1. The more well-known human rights, like the freedom of speech or the freedom of assembly protect individuals from assault by the state. Economic, social and cultural rights (ESCR), on the other hand, define a claim to entitlements such as food, health, water, education, housing and other.
2. The rights set-out in the United Nations (UN) Covenant on ESCR require, among other, the ‘state’ (in general) to perform certain functions and to provide certain services. It is thus much more difficult to pinpoint exactly who within the state is responsible when such rights are not being met. UN bodies are presently working on getting a better grip on such issues.
3. Governments which discriminate in the provision of health care –or even use it to apply political pressures– are guilty of violating the human rights (HR) they have signed-on-to. Furthermore, it has been clearly established that states have a duty to protect their citizens from, for instance, health hazards.
4. Therefore, to comply with their solemnly acquired obligation to progressively realize all HR, governments have to:
• take concrete, direct actions towards respecting, protecting and fulfilling these rights –indeed including ESCR,
• use available resources on an appropriate scale to implement the actions above (distinguishing inability from unwillingness to use these resources is key),
• implement the respective HR provisions at the various branches of government (executive, legislative, judiciary and administrative), as well as centrally and locally, and
• establish effective and credible mechanisms for monitoring progress.
But the question is: Have they really?
5. Under the influence of donor governments, poor countries have, instead, for long now, promoted a welfare-state-type-social-safety-nets-model that has only served (if at all) the middle-lower class –too often at the expense of further marginalizing the already most disadvantaged. Among other, this has clearly detracted from focusing the public debate on the actual rights of many under-represented (and under-empowered) groups of people.
6. We thus need to explode the myth that the promotion of safety-nets using overseas development assistance funds can bring about a huge leap forward in HR terms in poor countries (remember the failed ‘Structural-Adjustment-With-A-Human-Face’ pushed by UNICEF a couple decades ago?).
7. At present, development aid is hardly the vehicle capable of helping to overcome the structural barriers behind HR violations. This, even if much more cash is made available –as the infamous Jeffrey Sachs/WHO ‘Macroeconomics and Health Report’ called for a couple years ago. The same was an example of how the public health institutions of the rich countries, on whose expertise the international funding agencies draw-upon, are set to reshaping national health debates and strategies all over the world to suit their vision of the global order in health –an order that matches their vision of the global economic order.
8. The needed leap-forward in the public debate and in the ensuing actual implementation of the legally-based-UN-HR-framework depends crucially on more aggressively pursuing human-rights-capacity-building. This HR Reader promotes an international dialogue (…or a monologue…?) that seeks just that …but this is just a drop in the ocean.
9. In the absence of an open public debate, an under- and mis-informed public can hardly participate in any critical public HR debate. An educated general public is thus a prerequisite for any meaningful debate on the HR-based framework; only then can claim holders act as such and influence duty bearers by bringing pressure on them.
10. Adopting the HR-based framework should be an outcome of social learning that is rooted in the experiences of the so many injustices that people know intimately. In practice, this means that the HR-based framework has to make ultimate sense to the grievances perceived by the majority of the people. (Shula Koenig)
11. The question, of course, is why has this public debate been so overdue? Evidently, our priorities must be somehow wrong…
Claudio Schuftan, Ho Chi Minh City
cschuftan@phmovement.org