ACTIVISM AS A SOCIAL DETERMINANT OF HEALTH

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    EQUINET NEWS is designed to keep you informed about materials on

    equity and health in east and southern Africa, focusing primarily on

    EQUINET's principal themes. It includes news about EQUINET activities,

    policy debates or theme work to keep you updated on work taking place.

    Further information on EQUINET activities is available from the

    EQUINET secretariat at Training and Research Support Centre (TARSC)

    (email: admin@equinetafrica.org).

    ////////////////////////////////////

    1. Editorial

    ACTIVISM AS A SOCIAL DETERMINANT OF HEALTH

    Mark Heywood, SECTION27, South Africa

    We are living during a time of unprecedented threat and opportunity

    for the right to health. We are seeing cutbacks in the funding for

    prevention and treatment of HIV, retreats from commitments to

    ‘universal access’ to HIV and TB treatment, attacks on human rights

    and new threats to national and global health, including through

    climate change and food insecurity. At the same time there are new and

    better technologies available for health, new medicines and

    diagnostics for common diseases like tuberculosis, and an array of

    interventions that could improve health and reduce malnutrition. Some

    states, particularly South Africa and Brazil, are seriously seeking to

    improve health on the principle that health is a human right. But it

    is questionable whether they have the resources to do it. There are

    examples of growing global co-operation and legal agreement around

    social challenges, such as climate change, although not yet around the

    most immediate social challenges that face the poor. Activist

    movements exist around AIDS, health and around social justice.

    The Commission on the Social Determinants of Health pointed to the

    demand for a response to this moment of contradiction between threat

    and opportunity from a leadership and governance that is driven by

    social justice. It stated: “In order to address health inequities, and

    inequitable conditions of daily living, it is necessary to address

    inequities – such as those between men and women – in the way society

    is organized. This requires a strong public sector that is committed,

    capable, and adequately financed. To achieve that requires more than

    strengthened government – it requires strengthened governance:

    legitimacy, space, and support for civil society, for an accountable

    private sector, and for people across society to agree public

    interests and reinvest in the value of collective action. In a

    globalized world, the need for governance dedicated to equity applies

    equally from the community level to global institutions.”

    This is not a new call. It resonates with the recognition of the right

    to health as a human right found in the 1946 World Health Organisation

    Constitution, the 1966 International Covenant on Economic Social and

    Cultural Rights (ICESCR), the 1978 Alma Ata Declaration and the 2000

    UN Committee on Economic, Social and Cultural Rights ‘General Comment

    14’ on Article 12 of ICESCR. Increasingly it is also reflected in the

    incorporation of the right to health into the national constitutions

    of over seventy countries in the last decade.

    Nevertheless good health and access to adequate health care services

    remains out of reach to billions of people. Nearly two billion people

    (a third of the world’s population) lack access to essential medicines

    and about 150 million people suffer financial catastrophe annually due

    to ill health, while the costs of care pushes 100 million below the

    poverty line.

    The world is well aware of these facts. They are published by the WHO

    and others. When these facts are raised in international forums, it

    has led states to make bold promises….that they later do not keep. In

    Africa, 19 of the African countries who signed the 2001 Abuja

    Declaration to spend 15% of their government budget on health

    al¬locate less now than they did in 2001. Yet the WHO indicate that

    low-income countries could raise an additional US$ 15 billion a year

    for health from domestic sources by increasing health’s share of total

    government spending to 15%. Neither are high income countries meeting

    their promises. According to the ‘Africa Progress Report 2010’,

    published by a unique panel chaired by Kofi Annan, when the $25

    billion Gleneagles commitment comes due at the end of 2011, the

    resources allocated by G8 countries will have fallen short by at least

    $9.8 billion. The panel calls this a “staggering shortfall.”

    Does this mean that the right to health has no value? No. Has the

    right to health been sufficiently popularised or used? No. Are the

    state and United Nations institutions who have a duty to protect and

    realise the right to health fulfilling their obligations? No.

    In the last decade AIDS activists have established in practice the

    principle that states must fund treatment as a right, with the

    organisation of resources globally to meet this obligation. Currently

    we are seeing a reversal of this basic entitlement, as the right to

    these resources are being challenged by arguments over cost

    effectiveness, a retreat from funding treatment in middle income

    countries, despite the fact that three quarters of the poorest people

    in the world live in middle income countries; and a claim that too

    much money is going to AIDS treatment, despite the fact that an

    estimated ten million people still need treatment globally. Some

    states in low income countries claim to have inadequate resources for

    health even while their political and economic elites grow visibly

    wealthier, and even states who have met the Abuja commitment try to

    fairly distribute unfairly inadequate amounts of money for health.

    The Commission on the Social Determinants of Health called for

    conditions that would enable civil society to organize and act in a

    way that promotes and realises the political and social rights

    affecting health equity. It seems that we should go further than this,

    given the reversals in progress and growing inequalities in health. We

    need to see the level of activism by civil society as a key social

    determinant of health. The fight for health should be a central pillar

    of all movements for social justice and equality, not in the abstract,

    but for the specific goods, institutions, demands and resources that

    will realise the right to health.

    Please send feedback or queries on the issues raised in this briefing

    to the EQUINET secretariat: admin@equinetafrica.org.This is an edited

    extract of a speech given at the Southern African Regional Dialogue on

    Realising the Right to Health in March 2011. For more information on

    the issues raised in this op-ed and for this and other presentations

    made at the conference see: http://www.section27.org.za.

     

     

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    EQUINET NEWS IS THE ELECTRONIC MAILING LIST OF THE NETWORK FOR EQUITY

    IN HEALTH IN EAST AND SOUTHERN AFRICA (EQUINET)

    http://www.equinetafrica.org/

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