[P2P-F] Fwd: Right to health: Food for a de-commodification thought

[Michel Bauwens]

---------- Forwarded message ----------
From: Claudio Schuftan <cschuftan at phmovement.org>
Date: Mon, Jul 4, 2016 at 5:16 PM
Subject: Right to health: Food for a de-commodification thought
To: michel at p2pfoundation.net


Right to health: Food for a de-commodification thought Human Rights Reader
390 OUR STRUGGLE IS NOT FOR GLOBAL HEALTH JUSTICE; IT IS FOR GLOBAL HEALT

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Right to health: Food for a de-commodification thought

Human Rights Reader 390

*OUR STRUGGLE IS NOT FOR GLOBAL HEALTH JUSTICE; IT IS FOR GLOBAL HEALTH AND
JUSTICE, AS WELL AS FOR GOLBAL HEALTH WITH JUSTICE.* (Lawrence Gostin)
1. The reason why global health policy-makers are not implementing the
knowledge generated by global health scholars with the right empirical,
every-day experience, is not because they use different normative
standards; it is because, *when selecting priorities, too many
policy-makers are politically constrained by the interests and the power
structures in their environment.* The conflict is not a difference in
normative opinion, but rather a political issue. (C. Askheim)

2. Alex Scott-Samuel speaks of ‘fantasy paradigms leading to health
inequalities’ or, as he says, of utopian health thinking’. He argues that
in this world fantasy its proponents describe how *global policy officials
tend to write and speak within a parallel world in which the political
economy of the global economic crisis and the brutality of imperial
geopolitics do not exist* and add that global health policies must simply
comprise cost-effective interventions, political promises and philanthropic
largesse.

*Choices on offer in health care attract consumerist sympathy*


3. Fact:



**The appropriation of health care by business is being legitimized by
policy makers** --and, with that, goes the loss of the ideas of citizenship
and solidarity implicit and explicit in social rights. So strong has the
pressure to extend capitalist appropriation in the profitable domain of
health care been that not even ideological consistency has been respected:
Actually, neoliberal principles such as efficiency have themselves been
ignored. In poor countries, excessive emphasis on cost-effectiveness has
brought health care systems not only not to focus on the most vulnerable,
but also to be run in an economically unsustainable way. **Since the middle
and upper classes are more likely to have their voices heard, their more
exclusive and expensive health care needs are prioritized to the detriment
of the vast majority of the people rendered poor.** What social rights
primarily demand is the de-commodification of key areas such as the
provision of health care, education and other essential social services.
(Eduardo Arenas) 4. As regards the effects of privatization on research,
note that influential randomized trials are largely done by and for the
benefit of industry. Moreover, fashionable meta-analyses supposedly leading
to guidelines have become a factory also often serving vested interests.
**National and international research funds are funneled almost exclusively
to research with little relevance to global health outcomes.** Bottom line
here, under market pressure, clinical medicine has been transformed to
finance-based medicine. (John Ioannidis) 5. **We thus need a whole new wave
and breed of public interest civil society health activism** to address
what has been called the "GLP" virus (standing for Globalization,
Liberalization and Privatization) that is causing a monumental global
health divide that has become shocking if not criminal. (Anwar Fazal)

*Our human rights struggle in health focuses on addressing the eminently
social function of health and nutrition* (Malik Ozden, CETIM)


6. Let me start with a **caveat: It is not an innocent stands when
colleagues and whole health systems attempt to reduce the right to health
to the-right-to-receive-medical-care.**(i) For the right to health to
become a reality, policies of all sectors must fall into place. Further
(and much) more, the fulfillment of the right to health requires the social
mobilization of claim holders to grow steadfastly --to demand the needed
changes. (Julio Monsalvo)

(i): This is typical for countries that, despite high levels of economic
growth and of consumption, have not implemented the needed institutional
reforms that guarantee homogeneous progress by deliberately giving priority
to measures in the realm of social and human development. Yes, *inequality
is unfair and cruel, as well as unacceptable in a society striving to be
called ‘developed’*. (Foro Salud Peru)

7. Why the caveat? Because *the right to health simply has to guarantee:*
• universal and comprehensive health care that includes claim holders’
active participation;
• an increase in the public expenditures on health with priority given to
address the needs of the neediest;
• universal access to generic medicines and essential medical equipment
including sovereign pharmaceutical policies;
• a rejection of the signing and ratification of undemocratic and unfair
trade agreements;
• quality health care and dignified treatment;
• a closing of the gap in essential health personnel and their needs;
• addressing the social determinants of health and pursuing active health
promotion activities and, last but not least,
• addressing the special needs of women, gender issues and all issues of
sexual and reproductive health. (Foro Salud, Peru)
I ask: *How can all this possibly be achieved using a top-down approach?*

8. For our colleagues in El Salvador, *the right to health tasks at hand
further include:*
• The immediate abolition of all payments in the public health system
allowing an increase in the access to health according to need all the way
to the tertiary level.
• Passing legislation that regulates the prices of medicines nationwide.
• Giving a decisive push to citizens’ participation in the planning and
monitoring of health policies from the primary to the tertiary level.(ii)
• Setting up immediate and ongoing evaluation mechanisms of the delivery of
patient-friendly, non-discriminatory health services.(ii)
• Giving No.1 priority to comprehensive primary health care with ad-hoc
health care teams assigned to specific geographic areas.
• Organizing and coordinating the sector’s claim holders to coalesce into
public interest civil society pressure groups.
(ii): But the health indicators currently in use are ambivalent; some
advance slowly (…and more for some in society) while other stay put or
deteriorate. *The time for less-than-useful statistics to yield to
right-to-health-sensitive data has come*; reality and truth must impose
themselves on the data being/to be collected so that social and health
policies start addressing real human and citizens’ needs. (Foro Salud Peru)

9. Given the above, *organized claim holders, therefore, must:*
• *Urgently organize and mobilize* to repeal irresponsible public policies
that highlight economic growth, but hide stagnating poverty indexes.
[Perpetuating the use of national averages in health statistics is an
example of how this hiding operates].
• *Use all their energies* to negotiate/demand the needed political
changes/compromises based on pragmatic and legally-binding measures that
will fulfill the right to health for all. [The dialogues with government
and with public opinion leaders (duty bearers), as well as the claimants’
presence in the public debate through the media must be matched by their
organizations’ capacity to monitor health policies (their application) and
health statistics (their use) in all health services].
• *Work within a political framework* that actively pursues the right to
health and that deepens all people’s participation making sure they achieve
not only voice, but influence as the only way to guarantee needed changes
are eventually made. [An effective popular participation is the key element
that gives legitimacy to the claim holders’ human rights (HR) protection
struggle and gives legitimacy to their fight against the stigma, the
discrimination and the exclusion that affects so many in their quest for
quality health care].
• *Demand* that health interventions apply HR principles and standards
respecting all international HR covenants and conventions.
• *Consolidate* an active and wide social and political movement that will
address the social determinants of health face-on. [The commoditization and
the medicalization of health are just two examples of important
determinants of people’s health that need to be tackled].
• *Involve* the above movement much more with the struggle for a cleaner
and cooler environment.
• *Lobby* for the curricula of health professionals to be amended so as to
revert the current model being taught centered around treating diseases and
increasing the productivity of the health work force. [Breaking with the
biomedical model is urgent since it leads individuals and society to
situations detrimental to health].
• *Become part of the struggle* for fairer remuneration of the health
workforce, and
• *Denounce*, amend and/or revert all the current measures that affect HR
and people’s liberties. [An example is all current and in-negotiation free
trade agreements]. (Foro Salud, Peru)

*In the Universal Health Coverage era: Is health equality a sibling of the
right to health?*


10. **If and where universal health care (UHC) is implemented in line with
the recommendations of WHO, it is said it can come close to being anchored
in the right to health. But is it?** Let us see:

• *First*, UHC anchored in the right to health requires that
cost–effectiveness criteria are used with much more care to avoid
justifying UHC when it is not complying with the minimum principles and
standards demanded by the right to health.
• *Second*, identifying and overcoming the multiple barriers stemming from
socioeconomic exclusion and/or discrimination is certainly vital to
advancing UHC --but it is not sufficient in itself. Efforts are required to
identify the specific groups that are vulnerable or marginalized in a given
country and region(s) to make sure they are included in all UHC plans so as
to ensure that health coverage is truly universal.
• *Third*, comparing UHC and right to health norms highlights the
difference between a UHC anchored in the right to health and UHC not
explicitly anchored in the right to health. (Ooms)

*The right to health demands a set of core obligations that apply to all
countries, regardless of their wealth*


11.

**The right to health guarantees a minimum level of health care --anywhere.
In that sense, UHC cannot have any kind of ‘floor’**. If the economic
context of a given country leads to a level of health care that does not
even address standard health threats of the most vulnerable, how can UHC,
**as currently proposed**, tolerate that? Beware: Such a **UHC does not
guarantee a commensurate level of core health care entitlements to
vulnerable groups as the right to health does.** Furthermore, UHC norms pay
little attention to vulnerable and marginalized groups in terms of their
active participation in decision-making. (Ooms) 12. Bottom line, **if UHC
is not anchored in the right to health it risks not being universal with
respect to providing coverage to all people. It is the focusing on coverage
percentages** not disaggregating data by vulnerable groups what **mask**s
**exclusion**. The complex interplay between social marginalization or
exclusion and economic exclusion can render vulnerable and marginalized
individuals (e.g. the child of an unmarried, undocumented migrant) and
groups invisible to the authorities. Addressing this added dimension of
exclusion is thus a priority if UHC is to be anchored in the right to
health. Procedurally, **UHC anchored in the right to health requires that
authorities engage with those who are excluded and devise policies with
them** to amend the health system accordingly --actually the whole social
system more broadly. Only this will make UHC truly universal. (Gorik Ooms
for WHO)

*Universal Health Coverage, taxes and wages*


13.

**Tax revenue is a major statistical determinant of progress towards UHC**.
Each U$10 per-capita increase in tax revenue is associated with up to an
additional U$1 of public health spending per capita. Whereas each $10
increase in GDP per capita is statistically associated with increases in
the order of U$0.10. Crucially, tax revenues sit on the pathway between
economic growth and health spending. In short, **tax reform is an efficient
way of translating economic growth into greater health spending**. Over
time, taxation within a country is associated with changes in infant
mortality. The results have been crystal clear. Where taxes on goods and
services increase (thereby increasing the cost of food and health care),
infant mortality also increases. However, where taxes on income, profits,
and capital gains increase (progressive taxation), we do not find this same
relationship. Some countries can further increase revenues through reducing
corporate tax evasion. Bottom line here, **taxes are a cornerstone for us
to achieve UHC.** (A. Reeves) 14. The above notwithstanding, defending wage
subsidies to secure a ‘basic income’ is not the solution for UHC; we ought
to think twice before defending this. **Receiving a ‘better’ basic income
to only then have to pay for privatized health services will certainly not
tackle inequalities.** (Francine Mestrum)

Claudio Schuftan, Ho Chi Minh City
cschuftan at phmovement.org

*Postscript/Marginalia*

*Twelve arguments pointing towards why we need to embark on empowering
community capacity building activities in health* (From HR Reader 15)

*I.* The notions of duty and justice (…and not compassion!) give the right
to health its cutting edge.
*II.* Power is a key relation between health and HR issues. A right confers
power, i.e. the power to make key changes as far reaching as the prevailing
health system allows claim holders to demand for. (It is our duty to help
making the latter possible).
*III.* People have full power only when they are able to alter existing
power relations. (It is our duty to help making this possible too).

*IV*. X has to have power over Y to affect results. Power thus needs to be
used to change an existing unfair health system and to turn it to the
people’s advantage. (It is our duty to help this use is made).
*V*. Only exercising power can people freely select among the realistic
available possible solutions (people’s empowerment is thus needed).
*VI*. Active claims are rather useless if there is no power to have duty
bearers enforce their public health duties.
*VII.* A party other than the duty bearers has to have power over the
duties in order to make sure most public health duties are enforced.
*VIII.* Ergo, to enforce a duty, the claim holder needs power over the duty
bearer.
*IX.* It is not good if the claim holders have no power or control over the
enforcement of their health claims.
*X.* Actually, people can only have a true health claim when they also have
the power to claim for it; the power is a necessary ingredient in their
claim; ergo, having a claim necessarily involves having (or acquiring)
power.
*XI.* Claim holders cannot only be passive beneficiaries of the duties of
others.
*XII.* People’s health rights are recognized as long as the claim holders
have power over the duties not being enforced. (Urban Jonsson)
[image: 1px]
©2016 Claudio Schuftan | 121 38 St BTT D2, Saigon, Vietnam
[image: 1px]
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