1. The progressive weakening of public health systems, the growing privatisation of health care and the erosion of universal access to health care are phenomena seen across the globe. The health sector globally is still dominated by vertical and techno-centric approaches, often supported by ‘public-private partnerships’ active at several levels. There is thus an urgent need to replace this dominant discourse by a process aimed at universally achieving the ‘right to health and to health care’ as the main objective to achieve more equitable health care systems in both developing and developed countries. To counter and reverse the tide promoting ‘health care as a commodity’, there is a need to establish a global consensus on ‘health care as a right’.
2. Human rights violations are not accidents; they are not random in distribution or effect; they are linked to social conditions. It is the socio-political forces at work that determine the risk of most forms of human rights violations. One has to understand human rights violations as based on the broader analyses of power and social inequality and on their social, economic and political determinants. The promotion of equity is the central ingredient for respecting human rights in health.
3. It is mostly the poor who are the victims and they have too little voice, little influence and trampled rights. It is inequities of power that prevent the poor from accessing the opportunities they need to move out of poverty. Structures and not just individuals must be changed if this state of affairs is to change.
4. Since laws designed to protect human rights and the right to health (RTH) are mostly not applied, what additional measures have to be taken?
5. It is not enough to improve the situation of the poor within the existing social relationships. Rights are claimed through social action and the latter depends on how power is distributed and used to address health issues.
6. Human rights legislation alone –without enforcement mechanisms — is not up to the task of relieving the suffering already at hand. Rights are not equal to laws –they are realised through social action and by changing the prevailing power relations. Rights cannot be advanced but through the organised efforts of the state and of organised civil society. To work on behalf of the victims of violations of the RTH invariably means becoming deeply involved in pressing for social and economic rights.
7. Public health must be linked to a return to social justice. Denial of care to those who do not pay is simply legitimised in the free-market system. The commodification of health care changes people from citizens with rights to consumers with (or without) purchasing power. This leaves those who are economically marginalised also marginalised from accessing comprehensive health care.
Claudio Schuftan, Laura Turiano and Abhay Shukla, People’s Health Movement, Right to Health Campaign. (see www.phmovement.org )