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New video – The Struggle for Health in El Salvador

August 16, 2011

Dr. Violeta Menjivar, Vice-Minister of Health, and Dr. Argelia Dubon, Director of Health Clinics, discuss the current health reform in El Salvador in the context of the Salvadoran revolution.

In Spanish with English subtitles

Part I
Part II


Right to Health Series: Part 2

May 25, 2011

The first installment of this series on the right to health summarized what this right requires of governments. Human rights are more than just prescriptions for governments, however. They are an ethical system that applies to everyone and are the responsibility of everyone to practice. Human rights treaties, the written comments of the treaty committees, and the experiences of people practicing human rights are a guide to living together with the values that are the foundation of human rights: justice, dignity, inclusion, equity/equality and solidarity.

Practicing human rights in our daily lives and work is often referred to as a rights-based approach. The concepts that form the core knowledge base of the rights-based approach (RBA) grew out the work of the international development community. After many years of failing to significantly decrease poverty, some development organizations began to look critically at their work. They realized that poverty is not merely an absence of resources, but results from human rights violations. Simply trying to meet material needs, or provide health care services, whether through the government or the market, will not decrease poverty and marginalization over the long term. Neither addresses the deep injustices and societal systems that produce poverty in the first place. Only empowering people whose rights are violated can change those systems.

As people who work mostly in health we are very comfortable with a needs-based approach. When faced with a health problem we know what resources or actions are needed to treat and prevent it. For example, when diarrhea is common in a community there are a couple of strategies we commonly use. First, we try to change community members’ behaviors that promote diarrhea. We provide community education to teach hand washing and how to boil or chlorinate drinking water. Another strategy is to provide so-called appropriate technology and small-scale infrastructure. We fund wells or village level water purification systems and latrines. These projects may decrease diarrhea and lead to other improvements in the short term, but over time the human rights violations that maintain the system that produced the living conditions of the community will limit and undermine the positive change. The community might not have (or might lose) the know-how or resources to maintain the well pump. Because they live on marginal land, a flood or landslide might destroy the well.

A RBA explicitly uses different strategies to solve problems. It doesn’t exclude addressing needs, but it emphasizes realizing rights by uncovering and addressing the root causes of problems – the systems that perpetuate human rights abuses. A RBA protects and takes into account the groups most at risk of human rights violations due to marginalization and discrimination. The people affected by the problem are always included in all aspects of the program to solve it. A RBA program often focuses on building the capacity of marginalized groups and victims of human rights violations to claim their rights from governments or other duty bearers. But it also targets duty bearers to increase their willingness and capacity to fulfill their responsibilities. By identifying underlying causes, claim holders, and duty bearers a RBA enables people to specifically change systems of power.

Characteristics of NEEDS-BASED vs. RIGHTS-BASED programs

NEEDS-BASED                                                            RIGHTS-BASED
Emphasize meeting needs                                             Emphasize realizing rights
Focus on input and outcome                                         Focus on process and outcome
Individuals deserve assistance                                      Individuals are entitled to solidarity
Focus on immediate causes of problems                    Focus on structural causes and their manifestations
Recognize needs as valid                                                Recognize individual and group rights as claims
on duty-bearers
Individuals are objects of anti-poverty                       Individuals and groups are empowered to claim their
interventions                                                                     rights

Much of the information and the table in this article were adapted or copied from The Advocates for Human RightsA Rights-Based Approach to Social Justice Work: Training of Trainers Manual by Emily Farrell and Madeline Lohman.

Right to Health Series

September 8, 2010

I have been asked to write a series on the right to health for the Doctors for Global Health newsletter, the DGH Reporter. This is the first installment and it had to be very short. The next will be out in October or November, and hopefully, longer.

Right to Health Series – Part I

The right to the highest attainable standard of health is more than a slogan or aspiration. It has been well defined by the work of scholars and activists and contains very specific standards. By applying these standards in our own work and organizations, and by using them to hold governments to account, we can make the right to health a reality.

Economic, social and cultural rights, like the right to health, are the same as the political and civil rights we understand better in the US. We understand that in order to make the right to a fair trial more than just a slogan, we, through our government and other institutions, must put into place a justice system that meets certain standards. That system must include, for example, the presumption of innocence, rules about police conduct, and access to a lawyer. These are also rights in themselves.

If we are all to be as healthy as possible, we must create a health system that meets standards that have been shown to promote health for all. Briefly, those are:

  • Governments must put into place to a system to prevent people from getting sick or injured and to treat them if they do. 
(We don’t have a health protection system in the US. We have a patchwork of agencies like the OSHA and FDA. Our public health system has been under funded for many years. Medical treatment is also funded and provided through a patchwork of clinicians and insurers.)
  • All health related facilities, goods and services must be available, accessible, acceptable, appropriate, and of good quality. This means that everything that is done to improve health, from medical care to water treatment, must be available to all. Access shouldn’t depend on things like being able to pay or to fit your wheelchair in the door.  Services must be acceptable to people of different cultures and who speak different languages. “Appropriate” means that services that are unnecessary or extravagant shouldn’t be given.
  • Governments must respect, protect and fulfill the right to health. 
(We all should ensure that our actions as neighbors, workers, and citizens are consistent with human rights, but it is ultimately the government’s duty to make progress towards their complete realization.)
  • The system must include ways to monitor compliance with human rights obligations, accountability mechanisms, and remedies when there are violations.
  • People affected by health related policies must participate in the creation and monitoring of those policies.
  • Every person has freedom to make decisions about his/her own health.
  • These rights apply to EVERYONE without discrimination.

More details about what the right to health contains and how people are using it around the world in the next installments of this series.

A simple language suggestion for clearer thinking on health issues

February 4, 2010

If you can substitute the word “health” for “health care,” then say “health.”

If you can’t substitute health, then try “health system.”

If by “health care” you mean “medical care,” say “medical care.”

Do it. Think about it. See what happens.

Why don’t most “progressives” talk about what is really going on in health care reform?

January 16, 2010

I heard a very nice discussion today on KPFA radio about the latest on health care reform. (You can listen to an archive of the show here for the next two weeks.) This show has been featuring regular programs about heath care reform  (HCR) and what activists can do to improve the legislation. The regular guest is very knowledgeable and is experienced in lobbying for health related causes. She and the other guests today went into a lot of detail and suggested many action steps for people who want to make the bill better.

The discussion was mostly about the behind the scene reconciliation negotiations going on in the congress and how different parts of different bills might make it or not depending on who among the Democrats would refuse to vote for the final bill. There was also a lot of discussion about the abortion restrictions in both bills, what they would mean for women and different efforts going on to prevent them from going forward in the final bill. But in the end the guests made it clear that, despite all their complaints about the bill and their previous statements about how bad the abortion restrictions will be for women, they would encourage their representatives to vote for it because it really is a step forward, or some such nonsense.

The main problem with the discussion, and much of the HCR discourse among so-called progressives, is that it is like getting a great description of the ripples on the surface of the water produced by a feeding frenzy of sharks in the depths. You can analyze and describe the ripples very accurately, but they aren’t what is really going on. Since you aren’t fully aware of what is actually going on, you can never calm or control the ripples in any  significant way. Even if you do influence the ripples, the sharks don’t care and will keep on feeding until they have finished the seals. In other words, the people on this show never talked about what is really going on. As I outlined in this post, HCR is happening this year and taking the form that it is because corporations need new regulations and government funding to maintain their future profitability. The left has had no victories in HCR this year because they don’t understand the sharks and they still believe the ripples respond to their constituents. One of the most pitiful statements made by a guest was that we should keep up those phone calls and emails because the congress people and staff tell them that they keep track of those calls and “they aren’t hearing from us”. What are they going to say? “Don’t bother, we would love to take your concerns into consideration, but we can’t because the representative is depending on contributions from Pharma/AHIP/AARP to win the next election. Or, if he loses, to get appointed to the board of  Novartis.” The suggestions to call your representatives to ask them to tweak one element or another of the legislation is completely pointless. You are not a shark. They will send you to the answering machine.

Today there is yet another example of the sharks calling the shots. Obama and the Dems are being forced to re-negotiate their deals with Pharma and other industries as described in this article on Politico. Demonstrating how important the 12 year data exclusivity term for biologic drugs is to them, Pharma will pull its support for HCR if the final bill cuts the time down even to 10 years. The form the final bill takes doesn’t have anything to do with what we need. It is about the different industries with sometimes aligned and sometimes competing interests each trying to get the most they can out of the bill, and the Dems trying to give them as much as they can without getting a worse score from the Congressional Budget Office.

So why don’t many otherwise well informed and well-intentioned people on the left pay any attention to this or talk about it even they do know about it? I’m not them, of course, but I have several ideas.

1. If you admit this then you have to admit that everything you’ve been doing in your life as an activist (communicating with your representative, marching in the street or standing in front of buildings with signs, sending letters to the editor, etc), and that you’ve been telling others to do, has been mostly ineffective and a waste of time.

2. If you recognize that corporations call the shots then you have to admit that the US is no longer a democracy.

3. If you admit these things then you will have to conclude that your strategies and tactics need to change.

4. If you think about what might lead to a positive change, you have to conclude that what you do must actually negatively impact the corporations, the dysfunctional government structures, and the people who most benefit form the current status quo. Then you realize that this kind of action involves much more personal risk than you are willing to take. So you try not to think about it anymore and be hopeful instead.

Health-care reform and the right to health in the USA: our letter on the cover of The Lancet

December 7, 2009

The Lancet, Volume 374, Issue 9705, Page 1887, 5 December 2009
Health-care reform and the right to health in the USA
Laura Turiano, Matthew Anderson, Todd Jailer, Maureen McCue, Mohammad Shahbazi, on behalf of People’s Health Movement—USA

Thanks to everyone who contributed to the editorial! Besides the authors listed (The Lancet has a limit of 5), Michael Terry and Sarah Shannon also should be acknowledged.

One other note – the editorial was written before the inclusion of the Stupak Amendment in the House Bill, otherwise it would have mentioned this violation of women’s right to health.

This has also been posted with additional commentary by one of the coauthors at Social Medicine Portal.

Read PNHP blog series: “Two-thirds of Americans support Medicare-for-all”

December 7, 2009

Kip Sullivan, who writes on the Physicians for a National Health Program blog, has a new 6 part series coming out,  “Two-thirds of Americans support Medicare-for-all.” His work on what is really behind the public option movement (who he calls the “yes buts”) provided background for some of the things I have written in this blog. The new series debunks the central myth they have promoted, that fighting for single payer is politically unfeasible because Americans don’t support it.

This six-part series explores the research on American attitudes about a single-payer (or Medicare-for-all) system to evaluate the truth of the new version of the “yes but” argument. We will see that the research demonstrates that approximately two-thirds of Americans support a Medicare-for-all system despite constant attacks on Medicare and the systems of other countries by conservatives. The evidence supporting this statement is rock solid. The evidence against it – the focus group and polling “research” commissioned by the “option” movement’s founders – is defective, misinterpreted, or both.

The diversion of many progressives away from fighting for medicare for all caused by the “yes buts” in this latest health care reform round not only ensured that single payer would never have a chance. It has allowed legislators to craft a giveaway to the healthcare industries under the guise of reform. People involved  with groups like HCAN, SEIU, Health Access and others need to do some serious self examination and understand which side they are on.