An inspirational defence of the right to health
Rhona MacDonald
Lancet, 370, 379-380 (4 August 2007)

I was recently incensed by an editorial in The Economist that
dismissed all social and economic rights; like many other
readers I wrote in, querying their stance, and enquiring if The
Economist had ever heard of the United Nations' Universal
Declaration of Rights. The response I got from one of the
editors left me stunned: “I am of course aware that economic and
social rights feature in the UN declaration on human rights and
elsewhere. The ‘right’ to a job, education, health, etc sounds
superficially attractive, but in practice it is either
pernicious or meaningless.” He continued, “It would be more
honest if the defenders of these economic, social, and cultural
rights would come straight out and say that they believe that
socialism is the answer, and campaign for it, rather than
dressing up their demands for more state intervention in the
legalistic language of rights.”

So what is the best response to such human rights “denialists”?
Writer, mathematician, epidemiologist, and human rights
activist, Théodore MacDonald gives us many of the answers in The
Global Human Right to Health: Dream or Possibility? It is
perhaps a reflection of the breadth of experience and expertise
of the author that he takes you on a rapid, but well researched,
journey through many of the issues involved in human rights. He
explains the historical background of the UN, and its related
agencies—the World Trade Organisation, the International
Monetary Fund, The World Bank, and WHO—before discussing the
human rights involved in each of the Millennium Development
Goals, such as access to clean water. He details the
inequalities in global wealth distribution and the role of
transnational corporations in thwarting human rights. He uses a
wealth of data and evidence from many different sources to make
his case with conviction and clarity. His message is clear. We
must find and evaluate alternatives to neoliberalism or there is
no hope of ever achieving the human right to equity in health.
MacDonald outlines neoliberalism's fatal flaw; “Like any
competition, it produces winners (and that is its attraction),
but it must also produce losers, and they are as integral a part
of the system as the winners. We cannot merely say that the
losers are a blip on the system and that fine-tuning the whole
apparatus will gradually fade them out of the picture. Without
the losers, the system wouldn't work.” And when losing means
poverty and degradation, it is easy to see how neoliberalism
might lose its attraction for those not fortunate enough to be
winners. Indeed, the World Bank has estimated that between 1993
and 2003, globalisation created 200 million new poor people.

So what alternatives does MacDonald offer? He proposes that some
radical changes towards internationalism are needed, including a
global finance system, and believes that the only existing body
that has any hope of making the right to global equity in health
a reality is the UN. But the UN itself would have to change
almost beyond all recognition to take up this role. As the
author succinctly puts it: “The UN is constituted to protect the
rights of nations, but not the rights of people.”

At present, the UN is a complicated conundrum of contradictions.
How can it protect and support human rights while simultaneously
running agencies that sustain the violation of these rights? In
Health, Human Rights and the United Nations: Inconsistent Aims
and Inherent Contradictions? MacDonald deals with this very
question. The UN's many internal problems and frequent
inconsistencies in its decisions and actions are the inevitable
result of the incongruity of its current make up, which reflects
history rather than the 21st-century world. The current UN
reforms may deal with some of the more peripheral issues, but in
MacDonald's opinion the planned reforms will not tackle the root
of the UN's problems. These fundamental problems contribute to
its paralysis and powerlessness to do anything apart from
observe the many human rights abuses perpetrated by some
governments. For example, like many, I am frustrated by the UN's
inaction in the face of despicable atrocities such as that
currently taking place in Darfur. So I am left wondering what on
earth is the point of having the UN if it lacks the ability to
intervene in such appalling situations?

With impressive attention to detail and use of contemporary
information—much of it gathered from non-governmental
organisations (NGOs)—MacDonald studies the past and present
human rights situation in Darfur, Liberia, Burma, and the
Occupied Palestinian Territories. His analysis of this series of
UN disasters helps shed light on the reasons for the
organisation's present passivity.

The Darfur crisis raises the issue of the UN's inability to
sustain its stewardship of the Universal Declaration of Human
Rights. For example, in 2005 when it became obvious that the UN
was not going to intervene effectively, either by trade
sanctions or otherwise, the National Security officials in
Darfur suddenly became much more resistant to the UN Mission. As
for Burma, in 2005 Paulo Sergio Pinheiro, the UN Special
Rapporteur to Burma, vented his frustrations to the General
Assembly: “the Government of Myanmar (Burma) has not invited me
to visit the country since November, 2003…which I deeply
regret.” He then went on to detail the widespread and systematic
violations of human rights in Burma and the consistent failure
of the government to protect its citizens. However, the latest
UN attempt to censure Burma was vetoed by China who is the
biggest importer of natural resources from Burma and so would
have a lot to lose if sanctions were imposed. Liberia also has a
long history of human rights abuses, including recruiting child
soldiers and sexual exploitation of female refugees. According
to reports from several NGOs, which MacDonald documents, the UN
Mission in Liberia does not take sexual exploitation seriously,
with some UN employees reported as saying that “Liberian women
choose to be prostitutes”. And where do you even begin to start
with the Occupied Palestinian Territories? MacDonald writes:
“Since Israel's 1967 occupation of the West bank, Gaza and East
Jerusalem, there has been almost unanimous international
consensus on how to resolve the crisis—an international
conference based on international law and UN resolutions.
However, Israel disagreed, and this was backed by the US.” He
then discusses the repeated failures of the UN in this complex
and highly political humanitarian disaster.

After this depressing analysis that showcases the persistent
failures of the UN to protect human rights, MacDonald discusses
some possible ways forward. He describes the UN as a possible
“village policeman” in the “global village” but argues: “if the
UN is to be a successful ‘village policeman’ for the world
though, it has to find some way of separating its advocacy and
mediator roles.” He suggests doing away with the current veto
system that is a convenient vehicle to best serve the political
interests of the “Big Five”—the USA, Russia, China, the UK, and
France—and proposes an alternative: “General Assembly members
should be elected by balloting all the adult suffrage that they
will represent. If a smaller subgroup with veto powers is felt
(by the General Assembly members) to be useful, then they should
be elected regularly by the General Assembly. Permanent veto
power is unacceptable. This would effectively guarantee that the
economically powerful countries will not always wield their power.”

MacDonald acknowledges that overcoming the tendency of member
states to make decisions on the basis of narrow national
interests rather than global needs remains a difficult obstacle.
However, he believes that the remediation of this problem lies
with the political determination of each state, recommending
that powerful states like the G8 would have to lead the way. But
if progress on the nuclear non-proliferation treaty and the
agreement to give 0·7% of their gross national income to tackle
the MDGs in poor countries is anything to go by, the G8 has so
far set an appalling example.

So who can save the UN? MacDonald discusses the potential merits
of the current UN Secretary General Ban Ki-Moon to lead the UN
in a more positive direction, before pointing the finger
directly at us—citizens of the global village. MacDonald holds
great faith in the power of people, believing that the reforms
he has proposed are best made by the determination of citizens
to elect politicians most suited for the task. He is also
optimistic about the ability of people to change the world. His
books are educational, journalistic, and inspiring and are aimed
at “ordinary people”. He believes that if such people know what
is being done in their name, as he has outlined in his books,
they will stand up, make a noise, and start asking awkward
questions. I am also an optimist who believes in the power of
people to change the world, but I wish I had more faith in our
desire to do so. Both of these books highlight that there is no
excuse for inaction in the face of the human rights abuses
taking place under the UN's watch. After all, complacency equals
complicity.

Théodore H MacDonald, The Global Human Right to Health: Dream or
Possibility? Radcliffe Publishing (2007) ISBN 1-84619-201-3 Pp
232. £27·95, US$59·95.

Théodore H MacDonald, Health, Human
Rights and the United Nations: Inconsistent Aims and Inherent
Contradictions? Radcliffe Publishing (2007) ISBN 1-84619-241-2
Pp 224. £27·95, US$59·95. This book will be published in
November, 2007..