Pathologies of power, as well as social class formation are the motor forces behind most human rights violations which are themselves embedded in entrenched historical structural violence trends.
- Many previous and existing social struggles have demanded specific rights –without necessarily having used the international human rights framework. When discussing a ‘rights-based approach to health’ we should –but often do not– proceed from acknowledging this larger historical precedent of struggles for people’s rights and social justice. These struggles predate, as well as coexist with the use of modern human rights instruments. In practice, today’s international human rights law has codified old and new claims to a set of social arrangements that are thought to be capable of best securing the enjoyment of all inalienable human rights.
- It is possible, for example, to argue for the ‘right to health’ (RTH) on primarily public health grounds and on the basis of old social justice arguments, without making any reference to the international human rights framework. Nevertheless, the use of the human rights framework does complement the public health and social justice perspectives and thus strengthens the argument for the RTH.
- The right to health actually encompasses the ‘right to health care’ and the ‘right to the underlying determinants of health’. The distinction between both can pose a dilemma to health activists since it does not lead to a clear focus of action for them when working towards the attainment of the RTH. But the focus should not be blurred. It remains an important role of activists to document violations of the right to health care, as well as the right to the underlying social determinants of health.
- So, on top of working on health care issues, health activists have a critically important responsibility to co-initiate and participate in the promotion of the right to the determinants of health which are often primarily led by other allied, non-health movements. While doing the latter, they have a special role in pointing out the negative health effects of existing bilateral trade agreements and of detrimental globalisation-privatisation policies. Because of their dual responsibility, these activists may be uniquely placed to help initiate ‘social sector alliances’ which could build a powerful united movement as a counter-power to the onslaught of globalisation and the privatisation of various social services including health care.
5.This implies that the progressive health movement must lend its strength and voice to movements struggling to improve health-related entitlements such as nutrition services and food security, clean drinking water, sanitation and safer environmental and working conditions, among others.
6. The struggle for health rights must thus move-on to link with several other struggles (for the rights to food, water, education, housing, livelihood and social justice) in their various forms. Health rights work must become one strand of a much larger struggle to challenge the unfairness of the dominant social order.
The international human rights framework and the underlying global power structures
- Within countries, dominant classes have historically been forced to concede certain rights in a formal manner to maintain their legitimacy (although they are not always serious about implementing these rights, especially the full range of economic, social and cultural rights). [It is true that “hypocrisy is the homage paid by vice to virtue”].
In fact, in the case of dominant actors like the U.S. government, a particular version of human rights (mostly focused on rather narrowly conceived civil-political rights) is often used as a cover for policies that result in large scale denial of social and economic rights.
- To the extent that improvements do not take (or have not really taken) place, we have to question the legitimacy of the dominant system. So, we should also be keenly aware of the limitations of the dominant human rights framework, especially its failure –as often applied so far– to analyse and confront the underlying political economy of neo-liberal globalisation and the exploitative socio-economic system responsible for large scale denial of economic, social and cultural rights. In short, we can and should functionally use human rights to counter the social injustices of the globally-constructed-political-economic-system, without having any illusions about the nature of this global power structure, which plays with the language of human rights while perpetuating the systemic basis for their violation.
Pitfalls and strengths of the rights-based approach
9. A potential pitfall that can be encountered when using the rights approach to health –and that we need to be aware of– is the often seen primarily local focus it uses. We need to take our demands for health care rights beyond just local demands and targeting the immediate providers; continuously pointing out the larger links will increasingly bring the main decision makers into focus.
10. On the other hand, some strengths of the rights-based approach to health are:
- The rights approach can help us link somewhat complex issues of health policy with very concrete demands that can be taken up by people anywhere,
- the rights approach talks in terms of obligations and violations thus placing the responsibility to deliver on the different agents of the prevailing system,
- the rights approach can also form the basis for a comprehensive policy critique that exposes detrimental neo-liberal health policies, and
- the rights approach allows us also to pursue and institute legal action to revert violations and to seek redressal for those wronged.
- As regards the fight for health care rights, the same begins primarily as a form of resistance
- against the shrinking and weakening of public health services,
- against the denial of health care to the most needy through the application of user fees, as well as
- against the often found poor quality of care both in the public and in the private health sector.
(contd).
Claudio Schuftan, Ho Chi Minh City