The Right to Health: A holistic overview of its components and tasks for the global health movement.
8. The right to health has been defined as the ‘right to the enjoyment of a variety of facilities, goods, services and conditions necessary for the realisation of the highest attainable standard of health’. (General Comment 14, CESCR) (http://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.En?OpenDocument)
9. This right includes both the right to all the underlying determinants of health besides health care (such as water, food security, housing, sanitation, education, a safe and healthy working and living environment, etc.), and the right to health care (i.e., the right to the entire spectrum of preventive, curative and rehabilitative services plus health education and promotive activities).
10. In practice, this suggests two types of tasks for the global health movement:
a) Tackling the right to all the underlying determinants of health: Supporting and even co-initiating, campaigns or initiatives addressing key health determinants (e.g., campaigns for water, for food security, or for housing) is important and justified by itself. There are initiatives already working on behalf of these rights, not necessarily spearheaded by health activists. The focal points for each of these initiatives should be the organisations with the most experience and commitment to that particular issue (e.g., water, food security, housing, the environment). This recognition places an obligation on health activists to actively support and strengthen such initiatives though not necessarily to take up the responsibility of primary leadership of such groups. When liaising with these groups, health activists will bring-in the health perspective into those campaigns. An additional important role that has to be played by health activists is to help document violations of the right to the underlying determinants of health, for instance., showing how denial of food security and appropriate care of mothers and children leads to worsening malnutrition, increased morbidity and mortality. Health-based arguments can indeed significantly strengthen the demands of claim holders to tackle these determinants from a RTH perspective.
b) Strengthening the Right to Health Care: The global health movement has a primary and unquestionable responsibility to take the lead on this. The urgent need for action within the health care sector has already been pointed out. We are all witnesses to the often catastrophic consequences of the lack of economic access to adequate health care and the poverty trap associated with serious illness.
What is the added value of adopting the human rights-based framework (HRBF) to tackle the problems described?
11. In every development process, there are three types of actors: claim holders, duty bearers and agents of accountability. When the State does not respect human rights, claim holders have to demand their rights directly from the duty bearers in government plus interact with agents of accountability (e.g., HR commissions, ombudsmen, HR-oriented NGOs) who overlook the procedures being put in place by government and make sure duty bearers fulfil their obligations (including remedies and restitutions). If claim holders do not do it, it is in part their fault. One can thus say that it is also the duty of those of us who are aware of human rights to generate awareness about the bases of these rights, in partnership with the marginalised and underserved groups we work with.
12. The RTH is thus violated, when the poor, the marginalised and the discriminated, as claim holders, do not have the capacity to effectively demand (claim) their rights; rights are also violated because duty bearers do not have the capacity or the will to fulfil their obligations (technically called ‘correlative duties’).
13. Therefore, in the HRBF one has to carry out three types of analyses: a) situation analyses in which one determines the causes of the problems placing them in a hierarchical causality chain of immediate, underlying and basic causes or determinants, b) capacity analyses in which one determines who are the individuals/institutions that bear the duty to do something about the above causes calling them then to fulfil their duties as per their country’s obligations as signatory of the United Nations HR covenants, and c) an analysis of and liaison with accountability agents. Herein lies the call for HR activists to carry out rights awareness work, i.e., to educate and inform the broader society about what these rights mean and what accountability mechanisms should be put in place and made to work.
14. These three types of analyses have to be carried out with the representatives of the local community and the beneficiaries of the health system so that the rights being violated can be identified jointly and those responsible also be jointly confronted –for them to do something about the problems identified.
15. As a corollary of the above, note that, the rights activists’ ultimate goal is NOT to look for health policies that favour the poor… What is sought is significant poverty reduction policies that directly address the social determinants of health!
Claudio Schuftan, Laura Turiano and Abhay Shukla, People’s Health Movement, Right to Health Campaign (see www.phmovement.org ).