Human rights: Food for a thought nearing coma ‘HR in the health field’
HRR 765
[TLDR (too long didn’t read): If you are reading this, chances are you care about HR. This Reader is about what is happening and not-happening in regards to the fulfillment of the right to health. For a quick overview, just read the bolded text]. Traducir/traduire los/les Readers; usar/utiliser deepl.com
1. Regarding academic knowledge production and on-the-ground praxis, global health is a highly centralised field, with power concentrated in a handful of actors chiefly based/reliant-on and imitating the ways of the US and Western Europe. This dominance extends beyond financial contributions, shaping research agendas, training, methods, publications and determining program priorities, as well as governance structures. It generates and reproduces unfair knowledge practices that serve primarily the interests of the North often at the expense of countries and people on the recipient side on whose behalf and for whose benefit, it is said, knowledge is being generated and practices being applied. But, note, this dominance also offers us an opportunity to understand a) what risks it creates, and b) how it avoids embracing needed structural changes that address the social determination of health.
2. The critique of a dominated global health discourse has expanded over the last 20 years addressing issues ranging from what it represents and how funding is allocated to the castrating limitations of Western biomedicine. The space for critique has now opened to reflect on how global health ought to operate and how it is not governed in the name of justice and equality considerations. The discourse now embraces a movement of alternative networks establishing new international connections, forging new alliances, and beginning the slow, but necessary, process of imagining a post-imperial global health that is no-longer-just-an-ideal, but entails the dismantling of the many structures of dependency and the reshaping of the notion of what really ‘global’ ought to be. This critique has become an unavoidable necessity in light of the current crises of which health is part and parcel.*
*: As the health crises everywhere deepen, some experts are calling to depoliticize public health. But what we need is not less politics in health care — what we need is a mass movement to transform our broken system into one that serves everyone. (Eric Reinhart)
3. Years after the worldwide promotion of a distorted primary health care (PHC) approach –derived from the rise of neoliberalism– efforts are growing towards challenging the forces of the Global North that traditionally promote the status-quo (i.e., to change, but to change nothing). Meanwhile, the emergence and expansion of new private actors** in health philanthropy and humanitarianism is helping to consolidate a global hierarchy of governance that now rallies around a corporate logic and power imbalances with capitalist governments, like the US, at the forefront.
**: Uncontrolled profit-driven health care services are like a systemic infection of the whole health care system. Health care globally is poisoned with increasing inequalities and uncontrolled costs. The cure is to take back the democratic control and allocate available resources according to need. (Goran Dahlgren)
4. What this tells us is that, given the current US retrenchment, a new order is possible and has to be fought-for; and only collectively can we move in this direction. We face a window of opportunity on which alternative horizons can be imagined and worked-towards. Global health must move beyond its contemporary reliance on nation-states and corporate actors to incorporate the voices and expertise of grassroots organizations and those most affected by global and local health policies. Replacing the U.S. leadership with any equally centralised arrangement would simply continue the status-quo, patching-over systemic gaps rather than addressing the deeper inequalities that have long defined global health. (Cristian Montenegro, Sebastian Fonseca)
Human rights claims alone are not enough to achieve health gains
5. Those claiming their right to health must be linked to community mobilization at a local and national level. Unlike narrower interpretations that prioritize individual claims while accepting structural injustice, human rights are transformative of society in that they seek equity, equality and justice. Claim holders’ empowerment –as patients, as community members and as members of broader segments of civil society– is key to operationalize the right to health. This means that claim holders need, not only to be aware of their rights and entitlements, but also to take action to achieve these rights. However, all too often, health systems fail to trust communities to be authors of their own well-being and respond poorly to community approaches to be partners in their own health. (Leslie London).
Can we win this battle?
6. Thing already start with schools of public health increasingly entering into partnerships with the corporate sector. In their curricula, most schools offer an approach to health equality that does not question the dominance and influence of the capitalist economic system on health. This is not surprising as universities are part of the capitalist superstructure. This reminds us of Gramsci’s concept of cultural hegemony, whereby the ideas and values of the ruling classes –in this case, the corporate and philanthrocapitalist sector– are imposed upon and accepted by those being dominated. (https://en.wikipedia.org/wiki/Antonio_Gramsci)
7. The example of schools of public health (with counted exceptions) has much to offer in explaining corporate and business involvement with post-secondary education in general. Are these institutions doing this unwittingly as a result of subtle gratitude towards their funders? The faculty may not always realize that they are being instrumentalized***, and may not dare to undermine the underlying commercial interests of an industry sponsor. Historically, capitalist philanthropy has indeed shaped public health priorities and this is also the case in global health initiatives. (Birn & Richter 2018).
***: Instrumentalizing, occurs when political actors misuse existing legal institutions, procedures, and laws to exert political influence.
8. The Rockefeller Foundation and the (ex) Bill and Melinda Gates Foundation played key roles in shaping the role and influence of philanthropy in health the world over. Philanthropic foundations have made significant financial contributions to renowned institutions such as Harvard, MIT, Columbia, and John Hopkins among others in the US. This has significantly shaped the institutions, their ideology, and practices in the international global health field, shaping a belief in narrow, technology-centered, disease-control, biomedical approaches’. (Stella Medvedyuk, Dennis Raphael et al)
9. To win over this not-so-suttle penetration, I do not think we can rely on the faculty to start the needed revolt. It is the students that hold the cards in this front … and this is, of course, not the only front****. It is thus crucial to build student coalitions to create the conditions for sustained and appropriate pressure.
****: Take the needed struggle on pharmaceutical industrial policies (Jomo Sundaram) or the struggle against agrotoxins, just to name two at random here (note that every 1U$D of agrotoxin use results in 1.3 U$D cost to the health system).
10. Winning in all the crucial fronts will require _______ I will let you fill the blank…
Claudio Schuftan, Ho Chi Minh City
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Postscript/Marginalia
-Medicine is good for the revolution or else it is good for shit. (graffiti in Paris 1968)