1. I would like to think that you -as me- often ask yourself what we could all do better to achieve greater equity through what we do given that we most often work in countries with appalling social inequities. Allow me to share with you some of my thoughts on this.

2. I see our role in helping put in place the needed social processes and mechanisms that will drive sustainable human rights-based policies in health and nutrition as being inseparable from us helping to instill a new will and commitment to change underlying preventable structural inequalities in society. To achieve the latter, you can -as individuals- come to this will from either of two motivations: you can either come to it from a primarily ethical or from a political motivation.

3. These two motivational stances –that can drive us to become more involved in lessening social inequities– represent, not packages-of-universal solutions, but rather paths-to-follow to get things that need to be done, and the latter by whom, with whom, and against whom.

4. Living as we do in a mean, unfair and selfish world, I see the challenge we face as being one to graduate from the first into the second approach. Let me explain why:

The primarily ethical human rights-led process to sustainable development in health and nutrition

As is true for slavery, there are
ethical limits to tolerating
extreme poverty.

5. The quite prevalent development ethics that calls for working with the poor as protagonists and not merely as recipients of development aid has, so far, itself, unfortunately remained mostly a top-down approach. It represents mostly the view of academicians, of intellectuals, of church leaders, of international bureaucrats and of a few politicians (mostly in the opposition). Beneficiaries have remained mostly passive in this
approach, merely being counted as the ‘objects’ of the process. This ethics-led human rights process assigns a key role to ‘moral advocates’ who are to advance the following cascading process:

– NEEDS (Entails assessing needs requiring fulfillment using
“objective”(?) field research techniques)
|
– ENTITLEMENTS (Entails granting selected identified needs the status of
entitlements to be honored by society)
|
– RIGHTS (Entails translating accepted entitlements into actual
justiciable human rights)*
|
– LAWS (Entails delegating to members of Parliament the
legitimization of selected human rights by promulgating them
into laws)
|
– LAW ENFORCEMENT (Entails assuring/securing that the human
rights-related laws get enforced by government
institutions)**
_________________________________________________________
* : Promoting these rights is not, by itself, a progressive political act.
**: Often very weak or non-existent and without the people getting involved
directly in it; absence of recourse mechanisms.

6. The inherent weakness of this process is that to have human rights ultimately respected, someone other than the poor takes the responsibility at each step to steer the process from entitlement to enforcement.

The primarily political human rights-led process to sustainable development in health and nutrition

7. This more bottom-up political approach (in which commitments are needed beyond ethics) better accommodates and represents the perceptions of needed development actions as seen from the perspective of the human rights-based framework and that of the beneficiaries of development. In this approach, beneficiaries are clearly the protagonists of the process; the process is mostly politically motivated and assigns a key role to ‘social activists and political advocates’ who are to advance the following cascading process:

– FELT NEEDS (As freely and spontaneously expressed by organized
communities in relation to the rights they feel are being
violated)
|
[Consciousness raising] (The role of human rights activists importantly using
capacity analysis)
|
– CONCRETE CLAIMS (Felt needs are articulated into concrete human rights
claims directed at specific duty bearers, each tackling
perceived violations)*
|
[Social mobilization] (Also the initial role of human rights activists)
|
|
[Empowerment/Acquisition of Social Power]
|
|
– ORGANIZED PEOPLE’S ACTIONS (Mobilization of the community’s
own and then outside resources)
|
[Gains in self-confidence]
|
– DE-FACTO EXERCISE OF SOCIAL POWER (Within or challenging existing
laws; bringing in and using needed external
resources)
|
[Networking]
|
[Acquisition of Political Power] (Progressive influence over needed decisions)
|
– CONSOLIDATION OF NEW POWER (Coalition building)
|
[Leads to new felt needs and the cycle restarts]
________________________________________________________
*: Claims correspond to entitlements in the previous diagram.

8. Although the ethically and politically human rights-led approaches, as simplified in
these two diagrams, represent different paths, both can contribute –through their own merits– to sustainable changes in the health and nutrition of the poor. The two approaches complement each other, but would be even more synergistic if the ethically led process gets more proactive civil society inputs and gets more politically savvy.

9. It is in the realm of the second diagram that I see us ever getting a chance to influence the choice of needed investments in health and nutrition, as well as influencing the redistributive and social protection measures/priorities that will concomitantly address the poverty underlying the preventable ill-health and malnutrition we (as professionals) are left to deal with.

10. It is in the realm of the second diagram as well –with the added strength coming from a mobilized community– that I see us ever effectively influencing how the public sector allocates its resources and chooses the needed geographic/gender/socioeconomic/ethnic targets, and how, in the process, the government favors programs that are under strong community control.

11. Finally, it is also in the realm of the second diagram that I see us succeeding in instilling a new will and commitment to change underlying preventable structural inequities in society that underlie preventable ill-health and malnutrition; our strength will come from building the new constituencies that do have a vested interest in pushing for the unpostponable changes in the system that basically reproduces the existing structural inequities and determines the parameters within which we (as professionals) are “allowed” to intervene.

Claudio Schuftan, Ho Chi Minh City
cschuftan@phmovement.org

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