Zika and the political battle of rights

By Pia Riggirozzi, Associate Professor in Global Politics at the University of Southampton (@PRiggirozziAcademia.edu). You can find more posts by Pia here.


 

In recent years there has been growing global awareness of the interplay between rights and social development. In 1997, in an attempt to mainstream human rights as a central feature of all UN programmes, the UN Secretary-General Kofi Annan, called for a reorientation of the UN’s mission to reflect the realisation of human rights as the ultimate goal of the UN (UNDP 2005). Within this approach, the UNDP declared that human rights should not be regarded as the outcome of development but should rather be seen as the critical means to achieving it. With the signature of the Millennium Declaration and more recently the Sustainable Development Goals (SDG) there has been a renewed focus on the links between global poverty and human rights in development. As a consequence, protecting and promoting rights, and creating opportunities for individuals and groups to access, enjoy and reproduce those rights have increasingly been furthered in transnational campaigns promoting broader civil liberties, the ‘right to development’ (Grugel and Piper 2009) and ‘human right to health’ (Oslo Declaration).

However, as Easterly (2009) argues ‘which rights are realised is a political battle’ contingent on a political and economic reality often determined by what is considered (national and internationally) visible and urgent. The response to the outbreak of the Zika in South and Central America is manifestation of that battle.

Zika and systemic injustices

In February 2016, South America became, for the first time, the epicentre of a Public Health Emergency of International Importance when the World Health Organisation (WHO) declared that the Zika virus and its link to neurological disorders deserved global attention. After nine months Zika dropped from the international radar as the WHO declared it was no longer an international emergency. But the crisis is not over. The Zika outbreak that began in 2015 and has now spread across much of Central and South America has implications over the medium and long term on equity, health, education, gender and community relations. The challenges of managing the medium/long-term impact of outbreaks, as previously seen in the case of Ebola, are still poorly understood, and so are the prospects of safeguarding the right to health and the right to development in policies advanced by international and national health agencies addressing those amongst the most vulnerable.

The Zika virus, as with other insect-borne diseases such as Dengue and Chikungunya, is part and parcel of troubling inequities, amongst which health inequality is key, based on deprived living conditions. What raised international alarm in 2015 was the number of cases of microcephaly detected in countries affected by the Zika virus, particularly in Brazil. Microcephaly is a condition where babies are born with unusually small skulls. It is a developmental defect and is usually also associated with serious nervous system disorders – including deficiencies in mental functions and muscular weaknesses of varying degrees (WHO 2016). More than 1.5 million people in Brazil have been stricken with the mosquito-borne Zika virus, and since the outbreak began in 2015, the country has logged around 4,000 confirmed and suspected cases of microcephaly. This is alarming, particularly compared to 2014 when there were 147 cases.

Economically disadvantaged segments of the population are at higher risk of exposure to Zika, of being infected, and of their children of being born with microcephaly or other genetic conditions that require special care in the long term. The Zika crisis has also reinforced the socio-cultural expectations about the role of child-raising/caring that disproportionately fall on women, limiting even more opportunities to engage in education programmes or seek/obtain formal employment. Finally, promiscuity, lack of education and the simple fact that poor women might spend more time at home and thus are more exposed to dirty water, sewage, and mosquito breeding grounds than men, also means that women bear the burden of the prospect of infection. This drama typically unfolds in conditions where infrastructural deficiencies and lack of quality medical care and social services are the norm.

Consequently, poor women and their families are likely to be stigmatised as poor, as women, as sexually irresponsible, as families marked by disability. The Zika crisis is, in effect, a window that exposes systemic injustices related to poverty and marginalisation of poor women and children. It also a constitutive dimension of the ‘structural violence’ as global, regional and national responses to the Zika outbreak have disproportionately concentrated on prevention of infection and transmission which although necessary and urgent do not change the structural and related socio-cultural conditions that perpetuate injustice and inequality in these societies.

Which rights are right? 

The Zika crisis is not gender neutral and a focus on women is needed. Take Brazil, where there is a large proportion of single parent families, the majority of which are headed by women. These households are more likely to experience perpetual cycles of poverty as a result of the economic shock of disease. In addition, where children are born with potentially disabling impairments, they are often further isolated by limited support or social protection. The significant increase in the number of infants with microcephaly in the Northeast of Brazil which triggered of the WHO declaration of international emergency, highlights the centrality of the social determinants of health in the transmission chain, as well as issues such as the social division of care and debates on sexual and reproductive health.

During 2016, a roll out of official declarations put women at the centre: the High Commissioner for Human Rights and the WHO reinforced the importance of women’s human rights being central in the response to the Zika outbreak in many states (Gostin and Phelan 2016), while the US Center for Disease Control and Prevention advised pregnant women to refrain from travelling to countries affected by the Zika virus. Most dramatically, health officials in El Salvador urged women not to get pregnant until 2018; Colombia called on women to delay pregnancy for six to eight months.

This particular response focusing on behaviour is problematic for at least three reasons. First, implementing vector control programmes in the poorest areas is particularly challenged by more structural issues of lacking infrastructure, running water and access to healthcare. And even if such operations are conducted, mosquitoes have previously shown their capacity to quickly resurface whenever there is inadequate funding or surveillance. Second, shifting responsibility to women’s behaviour delinks the disease from its social determinants and their rights; not least because most pregnancies amongst poor and vulnerable women in the region are unplanned. As Davies and Bennett (2016: 1046) note, responses tend to focus on the ‘immediate’ health-care problem, while the status of gendered inequality that underpins the prevailing unhealthy conditions is considered ‘beyond’ the capacity of public health interventions. Add to this prevailing high rates of sexual violence, elusive contraception, teen pregnancies and the lack of sexual education prevalent in Zika-affected countries. According to a study published by the Guttmacher Institute in 2014, as many as 56 per cent of pregnancies in Latin American and the Caribbean are unintended, either because of lack of access to contraceptives or because of associated forms of gender violence.

Third, reducing the problem in this way to a few modifiable behaviours ignores factors of social determinants of health and poverty. Responses to communicable diseases such as Zika, and before Ebola, have so far tended to focus overwhelmingly on short-term-vector control and surveillance (Gostin and Hodge 2016; Davies and Bennet 2016). Such responses may be effective in terms of disease containment, effectively masking the precarious social conditions in which they live, in which many rights remain merely notional.

A final issue raised by the Zika crisis is that of reproductive rights. In a region where birth control is limited and sexual violence is widespread, the debate on legalising abortion has gained prominence. Last February, the Obama administration put under Congressional consideration $1.8 billion in emergency funding to help prepare for and respond to the threat posed by the Zika virus. But abortion politics sterilised these discussions as Republican lawmakers leading a congressional hearing on the Zika outbreak made funding conditional on anti-abortion policies in recipient countries. And while Pope Francis hinted at softening the rigid stance of the Catholic Church on contraception because of the threat posed by the Zika virus, it is the region’s restrictive abortion laws that remain a critical problem. In most Latin American countries affected by Zika, abortion is illegal or can only take place in exceptional situations. In El Salvador, for instance, where more than 7,000 cases of Zika were reported between December 2015 and January 2016, abortions are illegal under any circumstances and miscarriages could even lead to homicide convictions if proven to be self-induced.

Advocacy groups in Brazil are increasingly presenting legal cases to the Supreme Court to legalise abortion and secure reproductive rights for women under the principles of the 1988 National Constitution that guarantees the right to health. But the challenges ahead are many, not least in what a human rights-based approach to health may mean in addressing the long-term consequences of Zika (and other such health crises).

To be clear, vector control actions are imperative, but policies and recommendations based on behaviour, control and prevention are not only not enough to address women’s marginalisation in society and the effect this has on their health, they may further exacerbate this problem in addressing the immediate health risk. More academic and policy debate is needed on the scale and nature of future needs (health, social, economic, educational, welfare) of vulnerable communities particularly women and children, and how to calculate them. Government awareness of this issue is still low in Central/South America and although regional, global and expert/practitioner networks might be able to provide support in the future (Riggirozzi 2015; Riggirozzi and Yeates 2015) both in defining the scale of need and in providing support to governments in developing policies to address them, their roles over the medium/long term require greater definition.

Governments in South and Central America are in urgent need of a multi-policy approach – and funding- if they are to put in place effective responses to mitigate long-term effects and not derail progress in terms of meeting the SDGs targets on gender, childhood, disability and inclusive growth. Vector control and compliance could be seen as first step. The right to health needs to be delivered with a view that development in general and the delivery of health in particular should be anchored in an understanding of the inequalities, discriminations and power relations that prevent many people having access to good healthcare systems, care provisions and education and a view that states have legal and ethical obligations under international law to ensure the best possible provision of services for all.

 

Pia is currently involved in a funded project on regional organisations and access to medicines in South America.

 

The rise of the social sciences and what it can offer to policymakers

By Gerry Stoker and Mark Evans. Gerry Stoker is Professor of Governance at University of Southampton (Twitter). You can read more posts by him here.


We are all in this together

The social sciences are more relevant than ever in helping solve the problems of public policy. You might think that there are neat lines to be drawn between science-based disciplines, the social sciences and the humanities (these are traditional ways of expressing divides within the University sector) but in practice those lines are often blurred. There is an overlap in areas of interest and a sharing in methods used.

When engineers move from the laboratory to the field and propose solutions to deal with water management and distribution in developing countries that involve the establishment of complex human institutional devices, are they doing science or social science? When a randomised control trial looks at behaviour in classrooms in the hands of educational studies researchers (normally classified as social scientists) rather than the trialling of a new medicine by medical researchers (usually classified as scientists) is it any less scientific? The distinctions between types of academic study are not without value but they can lead to a false sense of difference that is neither helpful nor justified.

In particular we see no great value in making claims that some subjects are ‘hard’ science – physics, chemistry, mathematics and medicines for example – while others are ‘soft’ science such as the social sciences that would include economics, sociology, political studies, human geography, social policy and range of other disciplines. The ‘hard’ sciences deliver useable knowledge and the ‘soft’ sciences offer mere informed speculation might be the claim that follows the distinction. But such a proposition does more harm than good and overlooks a crucial question for the policymaker and for that matter a citizen. The issue is not how academia draws up its dividing lines but rather about which types of research can contribute to the problems we confront: does the research tell me what we need to know? The core concern is not how you know but what you want to know. If knowledge is going to be useful it has to be knowledge about something we need to know about.

Our argument is that if anything the social sciences has become more relevant because what we as policy makers and citizens need to know more about is how to make human-influenced or human constructed systems work more effectively. There are relatively fewer purely natural systems and increasingly systems that are either human influenced or human dominated. The domain of human dominated systems is that of the social sciences without doubt, but so too to a degree is that of human-influenced systems. The argument is that the social sciences rather than being the poor cousin of the sciences of natural systems has rather an expanding empire.

What can social science deliver? Not laws but insights

But can it deliver? There are many reasons why evidence from social science does not influence policymakers or is ignored in citizen debates. Lack of clarity about what social science research can offer is one stumbling block that could explain why social science might struggle to establish itself. In the nineteenth century and in several periods in the twentieth century, some advocates of social science suggested that what was on offer was either a full-blown or embryonic ‘science of society’. The prospect of generating general laws – true for all time about human behaviour – has now faded but the sense that somehow social science has failed to live up to that unrealistic promise perhaps explains a sense among policymakers and citizens that social science has not delivered. After all no less a citizen than the United Kingdom’s Her Majesty the Queen did feel it necessary to ask after the financial crisis of 2007/8 during a visit to the London School of Economics why economists had not been able to predict it. To offer powerful spot predictions asked of social science something that it was not able to deliver. Indeed research tends to find complexities and variations in behaviour that make the quest for neat and frugal laws of social behaviour a mission impossible.

What social science can offer? It can provide empirical evidence but also conceptual apparatus to challenge and develop existing understandings of issues. Good research may deliver sometimes solutions but it also may often a better debate about potential decisions. That contribution can stretch beyond initial conceptualisation of policy options to the processes of implementation. Although we might have evidence that something works at some place and at one time policymaking stills needs evidence that it will work in other cases or more particularly in the case in hand.

The policy process is best supported by continuous acts of exploring, investigating and yes research. Social scientists, policy makers and citizens should be working alongside one another in these tasks. Problems are more likely to be tackled, subdued and ameliorated. They may go away in one form, only to reappear in another form, at a later time. Learning and discovery are therefore at the heart of good policymaking and its needs to be at the heart of the relationship between social science and policymaking. Discovery captures the sense of exploration, challenge, checking and rechecking that is required for effective policymaking in a complex world. It also engages with the sense that there are many unknowns in any policy decision and that a sense of open investigation is therefore essential.

Come on in. There are plenty of options

For those seeking to use the social sciences a good starting point it is helpful to recognise the breadth of the approaches and methods available. There are new forms of discovery just waiting to be found. We want you to be able to touch base with the latest best practice on the use of Systematic Reviews, Randomised Control Trials, the analysis of Big Data, design thinking, qualitative techniques for comparison using Boolean and fuzzy set logic, citizen social science, the use narrative from policy makers and citizens. Of course some of the methods that we refer to have been on the shelves for a number of decades but we now know better how that to apply the method across a range of policy arenas. Other methods are relatively more novel within social science but again they have been growing examples of their application in the context of policy making.

Our point is that good policy requires good social science and there is richness in methods of research that is not fully appreciated. Of course you also need to think about choosing the right method for the right policy challenge. You also need to be clear and not naïve about how evidence plays into the complexities of the policy process.


Note: These ideas and understandings are expanded further in our recently published book Gerry Stoker and Mark Evans (eds) (2016) Evidence-based policymaking in the social sciences: Methods that matter. Bristol: Policy Press.