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writing for godot


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Sunday, 23 December 2018 14:07


1. The majority of the population supporting a change towards single-payer (tax financed) reform in health, cannot by itself overcome the power and financial resources of the opposition. Why? Consider the following: Political power emanates from two poles, ‘constituted power’ (the established power of the state) and ‘constituent power’ (popular power from below). Though constituent power plays a critical role in the making of political change, historically, it has become marginalized by victorious, newly constituted power.* Constituent power must be embraced instead of sidelined. A shift towards constituent power thus needs much greater emphasis. For instance, when a health system becomes a private monopoly, community accountability usually gets outmaneuvered by the profit motive proponents. Reinvigorating constituent power in health care starting from local organizations upwards must thus become an important goal in the road ahead. (Adam Gaffney, Howard Waitzkin)

*: Yes, this power should not be underestimated. But neither should ours! So, let us choose to win. (We do have power, but it is still embrionary).


Rampant conflicts of interest in the area of health must be properly regarded as population health hazards (Daniel Goldberg)


The problem with GAVI and SUN (that are de-facto PPPs) is that they were created top-down and are now posturing as ‘civil society’.  This is a key issue to be highlighted and denounced since these are not genuine civil societies, but public-private hybrids. (Judith Richter)


2. Public health professionals can and must respond to the conflict-ridden manifestations of corporate power in the health and nutrition domains. In the struggle for the right to health, tackling corporate power (Big Pharma, Big Food, Big Soda) must be made a public health priority.


3. But I am not naïf about the prospects. Yet health and nutrition professionals are not impotent --do not let anyone tell you otherwise! They can question corporations (or philanthropies) influencing or holding seats in health policy making bodies such as WHO and its regional offices or, in the case of food, in the Codex Alimentarius Commission,** as well as many other bodies.

**: The Codex Alimentarius Commission was established in 1961 by FAO and was joined by WHO in 1962. The Commission's main goals are to protect the health of consumers and ensure fair practices in the international food trade. The private commercial sector participates prominently under the guise of being ‘non-governmental organizations’…(!)


4. Health and nutrition professionals can further directly support communities that have stood up to corporations and align themselves with other social movements --and now with the UN Human Rights Council-- active in, once-and-for-all, holding corporations accountable.

Two possible styles of dealing with the issue of the right to health


[The following is a constructive critique I received from Dr Abhay Shukla in India regarding the contents and the tone of the Human Rights Readers on issues of the right to health. The text is verbatim.]


5. As a general comment on your approach to the right to health (RTH) in the Readers, I would contrast two possible styles of dealing with the issue of health rights:

(a) Taking the human rights (HR) approach as the starting point, deducing one's arguments mainly from the HR framework, using this as the principal justification for action, and appealing for an active use of this framework as the main form of action (moving mostly within the HR framework). Several of the Readers fall in this category despite referring to a political perspective, but in a more abstract manner.

(b) Taking people's experience of real life deprivation of basic health care and unhealthy living conditions as the starting point. In other words, taking the massive and avoidable suffering, inequalities*** and 'unjust' social situations as a major justification for change so that arguments for change are developed coming from the people's aspirations for a qualitatively better life, including better health as a key social aspiration. This means drawing upon the HR framework as one important justification and anchoring point, but not the only one for social action. It also means discussing a variety of small and large social actions and struggles that are actually already taking place on the ground --with or without using HR language-- as an exercise to provide new hope and direction. The use of the HR framework as one of the tools for further struggle can sharpen and politicize existing efforts, along with various other forms of mobilization (as said, starting from real life experiences and moving to various strategies for change, including the use of HR, thus ending up with suggestions for realistic forms of struggle on the ground).

***: While there have been improvements in important health and social indicators, what has not improved is the equity and equality.  While averages improve a great many divides are getting bigger. (Solly Benatar)

6. The above may sound like an oversimplification and perhaps 'stereotyping' the situation, but the HR Readers seem to me to fall more in category (a) than (b) and seem to rely very heavily, almost exclusively on the HR framework, rather than referring to it as one useful tool in a broader range of strategies and forms of struggle. Also, there seems to be a major emphasis on international HR covenants and instruments which are of rather limited use in the actual struggles of grassroots activists, even though they have some place (based on our experience in India, I would argue rather peripheral and limited) in a local-to-national spectrum of strategies.


7. Furthermore, there is usually a lack of reference in the Readers to actual struggles, movements, initiatives, which make them sound rather delinked from ground realities. Hence several of the Readers read like 'moral' arguments, expressing distress at violations of HR in a generic way, indirectly placing excessive and undue expectation that such a (mostly international, universal) framework would, in and of itself, in a major way fulfill and promote people's access to healthy lives and health care --a fact that often is at great distance from the real ground situation. As a matter of fact, people usually struggle without explicit knowledge of the 'human rights framework’ as such; instead they protest against perceived injustice, exploitation and deprivation, and may use HR language as part of a wider repertory of struggles and strategies. Our task as activists is to support such struggles, and help sharpen them with various tools that include, but are not limited to, the HR framework.

8. Keeping this in mind, I would strongly suggest that the Readers carefully look at how actual struggles on health rights have developed in various countries and places, how the HR framework has or has not been used, what broader perspectives and strategies have been used in social struggles, and then revisit what the HR framework has to offer in this larger scenario. This neither means abandoning the HR framework, nor being completely bent towards it, but rather having a sense of its appropriate use as one tool in a wider spectrum of struggles in social movements.

9. These comments are not a 'critique' of the Readers that do have useful insights. It is just that I feel they need to move a bit beyond 'moving within the HR framework' and then critically look at it and use it in a significantly broader socio-political context. I repeat, HR can be one useful tool in a spectrum of strategies. However excessive reliance on it, as the principal perspective and justification, ‘overshadowing political analysis and in-depth understanding of social situations and actual struggles’ on the ground, may constrain our vision.


Claudio Schuftan, Ho Chi Minh City

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