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Poverty and Human Rights: health, development, privatisation

Crossing the Boundaries: the place of human rights in contemporary scholarship
Afternoon panel session:

Chair: Dr Chaloka Beyani
Dr Zoe Pearson and Ms Fiona Haigh How good conversation can save the world: building interdisciplinary relationships between human rights and health
Dr Brigit Toebes Privatisation and human rights - the experience in the health care sector
Dr Aurora Voiculescu Re-mapping the human rights responsibilities: poverty, human development and the (corporate) triple bottom line

Dr Zoe Pearson and Ms Fiona Haigh
How good conversation can save the world: building interdisciplinary relationships between human rights and health

In a recent speech, Professor AC Grayling argued that we are at a crucial stage in the development of human rights, a stage which highlights the importance of interdisciplinary conversations in shaping human rights discourse. This stage involves intensifying the established momentum, concepts and minimum standards generated by human rights discourse to develop rich understandings of what human rights mean in everyday life.

The field of human rights is complex, both in terms of process (numbers of actors etc.) and concepts (i.e. various critiques that highlight that universality is problematic in terms of everyday practice around the world). The emerging multi-dimensional picture of international law exhibits a higher degree of complexity than the traditional one-dimensional, state-centric structure, conjuring up fears of chaos, disorder and unpredictability. An awareness of concepts and views associated with an array of other disciplines (and sub-disciplines, including socio-legal complexity theories) can provide a way to develop a richer and more complete understanding of human rights.

It also requires appreciation of the everyday aspects of human life to which rights may apply. Health Impact Assessment (HIA) draws on different disciplines to assess the potential effects of a policy, a program or project on the health of a population and the distribution of those effects within that population. Potentially HIA can create a richer understanding of the complexity of the reciprocal relationship between human rights and people's lives. The current UN Special Rapporteur on the right to health has recommended HIA as a way of operationalising the right to health.

If we do want to utilise HIA in the field of human rights then we have to face the well-known challenges of interdisciplinary work such as differences in epistemologies, language, perspectives, values and ways of teaching and learning. In this presentation, we will elaborate on these challenges and propose that an approach that focuses on conversations between disciplines (law, human rights and health) can help meet these challenges. In doing so, we draw from and connect our discipline backgrounds and relate our practical experiences.

Dr Brigit Toebes
Privatisation and human rights - the experience in the health care sector

Privatisation of public services takes place in all parts of the world, both in poor and in rich nations. It is a complex phenomenon that takes many different shapes and creates many different problems. For example, there is privatisation of schools and prisons, and increasingly water services, health care services and social security services are provided by private providers. Nevertheless, all forms of privatisation lead to similar human rights questions: what are the implications for consumers when a government delegates its responsibilities to private entities? What does this delegation mean in terms of the availability, accessibility and quality of the services? The human rights framework does not yet provide a clear answer to these questions.

A clear example concerns the current trend to privatise national health systems. In many countries where such national health systems currently exist, governments are (partially) privatising their health care sector so as to make the system more cost-efficient. In the Netherlands, for example, where there is currently a (partly) public system, all insurance companies are turned into private entities which are required to compete with each other. In the UK, the government seeks to bring in the private sector to make the NHS compete with private healthcare providers.

This paper discusses the privatisation of health care services by using the UN General Comment on the 'Right to the Highest Attainable Standard of Health' as a framework. It is suggested to do a 'right to health assessment' before the introduction of privatisation. Among other things, the General Comment obliges governments to guarantee the accessibility, affordability and quality of health care services for customers. In the Netherlands, for example, the accessibility of the health care services may come under threat if due to the privatisation, large numbers of the Dutch population remain uninsured. In the UK, the question may arise whether the governments succeeds to safeguard the quality of the health care services once they have been contracted out to private providers.

Furthermore, the General Comment makes a distinction between state obligations to 'respect, protect and to fulfil'. Privatisation implies a shift from the governmental obligation to 'fulfil' to the obligation to 'protect', implying that the government has to regulate the now more powerful actors in the health sector and that it has to provide adequate means of redress for customers.

Dr Aurora Voiculescu
Re-mapping the human rights responsibilities: poverty, human development and the (corporate) triple bottom line.

Until relatively recently, the State used to be the main, if not the only agency responsible for implementing poverty reduction programmes and for promoting human development within a context of human rights realisation. However, the once widely accepted dichotomy between State and non-Sate agencies with respect to the promotion and protection of human rights appears now to have been blurred. The need for dealing with poverty and human development in a more comprehensive way has brought private actors at the forefront of the search for human rights realisation. In the past two decades, we have witnessed the emergence in the human rights arena of a new social actor, the transnational corporation (TNC), whose role in poverty reduction is no longer seen just within the Friedmanian realm of profit making, but also in the one of actively engaging with human rights issues which can affect human development in the countries where TNCs operate.

This blurring of the sharp distinction between public and private actors in the domain of human rights has taken place due mainly to two simultaneous, yet independent and often at odds with each other trends, i.e. the globalisation of market economy and the globalisation of human rights (with all the controversies that the use of the term 'globalisation' might fuel). As a result, bringing TNCs under the umbrella of human rights responsibility for the purpose of addressing major issues - such as the reduction of chronic poverty in the developing countries and general human development - hasn't been straightforward. First of all, political and economic realities have made regulation of new corporate responsibilities very difficult. Second, from a conceptual point of view, such new responsibilities raise questions of autonomy and agency of the business organisation, concepts which do not lend themselves easily to collective entities (be they conglomerate or aggregate). The main way, therefore, in which human rights have been put on the TNCs agenda has been through voluntary self-regulatory mechanisms.

This paper will scrutinise these mechanisms through which corporate action and human rights discourse are brought together. It will also address the implications of these mechanisms for the realisation of anti-poverty policies and for the enhancement of human development, as well as for the consistence of the human rights discourse itself. Finally, the paper will look into the way in which international structures such as the ILO and the UNCHR have sought recently to re-appropriate the human rights discourse not by excluding the TNCs from anti-poverty initiatives and the human rights arena, but by harnessing their forces through what could be conceived of as proto-interactive regulatory initiatives.