1. The currently prevailing public health paradigm is suffering from myopia. It mostly embarks in analyzing what really are only the symptoms of the present public health crisis (i.e., non-performing vertical programs and top-down goals setting); it holds these symptoms of the crisis under a magnifying glass. Therefore, in its pursuit of specific solutions, the overall picture of health-as-a-human-right is lost (‘looking constantly through a lens makes one short-sighted’…if you were not short-sighted t begin with…).
2. Moreover, under the same optic, malnutrition is more often than not seen as a problem of micro-nutrients (iron, iodine, zinc, vitamin A) with the causes of drastic declines in food security and even of starvation taken as given and not being considered to be flagrant human rights (HR) violations.
3. We are further told that the resurgence of malaria is a matter of concern requiring new anti-malarials. Yet the phenomenon of annual migration of part of the poor population in many malaria-ridden countries –in search of a livelihood and thus changing their exposure to the parasite– is rarely discussed. Or, occupational hazards in the informal sector of the economy are only dimly perceived despite evidence of a deterioration in the already bad working conditions in this large sector of the economy that is growing as the world ‘globalizes’ and offers its cheap labor to transnationals so as to become ‘competitive’ in the global market.
4. As a corollary, the diagnostic approach that contemporary public health only succinctly glosses-over (considering it as being neither ‘practical’ nor ‘respectable’) is the search for the real-structural-causes behind the symptoms of the public health AND health-as-a-human-rights crisis.
5. Conversely, the HR-based framework not only entails a more systematic and detailed analysis of the proximate causes (not just glossing-over them), but also entails linking them with underlying, deeper social and economic processes, ergo the much talked-about social determinants of health. This brand of HR-sensitive public health offers concrete technical options to tackle some of the existing public health problems, but also holds up a mirror to society allowing society to understand that these problems are not accidental, but arise as a foreseeable and systematic consequence of the deliberate social and economic choices being made –which benefit a few and marginalize the many.
6. Just as good epidemiology accurately predicts the trends in the development of a disease (given specific initial conditions), good HR-sensitive public health focuses on alerting society to the consequences of specific social and economic policy choices being made (by commission or by omission), i.e., it also focuses on what is known as health impact assessment or analysis.
7. These consequences need to be assessed against the larger scale HR violations at country level and thus against the undue suffering they cause; they should not be assessed against promises, e.g., of a better access to global markets and a raised per-capita GDP with an expected though never-to-come trickle-down.
8. Only a HR-sensitive public health will help society quantify the human costs of the particular model of development it has adopted and to arrive at the right decisions on how to change the failing model and its misguided policies. [Remember: When there is political will, there is a policy way… (S. Ostry)].
9. …If you thought all of this is new, just read this:
“Palliatives will no longer do. If we want to take remedial action, we must be radical. Palliatives in such cases are more costly than radical action …” Rudolf Virchow, Report on the Typhus Epidemic in Upper Silesia, 1848.
10. [Note: The model here criticized also ignores undeniable realities of the under-funding of health care services in the public sector that are being cleverly turned into a mantra through which the proponents and supporters of the model attack public funding for health care. In this process, the real achievements of the public sector in delivering low cost, effective curative and above-all preventive health care services are swept under a propaganda carpet. No wonder, then, that primary health care is becoming a fee collection-driven exercise, and that user fees charged in public hospitals are being couched in the usual sugar-coating parlance of fees being introduced ‘for-those-who-can-pay’. This all, while the global experiences about user fees show that they serve only one purpose: to drive out the poor and the indigent].
Claudio Schuftan, Ho Chi Minh City
schuftan@gmail.com