Globalisation and health inequalities: Can a human rights paradigm create space for civil society action?
Highlights
► A neglected aspect of health systems analysis is the role of human rights approaches in strengthening pro-poor protections. ► Human rights paradigms can strengthen parliamentary oversight over the executive to advance health equity. ► Human rights paradigms can enable civil society agency critical to hold states accountable for the right to health. ► ‘Cunning states’ selectively disown accountability for socio-economic rights under diffused systems of global governance. ► By increasing state accountability, human rights can counter the negative consequences of globalization for health equity.
Section snippets
Background
Despite increasing technological innovation and advances in scientific knowledge, the health status of the world’s people remains threatened by high morbidity and mortality from long-existent infectious diseases such as malaria and tuberculosis, alongside new epidemics such as HIV/AIDS and avian flu (Boutayeb, 2006, Folch et al., 2003) as well as a seemingly relentless growth in non-communicable diseases related to trauma, chronic diseases and cancer, amongst others (Boutayeb, 2006). These
What does a human rights framework imply?
Human rights are entitlements people can claim because of their inherent humanity. Typically, they take the form of social or material claims that are universal across cultures and settings and are codified in national and international law. Human rights address fundamental needs and originated in concerns to protect people from an abusive state by limiting state power over individuals. The ‘modern’ human rights institutional framework guarantees for all of us, irrespective of the countries we
Human rights and health systems
The hallmark of a human rights approach to health systems is a set of principles (Table 1), which Chapman (2009) argues run contrary to the rationale of neoliberalism. For example, while neoliberalism focuses on the market, treats the conditions needed for health as commodities and benefits the most economically advanced, a human rights approach is based on the recognition of the inherent dignity and worth of the human person, frames the social determinants of health as public goods and focuses
States and human rights obligations under globalisation
What might be expected from governments committed to human rights when facing threats to human health from the consequences of globalisation? Logically, governments should use regulation to pursue economic policies that prioritise the needs of the most vulnerable of its people and approach policy negotiations regarding international cooperation from that same perspective.
However, there is evidence to the contrary (Katz, 2004, Katz, 2002; Loewenson, 2001, Meier and Fox, 2008). The normative
Methods
We explore this contradiction through a case study approach, which seeks to investigate a ‘phenomenon within its real-life context, especially when the boundaries between phenomenon and context are not clearly evident’ (Yin, 2003: 13). The propositions examined are that states renege on meeting obligations to the poorest of their peoples because of both unwillingness and failure of oversight; further, that civil society action is essential to both accountability and oversight of states for
Institutional accountability and the ‘Cunning State’
In both case studies, therefore, institutional accountability emerges as critical to the success or failure of human rights as a vehicle for health equity. It has been argued that public policy is being removed from “national legislative deliberation” and that the increasing rhetoric of accountability, in the form of attention to good governance, has gone hand-in-hand with increasing unaccountability of transnational corporations, international finance and trade organisations (Randeria, 2003:
Civil society: social movements and the right to health
Drawing from the Alma Ata declaration on Primary Health Care, the role of community participation in health is widely recognised. Less widely accepted, though, is its normative role within a rights framework, given conflicts over cost-effectiveness and evidence-based policies. Participation becomes key to the realization of the right to health through fair, transparent and meaningful procedures that engage relevant stakeholders and which generate both equitable outcomes and processes (Potts,
Conclusion
It is in the context of this dance of donors and states, in which donors know that states accept human rights standards they have no intention or capacity to implement but to which donors turn a blind eye, that civil society calls for a strong state as a bulwark against globalisation represents a challenge to the idea of the state as being the only site of norm production. Where states manifestly subordinate the health claims of people, particularly marginalised communities, human rights
Acknowledgements
The empirical data on parliamentary experiences in Southern and Eastern Africa was drawn from research funded by the Swedish International Development Cooperation Agency (SIDA) and conducted with the support of Southern and East African Parliamentary Alliance of Committees of Health (SEAPACOH) and the Regional Network for Equity in Health in East and Southern Africa (EQUINET). The assistance of Mr Boitumelo Ngkudi and Dr Nayna Manga in data entry and analysis is acknowledged as is the
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