Thursday, 31 October 2013

Who care about human rights anyway? Richard Horton's offline column.

Original link here.

The Lancet
Volume 382, Issue 9902, 26 October–1 November 2013, Pages 1390

Offline: Who cares about human rights anyway?

Sridhar Venkatapuram surprised, even shocked, his audience at this month's Global Health Lab, hosted by the London School of Hygiene and Tropical Medicine and The Lancet. The question he was asked seemed straightforward enough: what is the contribution of human rights to global health? To many engaged in global health, the right to the highest attainable standard of health is a sacred principle. But Sridhar, a lecturer in global health at King's College London, argued that human rights have very little to do with global health today. Human rights might be talked about, often with great rhetorical energy, but few in global health seriously believe in, let alone understand, what human rights mean. The problem lies with those who lead global health: “I have given up on this particular generation running global health.” The only coherent rights global health leaders truly believe in are civil and political rights. All other rights, including the right to health, are seen as “unAmerican” and “bad philosophy”. Sridhar looked to Isaiah Berlin's two concepts of liberty to understand why this is so. Berlin distinguished between negative and positive liberties. Negative liberty means freedom from interference. Positive liberty suggests mastery over one's environment. Good government, so those running global health today argue, is about leaving people alone. Human rights should be about protecting negative freedoms. They should be about defending us from interference. Right? Wrong. We need new leadership in global health, leadership that is willing to defend positive liberties. The right to health is a positive liberty. It means working to ensure people are given the possibility of leading flourishing lives. A generational change is coming.
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Gorik Ooms, a human rights lawyer based at the Institute of Tropical Medicine in Antwerp, drew a different distinction. He noted that rights-based advocacy had been a powerful means to secure access to financing for AIDS through the Global Fund and PEPFAR. But why have rights-based arguments not succeeded in winning wider provision for other aspects of global health, such as emergency obstetric care? Partly because the maternal health community is divided as to the best approach to take (facility-based deliveries or community platforms for care?). The result is that the maternal health community, despite adoption of rights-based arguments, seems unable to make a clear or specific demand. They are unable to show that intervening to save the lives of pregnant women is a global public good. And, of course, maternal health has no Global Fund. So although human rights arguments might be important, they are not sufficient to trigger political change. The lessons for universal health coverage (UHC) are clear. UHC certainly should use rights-based advocacy. It has a specific demand and it is manifestly a global public good. But there is no equivalent of a Global Fund. Without a financing mechanism, can universal health coverage succeed?
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“Human rights do exist!”, proclaimed John Tasioulas, Quain Professor of Jurisprudence at University College London. Indeed, they have “profound implications” for global health. But something is wrong with the way we use human rights arguments in health. Is it correct to say that human rights should be the predominant basis for global health advocacy and policy making? And if rights arguments are used, is the right to health really the most important right we should be considering? The answer to both questions is no. There is much more to global health than human rights. Other rights beyond health matter as much, if not more, than health. Health is only one aspect of what we might call a “good life”. Consider this: imagine the right to health was fully satisfied. Would the world's health problems disappear? Of course not. So why are human rights important? Not because they are the predominant means to improved health and wellbeing, but because they bring a moral dimension to our discussions about the suffering of others and because of the duties they impose on each of us. In sum, what is the contribution of human rights to global health? This perhaps. Human rights arguments have important work to do in global health. But we are still only beginning to discover what that work is. There was one more lesson from this Global Health Lab. We should embrace our philosophers. Philosophers may not have perfect answers, but they ask more precise and disturbing questions than many of us are prepared (or feel comfortable) to ask.
With thanks to Martin McKee, Erika Richardson, and Bayard Roberts.
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