Health for all: a pro-poor human rights approach
In recent years there has been growing global awareness of the interplay between rights and the development process and a generalised recognition of social determinants of health as a point of entry to re-connect poverty, equality and health.
Yet, for millions of people throughout the world, the full enjoyment of the right to health still remains a distant goal. Poverty remains one of the driving forces behind ill health, a lack of access to healthcare and medicines and consistent underdevelopment.
The World Development Indicators show that 700 million fewer people lived in conditions of extreme poverty in 2010 than in 1990 and that extreme poverty rates have also fallen across developing regions. However, the Global South is still struggling. Every day thousands of children, women and men die silently from easily preventable diseases associated with poverty – starvation, diarrhoea, malaria, tuberculosis, HIV and death in childbirth.
The United Nations acknowledges these issues as it continues to produce a stream of further guidance in the form of General Comments, such as the General Comment 14, while sponsoring global Declarations and Commissions on Social Determinants of Health. Human Rights Day observed by the international community on 10 December since 1950 acts as a reminder of the importance of recognition and advancement of rights and the human right to health. But the current high-level focus on health by the international community while recognising the strong relationship between poverty and health, in practice, has been quite conservative in turning the rhetoric into practice.
Translating normative principles into politics of compliance and practices for policy implementation remains uneven across the wide spectrum of human rights issues, acknowledging and thus affecting bearers of rights in different ways. As argued by William Easterly (2009) ‘which rights to health are realised is a political battle’ contingent on a political and economic reality that profits on the margins of (poor) health.
For instance, diseases like HIV, malaria and tuberculosis account for over 90 per cent of the global disease burden, while the other more ‘neglected diseases’ like dengue, leishmaniasis, Chagas and more recently Chikungunya in South America also add to the increasing toll of human life. Yet HIV/Aids accounted for 57 per cent of World Bank projects on communicable diseases from 1997 to 2006, compared with 3 per cent for malaria and 2 per cent for TB. Other big killers of the poor – such as pneumonia, measles and diarrheal diseases, which together accounted for more than 5 million deaths in 2008 – also received little attention.
Similarly, think of a funder – whether the Gates Foundation, Welcome Trust, private charity or government programme – their agenda may well spend a great deal of resources (financial and human) on dealing with one disease. Or programmes, such as those advanced by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund, or the Gates Foundation to eradicate polio and malaria, despite having the best intentions, they may be guided by their own (world) views, agendas and objectives. It is then not naïve to argue, as some some human rights and health activists have flagged up, that there are serious risks discussing equity from a perspective of ‘targeting’, either diseases or populations, when actions targeted to the poorest of the poor ignore the social factors that cause poverty and exclusion.
In other words, according to Armando De Negri Filho’s (2013; A human rights approach to quality of life and health: Applications to public health programming), tackling equity through social policies risks discriminating positively, normalising and even reproducing inequities.
Specific disease protection and prevention mechanisms are systemically developing, with advances made in reducing rates of HIV, malaria and tuberculosis. Despite these efforts, the Ebola outbreak in West Africa has provided evidence of how poverty, marginalisation and health are closely associated. It has undoubtedly presented a case for the global health community to refocus global anti-poverty efforts, ensuring systematic attention to social disadvantage, vulnerability and discrimination.
Current efforts to reduce the effects of poverty on health are limited. Limitations on resources, funding and capacity constrain attempts to address socio-economic imbalances, hindering access to healthcare and medicines. Perhaps also limited in the way global health issues, and global health diplomacy, are framed. Limitations to provision of healthcare and poverty reduction are further constrained by political and economic environments. There is thus much work to be done in clarifying the allocation of the (international) duties in relation to the right to health, bringing the international community, including wealthy countries, and drug companies, to accept and act upon them.
In this task, regional organisations can be key engines in the development of progressive social policies and advocacy of rights and the right to health. For example, the Economic Community of West African States has established a regional court of justice adjudicating on national labour rights, while the Union of South American Nations (UNASUR) is now driving initiatives to expand entitlements to health care and social security; it is shaping policies around disability all over the world.
While globally the Social Protection Floor Initiative (SPF) adopted in 2009 is a fundamental tool to provide universal health-care, and guarantee services and transfers paying particular attention to vulnerable groups, comprehensive regional social funds and regional social rights can mainstream and support national Social Protection Floor strategies.
Regional organisations that were built for other reasons are now becoming much more important for health and will be particularly important if we look at the Post-2015 Agenda. They have a key role to play because they are close to their populations and have the power and skills to develop efficient public health policies that may help to reduce health disparities by changing the distribution of the social determinants of health. Regional cooperation, unlike disease-led interventions, is about giving technical cooperation, building infrastructure and strengthening capacity. The current health challenges related to the Ebola Virus Disease in West Africa could have been different had there been robust and more efficient collaborative tools such as effective early warning systems shared between the member states of the region.
The realisation of people’s rights, entitlements, and obligations, is largely determined by the nature of the state, and its capacity to respond to internal public demands, interests, and pressures of a globalised world. But regional organisations also play a role in this regard, as they have the capacity to effectuate change through regional social policy, and become pivotal actors in contending (global) politics by means of providing a complementary normative framework and rescaling practices in support of rights-based approaches to health and social development.
Renewed focus on pro-poor access to healthcare and medicines and sustained poverty reduction efforts will ensure that health, as a basic human right, will remain a priority for the development community, ensuring a better quality of life for those in need. Only then can we genuinely discuss Sustainable Development Goals.