[TLDR (too long didn’t read): If you are reading this, chances are you care about HR. This Reader highlights the crucial role of activists in addressing the commercial determinants of health, proposing key strategies and actions while acknowledging the challenges they are likely to face. For a quick overview, just read the bolded text]. Traducir/traduire los/les Readers; usar/utiliser deepl.com
— When we talk about the commercial determinants of health and their corporate connections, remember these are lethal, but legal. (Schrecker, T., Bambra, C.)
1. If the substance of this commentary only aimed to describe and explain the causes of this interference, we think a disservice would be done to advancing and addressing the real social (and political) determinants of health as already masterfully suggested in WHO’s 2008 Report that is (frustratingly) largely ignored. As then pointed out by Sir Michael Marmot, “Health inequalities and the social determinants of health are not a footnote to the determinants of health. They are the main issue”.
2. Seventeen years later, the questions to ask are: What are the politics of the commercial determinants of health linked to? Is it not to the prevailing and still pervasive neoliberal system? And, if so, are we only to focus on these determinants in the health and nutrition field? Will this be enough –or rather necessary, but not sufficient?
The politics of ‘not enough being done’
3. This subheading has behavioral and procedural connotations and implications, if nothing else, because the actual politics of the commercial determinants of health are unmistakably linked to the human right to health and food –both so bypassed by Big Business. This, therefore, signals one of the avenues for us to pursue to address the processes and effects of the aggressive penetration by corporations into the right to health and nutrition, turning them instead into a lucrative business. Take, for example, the impact of the COVID pandemic on food poverty and on widely promoted hunger alleviation efforts, particularly those that were based on the marketing and brand engagement of the aid being provided.
4. The human rights (HR) activist community has been in the struggle of denouncing the commercial determinants for quite some time now. The question is: Do their efforts fall into the ‘not enough being done’ category? The answer to this question is a mixed one: some do, some do not.
What is different in what we propose as a path to address the commercial determinants of health?
5. The difference has to do with a roadmap to be pursued, namely a ‘wider political pathway’ as I explain further down. The food and health fields are perfectly good entry points to address the commercial determinants. But staying there is not enough. It is only by taking head-on the politics behind the growing commercial inroads being made by corporations that we will eventually have a chance to get somewhere longer-term and sustainably.
So, what does this mean?
6. It means that politics is fought with politics. Activists thus need to get involved in organizing campaigns of HR learning centered around the political economy of preventable ill health, preventable malnutrition, and preventable deaths. Specifically, fostering activists’ campaigns is essential to raising the consciousness of claimholder (mostly consumer) groups. This is, not only to be done nationally, but also needs to encourage groups to coalesce globally to organize and mobilize claim holders to effectively demand what their/our inalienable rights are. The idea is to create an up-swell of political consciousness at the base that will use health and nutrition demands to further demand structural changes of the neoliberal system progressively choking the health and food system.
7. It also means that, in engaging with adversaries, we must grant them perhaps individual and/or institutional respect, but not necessarily political respect. Questions about which negotiating strategies to prioritize thus become pressing. So, what should organized claimholder activists prioritize? Oftentimes, this translates into an understandable impulse to commit to all issues equally. However, we must mind the adage: ‘If everything is a priority, then nothing is a priority.’
8. It further means that we are not to worry about conflict: it is far worse to try to avoid it, because we just create new conflicts that end up being more insidious and costly than the original conflictual issue.
What does ‘claim holders effectively demanding’ mean in the context of the commercial determinants of health?
–Our force: Unity. Our goal: Victory… And you cannot win if you do not fight. (Graffiti in Santiago, Chile)
9. A revolution of expectations comes only from creating and fighting for true and realistic alternatives to changing such systems of oppression and manipulation as we have in neoliberalism. Such a revolution does not come from building castles in the air or proposing unproven patch solutions, especially when coming from self-proclaimed ‘experts.’ What kills revolutions is not zeroing in on hard realities and commensurate alternatives; the killer is for us to pursue unrealistic, non-evidence-based dreams that do not address the causes of the causes. Yes, we will find obstacles, but then they also open new avenues and concrete new ways to overcome them.
10. We are aware it is still very difficult for some of us in public interest civil society organizations (PICSOs) and social movements to maintain our political agility in a hostile environment where corporations are taking over intergovernmental and multilateral institutions, where they are gaining powerful seats at tables where global political economy decisions are made. But the role of an avant-garde is to cause fermentation. We cannot fall into the trap of believing someone else is going to take action for us against these things that are happening in front of our eyes with impunity; we have to get active. A strategic overhaul of our actions requires nothing less than a critical shift in our thinking and if by now there is no such shift in the mind of key activists, then perhaps we have to focus on that as a priority —‘starting next Monday morning…’. (Remember: ‘Divided we beg, united we demand!’). This is a call to help create a new politics to fight the illegitimate commercial determinants of health and nutrition.
11. If (as we should) we opt for adopting a HR-based approach to address the commercial determinants of health, the only way we have to ultimately drive meaningful institutional and structural change is to ‘get inside’ traditionally closed spaces or spaces where we are uninvited. We must thus consider the best ways to continue challenging the cozy and too-close relationship between industry and governments, as well as between corporations and UN agencies. In this effort, if we set the bar too low for our HR and political aims, what will prevail are mediocre results and achievements, i.e., well-intentioned and selfless actions that seem intuitively laudable but will have a negligible impact.
12. Putting disparity reduction (not poverty reduction!) within and among countries, as well as HR upfront in the battle against the commercial determinants is critical. So is avoiding uncritically accepting yet more purportedly ‘innovative’ quick-fix technical packages that the guardians of the neoliberal paradigm so ably put forward every time they feel threatened (e.g., greenwashing).
13. Furthermore, we are not to operate with a logic of winning or losing, because what it is all about is rather to start by giving a clear signal, a gesture that conveys the incitement to fight against the overwhelming neoliberal project behind these determinants, a signal that popular resistance can and will overcome corporate forces. Only such a resistance will give an outlet to people’s cry for dignity and move a step closer to true/direct democracy and, if necessary, to the streets.
Are you an activist doing some of these things?
–Activists confronting and condemning these commercial determinants are ultimately the only defense we have of the rights to health and food.
14. To inject a positive note here, growing numbers of activists are devoting a large part of their time to the struggle for HR and social justice (but not nearly enough on the commercial determinants of health and nutrition). So, the outlook is not grim. Human rights activists can indeed bring out and use the many ‘weapons of the weak’ that can, against all odds, contribute to recalibrating structural inequalities.
15. If HR activists simply behave rebelliously without a plan, their actions will, most likely, become ineffective, and they may lose respect. Activists ought to become defiant with a purpose and direction, with moral courage and good leadership. Perseverance alone does not guarantee results (think Spring Revolution and other). I apologize for this longer-than-usual Reader; please read on.
16. Sometimes, like in my case, you just feel that everything you do just goes to waste. We all have to be prepared to cope with this feeling. The challenge we face as activists is to help pull potential claim holders from where they are to where they have not yet managed to get by their desire or will. We must be, not only be organizers, but also permanent persuaders, and this is not easy. Never forget that it is possible to be right and still suffer defeat. (‘Failure festivals’ are worth trying, where everyone shares failures; this numbs some of the pain and helps us come up with new ideas).
17. To succeed, HR activists are in the business of eliciting effective demands from claim holders (effective demands are understood, not only as placing demands in front of pertinent duty bearers, but also consist of, when and as necessary, them showing a willingness to invest/give up resources they hold).
Yes, activists’ leadership is necessary, but so is accountability
18. Demanding accountability is the cornerstone for success. For it to work, we need to set annual and multiannual benchmarks for the progressive realization of HR –and in our case, for the right to health, nutrition, and food. Benchmarks set for reversing the commercial determinants must thus be monitored (‘watchdogged’) by HR and/or health and nutrition activist organizations. Ultimately, it is this mechanism that must take charge. Experts may be needed to set these benchmarks for the future. Expertise matters, but when it comes to charting the future, community involvement, especially in monitoring and denouncing, is ultimately much more effective and needed.
19. It is tempting to say that the UN system ought to be viewed as the key accountability agent when the national right to health and right to food enforcement is failing. But is the UN effectively such an agent? Seen from another angle, global and regional HR law courts and litigation are supposed to be the last resort in these cases. But are they? (or are they succeeding at it?) So far, this has not worked well at all.
20. And then, there are intellectuals... Most of their HR writings are about how other people could/should do things for claim holders —not so much about supporting claim holders to act on their own behalf. In this endeavor, what ultimately convinces claim holders is not logic but ‘rationally supported emotions’ –thus, the importance of addressing mass psychology in the work of activists. When we act for claim holders, we risk disempowering them instead of encouraging them to speak up for themselves.
21. In the work of activists with duty bearers, the key is to ask them:
- Who should get what goods and services?
- Who is to provide those?
- How?
- Using what resources?
- Is there anything that would motivate them (in our case, commercial entities) to change?
- What will keep them on track?
- Who is to be held accountable, for what, and in what way?
22. Human rights have neither lost their importance nor their centrality as a framework for reform. The HR movement surged as socialism dwindled as a cause to fight-for in the latter part of the 20th century. This is the reason why more attention must be given to the simple fact that many people do not know their rights —or, they may know them, but only in an abstract way; they may not know how to make use of them. To begin with (and as said), effective HR work will require a massive HR learning campaign. Participants, not only need to learn to better understand, but also to address the limits of the current political discourse. Such training must sensitize them to the need to demand change in what they see happening in the health sector. And this learning must ultimately be carried out by mass movements.
23. Yesterday as today, the question remains open as to what extent the various social groups can come together in the struggle against an ever more ruthless Capitalism with its commercial, neocolonial, and patriarchal characteristics.
Is the alternative to engage in acts of disobedience to say ‘no’ to the power of commercial entities?
24. Yes, our work will confront us with moral dilemmas if and when applying uncivil means to achieve civic and political/HR outcomes. Confrontations with the authority and with the private sector can take many forms and initiatives –using the weapons of the weak. In our struggle with them, always go from a health-centered political dialogue with strategic political enemies to a structural critique indicating how it is the system that is responsible for the commercial interests impinging on health.
Bottom line
25. What is needed is to release and mobilize claim holders’ counter-power to achieve positive collective structural change. There is no one approach to overcoming the chokehold of the corporate system. It will involve: a) coalition building, b) articulation of an ambitious shared vision, c) strategic use of multi-level institutional processes, d) social mobilization among like-minded and perhaps unusual bedfellows, e) organized campaigns with sympathetic political leaders, and f) a compelling framing of the political issues at stake.
26. Social movements that today take so many good initiatives, that take to the streets to fight for their demands for social, economic, and environmental justice, must also learn to organize themselves locally, nationally, regionally, and globally. Without organization, without structure, nothing can ever change sustainably. The transition may begin in your street, but it will be of no avail without the simultaneous fostering of a national and global approach: a roadmap. Social movements are weak, in part because of their lack of coordination and because they focus on protesting and give less importance to tactically planning a concrete strategy.
Beware: apathy can turn our work into stagnation
27. We need to transform apathy into activism and consolidate negotiated social contracts between people (as claim-holders) and decision-makers (as duty-bearers) at all levels.
28. Many single-issue movements have sprung up at the national and international level, but they rarely see themselves as a unified movement. Human rights activists have only begun to explore and set-up ways of weaving theoretical and practical approaches into a wider struggle for social and political change.
29. Social movements must start to build together, laying out fresh, bold visions for the future –visions that present credible pathways out of these crises (not least to counter the commercial determination of health). And, most importantly, they must begin engaging with progressive political parties to try to increase counter-power.
30. Finally, we must fight against the forces of conformity keeping us divided. To keep ourselves protected, we simply have to demand more of ourselves. Succeeding in this laudable endeavor is a moral imperative. The stakes are too high, and time is too short to settle for anything less.
Claudio Schuftan, Ho Chi Minh City and Angela Carriedo, London
Your comments are welcome at schuftan@gmail.com
Postscript: Note that this piece has not said anything about multistakeholder platforms and PPPs. Other authors have written more wisely on this issue.