- If you recognize and agree with
- a) the indivisibility of rights,
- b) the equal importance of people’s socio-economic entitlements, and
- c) the principle of equity,
you must accept that this runs counter to market-oriented development and health policies still fostered by many an international development agency.
- Therefore, what the adoption of the human rights framework brings to public health is that it ensures that social justice is made a constant counterbalance to unchallenged utilitarianism; it also ensures that checks on power relations are made routinely as well, and that these checks are the main way to protect the vulnerable by opening avenues that confer communities the power to get actively and de-facto involved in setting the policies and programs that affect their health and wellbeing.
- This makes human rights (HR) the centerpiece of early twenty first century development struggles. But mind you, the HR framework will only become a meaningful instrument to assure accountability if strong civil society pressures on government ultimately turn HR codes and standards into laws and regulations.
- Furthermore, HR are not just about empowering individual duty bearers [remember that duty bearers are often oppressed oppressors], but are, by extension, a framework for the contestation of power, at local, national and international level. And where power is contested, we should expect that the products of this contestation will actually reflect the relative balance of forces (or power) of the different actors. Therefore, empowering claim holders we must.
- On the other hand, the current emphasis
-on ‘good governance’ (no matter if participatory or not…),
-on ‘representative democracy’ (no matter if through rigged elections or not…), and
-on ‘civil liberties’ (no matter if fair to the marginalized or not…)
that has emerged as the dominant paradigm in the development discourses driven by most Western governments has ironically contributed to a de-politicization of the human rights and of the development discourse, because it strips the struggles-for-health of any content that challenges power imbalances –again at local, regional and international levels.
- Because of the above underlying power issue, many have questioned “Why rights, why rights now?” “Is human rights work the most effective way to tackle power imbalances?”
We respond: If and when the language of rights becomes denuded of a focus on power relations, it is turned into an ineffective, worthless technical exercise of compliance with existing norms; human rights then become palliative rather than the cornerstone to ease human suffering. In practice, in health, placing demands from a rights framework, among other, challenges service providers to see their role as fulfilling the state’s human rights obligation to assure comprehensive and universal health care rather than simply to deliver health services.
- There is no unambiguous answer to the question whether, in the reigning paradigm, public health still is a-bundle-of-services-shaped-by-ideologically-pro-status-quo-positions. But if you think it indeed is, the application of the human rights-based framework is most probably the best currently available counterbalance to challenge a paradigm that desperately needs to be replaced.
Claudio Schuftan, Ho Chi Minh City