Paper: Human rights & health systems development: Confronting the politics… Duncan Maru & Paul Farmer
Human rights and health systems development: Confronting the politics of exclusion and the economics of inequality
AbstractThe social movements of the last two decades have fostered a rights-based approach to health systems development within the global discourse on national and international health governance. In this piece, we discuss ongoing challenges in the cavernous “implementation gap ”— translating legislative victories for human rights into actual practice and delivery. Using accompaniment as an underlying principle, we focus primarily on constructing effective, equitable, and accountable public sector health systems. Public sector health care delivery is challenged by increasingly exclusive politics and inequitable economic policies that severely limit the participatory power of marginalized people. Finally, we discuss the role of implementation science in closing the delivery gap.
Introduction: The right to health
The human rights approach to public health systems development has been a central theme to emerge from the explosive growth in global health awareness and funding in the last two decades.1 The notion that health care systems are both national and international public goods protecting the essential rights of all citizens, while not wholly embraced, has gained traction in global debates about health care financing, governance, and implementation.2 In this piece, we discuss challenges in translating consensus around health as a human right into one particular aspect of the right to health: namely, access to effective health care systems that reach the most vulnerable.
The Universal Declaration of Human Rights was published in 1948,3 marking the start of the modern human rights movement. The poles of civil and political rights versus social and economic rights established during the Cold War era prevailed until the early 1990s, when a relative consensus emerged that the different human rights domains should be integrated. The global movement to combat HIV/AIDS represents the broadest, deepest, most concerted effort to date to forge a link between health and human rights. It is no coincidence that this movement was initiated, expanded, and sustained by individuals from communities bearing the highest burdens of HIV disease. The movement was successful because it was driven and led by individuals directly affected by the epidemic. This movement both globalized public health and connected it to the rights agenda.4
A major challenge in translating the successes of the HIV/AIDS movement into broader health systems change is deepening the involvement of citizens who would be most impacted by such changes—often the most marginalized populations. Wealthier citizens tend to be able to rely on for-profit, privatized health services and therefore have little incentive to partner with poorer citizens to advance public sector health systems change.
Herein lies a paradox in health and human rights. At no time in human history has health as a human right been as prominent in international and national health discourse as it is now. Yet we also face ongoing expansion of the politics of exclusion and the economics of inequality, which pose immense challenges to implementing human rights-based advances. Human rights legislation without effective delivery systems is impotent; effective delivery systems without human rights protections (for example, legislative guarantees) will fail to deliver to the most vulnerable.
For health systems development, why does the rights-based view remain relevant today? While much has changed, the underlying forces driving health inequity remain the same. We believe that effective health care systems must guarantee the right to health for our most vulnerable citizens. While this is a sweeping statement, it is important to differentiate this rights-based approach from other approaches that seek merely to reduce population disease, maximize cost-effectiveness, or facilitate rational private investment in health. Our stance is a fundamentally moral one, rooted in the lived experiences of our patients, but it is also deeply pragmatic. To free the world’s poor from the diseases that continue to stalk them, we must build better public sector systems. more….
About the Publication: Health and Human Rights:
Health and Human Rights began publication in 1994 under the editorship of Jonathan Mann. Paul Farmer, co-founder of Partners In Health, assumed the editorship in 2007. Health and Human Rights is an online, open-access publication.
Health and Human Rights provides an inclusive forum for action-oriented dialogue among human rights practitioners. The journal endeavors to increase access to human rights knowledge in the health field by linking an expanded community of readers and contributors. Following the lead of a growing number of open access publications, the full text of Health and Human Rights is freely available to anyone with internet access.
Health and Human Rights focuses rigorous scholarly analysis on the conceptual foundations and challenges of rights discourse and action in relation to health. The journal is dedicated to empowering new voices from the field — highlighting the innovative work of groups and individuals in direct engagement with human rights struggles as they relate to health. We seek to foster engaged scholarship and reflective activism. In doing so, we invite informed action to realize the full spectrum of human rights. more…
This article is important in its own right. WASHLink believes Hygiene, Sanitation, Water, & Public Health can not, must not, should not be siloed. If we shall build apart we shall fall together, so while not addressed directly, we see there is a underlying appeal in this article for such. We encourage you to read on, and explore the invaluable site it is posted on. We can hope this article and other articles found on the Health and Human Rights site reach the eye of the policy makers and there minions that execute their edicts. While perhaps trite: we all have some responsibility / some role to play in moving this forward.
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