[TLDR (too long didn’t read): If you are reading this, chances are you care about HR. This Reader is about two key concepts and practices keeping the right to health at bay. For a quick overview, just read the bolded text]. Note: You can easily translate the Readers to many languages. Use the app deepl.com and it is done instantaneously. It takes seconds to download the app into your computer or phone and translations are of high quality.
Two examples of such bad signs in an indeed sick society can be illustrative:
A. Multistakeholderism in health
1. Together with many, the People’s Health Movement does indeed oppose multistakeholder governance in health. Why? Because these arrangements involve TNCs and others in the private sector in public policy making, not just as equal partners (that would be bad enough), but as decision-making partners. (In 2005, at its People’s Health Assembly in Cuenca, Ecuador, PHM declared that the private sector has no role to play in global public policy making in health)*. In simple terms, either one believes in a democratic global governance in health (or in any other domain relating to human rights and/or other global commons), or one believes in a plutocratic global governance system in health —as seen in the current multistakeholder governance arrangements, including those of UN agencies!**
*: When it comes to global health governance, there is no ‘them and us’…only ‘us’. (Global Health Council)
**: It should not need to be stated that this does not imply no interaction with the private sector. It does imply though that agents of the latter are not partners for the simple reason that partners must share the same objective.
2. Many non-governmental organizations participate in such multistakeholder arrangements. (The question is: Are they being co-opted to do so or are they being corrupted by the private sector?). This observation is not made in order to condemn organizations that participate in such arrangements. The aim is for them to expose the fundamental flaws in multistakeholder governance so as to start the long process of abandoning these arrangements in favor of arrangements that allow and promote a democratic governance.
3. It is well understood that all kinds of valuable and genuine organizations have had to participate in multistakeholder arrangements, because these are promoted as the only option for funding. But they ought to pursue their objectives without interference from pressures and must pursue arrangements in which a democratic, participatory and publicly accountable governance is practiced. The question is: are they doing this and, if not, why?
4. These arrangements cannot be changed overnight. True. Nevertheless, mobilizing and advocating to abandon these arrangements where private interests interfere is urgent and well overdue. This has been a 25-year struggle for those who regard health as a human right and who support meaningful democracy. There is an enormous literature to support this social-justice-in-health position. (Alison Katz)
B. Social determinants vs social determination of health
5. Over the past two decades, the concept of the social determinants of health has become increasingly accepted and mainstreamed in anglophone public health. By recognizing the role of social conditions in influencing health inequalities, the concept challenges narrow behavioral and reductive biological understandings of health. Despite this, scholars and activists have critiqued the concept of the social determinants of health for being incomplete and even misrepresenting the true nature of health inequalities. These critiques have been most thoroughly developed among those working in the Latin American social medicine traditions who proposed the ‘social determination of health’ paradigm and the concept of interculturality even decades prior to the advent of the social determinants of health. Social determination challenges the concept of the social determinants of health. It focuses on how it rather is a process that leads to the determinants.
6. Recognizing that health and disease are socially determined entails expanding the scope of epidemiological analysis so that it is not limited to the end phenomena (i.e., the ‘tip of the iceberg’), but must encompass the underlying social, cultural and political determinants that generate the observable outcomes. The social determination concept seeks to establish a causal chain of social risk factors (i.e., socioeconomic status, education level, characteristics of the neighborhood and physical environment, employment status and working conditions, and access to health care…) too often seen as divorced from the processes that generate the determinants. An analysis of these social processes is largely absent from the social determinants of health literature. The processes responsible for the social reproduction and the perpetuation of preventable ill-health and health inequalities are ignored and left uninterrogated.
7. The work of Dr Jaime Breilh and other health scholars has made a call for an “emancipatory social project, one that implies the construction of alternative power, and that must be articulated not only around academic or institutional efforts, […] but also around the vital processes of and inputs from popular organizations and movements”. (Michael Harvey et al.)
Claudio Schuftan, Ho Chi Minh City
Your comments are welcome at schuftan@gmail.com
All Readers are available at www.claudioschuftan.com I