69. Health and Human Rights Readers (contd.)

101. NGOs: A network of protagonists (and denouncers of the slow progress being made) in human rights work?

Food for a thought made more visible

1. Can the NGO Establishment overcome the North-South-divide or is it just reproducing it at civil society level? NGOs have been accused of being paternalistic and not-sufficiently-radical-in-fostering-human-rights (HR). The heavy pressure from donors to produce results and the brevity of Northern NGO projects have pushed them to often become commercialized, delivery of services-oriented and over-extended. The other side of the same coin is that NGOs of the South are downgraded to mere implementers.

2. Is this a consequence of the fact that it is the educated urban middle-class that provides the decisive actors to these civil society organizations? This fact is, of course, of great socio-political significance. It may, in part, explain the international community passiveness on embarking in decisive HR work. One can only wonder, for instance, how many among the NGO staff still see the causes of many a conflict at the religious and ethnic level rather than at the economic and political level.

3. It is thus not surprising that NGOs have implicit and/or explicit socio-political missions - despite them seeming to seek the same (?) improved access to services, the same (?) reductions in poverty, the same (?) empowering of men, women and children, the same (?) building of community solidarity and the same (?) promotion of economic development. Different degrees of success in meeting these goals has to be looked at from different socio-political and HR perspectives...results are not the same across the board...and some are meager (or nil).

4. Be it as it may, a reformed NGO Establishment - functioning with a focus re-missioned around the HR-based-approach - is a potential natural-social-avant-garde-actor-and-strategic-ally in the long struggle for human (people’s) rights and accountable governance.

5. Re-missioned NGOs can increase the proportion of direct democracy being added to the representative-variety-of-democracy which has shown a tendency of increasingly denying citizens their right to decision.

6. From a HR-based perspective, civil society is to be seen as a force able to rekindle long-lost citizen sovereignty (reversing both ‘power-abuse’ and ‘obedience-abuse’ as per M. Foucault). NGOs should thus ideally be the people’s-mouthpiece-between-elections since NGOs have the potential power to make demands (that politicians take heed-of) by directly intervening in the political process.

7. All this calls for consolidating a new legitimacy of NGOs in the political arena (at the same time calling for a new order and for the de-legitimization of an order that violates HR with impunity). But this requires greater visibility; and the majority of NGOs have problems with this. They are poor at, for instance, writing effective press releases and/or fostering media relationships, or doing more visible ethical and political lobbying. Designing effective media campaigns is important, because it helps placing ‘HR-as-news’ in the context of competition with other news (most often of lesser social relevance).

8. NGOs must not passively wait for abused claim-holders’ and non-compliant duty-bearers’ HR-relevant-information to be offered to them; they must take the initiative to investigate, ask questions and insist on answers to pass on to the media. This is a much neglected activity if NGOs honestly strive for direct participation in the political process (challenging policies and administrative bottlenecks); This is thus a call for NGOs to cooperate with the critical investigative media (who rightly start from the assumption that power can-be-and-is abused), and to set out to expose such abuses.

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

Mostly taken from D+C Vol 31, July and Aug/Sept 2004 and Insights 51, Dec 04 (id21, IDS, Sussex).

102. More on Poverty and Human Rights

Food for a principled thought expressed with conviction

Many have the misfortune of being born in a poor country, but not a poor world! (G. Kent)

2. Not only have we witnessed that ‘clever solutions’ have not solved the resilient poverty and HR problems the world over, but they may have further had the unintended (?) consequence of detracting from the less attractive, painful structural reforms that were ultimately needed to solve the same problems.

3. Focusing public resources on the poor (as in traditional development) to ‘lift’ them out of poverty is not the way to go: sustained societywide-targeted-income-transfers/redistribution measures are needed for poverty reduction.

4. To achieve this, poor people must gain voice and influence to claim their rights in front of the relevant social sector institutions and in the national political discourse overall (thus reversing decades of exclusion).

5. To have a higher probability for solutions to the poverty and HR problems to work, these have to be structurally sound, i.e., be designed to tackle the basic socioeconomic and political causes of the problem.

6. These days, the HR-based approach to development cooperation has to be oriented to developing the capacities and the resolve of duty-bearers-to-meet-their-obligations and the capacities and the resolve of claim-holders-to-claim-their-rights.

7. This calls for a big shift, one that places individuals and communities and their rights and responsibilities at the center of the development process. The shift also has to result in forgoing the myopic focus on higher per-capita income as a goal, to be replaced by key social and HR goals - this, a matter of social choice.

8. Are these old recipes for a different new world? Not in my view! Quite on the contrary, they represent a principled position maintained with conviction in the face of new challenges...in the same old world.

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

Mostly taken from Ted Freeman and Urban Jonsson, F&D, 41:1, March 2004 (IMF), F+D Vol 41: 2, June 2004, IFPRI Forum, March 2004, and D+C Vol. 31, Aug/Sept 2004.

103. People who file claims to secure their right to health and adequate nutrition cannot wait for a whole generation

Food for a widening thought gap

1. Malnutrition packs the mortality equivalent of a 9/11 every 3 ½ hours, except that most of the victims are small children, all the deaths stretch out in tortuous misery for weeks, and there are another quarter-million such attacks, each with 3,000 victims, who instead of being killed, are left disabled or seriously ill. (J. Teton). Many of the malnourished children are child laborers - 350 million of them worldwide.

2. Currently, only about 10% of ODA goes to health and nutrition projects and programs in developing countries. This means that external funding for health care and nutrition in developing countries is currently only in slight excess of $8 billion a year.

3. Unregulated private health care providers today are the first port of call for many poor people. Governments must, therefore, bring them into the public domain through better regulation. (Human Development Report 2003)

4. The disturbing news though is that we have evidence of widening gaps in health and nutrition worldwide (in terms of numbers of those affected by many types of preventable ill-health and malnutrition).

5. This, most likely because health and nutrition are more about power imbalances than about morbidity and mortality; they are more about control over the basic determinants of ill-health and malnutrition than about the treatment of diseases and the rehabilitation of the malnourished. We need to view and act upon both in a way that addresses power relationships and related rights issues.

6. It is not enough for human rights activists to make information on these risks available to public authorities. It is organized claim holders who have to ensure these risks are indeed recognized-and-acted-upon.

7. Why? Because health care is increasingly used as a subtle and widespread instrument of social control. Western medicine attributes the causes of illness to faulty-individual-behavior or natural-misfortune rather than to social-injustice, economic-inequality and oppressive-political-system that disregard human (people’s) rights. Western medicine thus fights disease at the individual level rather than promoting community health from a holistic, human rights-based perspective. (i.e., ‘disease fighters’ vs ‘health promoters’).

8. More efforts have been devoted to denouncing this fact than to do something to mitigate its effects. I am aware that this Human Rights Reader is not immune to this criticism and this may be considered its greatest weakness.

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

Mostly taken from D+C Vol. 31:6 and Aug/Sept 2004, Perspectives in Global Development and Technology, Vol 3, No. 1-2, 2004, IFPRI Forum, March 2004, and F&D, 41:1, March 2004 (FMI).

104. How aggressively should governments be put under pressure in the struggle for Human Rights?

Food for an engaging thought

It is dangerous to be right when the government is wrong. (Voltaire)

(*): Do not deceive yourself here though: I used to think that ideas and words would be sufficient. How wrong I was. The ideas I write about human rights (HR) are maybe essential, but if they are not accompanied by resolved actions by the victims of HR abuses, the beautiful words will go up in smoke and will never rise from the parlors of intellectuals. We often think that printed words denouncing evil will be enough to set in motion social change. But, at best, this is a form of anger-without-sufficient-follow-up-enthusiasm-to-see-actions-through. The fundamental is not what is written - it just puts people to sleep a pleasant sleep; what is fundamental is changing society. Compromise creates synergy. In the best of cases, written radicalism may end up replacing some government policies by other (sometimes a bit better) policies, without really changing the political system. In the worst of cases, it provokes government repression. Our focus ought to be to change the power balance in the political system, not just to make grandiose political declarations.

[If people could eat international resolutions and summit agreements, Africans would be among the best fed people in the world. (IFPRI)].

3. Today, in many countries, fellow activists are already seriously fighting for constitutional rule, to check corruption and check abusive power. As such, they are directly pleading for changes toward greater democracy and, therefore, implicitly pleading for the wider respect of HR; what is now needed is to explicit this HR pleading.

4. The good-news is that the various existing covenants and treaties on HR increasingly make it possible to hold-perpetrators-of-HR-violations-liable, but the not-so-good-news is that, in most places, there are no good preventive-means-in-place-to-address-HR-violations. Experience tends to show that a society will not observe HR standards until it adopts them as ‘normal’ in day-to-day life. It is thus important to consider customary law and to link the key HR norms to it; this will contribute to HR being perceived as being-in-accord-with-the-local-culture.

5. Public-interest-litigation and social-action-litigation are key elements of the rights-based approach. In them, un-represented, disadvantaged, deprived and dispossessed people use courts for the restoration of their basic, fundamental rights. Courts need to be lobbied to accept petitions sent-in in informal formats as, for example, letters from the affected and the ‘rightless’ seeking restoration of their rights. HR activists like us are to bring this situation of ‘rightlessness’ to the attention of the courts. We are aware that enforcement of court orders may not be guaranteed, but the moral boost favorable rulings can bring to social mobilization cannot be emphasized enough. Even symbolic pronouncement by a court are invaluable. We know that, when determined, a court can have its will enforced. Social-action-litigation has indeed led to some important reviews of laws and to the creation of a new HR-responsive-governance-culture as, for example in India, where an impressive jurisprudence of incorporation of HR standards into laws and regulations already exists.

6. So, a new era can dawn where marginalized people freely recourse to courts and ‘have-their-day-in-court’. Governments will thus have to eventually explain and, at times, fully redress acts-of-commission and acts-of-omission in the HR domain. All this does not amount to an emancipation of the marginalized; but judicial activism can make those in power a little more accountable. At stake in this process is, not so much the legal, but the political correctness of the judiciary. (U. Baxi)

7. Moreover, the internet is beginning to change things...also for HR; civil society groups have begun to use cyber platforms (e.g., the People’s Health Movement or this very same HR Reader). The www serves to inspire confidence in people’s power to make a peaceful difference and to connect claim-holders worldwide to the global-anti-negative-effects-of-globalization and pro-HR campaigns. The internet is thus serving the democratic and HR discourse. The question though is: Faster and more effectively than the undemocratic forces are using it?

8. As regards the media, it certainly should become more of a public witness of successful outcomes of civil-society-activism of all kinds. (...Success always seems to happen in private; failure in full view...) But unfortunately, there is little independent press these days to keep a watchful eye on civil society, on the government and on dominant political interest groups. It is for us as activists to engage them.

10. So, in conclusion (is a conclusion the place where one got tired of thinking?), it will indeed take organized-concerted-and-aggressive-grassroots-pressure - as well as concerted-action-at-the-global-level - to bring about the profound social and political changes that are needed for the HR cause to make faster headway.

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

Mostly adapted from Insights 51, Dec 04 (id21); F&D, 41:1, March 2004 and 41:2, June 2004; IFPRI Forum, March 2004; Mario Vargas Llosa, El Paraiso en la otra esquina, Alfaguara, Madrid, 2003; D+C Vol 31, July and Aug/Sept 2004; and Perspectives in Global Development and Technology, Vol 3, No. 1-2, 2004.

105. Is there such a thing as a fair and human-rights-sensitive (Capitalist) Global marketization?

Food for a fair and sensitive thought

1. Did you know that half the people you know are below average? And that 42.7% of the statistics are made-up on the spot?

2. The above not withstanding, a tiny sample of statistics is called-for here to start a discussion on this topic: In 2003, the 400 richest Americans had a total annual income of U$69 billion - more than the economic performance of five African countries combined. (G. Sachs) The richest one-tenth of the population in Latin America and the Caribbean earn 48% of the total income while the poorest tenth earns 1.6% (World Bank). The income mobility that does exist and has been documented does little to erase this extreme concentration of income and wealth in the hands of a few. The Human Development Index (HDI) has actually gone backwards in 40 countries. [Furthermore, there is evidence now that around U$130 billion has been misappropriated from WB loans since the Bank was established 60 years ago. (As a reference, total ODA in 2003 was U$68 billion). (D+C)]. So, "unless something changes, poverty in sub-Saharan Africa may not be halved before 2146". (E. Herfkens, Executive Coordinator, MDGs).

3. But the main focus of this Reader is human (people’s) rights, no? So, let me leave you with one simple additional thought: It is importantly the non-recognition of workers rights that explains why income disparity is as pronounced as it is.

4. But the rich countries are trying to help the poor! - you will say. Well, let’s look at another sample here:

-The G8 seem to promote mostly that which costs nothing - such as good governance;

-they wrongly feel that focusing on politics or human rights (HR) deters attention from getting the macroeconomic fundamentals right;

-they proclaim the hegemony of economics over other social sciences and over people’s rights;

-to prove the above, they carry out econometric studies with a clear neoliberal ideological bias;

-with a ‘do-as-I-say-and-not-as-I-did’ attitude, they impose on poor countries practices that are the exact opposite of what they historically did to become developed themselves;

-to achieve the above, they use the ethnocentric (pro-G8) approaches of the WB, the IMF and the WTO which have given us Structural Adjustment and TRIPS. [The IMF, the WB and the WTO are actually chosen as avenues by which the business and political elites of the G8 countries operate to rule the global economy and to dictate to the rest of the countries of the world how they should be run].

- Isn’t it thus time, at the WTO for example, that we much more forcibly demand a ‘trade-round-for-the-poor-and-the-rightless’?

- Isn’t it time we insist that the most effective form to get development going is still the consistent waiver of unpayable debt?

- Isn’t it time governments around the world stop aggravating the ‘level-of-social-debt’ towards their citizens - especially the ‘nothing-holders’ among them?

7. From our perspective, the globalization of the world market economy has failed to defuse existing HR violations - and conservative leaders are still showing an apparent reluctance to de-facto introduce the adjustments needed for decreasing the same violations. In short, in HR terms, the global market integration has proved to be costlier than expected.

8. Another ever-recurring issue in the era of Capitalist Globalization is the issue of democracy and governance. Unfortunately, the West (especially the US administration) has given democracy a bad name. On the other hand, the introduction of ‘good governance’ as a conditionality often ends up with a long wish-list doomed to failure. Political elites are resisting changes to the traditional political order they so ably control and fiercely defend - and they are getting away with it - wouldn’t you agree? Good-governance-reforms are thus isolated and more-cosmetic-than-structural with no positive impact on the HR situation. With good or with bad governance, representative democracy (with its veneer of altruism) has simply not been a responsive ground for desperately needed reforms. This is why an analysis of the political system/situation is necessary to begin with - as this Reader so often calls for.

[For us, good governance rather means more equitable and inclusive state-society relations (including the respect of HR!), and not only (vaguely) "the exercise of power to manage a nation’s affairs". In the same vein, for us, national liberation is an integral element of any meaningful concept of HR. (Not being facetious, this should remind us that war - internal or external - does not determine who is right; it determines who is left)].

9. Moreover, in too many countries, parliaments are dominated by status-quo powers. Political parties have lost their mediating function between state and citizen to be effective allies in the struggle for HR. The interests of markets and those the politicians-in-power are more often than not mutually reinforcing. The great challenge is to win-over/convince (or vote out) these pro-status-quo politicians all over the world - whenever they are holding-up progress in HR work. For them, a clear conscience on HR issues is often a sign of a bad memory...

10. For a couple of decades at least, transnational corporations have been central players in Capitalist Globalization. But, as everybody knows, they do not concern themselves with HR - which they contend governments are supposed to enforce. Some have claimed that these corporations adopting HR positions risks privatizing (sic) HR which could lead them to use HR principles to their advantage - as has been the case with the Global Compact, i.e., the corporate cooperation (?) with the UN. (CETIM) The non-binding nature of the concept of ‘corporate-responsibility’ (the latter seldom in HR terms) is basically nothing more than a useful tool for big corporations to polish and beef-up their corporate image. As HR activists, we need to move beyond demanding corporate-social-responsibility and demand full-corporate-social-and-environmental-accountability.

11. Finally, the inequality that Capitalist Globalization is bringing about day-in-day-out is the product of powerful economic and political interests and of weak policies for the channeling of the benefits of Capitalist Globalization to those most in need. Inequality is not ‘simply happening’; it is a natural consequence of this globalization: inequality is being constructed by powerful economic and political interests and biased public policies. So, because the attainment of equity and HR is ultimately only achievable through social-action-geared-at-forcefully-demanding-needed-changes-in-public-policy, in a nutshell, all the above calls for the victims (nation states, organizations and individuals) to be mobilized in economic and political terms.

12. I thus end where I started and ask you: Is there such a thing as a fair and HR-sensitive Capitalist Globalization? I let you be the judge.

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

Mostly adapted from D+C 31:4, Apr, June, July, Aug/Sept and Oct 2004, F&D, 41:1, March 2004 (IMF), and Perspectives in Global Development and Technology, Vol 3, No. 1-2, 2004.

106. Feeling helpless or lost (or being used) in your work?: Adopt the Human Rights-based Approach to development!

Food for a morally imperative thought

In development policy, human rights are frequently understood above all as values; their legal nature is often neglected. Human rights contain both: values, but also binding obligations.

2. On top of promoting a national consensus around HR, mainstreaming the RBA also means improving the legislative basis of HR. Striving for a strong, independent judiciary is also, therefore, a working front for HR activists; the judiciary needs strong, independent lawyers and judges, well versed in HR issues. Consequently, the RBA aims at influencing national legislation, legal practice, distribution of budgetary resources and national policies in critical rights-related areas. ‘Social observatories‘ can and should be set-up to monitor the allocations in the national budget every year. [The participative, popular budget preparation process in Brasil’s Porto Alegre Municipality is a fitting example].

3. The RBA is meant to produce verifiable results in terms of changes in processes and changes in the capacities of claim-holders and of duty-bearers. It ultimately tests our ability to make a country’s authorities abide by the HR covenants they have signed. Therefore, monitoring the achievements of the RBA puts emphasis on capacities developed by duty-bearers and claim-holders, checking that they have resulted in verifiable improvements (more so as regards intentional than incidental impacts). Capacity development is crucial to link HR standards and the specific development processes set in motion.

4. Applying ‘good programming’ does not in itself constitute a RBA; a RBA requires unique additional elements like the following:

- Identifying the unfulfilled rights of claim-holders and the correlative obligations of duty-bearers, as well as the underlying and basic causes of the non-realization of those rights;

- assessing the capacity of claim-holders to claim their rights and of duty-bearers to fulfill their obligations;

- monitoring both outcomes and HR-directed processes set in motion; and

- doing all programming based on recommendations emanating from existing HR bodies and covenants.

6. Ergo, as HR activists, when using the RBA we are not trying to achieve the biggest-difference, but the most-qualitatively-correct-and morally-called-for-difference.

7. To achieve the above, the media should also be lobbied so they contribute their share to spreading constitutional, democratic and HR ideals. But, as the HR Readers have contended previously, this is often not the case: abuses of power and flagrant violations of HR are covered only occasionally. There is a ‘potential for democratization’ there, but national press coverage has yet to become democratic; so far, there is no sign of this happening (enough). Transparency rules are of little use unless active media and civil society organizations involved in HR serve as watchdogs to alert the wider public about ongoing abuses (the latter either through or not through the media). This, also because - unless they are reported - distortions, violations and abuses continue to occur even under conditions of improved transparency. What this means is that anyone who is not party to knowledge about ongoing violations, is excluded from exerting the power to revert the same violations by holding the corresponding duty-bearers accountable. This explains why this Reader has always been of the opinion that political and historical development perspectives should be analyzed in the light of class interests. [Beware, knowledge will forever govern ignorance, and people who mean to be their own governors must arm themselves with the power knowledge gives. Knowledge is power, but sharing information also is progress. Without knowledge, an effective demand cannot be achieved to have a chance to influence public HR policy]. (D+C) (IDS)

8. Granted, many practices in the RBA may infringe social customs which people do not (yet) regard as wrong (e.g., female genital mutilation). But the fact that HR principles were first postulated in Europe and North America is merely a historical, but not an ethnocentric fact. As early as 1990, the South Commission, under former Tanzanian president Mwalimu Julius Nyerere, already described democracy and HR as key foundations of development. Social peace, it was said, only prevails where all citizens are able to pursue their interests and rights through legitimate means and with realistic chances of success.

9. Moreover, in HR work, institutions are also key actors. Therefore, policy measures in the HR domain will have no long-term impact without institutional reform. Rights-based solutions need to be customized - with proposed reforms firmly anchored in the local political realities. In an effort to make the pertinent institutions truly accountable to the people they are supposed to serve, we have to make sure they ‘own’ these reforms before they are adopted. A lot of advocacy needed here.

10. But in 2005, this is not an easy road to follow. As long as the G8 countries continue to define development policy along the lines of security policy, and as long as fragile states are myopically seen as breeding grounds of terrorism, HR will continue to be violated with impunity mostly by using sheer might. The military will simply never become a true partner in development work. In such a world, we need to forcefully counter the renewed tide of hawkish authoritarian influences.

11. Development and security policy need to be kept strictly separate; they pursue different goals and use different tools. At the very minimum, these opposing policies bring about conflicts in the distribution of resources, i.e., how much money is allocated for development and how much for security work. If we do not start our struggle at this level, much of what we do afterwards will be simply reactive and not proactive.

12. The RBA contends that inequitable public policies - even if beefed-up with more resources to tackle social problems targeted at specific vulnerable groups - will not succeed. In the RBA, a deeper level of political and economic action is called-for. The RBA assigns social value to what is considered to be unfair, avoidable and unnecessary within the spectrum of inequities found; and what is unfair is a social and political decision. Inequities arise from patterns of ownership, of wealth, of employment, of trade, and of political influence; these are all more consistently addressed in the RBA than in the current development paradigm.

13. Greater equity is achieved by sharing empowering-knowledge-to-be-used-as-evidence and by building-the-political-momentum-for-that-knowledge-to-be-used-for-sustainable-equitable-and-HR-friendly-changes.

14. Confronting inequity cannot, therefore, be separated from the political struggle for better policies and more resources for the poor and rightless.

In sum, organization and social mobilization are fundamental to equity and HR. An early success will depend on the extent to which the RBA tackles inequity by giving priority to the organizational aspects to combat it.

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

Mostly adapted from Ted Freeman and Urban Jonsson, D+C Vol. 31, June, July, Aug/Sept and Oct 2004, Perspectives in Global Development and Technology, Vol 3, No. 1-2, 2004, and Insights 51, Dec 04 (id21-IDS).

107. Always check if the Government is ‘putting its money where its mouth is’: A guide to using budget analysis to advance human rights. Part 1 of 2

Food for a violated thought

1. ‘Budget Analysis’ is a tool that can be used with surgical effectiveness to protect and promote the enjoyment of human rights in general and economic, social and cultural rights in particular. Beyond any doubt, budget analysis allows assessing transparency and accountability, as well as compliance by governments with their human rights obligations. This, because of the ultimate effects of budgets and budgetary policies on the poor.

2. Budget analysis can highlight specific actions that can be taken to remedy governments’ non-compliance with respecting, protecting and fulfilling human rights principles - something that should be one of a their highest priorities to begin with. Government budgets should thus reflect those policies - and by looking at the government’s revenue allocations one instantly knows... Ergo, the results of budget analysis can be integrated into active advocacy.

3. We need to be reminded though that assessing quality of spending requires something other than budget analysis. Although the latter is a powerful value-neutral tool per-se (that allows to pinpoint a government’s failure to comply with its rights obligations), a human rights perspective ‘grounds’ budget analysis by pointing out what is right and what is not: Budget figures do shed light on key human rights issues.

4. Budget analysis cannot thus by itself identify what human rights true priorities ought to be. A human rights framework is needed to help fill the gap. Ultimately, one has to ask: Does the budget reflect an effort towards the progressive achievement of human rights? Does the government use the maximum available resources to comply with human rights provisions of the treaties it has signed? (i.e., does it prioritize the allocation of resources to necessary services? Let us remember that, according to international law, it has to).

5. It therefore becomes plenty clear that, when human rights are dismissed by some as being idealistic and unrealistic, a struggle to build a consensus on the fact that certain practices and budgetary allocations violate human rights/dignity must antecede efforts to carry out a human rights-based budget analysis.

6. The caveat is that the capacity to enforce human rights depends on the existence of legal provisions protecting rights (national constitutions and laws, as well as international and regional treaties). Most constitutions contain a range of rights provisions including economic, social and cultural rights provisions. Therefore, because rights are claims against a state, it behooves us to study the national constitution and human rights-related laws.

7. Why?, because if a government has ratified human rights treaties, it is obliged to bring its national constitution and laws into line with the provisions of the same treaties. But, typically, constitutional provisions and laws are stated in brief or vague terms - and, moreover, it does not always follow that governments respect these provisions: and this is where budget analysis comes in!

8. Violations of human rights occur under many different guises, not least the one that ensues when governments prioritize foreign debt servicing over social investment and, against that, no law protects individuals vis-a-vis the state. [ Individuals are also not protected against Corporations who are not legally obliged under international law to respect human rights (and have instead come up with ‘voluntary codes of conduct’...)].

9. A budget is the most important economic policy instrument any government produces. Understanding what governments are actually doing requires understanding what is in the budget. That is why analyzing the extent to which human rights provisions are guaranteed in practice through the budget is so important. Subjectively, we know that the lack of political power among the poor most often means that state funds are not earmarked for (and/or do not reach) them. Therefore, pro-poor groups influencing the budget can be a powerful tool for advancing human rights. Again here, this is where budget analysis helps since:

- it measures governments’ real commitment,
- it discovers trends,
- it unveils the funding allocation implications of policies,
- it predicts the outcome of the budgetary choices made,
- it makes the raw numbers tell a story about government priorities,
- it helps lay out the de-facto choices made by the government, and
- it helps translating dry data of a budget into a compelling case for improved and expanded programs for the poor and the marginalized.

11. But beware: Budget analysis cannot and does not determine what should be spent on economic, cultural and social issues benefiting the poor and marginalized; that is a political question; it is also a human rights question! Budget analysis does not tell how effectively or efficiently the money is spent either or if it is reaching the intended purpose(s) and beneficiaries. Always keep in mind the difference between ‘budgeted spending’ and ‘actual spending’; the latter is what really matters since budgets do not always pan out as planned.

12. The population of most countries is actually comprised of claim-holders and ‘nothing-holders’ (those with no access to any social security benefits). This, because, often the comprehensive realization of the right to health is directly related to an individual’s capacity to contribute to a social security system - any right to health thus depending upon the economic provision and employment of a person. That is why, a quarter or more of the population of most countries has very poor access to health. Not surprisingly then, governments fall short of ensuring the right to health for everyone; they do not meet their obligations regarding the right to health (and other key social and economic rights obligations). Low income populations are not getting the health care that should be available to them. Often, health spending has seen a downward trend (not necessarily corresponding to a general decrease in public resources, but simply put, resources available are spent elsewhere). The MOH also often underspends in the social program areas under its tutelage and existing programs fail to target the poorest communities.

13. Actually, budget analysis exercises can also discover that:

- more pro-poor spending is done in better-off than in poorer provinces (i.e., on a per-capita basis there is a discrimination against the poorest provinces);

- the trend in resources allocation for the control and prevention of diseases is declining;

- the severity of poverty is not taken into account for a more equitable distribution of health resources, i.e., the Government is not giving preference to the most vulnerable groups;

- resources allocation to health infrastructures has followed a clear regressive trend; and

- the Government allocates a disproportionate share of the budget to those employed in the formal sector and discriminates against those informally employed and unemployed.

(contd.)

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

Mostly taken from Dignity Counts: A guide to using budget analysis to advance human rights, Centro de Analisis e Investigacion (FUNDAR), International Budget Project (IBP) and International Human Rights Internship Program (IHRIP), Mexico, 2004.

108. Always check if the Government is ‘putting its money where its mouth is’: A guide to using budget analysis to advance human rights. Part 2 of 2

Food for a violated thought (2)

15. Meeting one’s human rights obligations is not necessarily about spending money, but the reality is that very often it does take money to fulfill these obligations. Therefore, a ‘human rights framework’ (as the one repeatedly depicted by this Reader) is needed as a reminder that the welfare of human beings - and the needed investments for that - should be the driving motivation of our work.

16. Work driven by a concern about poverty and social justice gains legitimacy through the use of a human rights framework. Such a framework makes clear that fiscal choices must not violate human rights; this, since human rights standards often direct governments to give priority to certain types of expenditures over others. Therefore, it is strongly contended that human rights plus budget analysis leads to greater power. Budget analysis looks for upfront guarantees that governments are protecting human rights.

17. Starting with a ‘rights frame of mind’ - a perspective that considers a situation through the lens of rights - means looking for rights issues in all what we do in development work, as well as looking for strategies to advance rights. The human rights struggle is one for the recognition of and respect for human dignity.

18. Starting with a rights frame of mind also means always analyzing whether what one is seeing is a violation of a right; so bringing this frame of mind to our work is essential; and for that, access to information regarding public matters is crucial - and this per-se is a right under international human rights law. Information produced by budget analyses is key and potentially powerful public information to be used at national policy level; it can have even greater impact when shared with and used by communities so they can hold their local government officials accountable.

19. In the case of health, the more vulnerable the situation a person finds herself in, the fewer guarantees she has that her right to health will be fulfilled. Why? Because the health system is conceived that way: The higher the level of marginalization, the poorer the health services.

20. Despite the absence of explicit discrimination against human rights in existing policies and laws, the system itself seems to be discriminatory. And it is absolutely crucial we all understand this.

21. Slavery and torture are today universally condemned as human rights violations. Why is the discriminate and well-known lack of access to health of the poor not condemned??

Basically, because what may not feel like a violation of human dignity at one point in history or in a given place may be perceived as a significant infringement at another time or in a different place. In a way, thus, our role is to act as an avant-garde accelerating time....

Using budget analyses for human rights advocacy:

22. Together, human rights and budget analysis provide compelling evidence of a government’s compliance or non-compliance with economic, social and cultural rights obligations. Any strategy that is effective in protecting and promoting human rights can be that much more effective through the forceful insistence on new budgets integrating the findings derived from budget analysis.

23. It is important to stress that a confrontational approach is not a necessary part of the human rights framework. It is an approach that has been used by human rights organizations in a large number of countries where they have found the government otherwise unresponsive to their concerns.

24. Be it as it may, getting the facts straight is fundamental to address any human rights issue. What the government has spent or not spent to address a problem can be a pivotal factor in our advocacy. Budget figures can be a valuable tool in our armamentarium since the budget is an embodiment of a government’s policies and laws including those on human rights.

25. A community becomes effectively energized to demand accountability from local government officials when it is provided with specific information about expenditures the local government is supposed to make.

26. But also parliaments should be brought into this discussion, so they can exert needed pressure. Moreover, when the government fails to follow through on its rights obligations, it is often necessary for civil society to initiate litigation to put pressure on the government. At times, it is even necessary to go to regional/international human rights bodies in the hope that pressure from the international community will move a government where domestic pressure alone has been inadequate.

27. NGOs are also called to develop ‘shadow reports’ and to submit them to international human rights bodies to point out inaccuracies in the government reports on these matters.

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

Mostly taken from Dignity Counts: A guide to using budget analysis to advance human rights, Centro de Analisis e Investigacion (FUNDAR), International Budget Project (IBP) and International Human Rights Internship Program (IHRIP), Mexico, 2004.

109. Glossary of Human Rights Terms

Food for a well defined thought

Accession	The act by which one nation becomes party to an agreement already in force between other powers.
Adoption	Formal acceptance and putting into effect.
African Commission on Human and People’s Rights	The principal regional HR treaty for Africa. Adopted by the OAU in 1981; went into force in 1986.
Civil rights	Rights an individual has in his/her role as a citizen or in his/her relation with the state.
Committee on Social, Economic and Cultural Rights (CESR)	Body charged with supervising the implementation of the ICESR (see below).
Committee on the Elimination of all Forms of Discrimination against Women (CEDAW)	Body charged with supervising the implementation of CEDAW (see below).
Convention	Treaty; agreement between states relating to matters affecting all of them.
Content (of a right)/Core Content/Minimum Core Content	The meaning of the right; what it guarantees; the core content of a right refers to entitlements that make up the right; minimum core content has been described as the non-negotiable foundation of a right to which all individuals, in all contexts and under all circumstances, are entitled.
Covenant	Formal, written agreement between parties, usually requiring the performance of some action. In the HR context, ‘covenant’ usually refers to either the Intl. Covenant on Economic, Social and Cultural Rights or the Intl. Covenant on Civil and Political Rights (see below).
Cultural Rights	Rights that protect a person’s enjoyment of his/her own culture.
Declaration	A statement by governments that is not legally binding on them.
Discrimination	In the HR context, the act of practice of discriminating against someone on the basis of their membership in a category (e.g., race, ethnicity, gender, religion). Discrimination is normally a violation of HR.
ESC Rights	Shorthand for economic, social and cultural rights.
European Commission on HR	Body charged with supervising the implementation of the European Convention (see below).
European Convention on HR	Principal regional HR treaty for Europe. Adopted in 1950; went into force in 1953. Addresses a broad range of HR.
European Social Charter	Adopted in 1961; entered into force in 1965. Addresses economic and social rights in more detail than does the Eur. Convention. Effective primarily since the 1990s when a supervisory system was established.
General Comments	Produced by the CESR to clarify and provide detail on procedures related to its work and, primarily about the content of specific ESC rights.
General Recommendations	Produced by CEDAW. Similar in purpose to General Comments.
Inalienable	Incapable of being alienated, surrendered or transferred. HR are inalienable, meaning that no one can take away a person’s rights.
Indivisibility	See interdependence (below).
Inter-American Commission on HR	Body charged with supervising the implementation of the American Convention.
Interdependence/indivisibility	Guiding principle of HR work meaning that civil and political rights and ESC right are interdependent; one set of rights does not take precedence over the other and neither set can be fully guaranteed without the other.
Intl. Convention on the Elimination of all Forms of Discrimination against Women (CEDAW)	Adopted by the UN General Assembly in 1979; came into force in 1981. Principal intl. treaty related to women’s rights.
Intl. Convention on the Rights of the Child (CRC)	Adopted by the UN General Assembly in 1989;detais civil and political, as well as ESC rights of children; most widely ratified intl. HR treaty.
Intl. Covenant on Civil and Political Rights (ICCPR)	Adopted by the UN General Assembly in 1966; came into force in 1976.
Intl. Covenant on Economic, Social and Cultural Rights (ICESCR)	Adopted by the UN General Assembly in 1966; came into force in 1976. Principal intl. HR treaty focused on ESC rights.
Intl. HR	Generally refers to the rights contained in the intl. legal documents and treaties related to HR that have the roots primarily in the UN system.
Legally Binding	Having the force of law.
Maximum Available Resources	Key provision of article 2 of the ICESCR related to governments’ obligations with respect t ESC rights. Governments must use the maximum of available resources to meet their ESC rights obligations.
Non-discrimination	Fundamental HR principle meaning that all rights are guaranteed to all without discrimination.
Norms (HR)	Requirements in HR treaties or declarations. A standard against which a government’s actions are measured. Same as standards.
Obligations to Respect, Protect and Fulfill	Governments’ obligations with respect to ESC rights. Respect: The government must not act counter to the HR standard in question. Protect: The government must act to stop others from violating the HR standard. Fulfill: The government has an affirmative duty to take appropriate measures to ensure that the HR standard is attained.
Political Rights	Rights related to government or the conduct of government (e.g., the right to vote and to participate in government decision-making).
Progressive Realization/Progressive Achievement	Key provision of article 2 of the ICESCR related to a government’s obligations with respect to ESC rights. ESC rights must be achieved progressively; no backward steps may be taken.
Protocol	Document or treaty related to an existing treaty.
Provision	An article or clause in a treaty or other legal document.
Ratification	Formal approval, in this case of a treaty. Has greater legal force than a signature.
Social Rights	Rights relating to the person in society, such as the right to education, social security, health.
Standards (HR)	Requirements in HR treaties or declarations. Used to assess/measure how well a government’s policies and practices comply with HR.
Treaty	Written contract between states. Legally-binding on states that ratify it.
Treaty Body	Group established to oversee compliance with a treaty.
Universal Declaration of HR	Adopted by the UN General Assembly on December 10, 1948; generally considered the primary intl. HR document. Although not a treaty, it is generally considered binding on all members of the UN
Universal	Applying to all human beings (as in ‘HR are universal’)
Universality	Essential quality of HR meaning that HR apply to all human beings by the fact of their being human.
Violation of HR	Failure of a state wit regard to one of its obligations under HR norms.

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

Taken verbatim from Dignity Counts: A guide to using budget analysis to advance human rights, Centro de Analisis e Investigacion (FUNDAR), International Budget Project (IBP) and International Human Rights Internship Program (IHRIP), Mexico, 2004.

110. If I accept the responsibility that I should act, and I have the authority that I may act, and I have the resources so I can act, I can indeed be held accountable for my actions (or non-actions)

Food for a rhetoric thought to be put into action

Development, Human Rights and Democracy have one thing in common - they all represent un-achievable human aspirations. There will never be a society in which all human rights are realized for everybody; but strive towards these un-achievable goals we still simply must.

1. We live in a world in which 1.2 billion people (or 24% of total world population) live in extreme poverty (below $1 a day) and extrapolations tell us that, despite MDGs, 1.44 billion will still be extremely poor by 2015.

2. This makes one wonder whether those who prepare these globally-binding documents and who adopt them so easily are really "ignorant of the nature of the subject and of the matters with which they deal". To focus on the MDGs totally out of context of the overall Millennium Declaration context - as most development agencies are doing - is a politically motivated step that we must be aware-of and react-to. (see below).

3. Over the years, human development has become ‘goal-oriented’ and ‘outcome-focused’ with limited attention being given to the quality and legitimacy of the process(es) of development being fostered (or imposed). A proof of this is that most of the MDGs represent specific, and at that only desirable outcomes. One cannot but be sensitive to how these outcomes came about, i.e., issues of participation, local ownership, empowerment, and sustainability (essential characteristics of a high-quality, bottom-centred process) are mostly ignored. Level of outcome and quality of process are inseparable for positive social action. Period.

4. Actually, the gap between goal-oriented rhetoric and practical action is a gap between theory and practice...and ethics. This is why this Reader keeps repeating that the current type of globalized-free-market-economy is ‘un-ethical’. These days, free-market-economics is promoted as an ideology, with a very uncaring ethical base. - the latter often denied by its proponents. Therefore, being a political-ideological-development-model with its own (uncaring) ethics, it is absolutely legitimate for us to challenge the free-market-economics model’s validity. This because Globalization - the flagship of free-market-economics - creates winners and losers, the latter having many of their rights violated. [On the other hand, we are reminded that globalization, in its positive aspects, provides us with new opportunities for the promotion of a ‘global ethics’ - as embedded in the human rights approach to development].

5. As Denis Goulet says, "Development needs to be redefined, demystified and thrust into the area of moral debate." Amartya Sen adds that development has to be built on "cross-cultural moral minima". On the other hand, Emmanuel Kant tells us that "Ought (ethics) must be preceded by can (science) - otherwise it is Utopia," Yet other have added the concept of "do-ability of development changes" meaning that trying to realise ethically-desirable, defined development goals, we can only proceed as fast as circumstances allow. [The fallacy here is that we do not have to take the ‘circumstances’ as given! We can and should embark in changing them].

The development/human rights interface:

6. The ethics of current free-market-economics promotes aggregate economic growth, profit maximization, individualism plus non-intervention/minimal-intervention and minimal public expenditure by the State. This ethic includes the realization of civil and political rights through procedural democracy (i.e., elections), good governance and the rule of law, but it rejects the legitimacy of economic, social and cultural rights. So, since the ethical base of free-market-economic-theory excludes human rights, it is not surprising that its proponents hardly look for any human rights violations.

7. The issue is not to spend precious time criticizing free-market-economics because it is un-ethical, but rather to struggle for it to accept and adopt a ‘better’ ethical base: the ethics of rights and the ethics of justice.

8. The equality-trade-off (compromising equity in order to allow rapid capital accumulation and economic growth) (1), and the liberty-trade-off (denial of some civil and political rights in order first to address underdevelopment) (2) at the core of free-market-economics are, of course, unacceptable trade-offs from a human rights-based perspective.

9. Coming back to the implications of all this on the MDGs, most UN and bi-lateral agencies have actually reduced the Millennium Declaration (September 2000) to the 11 development goals (MDGs) defined in only two of the 32 paragraphs-long document. Six of these goals define targeted desirable outcomes; out of the other five goals, four are related to desirable processes. But the Declaration contains 39 additional goals, most of them necessary for a sustainable and acceptable process of development - many of them explicitly referring to human rights principles. (see below)

10. In September 2001, the UN Secretary-General presented a report to the General Assembly entitled "Road Map Towards the Implementation of the United Nations Millennium Declaration" outlining strategies for action to meet the goals of the Millennium Declaration. The Road Map report does bring human rights up, but does not emphasise "the centrality of human rights in all activities pertaining to development." The focus thus remained on the MDGs, not on the Millennium Declaration as a whole! So, when the MDGs are taken out of their intended context - as they currently are - we are no longer pursuing a human rights-based approach...Disappointing, isn’t it?

Human rights:

11. To start with, a caveat here: Human rights are not only those entitlements codified in human rights covenants and conventions. Human rights are human constructs, which means that new rights will be constructed and gradually codified; the codification is the end of the process, not the beginning. Human rights represent one of the most positive manifestations of human endeavour in the last 50 years. There is no reason why today’s globalized world cannot provide for the advancement and active promotion of the human rights-based approach to development.

12. Further, a human right is both a right to something (for example basic education) and a right against somebody (for example teachers and/or ministries of education). This is different from an "entitlement", which has no correlative duty-bearer(s).

13. "Human rights standards" define the minimum acceptable level of an outcome, while "human rights principles" specify the criteria for an acceptable process to achieve an outcome. The HR principles now universally accepted are those of:

Universality and Indivisibility - Equality and Non-Discrimination - Participation and Inclusion - Accountability and Rule of Law.

15. The realization of human rights requires that the individual is in a position to make demands on others (i.e., duty-bearers) - that is, to claim their rights against somebody. This does not mean that, just because an individual cannot claim his or her right, the individual does not have that right. (Slaves did have the right to freedom before they were in a position to realize that right).

16. In sum, the human rights approach thus provides a transparent pattern of claim(holder)-duty(bearer) relationships which define accountabilities at all levels of society. The ‘pattern of rights’ in society can, therefore, be translated into a ‘pattern of accountabilities’.

17. This makes it clear that the immediate, underlying and basic causes of the non-realization of specific rights need to be identified. These can either be (1) a lack of capacity of claim-holders to claim their rights, (2) a lack of capacity of duty-bearers to meet their duties, or (3) both. Capacity here broadly means (a) responsibility, (b) authority, (c) access and control of the resources needed (human, economic and organizational) plus the capability to communicate and to make rational decisions.

18. These capacities and the commensurate capacity-development-efforts can be monitored. Activities to assess the capacity-of right-holders-to-claim-their-rights and of duty-bearers-to-fulfil-their-obligations thus need to be planned-for and implemented.

Democracy/human rights interface:

19. Democracy has not had the same ideological standing in the UN as Human Rights. "Compared to democracy, human rights hold a very powerful institutional position in the international arena." Peace, justice, freedom, and human rights are the pillars of the UN Charter - yet democracy is never mentioned.

20. For some time now, the World Bank has openly strived for accountability, rule of law, good governance and transparency of their borrowers - all elements of democracy. But it uses these HR principles more with the intention to create a stable and safe business climate than to look after the rights of the ‘rightless’ - no matter how much they try to convince us about their ‘new’ poverty-reduction focus.

21. With or without WB loans, some non-democratic countries have experienced very rapid development, and some poor countries with insignificant development during the last two decades are, in fact, democracies. Human rights standards can be met in a non-democratic country; for example, the human rights standards of universal primary education may be provided, but, remember, they are then enjoyed as a privilege. Even the MDGs can be purportedly met without democracy, although this is less likely. Be it as it may, talk about and/or steps towards democracy are threatening to many non-democratic governments.

22. Recognition of human rights - including ratification of UN conventions - does not require democracy either. Many non-democratic governments have ratified them. Many governments ratify these conventions primarily for reasons of international legitimacy.

23. The above provides a good background to understand what a number of international organizations are saying these days: ‘Democracy will take time; many human rights can be realised in non-democratic countries’. The rationale behind this thinking is: ‘Human rights can be realised without democracy, so why wait?’. [The fallacy here is that, for us, meeting human rights standards and principles can only be achieved in a democracy. Democracy and human rights are dialectically related. One lacks the full meaning without the other].

Summing up:

24. Development, democracy and human rights - all three must progress simultaneously. So, our task is to create a ‘global embarrassment’ for governments that fail to use their utmost resources for the realization of development, human rights and democracy of their citizens.

Claudio Schuftan, Ho Chi Minh City
claudio@hcmc.netnam.vn

cschuftan@phmovement.org

Adapted from ‘MDGs, PRSPs and Other Good Intentions: How to Translate Rhetoric into Action’ by Urban Jonsson.

111. Before I start this poem *

Food for a thought without a rhyme

Emmanuel Ortiz (USA)

Before I start this poem,
I’d like to ask you to join me in
A moment of silence
In honor of those who died
In the World Trade Center.

I would also like to ask you
A moment of silence
For all those who have been
Harassed, imprisoned, disappeared,
Tortured, raped or killed
In relation to those strikes.

And if I could just add one more thing...
A full day of silence
For the tens of thousands of Palestinians
Who have died at the hands of
US-backed Israeli forces
Over decades of occupation.

Six months of silence
For the million-and-a half Iraqi people,
Mostly children, who have died of
Malnutrition or starvation
As a result of the 11-year US embargo
Against the country.
Before I begin this poem:

Two months of silence
For the Blacks under Apartheid
In South Africa.
Nine months of silence
For the dead in Hiroshima
And Nagasaki.

A year of silence
For the millions of dead
in Vietnam - a people, not a war.

A year of silence
For the dead in Cambodia,
Victims of a secret war...ssshhh...
Say nothing...we don’t want them to
Learn that they are dead.

Two months of silence
For the decades of dead in Colombia.

Before I begin this poem,
An hour of silence
For El Salvador...
For Nicaragua...
Two days of silence
For the Guatemaltecos...
None of whom ever knew
a moment of peace
45 seconds of silence
for the dead in Chiapas
25 years of silence
for the hundred million Africans
who found their graves far deeper in the ocean
and for those who were
strung and swung
from the heights of sycamore trees.

100 years of silence...
For the hundreds of millions of
Indigenous peoples
From here in the US.
So you want a moment of silence?

And we are all left speechless
Our tongues snatched from out mouths
Our eyes stapled shut
A moment of silence
And the poets have all been laid to rest
The drums disintegrating into dust
Before I begin this poem,
You want a moment of silence
You mourn now as if the world will never be the same
And the rest of us hope to hell! It won’t be.
Not like it always has been.

Because this is not a 9-1-1 poem
This is a 9/10 poem;
A 9/9 poem,
A 9/8 poem,
A 9/7 poem.
This is a poem about
What causes poems like this
To be written.

And if this is a 9/11 poem, then
This is a September 11^th poem
For Chile, 1971
This is a September 12^th poem
For Steven Biko in South Africa, 1977

This is a September 13^th poem
for the brothers in Attica prison,
New York, 1971
This is a September 14^th poem
For Somalia, 1992..

This is a poem
For every date that falls
To the ground in ashes
This is a poem for the 110 stories
That were never told
The 110 stories that history
Chose no to write in the textbooks
The 110 stories that CNN, BBC,
The New York Times
And Newsweek ignored

This is a poem
For interrupting this program.
And still you want
A moment of silence
For your dead?
We could give you
lifetimes of empty:

The unmarked graves
The lost languages
The uprooted trees and histories
The dead stares on the faces
Of nameless children
Before I start this poem
We could be silent forever
Or just long enough to hunger,
For the dust t bury us
And you would still ask us
For more of our silence.

If you want a moment of silence
Then stop the oil pumps
Turn off the engines and the televisions
Sink the cruise ships
Crash the stock markets
Delete the instant messages.

If you want a moment of silence,
Put a brick through
The window of ‘Taco Bell’,
And pay the workers for wages lost
Tear down the liquor stores,
The jailhouses, the White Houses,
The Penthouses and the Playboys.

If you want a moment of silence,
Then take it
the next time your white guilt
fills the room where my beautiful
people have gathered.

You want a moment of silence
Then take it
Now,
Before this poem begins.

Here, in the echo of my voice,
In the space
Between bodies in embrace,
Here is your silence.
Take it.
But take it all.
Let your silence begin
At the beginning of crime.
But we,
Tonight we will keep right on singing
Four our dead.

*: Selected verses from this poem published in Third World Resurgence, No.161/162, Jan/Feb 2004,m pp.70-72

112. The Sachs Macroeconomics and Health Report: Investing in health for economic development or increasing the size of the crumbs from the rich man's table? (Part 1 of 3)

Food for a thought that twists the logic

A restricted mandate and a reversal of logic:

1. The relationship between health and poverty is two way, but the relationship is not symmetric. Poverty is the single most important determinant of poor health. People suffer from ill-health and malnutrition because they are poor. But poor health is very far from being the single most important determinant of poverty. Poor health exacerbates existing poverty...and poverty is most often a political problem, i.e., people are poor because of structural, man-made situations.

2. The neoliberal approach to health has turned this reasoning on its head by asserting that people are poor because they are ill, because there are too many of them, because they place a strain on scarce resources and - to add insult to injury - because they behave irresponsibly.

3. But no amount of top-down health interventions delivered to Haitians or Tanzanians today are going to make them or their country prosperous tomorrow if the national economy is strangled by debt, unfair terms of trade and the continued pillage of natural resources. To this, add the destabilization caused by uncontrolled financial outflows, widely fluctuating commodity prices and outside interference in matters of national sovereignty.

Is economic growth the ultimate aim?

4. The last 25 years of globalization (1980-2005) have shown clear declines in progress in development as compared with the previous two decades, e.g., income inequality has risen in most countries since the early-mid 1980s and in many cases sharply. Moreover, the higher the levels of inequality, the less impact economic growth has in reducing poverty - for any rate of economic growth. [Oddly enough, the development community frequently offers poor persons "micro" versions of the advantages that the rich enjoy, such as, micro-credit - a micro-life perhaps...?].

5. Globalization also gives us 'doublespeak': For example, 'free' trade is far from being free - it is very carefully set around the interests of private capital and rich nations. It also fosters the privatization of profits...and the nationalization of losses and debt. Worse even, economic liberalization is cynically made synonymous with political democracy, and the creation of decent livelihoods is made incidental to the making of money for those who already have far more of it than they need.

6. The main differences that we have with the Sachs Report are that the neoliberal approach to health tends to blame the victims; a social justice/human rights approach to health blames the 'system'.

7. Some of the main thoughts that are of relevance to the right to health and to sustainable development in the alternative economics we put forward are as follows:

· The current system must be brought under democratic control.

· The economic system and structures should be informed by the ethical and political values of social justice and human rights.

· There is an urgent need to democratize the debate on economics and on health to encourage public action on these issues.

· Economic growth must be replaced by a fair distribution and sustainable use of existing and new resources; economic growth, when pursued, must not be achieved at the expense of poor people or the environment.

8. Health problems are not solved through technical interventions delivered through health services. Scaling up the access of the world's poor persons to essential health services, including a focus on specific disease-oriented interventions, will not solve their health problems either.

9. The Establishment further regards acting on the major determinants of health as 'complementary and additional actions' rather than as the fundamental actions in reaching Health For All.

10. ‘The major interventions required lie outside the health sector’ - people repeat this over and over. But it is hard to tell if we are dealing with insincere lip service, ignorance or cynicism here.

11. The bottom line is that the proportion of diseases attributable to factors lying outside the health sector - and which cannot be addressed through health services - is overwhelming.

12. It is, therefore, puzzling to find statements in the Sachs Report urging the international health community to undertake yet more research or to base policy on 'evidence' - as if in the past, public health decision makers sifted through policy options selecting at random or even selecting those for which there was no evidence!

13. Do we need to say it again? In the context of basic interventions for health, we do have all the knowledge we need to eradicate the major burden of disease and its root cause - poverty.

14 The political will is lacking among those who have the power to eradicate disease and poverty and who have in no small measure contributed to the current state of affairs (or is it a deliberate choice rather than a lack of will...?).

International aid is the only way to finance health?

15. Seriously suggesting that there are no ways of distributing income and assets between countries other than through international aid is, we think, a fallacy.

16. The Human Rights-based approach to health rejects poverty being ‘a fact of life’ and focuses attention on impoverishment as a process which is inherent to capitalist accumulation and the inevitable and galloping concentration of power and wealth.

17. The factors that allow the North to flourish, the South to wither and the disparities to widen are at the centre of inequities in health. It is simply impossible for all nations to benefit from unfair terms of trade. And international aid is not designed to change the structure and dynamics of relations between North and South. Aid is more an instrument to project power beyond national borders. So we see the globalised economy of today as equivalent and not greatly different from the colonial economy of the past. Moreover, official aid can be considered to function largely as an export subsidy for Northern companies.

18. Aid then, inevitably results in undue influence if not outright interference in national public policy. The supposed beneficiaries (the people) are very rarely consulted, but then neither are their elected representatives.

19. Because of this, the Human Rights-based approach to health rejects the assumption that international aid is the only way to finance health and proposes an alternative assumption: A fair and rational international economic order so that sovereign and solvent states can meet the needs of their people sustainably and without external interference.

(contd)

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

Extracted, adapted and paraphrased from the article by the same name by Alison Katz.

112. The Sachs Macroeconomics and Health Report: Investing in health for economic development or increasing the size of the crumbs from the rich man's table? (Part 2 of 3)

Food for a thought that twists the logic (2)

Models of democracy and respect for human rights:

20. There is no indication currently that people will soon (or ever?) be consulted on budget levels for health or indeed on the choice of economic policies [which may even violate (or have already violated) their rights].

21. Actually, there are strong indications that the same coercion that was applied to implement Structural Adjustment Policies (SAPs) will be applied for Poverty Reduction Strategy Papers (PRSPs) - through the imposition of various conditionalities, for example, or through - against all odds - pushing actions that will make the statistics of MDGs look good with no sustainability left behind.

22. This begs the following not-so-rhetorical questions:

a) Can a donor nation consider itself democratic if it consistently undermines democracy in other countries? and

b) Is a meaningful debate on democracy even possible when wealth and power are concentrated in so few hands?

24. This has led some to speak of 'low intensity democracy', i.e., of participation at the ballot box by a minority of the population...and of the USA having just one party: ‘the business party’...with two factions. (N. Chomsky)

25. No matter how we look at it, there is gross interference by the powerful nations in the democratic processes of developing countries. In particular, the case of the USA is well documented. As Arundhati Roy said: "every kind of outrage is being committed in the name of democracy ".

26. It has become obvious that Capitalism ha mastered the techniques of infiltrating the instruments of democracy - i.e., the 'independent' judiciary, the 'free’ press, parliament - moulding them to its ultimate purposes. Free elections, a free press and an independent judiciary mean little when the free market has reduced them to commodities available on sale to the highest bidder. A wide repertoire of devices is used to subordinate developing countries' economies; many think the WTO is one such device.

27. Will we ever learn that people canNOT be forced to be democratic? Democracy must have a social basis in which it can arise, be nurtured and sustained. Only such a real grassroots democracy in poor countries can lead to the defeat of client regimes installed to serve powerful nations' economic interests.

28. Do we need to remind the reader that, for instance, a handful of corporations dominate the world's media and communications? In 2001, ten of them controlled most of what we heard, read and saw. Yes, we do live in an information age. But we actually live in a media age in which information is limited by boundaries cleverly made invisible. How often do we see the media denouncing the everyday violation of human rights? The bottom line is that private corporations do not exert undue influence on the media. They are the media.

29. Money rules in a world in which everything is a commodity. [A reminder of contrasts helps here: Ford Motor Company is roughly equivalent to the economic size of Norway; Mitsui is worth slightly more than Saudi Arabia].

30 So, in terms of models of democracy, the assumption that the powerful nations responsible for today's world order are models of democracy and of respect for human rights is pure propaganda. Democracy is in crisis everywhere. But the myths about this thrive - precisely because they are rarely subjected to scrutiny.

31. In such a context, it is no surprise that the Alma Ata Declaration of 1978 threatened the status quo. So it was politically sanitized and reduced to a few technological interventions that pushed primary health care back to the era of providing for basic human needs.

This notwithstanding, we contend that the only progress possible in public health today (and in the fight against AIDS) is a return to the wisdom of Alma Ata.

Wishful thinking, ideology and untruths:

32. Unfortunately (but not surprisingly), most ‘explicitly political positions’ promoted in the Sachs Report are presented as neutral and as established facts. Only a fine line divides the Report’s ideology from untruth: There are dozens of examples of ideology disguised as fact.

33. The pharmaceutical industry's profit margins (over 18% compared to around 7% on average in other industries) are justified as a need for them to carry-on with Research and Development of new products. But R&D costs are far lower than the amounts devoted to the marketing of pharmaceutical products - 27% versus 11%. Things like these receive, if at all, uncritical mention in the Report.

34. Another example is the mention of the debt crisis as a constraint to health. What remains unsaid though is that the more explicit purpose of the debt reduction initiatives on the table these days is to make the debt ‘sustainable’ and, in the process, protect the financial integrity of the IFIs.

(contd)

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

Extracted, adapted and paraphrased from the article by the same name by Alison Katz.

112. The Sachs Macroeconomics and Health Report: Investing in health for economic development or increasing the size of the crumbs from the rich man's table? (Part 3 of 3)

Food for a thought that twists the logic (3)

Justifying the reversal of logic:

35. We consider it a reversal of logic that attention in the Report is directed primarily to a few highly prevalent diseases of poverty hoping that conquering them will revert the sorry situation we are in now and that that will ultimately create prosperity for all; this is perhaps the central thesis of the Report. It somehow would have us believe that the recommended health interventions will 'jump start' the economies of poor persons in poor countries.

36. But we counter-argue:

· Poverty is very likely to make poor persons ill repeatedly of a host of many diseases - and the chances are quite high that one of these, together with malnutrition, will kill them prematurely.

· When poor people are in good health, and live in miserable conditions, this is usually only a temporary state.

· Neither health nor illness make countries rich or poor; it is way more complex than that.

· Mainly targeting the main killer diseased is not a sustainable solution to the poor countries’ health problems. It will take more than "each time a person falls ill, they will get the appropriate medicines".

· In short, health may rhyme with wealth, but unfortunately it is not wealth. Good health does not automatically lead to wealth.

38. The losses incurred through unfair terms of trade have been devastating, for example. The rewards of liberalizing world trade are immensely skewed towards the rich....and we want to concentrate on killer diseases?

39. Need another example? Take ATTAC (Action pour une Taxe Tobin pour Assister les Citoyens); it fittingly reminds us that the major bankruptcies of the capitalist world have been absorbed by the state - in other words have been paid for by the people.

40. Not being facetious, debt provides the North with the political and economic leverage that makes it far too valuable for cancellation. For every dollar received in aid, three go back to rich countries to service the debt. This is how debt itself - which can be seen as bonded labour at the level of nations - becomes a major impediment to development. So, debt is actually an obstacle to development that the North continues to impose on the South. As Groucho Marx would have said, the North tells the South: "These are my principles. If you don't like them, I have others".

41. Ethically, we are for asocial justice approach to health. For us, ends are only justified through the use of certain means. A characteristic of an ethical principle is that it is absolute. It can neither be diminished, modified, nor disproved with formulae, models or diagrams, all these so cherished by mainstream economists. Economic reality cannot be fitted into diagrams or econometric models (perhaps in an attempt to make principles more attractive to investors?).

42. But in the Report, growth, market economies, competition, decentralization, cost containment, foreign investment - even public private partnerships - are all presented unquestioningly as desirable. But all of these are means to an end, one that is never made explicit.

43. The Report’s dubious incursions into the field of ethics reveal at best a shallow grasp on international affairs, but at worst, an inexcusable ignorance or simply arrogance.

Asking the ultimate question: Why this Report?

44. This question only brings-on some more questions; a response evades us.

45. Is a discussion of the structural determinants of poverty and inequity and, in turn, of ill-health and preventable mortality threatening to the Report’s authors? Or, Does it threaten the existing order?

46. Did the Report start out just to provide modest relief to the poor so as to defuse a potentially more dangerous situation? Misery is destabilizing, we know that much. If the proposals set forth dampen that spark, will they have served the status-quo? They certainly would not serve the cause of global social justice and human rights...

47. We are worried; worried that the espousal and promotion of a bad set of solutions can inflict great suffering on a large number of our fellow human beings. Was blind faith or blind self interest the driving force behind this Report? Whatever the answer, it is our duty to reject its key prescriptions and embrace the alternative thinking and strategy here sketched.

Playing god?

48. Clearly, the era of hidden agendas is over. If today the purportedly apolitical and ahistorical discipline of macroeconomics explicitly promotes and legitimize corporate-led capitalist globalization - including its application to the health sector - it behoves us to speak up forcefully. This is what these three Readers have attempted.

49. Today, the struggle for health as a right is a struggle against the mechanisms, structures and processes of impoverishment and deepening inequity.

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

Extracted, adapted and paraphrased from the article by the same name by Alison Katz.

112. The Human Rights Discourse in Health (19 key statements)

Food for a flagrantly violated thought

A. Meaning of the human rights discourse in health:

1. The revived interest in a HR-based approach to development and to our work in health is well justified and an advantage over our current approach. Human Rights (HR) - and the Right to Health - have a particular concern about those who are disadvantaged, marginal and living in poverty.

2. Widespread unsatisfied health needs - primarily of the poor who lack economic access to health services (and are now faced with widespread fee-for-service charges) - represent flagrant violations of the rights of a majority of people. This is to be seen in good part as a failure of beneficiaries themselves to act as empowered claim holders placing their demands from a power base that can force non-performing duty bearers (individuals and organizations) to provide the services and resources needed to reverse those violations.

3. We have become quite good at doing detailed Situation Analyses of unfulfilled needs and entitlements. But these only list and sometimes characterize the multiple violations of the right to health. So these represent diagnoses only.

4. To get something done about these violations we have to further embark in Capacity Analyses that look at who is supposed to do what about each of the violations we document (and why they are not doing much or anything). Capacity Analysis has also been called Accountability Analysis, because seeking accountability provides claim holders with the opportunity to understand how duty bearers have discharged their obligation and provides duty bearers with the opportunity to explain their conduct.

5. After carrying out these capacity analyses, we have to - in an organized way, through proactive community mobilization - embark with the beneficiaries in doing-something-about-those-violations, knowing exactly who in health needs to be approached/confronted and with what specific demands.

6. All unfulfilled needs and entitlements, by definition, cause some kind of harm (by omission). But the satisfaction of basic needs is not always seen as a legal obligation by most decision makers - though perhaps seen as a moral obligation. But moral obligations have not been sufficient to satisfy the numerous unfulfilled needs of the poor in the last 40 years (or more) of Northern-led development; much less will they be sufficient to revert the violation of rights.

7. Unfulfilled-needs-and-entitlements do not bind duty bearers. Violations-of-human (people’s)-rights, on the other hand, DO bind duty bearers legally under international law and, among other, under the Constitution of the World Health Organization (WHO). Most countries have signed the respective UN Human Rights Covenants - and this is the most important... We are now demanding duty bearers to legally uphold the health contents of what has been signed by their respective countries and has now been sanctioned by the international community.

8. Moreover, the Constitutions of over 100 countries include the respect of health-related rights; courts around the world are already adjudicating cases involving the right to health. There is thus now a growing body of international HR law and practice to help us identify the specific interventions and policies that are needed to achieve HR goals in health. Therefore, the challenge now is to bring the Right to Health to actually bear upon local, national and international policy making processes and bodies. It is to be noted that proactively influencing policy making in health does not depend on winning related HR court cases; the policy-influencing-approach is not a soft option; it calls for forceful social mobilization: It is not about listening to the powerless and marginal; it is for the latter to be empowered to demand accountability for key structural changes not occurring. The court-based and the policy-based approaches are thus mutually reinforcing and both should be used in our struggle; we thus need to promote both. What is now left is to implement all these practices that operationalize the right to health at the community, at national and international level. This, by addressing issues of poverty, discrimination and stigma particularly in relation to gender issues, children, racism, HIV/AIDS and mental health (*).

9. All this represents an important quantum jump in our prospects to achieve some of the changes we want to see being implemented in health and in society.

10. It needs to be emphasized here that reaching the MDGs also will have to pass through breaking the poverty syndrome behind pretty much all the indicators of the MDGs. In our case, looking at these goals only through the prism of the right to health will only advance our cause in the health indicators (goals), i.e., a very partial victory. Many are calling for specific ‘contributions of the right to health to poverty reduction’. (*) We rather see it the other way around: "how-will-poverty-reduction-contribute-to-the-right-to-health". (Or, at best, we see it both ways, but not the former way alone). We are NOT seeking pro-poor health policies! We are seeking "pro-health-poverty-reduction-policies".

11. The HR cause gives us the possibility to advance our political agenda towards equity, towards the indispensable structural changes that need to be made for health and other social services to receive the resources they need to reverse the corresponding rights currently being violated.

12. We now can face duty bearers accusing them of violating international law. And that is a tactical advantage. We can now demand structural changes under the wing of international law. Our challenge now is to spread the word about this so that, in alliance with claim holders, we can muster the power to give a new direction and greater momentum to our struggle.

B. How to strengthen the HR-based approach in our work in health: (**)

13. The more specific challenge we face is to incorporate the HR-based approach into the Health-For-All-Now agenda. The popularization of what the HR discourse means, as characterized above in a very simplified way, is step one. We need to do this first with our strategic allies in bilateral, multilateral and non-governmental organizations. Several of them have already started: UNICEF has taken the lead among UN agencies to set the course of what needs to be done to apply the HR-based approach in development planning; CARE has made substantial advances in adopting a HR-based approach in its operations worldwide. Because most international, governmental and non-governmental development agencies have not yet re-visioned and re-missioned themselves to adopt a HR-based approach, there is much we can learn from the two experiences cited here - followed by much we can (and need to) do.

14. In step two, it will be for these allies to then bring the new concepts to their colleagues and peers, as well as to a host of different health workers in their respective workplaces and then to community leaders in the areas where they work.

15. The incorporation of capacity analyses to identify and characterize duty bearers that are not doing what needs to be done will, from now on, be key to our work. This process is in itself empowering for us and for the claim holders we work with. (**).

16. Both in steps one and two, it has to be emphasized that there is no hierarchy of HR; there are no ‘competing rights’. All rights are universal and inclusive, so we have to work for their fulfillment in all areas; that is why looking at Health-for-All as part of our struggle for the drastic reduction of poverty is crucial.

17. The neoliberal development paradigm tries to fragment the social reality into sectors allowing partial small victories to be hailed as successes alas with absolutely no sustainability. If the system that causes all the symptoms and signs that come with poverty is not fixed, small victories in health, in education or any other sector are just deceiving us. For example, the emphasis on trade that globalization fosters is not going to benefit the poor unless we specifically build-in fair trade rules AND mechanisms of distribution of the benefits of trade to the lowest income quartile. Or, an example from the health sector would be: We have seen Herculean efforts and resources being poured into the Expanded Program of Immunization; who could fault that when it saves lives? But saves lives for how long? Until the child saved from dying from one of the six immunizable diseases, because s/he is malnourished and lives in a poor and contaminated environment, falls prey to a pneumonia or a diarrheal episode for which we do not have a vaccine yet... Who are we fooling here?

18. What is highlighted here is that we cannot let the forces of status-quo hijack the concept of HR in health. Any partial/sectoral interpretation of this concept is ultimately dishonest. HR is about a more equitable distribution of resources in society and health is one of many entry points to achieve this goal. Human beings are born with a right to health and society has to proactively make the investments to prevent totally preventable ill-health and malnutrition and to treat those affected by the diseases of poverty. Focusing our efforts in anything short of this is a job half done, more so if we do not arrive at such a situation through the empowerment of claim holders themselves to relentlessly demand that the needed changes are implemented. This is not a task for an avant-garde only: it is a mass mobilization task.

19. We are not saying that all this is easy, or fast, or that there are no small victories on the road to achieving our main objectives. But the focus has to remain on the big picture....do not miss the forest!

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

(*): Statement by Paul Hunt, Special Rapporteur on the Right to Health, Commission on Human Rights, 59^th session, March-April, 2003, Geneva.

(**): See article on Human Rights-based Planning further up in this Reader.

115. It will be via Poverty Alleviation Programs that Human Rights will be Fulfilled

Food for a capital thought

To deny people their rights is, by definition, a way to keep them poor.

2. As obvious as this is, suggesting rights-based solutions to this problem always meets a high degree of resistance. This, mainly because sustainable development is inseparable from a rights-based empowering development.

3. Sustainable development is the distributional dimension of the benefits accruing from the process of physical, financial, human, natural, institutional and cultural capital accumulation... and the economic growth paradigm pushed by the Establishment is basically a process of capital accumulation. Only the empowerment of the right-less can break the economic growth paradigm.

4. This is why, Human Rights values and principles must be regarded as, precisely, another form of capital!

5. In order to escape poverty, HR are the form of capital endowment that the poor need to accumulate (within the context of all the forms of capital listed above). This key principle offers a common framework to assess how violations of HR become major determinants of entrenched poverty, because they directly limit the ability of the poor to accumulate HR capital, as well as indirectly limit their access to other forms of capital.

6. Any process to achieve collective welfare is thus permeated by issues of HR. This means that any policy prescription in welfare economics rests on the application of HR principles. This is why HR are more than just laws, rules and regulations to be enforced and complied with. HR must be understood as an integral part of any initial endowment that the poor can draw upon to allocate, use, manage and control all other forms of capital.

7. In that way, HR contribute crucially to the efficient andfair ‘allocation of HR and all other forms of capital’. The state-of-HR-capital of the people is the most powerful explanation of how resources are allocated. This makes the mainstreaming of HR a must, so much so that this is to become the key element of development work.

8. HR are thus to be seen as a significant modifier-of-the-enabling-factors-needed-for-development. Exclusion from any form of HR capital explains underdevelopment and poverty. Precisely because they are uncoupled from issues of human capital and rights, infrastructure development projects have not attained effectiveness and have actually been of marginal benefit to the poor.

9. HR, as an initial capital endowment, imply a number of things in regards to equity, social justice and poverty alleviation, e.g., wage levels depend on whether HR are effectively realized or not.

10. For people-who-are-rich-in-all-forms-of-capital, HR (as another form of capital) may not be important. For the poor it is essential. This is why HR capital is so important in addressing the challenges of poverty and inclusion. In addition, HR as capital is important in relation to the ways in which governments and societies define anti-poverty policies. The proactive acquisition of HR capital is an essential component of any serious empowerment strategy. This, because empowerment leads to a societal re-distribution of rights and obligations; empowerment ultimately affects how all forms of capital are allocated and used in society. This is why HR must be seen as a key dimension of development rather than as a residual factor in economic and financial decisions. To disregard the importance of HR is tantamount to keeping people in poverty.

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

Mostly adapted from International Social Science Journal, No.180, UNESCO, 2004: A Sfeir Younis, Violations of HR as determinants of poverty.

(SCROLL ON: CONTINUED UP TO READER No. 211, MARCH 2009)