public sector that is committed,<br>
capable, and adequately financed. To achieve that requires more than<br>strengthened government – it requires strengthened governance:<br>legitimacy, space, and support for civil society, for an accountable<br>private sector, and for people across society to agree public<br>
interests and reinvest in the value of collective action. In a<br>globalized world, the need for governance dedicated to equity applies<br>equally from the community level to global institutions.”<br><br>This is not a new call. It resonates with the recognition of the right<br>
to health as a human right found in the 1946 World Health Organisation<br>Constitution, the 1966 International Covenant on Economic Social and<br>Cultural Rights (ICESCR), the 1978 Alma Ata Declaration and the 2000<br>UN Committee on Economic, Social and Cultural Rights ‘General Comment<br>
14’ on Article 12 of ICESCR. Increasingly it is also reflected in the<br>incorporation of the right to health into the national constitutions<br>of over seventy countries in the last decade.<br><br>Nevertheless good health and access to adequate health care services<br>
remains out of reach to billions of people. Nearly two billion people<br>(a third of the world’s population) lack access to essential medicines<br>and about 150 million people suffer financial catastrophe annually due<br>
to ill health, while the costs of care pushes 100 million below the<br>poverty line.<br><br>The world is well aware of these facts. They are published by the WHO<br>and others. When these facts are raised in international forums, it<br>
has led states to make bold promises….that they later do not keep. In<br>Africa, 19 of the African countries who signed the 2001 Abuja<br>Declaration to spend 15% of their government budget on health<br>al¬locate less now than they did in 2001. Yet the WHO indicate that<br>
low-income countries could raise an additional US$ 15 billion a year<br>for health from domestic sources by increasing health’s share of total<br>government spending to 15%. Neither are high income countries meeting<br>their promises. According to the ‘Africa Progress Report 2010’,<br>
published by a unique panel chaired by Kofi Annan, when the $25<br>billion Gleneagles commitment comes due at the end of 2011, the<br>resources allocated by G8 countries will have fallen short by at least<br>$9.8 billion. The panel calls this a “staggering shortfall.”<br>
<br>Does this mean that the right to health has no value? No. Has the<br>right to health been sufficiently popularised or used? No. Are the<br>state and United Nations institutions who have a duty to protect and<br>realise the right to health fulfilling their obligations? No.<br>
<br>In the last decade AIDS activists have established in practice the<br>principle that states must fund treatment as a right, with the<br>organisation of resources globally to meet this obligation. Currently<br>we are seeing a reversal of this basic entitlement, as the right to<br>
these resources are being challenged by arguments over cost<br>effectiveness, a retreat from funding treatment in middle income<br>countries, despite the fact that three quarters of the poorest people<br>in the world live in middle income countries; and a claim that too<br>
much money is going to AIDS treatment, despite the fact that an<br>estimated ten million people still need treatment globally. Some<br>states in low income countries claim to have inadequate resources for<br>health even while their political and economic elites grow visibly<br>
wealthier, and even states who have met the Abuja commitment try to<br>fairly distribute unfairly inadequate amounts of money for health.<br><br>The Commission on the Social Determinants of Health called for<br>conditions that would enable civil society to organize and act in a<br>
way that promotes and realises the political and social rights<br>affecting health equity. It seems that we should go further than this,<br>given the reversals in progress and growing inequalities in health. We<br>need to see the level of activism by civil society as a key social<br>
determinant of health. The fight for health should be a central pillar<br>of all movements for social justice and equality, not in the abstract,<br>but for the specific goods, institutions, demands and resources that<br>will realise the right to health.<br>
<br>Please send feedback or queries on the issues raised in this briefing<br>to the EQUINET secretariat: admin@equinetafrica.org.This is an edited<br>extract of a speech given at the Southern African Regional Dialogue on<br>
Realising the Right to Health in March 2011. For more information on<br>the issues raised in this op-ed and for this and other presentations<br>made at the conference see: <a href="http://www.section27.org.za/" target="_blank" style="color: rgb(0, 0, 204);">www.section27.org.za</a>.</span><div>
<font class="Apple-style-span" face="arial, sans-serif"><span class="Apple-style-span" style="border-collapse: collapse;"><br></span></font></div><div><font class="Apple-style-span" face="arial, sans-serif"><span class="Apple-style-span" style="border-collapse: collapse;"><br>
</span></font><div><span class="Apple-style-span" style="border-collapse: collapse;font-family: arial, sans-serif;font-size: 13px;">For the rest of April's Equinet news go to:</span></div></div><div><span class="Apple-style-span" style="border-collapse: collapse;font-family: arial, sans-serif;font-size: 13px;">EQUINET NEWS IS THE ELECTRONIC MAILING LIST OF THE NETWORK FOR EQUITY<br>
IN HEALTH IN EAST AND SOUTHERN AFRICA (EQUINET)<br><a href="http://www.equinetafrica.org/" target="_blank" style="color: rgb(0, 0, 204);">http://www.equinetafrica.org/</a></span></div><div><br></div>
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