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 connecting 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 is still one of the driving forces behind ill health, a lack of access to healthcare and medicines and consistent underdevelopment. According to the World Bank, 700m fewer people across developing regions lived in conditions of extreme poverty in 2010 than in 1990. Yet every day thousands of children, women and men die silently from preventable diseases associated with poverty.
The United Nations acknowledges these issues and streamlines guidance on the subject alongside the Universal Declaration of Human Rights, supporting the actions of member states and multilateral development agencies. In 2000, the UN Committee on Economic, Social and Cultural Rights issued legal guidance on implementing the right to health through its General Comment 14 document. It also sponsors global declarations and commissions on the social determinants of health. And since 1950, the annual human rights day on December 10th has acted as a reminder for recognition and advancement of rights and the human right to health.
Turning rhetoric into practice
Despite this high-level focus on health by the international community and recognition of the strong relationship between poverty and illness, turning rhetoric into practice is a problem.
International frameworks provide valuable and concrete guidance for action. However, in practice, implementing policies remains uneven across the wide spectrum of human rights issues.
The political game
For William Easterly, professor of economics at New York University, “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.
He is right, we can’t downplay politics. Think of a funder – whether the Gates Foundation, the Wellcome Trust, a private charity or government programme – their agenda may well see them spend a great deal of resources (financial and human) on dealing with one disease overlooking wider problems or the causes behind it. Or programmes advanced by the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund – despite having the best intentions, they may be guided by their own views, agendas and objectives.
Undoubtedly, conditions such as HIV, malaria and tuberculosis account for more than 90% of the global disease burden, yet the millions of dollars poured into programmes to tackle these diseases have done little to tackle weak healthcare systems which are in many cases unreachable or distrusted by the people they are designed to help.
Equally critical to people’s right is that diseases such as HIV/AIDS, tuberculosis and malaria tend to receive a disproportionate share of attention and resources compared to other diseases such as chagas, dengue and Chikungunya. The latter while adding to the toll of human life and highly linked to poverty and marginalised societies remain at the margins of global health governance as they don’t lead to global epidemiological emergencies.
The risk is that what is visible and urgent takes precedence over the marginal and actions targeted at the poor. This ignores the social factors that cause poverty and exclusion, discriminates positively against them and normalises, even reproducing inequities. The Ebola outbreak in West Africa is a reminder of these risks.
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. Philanthropists in rich countries and the global aid community more generally, can support national strategies and bring them into mainstream. But we believe there is a role to pay by the neglected partners in development: regional organisations.
Regional organisations can be key engines in the development of progressive social policies and advocacy of rights. For example, the Economic Community of West African States (ECOWAS) 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 healthcare and social security within member states. It is also shaping policies around disability all over the world by speaking in one voice at the World Health Organisation. This makes sense because some social harms and epidemics are inherently cross-border, and are exacerbated or facilitated by regional developments.
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 Sustainable Development Goals, recently launched by the UN to carry on the work of the 2015 Millennium Development Goals initiative.
Organisations such as UNASUR and ECOWAS can provide donors and partners with a single point of contact for discussions and the implementation of poverty reduction programmes in their countries. They are close to their populations and can develop technical co-operation, build infrastructure and strengthen capacity between the member states, rescaling practices to reduce socio-economic disparities.
Renewed focus on health, as a basic human right, is a poverty issue. It demands thinking about the deep determinants of (under)development and social exclusion and national, regional and global commitments to enhance access to health services, medicines, and opportunities. Neglecting this will be a tragedy of aid assistance and possibly of the sustainable development goals.