OpenForum – a blog by the Health and Human Rights community

[Editor's note: This is a guest post written by Sarah Mi Ra Dougherty.]

In a recent opinion piece in the Financial Times, William Easterly argued that a rights-based approach to health care would favor the agendas of the rich and powerful, leaving the poor to die of neglected diseases. He then contends that holding ourselves to such unrealistically high standards would open the floodgates for unchecked spending, “since any of us could get healthier with more care.” Unfortunately, both of his slippery slope arguments are premised on inaccurate assumptions about the right to health, health spending dynamics in the US, and the history of global health assistance. The inequalities he describes are not the result of a push to promote health as a universal good. Instead, they are the flawed legacy of institutions and policies that persist in treating health as a commodity.

At a basic level, Easterly distorts the purpose and scope of a rights-based approach to health, specifically what is meant by “highest attainable standard of health.” He frames this as a personal right to absolute health, subject to immediate realization, when it is actually a collective right to equivalent health, subject to progressive realization (ICESCR, Art. 12). This mischaracterization underlies Easterly’s argument that human rights operate in a zero-sum environment. In reality, the right to health goes beyond mere delivery of goods and services; it is fundamentally concerned with promoting equitable outcomes and empowering people to achieve these ends. The problem is not one of scarcity: rich countries contribute less than 1% of their gross national income to support health care in poor countries. Rather, it is one of exclusion: the current balance of rights and duties fails to contemplate that everyone is entitled to a basic level of health. The Millennium Development Goals seem so ambitious because they seek to extend to all what those of us in the developed world take for granted — “minimum essential levels” of health and the preconditions for health, such as access to water, sanitation, and nutrition. While a certain amount of jockeying for priority is to be expected, it would take place within this basic inclusive framework. By resorting to economic scare tactics, Easterly displays fundamental misunderstanding of what is at stake in the human rights debate.

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A number of non-traditional practices are arising in poor and developing communities to fight high maternal mortality rates. One example that has taken hold in many African countries is the use of non-physician clinicians (NPCs) – health care providers who are not licensed physicians but who still provide substantial medical care. The retention rate of these types of practitioners tends to be higher, and the cost of training and deployment much lower, than those of doctors.

At a recent conference, health delegates from 42 countries agreed to implement a new strategy that trains NPCs in emergency obstetric surgery to address the lack of health care workers. Along with other developing areas, most African countries are suffering from a significant lack of medical professionals. This shortage is particularly implicated in the high rates of maternal and infant deaths during childbirth. The WHO has estimated that in sub-Saharan Africa alone, there is a shortage of nearly 1.5 million health care workers; women there face a 1-in-13 risk of dying in childbirth. Most women are unable or unwilling to access medical facilities or workers, even during emergencies; for example, in Ethiopia, only 6% of all births occurred in a health facility.

By expanding the number of NPCs and training them in surgical childbirth procedures, it is hoped that more births will be attended by trained health care workers who can assist women during emergencies. A program in Mozambique that trains midwives in surgical techniques has already achieved significant results. The country is on the way toward meeting several of the UN’s Millennium Development Goals, particularly those surrounding maternal and newborn health. Read more

Two recent reports emphasize that significant global climate change has already begun, and that it has had “catastrophic” effects on human populations, primarily those living in developing nations. The first report, from the US Global Change Research Program, warns that “warming of the climate is unequivocal” and that climate-related changes that effect natural resources, agriculture, and human health have already occurred. Major consequences of continued climate change include an increase in heat-related illnesses and deaths, more health-related problems caused by poor air quality, and increased transmission of food-, water-, and insect-borne diseases.

This report, which compiled past scientific work on the effects of climate change, also warned that severe weather events, along with the physical and mental health problems associated with them, are likely to increase, especially in countries with less developed public health systems. In general, vulnerable groups such as the elderly, children, and people living in poverty experience more severe health effects from climate change. The report states that “[t]he greatest health burdens related to climate change are likely to fall on the poor…” because they often lack resources and choices in their ability to avoid harm. In particular, the report noted that the poor and elderly faced the most severe circumstances during Hurricane Katrina, and that Native Americans are uniquely vulnerable to global warming because they often rely on reservation land for their livelihood and cannot easily relocate. Read more