Combining health and social protection measures to reach the ultra ...

Access to health
Resources outside
the health sector
Community
engagement
Access to information
Agency:
vulnerable groups
Agency:
vulnerable individuals
Alliances vulnerable
with non-vulnerable
National
Public and
private sphere
Public
sphere
International
Health
equity
Human rights
approach
Figure 1: Human rights approaches, agency and equity: a model 5
movement, human rights campaigns have effectively won
victories for expanding access to care for millions worldwide
through judicious partnering of governments in court action
against pharmaceuticals and in trade negotiations to protect
national capacity to invoke special measures for health
emergencies 5 . This is particularly important given the trend
under globalization towards the weakening of national
sovereignty. Even in tackling the thorny issue of human
resource migration, the notion of an “international mobility
regime” that addresses the critical needs of developing
countries 30 will not be effective without a recognition of the
inter-relatedness of national obligations of both source and
recipient countries to respect, protect and fulfil the right to
health and international oversight consistent with provisions
of the International Covenant on Social, Economic and
Cultural Rights. For that reason, it has been proposed that
with the growth of Health Impact Assessments as a tool for
assessing health impacts of policies, programmes or
projects 31 , human rights criteria be incorporated into such
tools, bringing accountability to, not only governments, but
also trans-national corporations and multilateral bodies 29 .
Such strategies provide the opportunity to address global
phenomena impacting adversely on health equity such as
foreign and trade policy, helping to realize formal global
commitments to health as a right 3 .
Lastly, the case studies from Southern Africa highlight how
human rights strategies provide opportunities for mobilizing
resources required for health from outside the health sector.
Partly by mobilizng constituencies across sectors and partly
because health is itself determined by factors outside the
health sector, human rights challenges in areas of housing,
social security, water and sanitation contribute to health
equity-oriented policies and programmes.
To summarize the evidence: where it is clear that rights
approaches are predicated upon understanding the need to
prioritize vulnerable groups, where the way rights are
operationalized recognizes the role of agency by those most
affected, and where rights are conceived as the complete
spectrum of civil and political, through to socioeconomic
rights, human rights approaches appear to offer powerful
tools to support social justice and health equity (Figure 1).
Public health concerns for equity then become entirely
consonant with human rights-based approaches. The synergy
between public health and human rights in relation to equity
lie less in the pursuit of individual rights but rather in the way
social processes and consciousness are given the opportunity
to interface with the state in ways that secure
collective rights.
New directions, ongoing challenges
In the context of development economics, Sen demonstrated
the link between equity and empowerment 21 and the role of
opportunities to develop individual capacity as critical to
development and health. Rifkin has built on this theoretical
work to develop a framework for understanding the
relationship between equity and community empowerment
for health, emphasizing the critical importance of active
engagement by both individuals and collective to address the
situation responsible for their condition 24 . Not only are human
rights one of the pillars of the model (the “H” in her acronym
CHOICES), but they also inform the applications of the other
elements in the model (Capacity-building, Organizational
sustainability, Institutional accountability, Contribution, and
an Enabling environment).
A second area for further development is the critical need
for resource allocation models that incorporate active and
056 ✜ Global Forum Update on Research for Health Volume 4