Posted by Gorik Ooms

reply from Claudio Schuftan to William Easterly's comment in the Financial
Times (http://www.ft.com/cms/s/0/89bbbda2-b763-11de-9812-00144feab49a.html)
********************
HUMAN RIGHTS ARE INDEED A FUNDAMENTAL BASIS FOR THE FUTURE OF HEALTHCARE A
rebuke to William Easterly's Financial Times piece.

It is regrettable to read a piece based on such ignorance –more so coming
from a prominent economist who is supposed to know better. It is obvious Mr
Easterly is only familiar with the Universal Declaration of Human Rights and
has not kept up with the ICESCR and the corresponding General Comment on the
HR to health.

As an economist, he should know that the global-right-to-health-campaign is
precisely aimed at making access to healthcare more equitable, and that it is
preposterous to say that it "has made global healthcare more unequal".

The "right to health" may have its origins in the United Nations' Universal
Declaration of Human Rights of 1948, but has been vastly expanded since with
newer UN covenants and general comments. Past successful (?) efforts in
health –"such as the World Health Organisation and UNICEF campaigns on
vaccines and antibiotics were [indeed] based on a more limited goal:
obtaining the largest possible health benefits for the poor from finite
foreign aid budgets"…But what do they have to show-for in terms of even
touching the conditions of poverty and the social determinants of health that
are at the root of perpetuating conditions of preventable ill-health,
preventable malnutrition and preventable deaths?

Yes, "the moral argument [has] made a big comeback in the new millennium", Mr
Easterly. And it has now added a combative political component based on
demanding accountability for the obligations sanctioned by international
human rights law. "Dr Paul Farmer [is right in] saying that healthcare is a
fundamental human right, which should be available free"… and WHO is right
in "shifting from pragmatic [meaning what?] improvements of health outcomes
towards the universal realisation of the right to health".

Mr Easterly asks: "So what is the problem? And responds: "It is impossible
for everyone immediately to attain the highest attainable standard of health"
But that is what the HR-based framework strives-for, Mr Easterly. And you are
100% right on the following: "The human right to health [IS] realised in a
political battle".

I ask readers, is your experience compatible with what Mr Easterly adds
thereafter?, namely that "political reality is that such a 'right' is a trump
card to get more resources". How I wish it were true… Furthermore, he may
be right that one of "the biggest victory of the right to health movement has
been the provision of aid-financed antiretroviral treatment for African Aids
patients". It was the social mobilization that empowered people living with
AIDS to bring this about –and that is no small step in the direction of
human rights.

The same empowerment has not happened in malaria and TB where global efforts
have been typically top-down (or has not happened for diarrhea or pneumonia
where there are not even top-down programmes any longer).

For the information of Mr Easterly, his statement that "rights advocacy
favours some aspects of health relative to others", let it be said that in HR
work all HR violations receive equal attention; this is one of the main HR
principles and, therefore, includes claim holders demanding their "right to
prevention". The fact that in Pepfar "only 22 per cent of its budget goes
towards prevention, compared with
48 per cent towards treatment" is proof of the misguided direction a top-down
project can and does take.

Moreover, it is maliciously deceiving to say that "we can never be certain
the right to health may have cost more lives than it has saved". And only an
economist with limited public health knowledge can say (after what selective
PHC did) that "the pragmatic approach –directing public resources to where
they have the most health benefits for a given cost– historically achieved
far more than the moral approach". That evidence is just not there.

Finally, Mr Easterly shows his ideological colours when he ends by saying
"the international experience is that this 'right' skews public resources
towards the most politically effective advocates, who will seldom be the
neediest". Yes Sir, right to health work does skew public resources towards
the most politically effective advocates –and those invariably ARE the
neediest.

Claudio Schuftan, Ho Chi Minh City
Cschuftan at phmovement.org

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