1. As a general comment on the Readers, I would contrast two possible styles of dealing with the issue of health rights:
a. Taking the human rights (HR) approach as the starting point, deducing one’s arguments mainly from the HR framework, using this as the principal justification for action, and appealing for an active use of this framework as the main form of action (moving mostly within the HR framework). Several of the Readers fall in this category despite referring to a political perspective in an abstract manner.
b. Taking people’s experience of real life deprivation of basic health care and unhealthy living conditions as the starting point. In other words, taking the massive and avoidable suffering, inequalities and ‘unjust’ social situations as a major justification for change so that arguments for change are developed coming from the people’s aspiration for a qualitatively better life, including better health as a key social aspiration. This means drawing upon the HR framework as one important justification and anchoring point but not the only one for social action. It also means discussing a variety of small and large social actions and struggles that are actually taking place on the ground –with or without using human rights language– as an exercise to provide new hope and direction. The use of the HR framework as one of the tools for further struggle can sharpen and politicize existing efforts, along with various other forms of mobilization (as said, starting from real life experiences and moving to various strategies for change, including the use of human rights, thus ending up with suggestions for realistic forms of struggle on the ground).
2. This may sound like an oversimplification and perhaps ‘stereotyping’ the situation, but the Readers seem to me to fall more in category ‘a’ than ‘b’ and seem to rely very heavily, almost exclusively on the HR framework, rather than referring to it as one useful tool in a broader range of strategies and forms of struggle. Also, there seems to be a major emphasis on international HR covenants and instruments which are of rather limited use in the actual struggles of grassroots activists, even though they have some place (based on our experience in India, I would argue rather peripheral and limited) in a local-to-national spectrum of strategies. Furthermore, there is usually a lack of reference in the Readers to actual struggles, movements, initiatives, which make them sound rather delinked from ground realities. Hence several of the Readers read like ‘moral’ arguments, expressing distress at violations of HR in a generic way, indirectly placing excessive and undue expectation that such a (mostly international, universal) framework would, in and of itself, in a major way fulfill and promote people’s access to healthy lives and health care –a fact that is at great distance from the real ground situation. As a matter of fact, people often, or perhaps usually, struggle without explicit knowledge of the ‘human rights framework’ as such; instead they protest against perceived injustice, exploitation and deprivation, and may use human rights language as part of a wider repertory of struggles and strategies. Our task as activists is to support such struggles, and help sharpen them with various tools which include, but are not limited to, the human rights framework.
3. Keeping this in mind, I would strongly suggest that the Readers carefully look at how actual struggles on health rights have developed in various countries and places, how the HR framework has or has not been used, what broader perspectives and strategies have been used in social struggles, and then revisit what the HR framework has to offer in this larger scenario. This neither means abandoning the HR framework, nor being completely subjugated to it, but rather having a sense of its appropriate use as one tool in a wider spectrum of struggles in social movements.
4. These comment are not a ‘critique’ of the Readers which have several useful insights, it is just that I feel they need to move a bit beyond ‘moving within the HR framework’ and then critically look at it and use it in a significantly broader socio-political context. I repeat, HR can be one useful tool in a spectrum of strategies. However excessive reliance on it as the principal perspective and justification, “overshadowing political analysis and in-depth understanding of social situations and actual struggles” might constrain our vision.
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cschuftan@phmovement.org