In last instance, rights practices sow the seeds of a different social order since they hold duty-bearers effectively accountable.
- The struggle to replace ‘clientelism’ with rights is ongoing. (Clientelism is an ‘instrumental friendship’ in which an individual of higher socioeconomic status, –the ‘patron’ (or boss)– uses his own influence and resources to provide protection and benefits for a person of lower status –the client– who reciprocates by offering general support, assistance and personal services to the patron). Clientelism and rights thus exist as polar opposites, because the human rights-based approach (HRBAP) builds accountable, equal-to-equal relationships between citizens as claim-holders and government institutions and officers as duty-bearers.
- This new pattern of relationships highlights the political artistry necessary to advance the new-to-many human rights standards and principles*, because, to be successful, the HRBAP will have to break the monopoly on the legitimacy of power and on the control of resources enjoyed by clientelist ‘patrones’.
*: Standards define the minimum acceptable level of a given right. Principles specify the criteria for an acceptable process to achieve a given right.
- The lesson here is that the politics of human rights (people’s rights) is not for the naïve. Part of it is about forging cross-class alliances to displace traditional elites’ grip on power.
Let us be clear: Policy making is political since it is about power and values; it is not a domain of technical judgment only, especially not in health. The same is true for the science behind policy decisions (and for science in general) since there always is a social and political contextualization of scientific knowledge (biomedical sciences included).
- So, when we talk about governance problems in relation to human rights (HR), let us understand that bad governance is not only about corruption and the rule of law… it is about the politics-and-power-relations-that-underlie. In the same vein, it is not enough to provide a legal base to HR: We have to guarantee that HR principles are applied and complied with.
- I am afraid we have an attitude of complacency in our societies concerning HR-seen-in-the-light-of-the-above. To many, HR violations, including the violations to the right to health, are just a fact of life; few really believe that these violations often actually kill. Let us wake up. The impact of HR violations on poor people is so great and so ‘in-your-face’ that we have chosen to filter it out. Maybe, we act like this out of complacency or out of despair, in light of the economic and financial implications that eradicating these violations has. So, perhaps the first step we take will have to be to eradicate our complacent attitudes. This is key. The question is what will it take to eradicate this attitude? Whatever it takes, we have to overcome this inertia, because it is this attitude that perpetuates the tame and conservative approaches we embark-on (the efforts at health sector reform in the last 15 or more years is a good example). Such approaches are but an attempt to assuage our conscience –so that we can be able to lament when finally forced to admit defeat by saying: “well, well, we tried!” (R. Karanja)
- This is why we are asking HR activists to get rid of this missionary position and not to be politically tone-deaf, but actually to defy political abuse when they see it. They ought to remember the maxim: “You can always be political, and hate party politics”. Under that banner, HR activists ought to function both as the ‘opposing team’ and as referees. Or, as somebody already said, “be with the system during the day and against it at night”. [Yet others have said: HR activists should “comfort the afflicted and afflict the comfortable” (Todd Jailer)].
- HR activists cannot uncritically take the ‘facts’ they are fed as truths; they have to analyze the evidence in-depth and come to their own conclusions. Then, they should spare no effort to work with claim-holder and duty-bearers to demand the needed changes from the latter.
- Moreover, at national level, they ought to apply equal rigor for abuses-of-dominance exerted by companies and corporations (e.g. pharmaceutical houses) than the rigor they apply for abuses-by-the-state.
- Internationally, HR activism is, in part, about putting pressure on countries and agencies that fall short of delivering on their verbal and/or formal commitments on HR. Publishing a list of them is one way of applying pressure, i.e., using the some-times-effective-technique of naming-and-shaming.
Claudio Schuftan, Ho Chi Minh City