and transparent process; they shall include methods, such as right to health indicators and benchmarks, by which progress can be closely monitored; the process by which the strategy and plan of action are devised, as well as their content, shall give particular attention to all vulnerable or marginalized groups. 115 Like the Universal Declaration, the ICESCR embraces a broad con- ception of health that encompasses social determinants such as nutri- tion, access to care, and basic living conditions as well as political fac- tors such as nondiscrimination and participatory processes. As Rachel Hammonds and Gorik Ooms argue, expanding health services is neces- sary but not sufficient for realizing the right to health. 116 Guaranteeing Reimagining Global Health, edited by Paul Farmer, et al., University of California Press, 2013. ProQuest Ebook Central,.Created from yale-ebooks on 2017-07-09 15:20:49.
Values and Global Health | 271 this far-reaching conception of health to all people would require polit- ical reform, economic redistribution, and massive social change in countries rich and poor alike. It would, in short, require the realiza- tion of other human rights—social, economic, civil, and political. In the words of the late Jonathan Mann, former director of the World Health Organization’s Global Program on AIDS, “re-thinking of the taxonomy of health calls for re-consideration of the conceptual frame- work of human rights.” 117 But should health or access to health care be considered a human right? The alternative, which has long been the predominant paradigm in many parts of the world and in the global health and development discourse, is that health is a commodity that can be most efficiently allocated by the market according to consumers’ willingness to pay. As chapter 4 details, the gradual unraveling of the 1978 Alma-Ata consensus supporting “health for all”—an affirmation of the right to health care—and the rise of selective primary health care and struc- tural adjustment programs meant that market-based, not rights-based, approaches to health reform became the norm among international pol- icymakers in the 1980s and 1990s. Health care, many then assumed, could be delivered more efficiently and even more equitably by private markets. 118 In fact, the World Bank and the International Monetary Fund, the architects of the structural adjustment era, have tended to eschew human rights language altogether. Of twenty-one World Bank Poverty Reduction Strategy Papers published in the past few decades, none mention health as a human right. 119 The World Bank’s website couches the AIDS epidemic as a “development problem that threatens human welfare, socio-economic advances, productivity, social cohe- sion, and even national security,” but does not describe it as a human rights issue.
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- Spring '15
- Global Health, Amartya Sen, Martha Nussbaum