AFRO-NETS> Food for the power to use your thoughts

[Claudio Schuftan <aviva@netnam.vn>]

Food for the power to use your thoughts
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Human Rights Reader 42

On capacity building needs: The macro issues in Human Rights.

Capacity development is not merely the acquisition of skills, but 
also the capability and power to use them.

Why so little progress:

1. In general, within existing institutions and structures, capacity 
building work towards the achievement of the rights to health and to 
food (or to adequate nutrition) is currently still highly inadequate.

2. The inadequacies relate largely --but not only-- to constraints 
imposed by the international political and economic order which is 
the one that is relentlessly deepening inequality, poverty and injus-
tice --the root causes of the excess malnutrition, ill-health and 
mortality of poor people. In other words, the rights to health and 
food are closely related to, and dependent upon, the realization of 
other human rights, frequently beyond the immediate (but eventually 
achievable) control of beneficiaries.

3. Poverty is the single most important determinant of health. But 
health is very far from being the single most important determinant 
of poverty. Poor health exacerbates existing poverty. [From health 
services one gets health only...].

4. The enormous gap between human rights declarations and their re-
alization can only be filled by addressing the international and na-
tional dimensions of power, the root causes of poverty, as well as 
the relative current powerlessness (or procrastination) of govern-
ments to meet their human rights obligations. In most developing 
countries, the willingness to formulate policy is yet to be matched 
by action.

5. And action has to start with capacity building for claim holders 
and duty bearers alike for them to unequivocally understand that the 
determinants of poverty are fundamental violation of human rights --
evidence for which has been around for over 150 years... [Under the 
same optic, the pervasive privatization-of-public-social-services 
model is, by itself, a violation of human rights...].

6. People also have to be made to understand that:
- macroeconomic policies imposed by International Financial Institu-
  tions (IFIs),
- the world crisis in democracy,
- the weakening of states,
- the control of information,
- militarization and state terrorism (bringing us to open war), and
- the 'capture' of the UN system by these macro issues so that it
  finds itself with the hands tied to turn the spirit of human rights
  declarations into reality, all are equally major obstacles to the
  achievement of health and adequate nutrition as human rights (HR).

7. But even under these compelling constraints, the strategies and 
actions of the international and national health and nutrition commu-
nity are still heavily influenced by neoliberal thinking. [We all 
have our preconceptions that limit our resolve to act within a true 
HR perspective...].

8. The decision to implement programs and policies within the per-
spective of HR implies an enormous effort of consciousness raising 
and capacity building at many levels. It is a continuous process that 
needs to permeate all our activities in our work and in society as a 
whole. [If only this would be universally understood...].

9. But, beware, even adopting a HR framework does not automatically 
change the way managers relate to beneficiaries. This, since the lat-
ter are still not always seen as full citizens with the same rights 
as more fortunate members of society.

10. Let's face it, in development circles, health is still mostly 
promoted as a tool for economic growth rather than as a human right. 
Medical/technical interventions are proposed as solutions to health 
problems... as 'the way out of poverty'...(!). Furthermore, this ap-
proach disallows discussions about and actions to directly tackle 
structural inequalities and the root causes of poverty and powerless-
ness and their consequences in terms of preventable malnutrition, 
ill-health and mortality. In short, this approach maintains and, if 
only tacitly, reinforces the current international order.

11. For example, the power of transnational corporations (TNCs), ac-
countable to no-one, is in direct conflict with the principles and 
aims of the UN to enhance human rights and the capacity for self-
governance. IFIs and TNCs simply have to be made accountable for 
their actions in terms of meeting their (so far poorly explicited) HR 
obligations. [But do professionals in this area --and some UN agen-
cies flirting with TNCs-- really worry greatly about this...?].

12. Human rights work, badly needs to produce the evidence on the ob-
stacles faced by state parties to meet human rights obligations and, 
more so, obstacles preventing people/communities from meeting their 
basic needs --to then use this evidence effectively in capacity 
building.

[From the above, then, already flows a full mini-agenda for ac-
tion...].

Four more areas of need:

13. The 'access-to-treatment-for-HIV/AIDS movement' illustrates nu-
merous aspects relevant to equity and HR work; it provides an evi-
dence-based example of a strong grassroots civil society mobilization 
that has successfully raised legal and advocacy issues from a strong 
rights perspective. Their claims are now increasingly taking a re-
gional and international dimension. These groups now urgently need 
capacity building in HR. They need to go beyond directly addressing 
equal access to care in resource-poor environments and need to start 
raising more overall health system concerns. A greater HR focus can 
help them contesting resources in ways that are pro-poor and open 
doors to access resources outside the health sector.

14. The 'patients-rights movement' has, so far, not been much in-
volved in promoting a veritable right to health approach. Patients' 
Rights Charters have promoted the right to health care alright; but 
they have focused more on improving the availability of minimum qual-
ity health services and have addressed health primarily as a socio-
economic right; few of these movements have been linked to de-facto 
strategies mobilizing beneficiaries. In short, the limitations of 
this movement may be as many as its successes. In the future imple-
mentation of such charters, the role of public participation will be 
as critical as the further capacity building of their promoters in 
HR.

15. The few existing 'civic coalitions (or people's movements) for 
health' also have the potential to progressively adopt a rights-based 
approach to more effectively influence State policies. Few have done 
so far. They thus also urgently need capacity building in HR. Where 
these coalitions are active, the actual expression of social and eco-
nomic rights at community level gives them a greater potential to 
promote more equitable public policies . This, because the HR ap-
proach can clearly strengthen the proactive engagement of communities 
with the State by fostering a participatory empowerment that promotes 
social justice and equity, in our case in health and nutrition. A HR 
approach will also confront these communities with what they need to 
know about how the negative aspects of Globalization impact them 
(this will not happen automatically though; the process has to be ex-
plicitly steered in that direction).

16. Furthermore, the role of 'organized labor' in pushing for health 
equity through a rights perspective has also been neglected. Labor 
unions now need as much capacity building in HR as the above groups.

[Another couple mini-agendas for action here. The challenge is to 
take a practical approach to these questions so as to make the HR 
message central and, at the same time, accessible to those being em-
powered through the needed capacity building...].

State, society and Human Rights:

17. It is the obligation of the State and of society to create easily 
accessible legal and administrative mechanisms for use by the popula-
tion as instruments to denounce and seek correction of violations of 
HR.

18. Examples of such violations most of us fail to identify are ac-
tions that:
- bring about or facilitate the expulsion of small producers from
  their land;
- allow importing food products at below national production costs;
- cause reductions in the support to national food crops production;
- create unemployment;
- discriminate against participants in social programs;
- close down social programs directed at vulnerable groups;
- allow enterprises to violate HR, (e.g. mergers that result in large
  dismissals of staff);
- are lenient towards those responsible for oil spills that jeopardy-
  ize the livelihood of small fishermen;
- condone the introduction of dangerous foods in the market;
- allow dishonest advertising of certain undocumented nutritional
  values of foods...

19. Other examples of violations include:
- the allocation of grossly insufficient budgets for health;
- the non-elaboration of national policies on food security;
- the non-fulfillment of agreed-upon health and nutrition (Millenium)
  goals;
- allowing vaccination coverages to slip;
- the non-information of citizen about their rights in health, educa-
  tion and other social spheres.

[Do any colleagues you know greatly worry about any of these...? I 
seriously contend that, as part of a HR approach, it is time they 
did.].

20. To bring home the concept of rights, we can use the not so sim-
plistic example of our own families: Not all their members can, by 
themselves, guarantee their own daily sustenance. In a way, the fam-
ily has to provide for those of its members who cannot provide for 
themselves. In the same way, society needs to guarantee mechanisms 
that assure all its members have the economic and physical possibil-
ity to access adequate health and food. Each individual household 
simply has to be treated with equity.

21. Condoning preventable hunger, disease and misery represent the 
negation of our individual and collective humanity. This dehumaniza-
tion is not only the one that affects those who do not get their 
needs fulfilled, but also the dehumanization of society that does not 
guarantee them the corresponding rights.

22. Paternalistic approaches to secure the fulfillment of needs es-
tablish a relationship of power and submission that, in itself, vio-
lates the rights of beneficiaries. Our societies have a long history 
of paternalistic and authoritarian approaches to development. The 
process of construction of a truly democratic society passes through 
the redefinition of the roles of its social actors and the State. 
[How and when will each of us redefine our roles --individually and 
collectively...?].

23. Health staff, for instance, has the obligation of informing bene-
ficiaries of their rights. But there is a lack of information on the 
side of these public servants about their duties in relation to peo-
ple's rights. Only one thing is sure: There is no justification for 
the non-realization of HR. So, again here, these civil servants ur-
gently need capacity building in HR. [We urgently need to design ad-
hoc training modules (both their contents and effective teaching 
methods) and to train a rather massive cadre of alternative trainers; 
let us hope that the upcoming UNICEF and CARE materials will guide us 
in this direction].

24. Many small, unpretentious capacity building exercises in the di-
rection of HR in different sectors of society will eventually have a 
synergistic effect. An increase in the consciousness of the popula-
tion about their rights --and decisively exercising the same-- will 
ultimately increase the pressure on public and private services, not 
allowing them to procrastinate any longer in terms of improving the 
same. Joint action of all actors in their different sectors is 
needed. [Divided we beg; united we demand...].

Claudio Schuftan
Ho Chi Minh City, Vietnam
mailto:aviva@netnam.vn

Mostly taken from Rene Loewenson, EQUINET-news, Feb 11, 2003, Flavio 
Valente, HR and the promotion of nutrition and healthy life styles, 
mimeo in Portuguese, 2002, SCN News No.25, HR and food security ca-
pacity building, Dec 2002, pp 58+59; and Alison Katz, for the Peo-
ple's Health Movement, submission to the UN Committee on HR, Sub-
committee on the Promotion and Protection of HR, Feb 2003.

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