** Health rights as a tool for health equity
Abstract of paper presented at the Equinet conference, Durban, 8-9 June 2004, by Leslie London, University of Cape Town, EQUINET theme co-ordinator
Health rights as a tool for health equity Leslie London, University of Cape Town, EQUINET theme co-ordinator Most public health practitioners acknowledge the value of human rights in promoting human well-being. However, there is potential for tension between human rights approaches and public health objectives such as equity, access and efficiency, particularly in developing countries where resource constraints exacerbate balancing of competing priorities. This potential tension may stem from inappropriate conceptualizations of human rights and how they should be operationalised in a public health context. For example, where human rights are conceived as individual entitlements, public health officials could erroneously equate this to favouring individuals over the welfare of the community to the detriment of equity. Health and health care are recognized as human rights, which span the full range of civil, political and socio-economic rights, many of which are essential requirements for health. Human rights approaches include the use of internationally recognized standards for policy development, for analysis and critique government performance, and for the facilitation of redress for those who suffer rights violations. Considerations of social justice and social patterning are core to what constitutes a human rights approach. Human rights approaches, therefore, should fundamentally serve as important tools to support advocacy and civil society mobilization. Three case studies in Southern Africa were explored to highlight a human rights approach for the promotion of health equity: (1) Treatment access for HIV (South Africa), (2) Use of Patients’ Rights Charters (Malawi, South Africa, Zimbabwe), and (3) Civic Organising for Health (Zimbabwe). The main findings to emerge from the studies are that human rights approaches could offer powerful tools to support social justice and institutional transformation when: § Rights approaches are predicated upon casting rights in a specifically vulnerable group context; § The operationalisation of rights confers agency on the part of those most affected, and § Rights include the complete spectrum of civil, political, and socio-economic rights. Public health concerns for equity then become consonant with human rights-based strategies. The synergy between public health and human rights in relation to equity lie less in the setting and mechanisms for pursuing individual rights, but rather in social processes and consciousness, and the interface with the state that secures collective rights. Key themes emerging from the study illustrated the importance of collective agency: Rights alone are insufficient, need to be coupled with community engagement and can both be realized by and, in turn, strengthen community engagement. When conceived in terms of agency, particularly collective agency, rights are the strongest guarantors of effective equity-promoting impacts. To build equity, rights approaches should address the public-private divide, provide opportunities for mobilising resources outside the health sector, utilize access to information and emphasise transparency. Numerous questions remain as to how to test out these preliminary findings in further depth and in the context of international inequities. It is evident, though, that important gains can be made for equity using a human rights approach. Health systems analyses need desperately to muster stronger rights arguments to ensure equity promoting transformation.