16. As rights activists, we are no longer going to go to beg for changes to be implemented; we are now going to demand them based on existing international law already in force in most of the countries where we work. Disseminating this concept is in itself empowering. Note that people in countries that have not ratified these covenants do have the same rights; their problem is that their governments have not made a commitment to honour them.
17. Health activists need to seek to overcome the culture of silence and apathy about the HR violations in health we all know are happening. This, because HR and the RTH will never be given to poor, marginalised, discriminated and indigenous persons. Repeat: rights are never given, they have to be fought for!
18. As regards the added value of adopting a HR-based framework, several advantages come to mind:
a) A RTH Campaign has a big social mobilisation potential –and this is an indispensable part of any campaign, b) as said, the HR framework is backed by international law, c) it demands –from a position of strength– that decision-makers take responsibility, d) HR imply correlative duties that are universal and indivisible (there is no such a thing as ‘basic rights’), and e) the HR framework is focused on processes that lead to outcomes (just setting goals, like the MDGs, is thus not sufficient in the HR-based framework).
What may be realistically achieved through the proposed process?
19. It is wrong have the illusion that systematically raising the issue of the ‘Right to Health’ will by itself lead to an actual complete implementation of this right in countries across the globe. The universal provision of even basic health care services involves major budgetary, operational and systemic changes. In addition to shifting to a rights-based framework, major political and legal reorientations are thus needed –and such major changes cannot be expected to happen in full in the near future, given the political economy of health care in most countries of the world today.
20. However, we can work on a number of more achievable objectives that can take us towards the larger Human Rights goal. Some of these ‘achievables’ to be considered are: a) the explicit recognition of the Right to Health Care at country level, b) the formation, in some countries, of health rights monitoring bodies (accountability agents) with civil society participation, c) a clearer delineation of health rights being quite systematically violated at both global and at country level, d) the shifting of the focus of WHO towards health rights/universal access systems and the strengthening of groups within WHO that will work along these lines and along the lines of more proactively tackling of the social determinants of health, e) the bringing of the Right to Health Care more into the global agenda thus making it a central reference point in the global health discourse, and f), the strengthening of the HR activists’ network in as many countries as possible so that all its members work around a common and broad rallying point, along with building partnerships with other networks.
21. Nearly 150 countries around the world are parties to the International Covenant on Economic, Social and Cultural Rights. General Comment 14 (GC 14) of the Committee on Economic, Social and Cultural Rights (CESCR) adopted in the year 2000 elaborates-on and clarifies the Right to Health by defining the content, the methods of operationalization, the violations and the suggested means to monitor the implementation of this right. There is now a need to launch a global process of mobilisation to actually implement the provisions of GC 14 in all ratifying countries. This clearly calls for measures to operationalize the RTH and to review and recast all global and national health sector reform initiatives in the light of the framework of health as a right (such as, for instance, recasting the reforms that are now being pursued to achieve the Millennium Development Goals!).
22. There are a host of reasons to adopt the Right to Health framework. Among them is the fact that the Basic Human Needs Approach (has) never delivered. Other, as valid, justifications are: a) the Human Rights-based framework is the new UN policy, b) it is founded on the principles of an equitable access to health care services at all levels with no discrimination, and c) at this moment in time, there is growing recognition of the need for a global initiative to address health system issues in a rights-based framework.
23. There is also a growing worldwide need for solidarity in and mutual learning from our struggles, so as to strengthen our efforts in the various countries and regions. There is a related need to challenge the dominant global discourse of ‘safety nets for those left outside the existing packages of benefits’ that results from health services being increasingly commodified and from governments retreating from funding the provision of universal health care, limiting their role to supporting said ‘safety nets’ or other kinds of reduced public ‘health services for the poor’. We need to counter this with a strong ‘Health care as a human right’ strategy that unequivocally asserts the central role of the state and public health systems –and their responsibility to provide health services for all.
Claudio Schuftan, Laura Turiano and Abhay Shukla, People’s Health Movement, Right to Health Campaign (see www.phmovement.org ).