By Pia Riggirozzi and Erica Penfold. Pia Riggirozzi is Senior Lecturer in Global Politics at University of Southampton (@, Academia.edu) and Erica Penfold is Research Officer at the South African Institute of International Affairs. Both are partners at the ESRC-DFID funded project ‘Poverty Reduction and Regional Integration: SADC and Unasur Health Policies’ (@PRARIRepir). You can find more posts by Pia here.
In recent years there has been growing global awareness of the interplay between rights and the development process and a generalised recognition of social determinants of health connecting poverty, equality and health. Yet, for millions of people throughout the world, the full enjoyment of the right to health still remains a distant goal. Poverty remains one of the driving forces behind ill health, a lack of access to healthcare and medicines and consistent underdevelopment. The World Bank shows that 700 million fewer people live in conditions of extreme poverty in 2010 than in 1990 across developing regions. However, the Global South is still struggling, everyday thousands of children, women and men die silently from preventable diseases associated with poverty.
The United Nations acknowledges these issues as it continues to produce a stream of further guidance in the form of General Comments, such as the General Comment 14, while sponsoring global Declarations and Commissions on Social Determinants of Health. Human Rights Day observed by the international community on 10th December since 1950 acts as a reminder of the importance of recognition and advancement of rights and the human right to health. But the current high-level focus on health by the international community while recognising the strong relationship between poverty and health, in practice, has been quite conservative in turning the rhetoric into practice. Translating normative principles into politics of compliance and practices for policy implementation remains uneven across the wide spectrum of human rights issues, acknowledging and affecting bearers of rights in different ways. For William Easterly this is clear, ‘which rights to health are realised is a political battle’ contingent on a political and economic reality that profits on the margins of (poor) health. He is right, we can’t downplay politics. Think of a funder – whether the Gates Foundation, Welcome Trust, private charity or government programme – their agenda may well spend a great deal of resources (financial and human) on dealing with one disease. Or programmes advanced by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund, or the Gates Foundation; despite having the best intentions, they may be guided by their own views, agendas and objectives. Undoubtedly, diseases like HIV, malaria and tuberculosis account for over 90 per cent of the global disease burden, yet the millions of dollars poured into programmes to tackle these diseases have done little to tackle weak healthcare systems which are in many cases unreachable or distrusted by the people they are designed to help. Equally critical, other peoples’ rights could be neglacted if diseases like dengue, leishmaniasis, Chagas and Chikungunya that also add to the increasing toll of human life and to the poverty-disease burden receive little attention. The risk is that what is visible and urgent leads over what is marginal and that actions targeted to the poor, yet ignoring the social factors that cause poverty and exclusion, discriminate positively, normalising and even reproducing inequities. The Ebola outbreak in West Africa is another reminder of these risks.
The realisation of people’s rights, entitlements, and obligations, is largely determined by the nature of the state and its capacity to respond to internal public demands, interests, and pressures. Philanthropists in rich countries and the global aid community more generally can mainstream and support national strategies. But we believe there is a role to pay by the neglected partners in development: regional organisations. Regional organisations can be key engines in the development of progressive social policies and advocacy of rights. For example, the Economic Community of West African States (ECOWAS) has established a regional court of justice adjudicating on national labour rights, while the Union of South American Nations (UNASUR) is now driving initiatives to expand entitlements to health care and social security within member states and it is shaping policies around disability all over the world, negotiating with one voice at the World Health Organisation. This makes sense because some social harms and epidemics are inherently cross-border, and are exacerbated or facilitated by regional developments.
Regional organisations that were built for other reasons are now becoming much more important for health and will be particularly important if we look at the Post-2015 Agenda. Organisations such as UNASUR and ECOWAS can provide donors and partners with a single point of contact for discussions and implementation of poverty reduction programmes in member countries. They are close to their populations and can develop technical cooperation, building infrastructure and strengthening capacity between the member states, rescaling practices to reduce socio-economic disparities.
Renewed focus on health, as a basic human right, is a poverty issue. It demands thinking about the deep determinants of (under)development and social exclusion and national, regional and global commitments to enhance access to health care, to medicines, to opportunities. Neglecting this will be a tragedy of aid assistance and possibly of the Sustainable Development Goals.