Boarding the FCGH Express
Sometimes the right to health provides a clear answer. Discriminatory laws must be abolished to ensure the right for all people, and not deny it because of someone’s “legal status” or nationality, for example. The right to health does not always provide a definitive answer, though. To borrow an example from my colleague Alicia Yamin’s book Power, Suffering, and the Struggle for Dignity, consider the right to health requirement of equitable distribution of health services. Providing maternal health services in remote areas may well cost more than in urban areas. For countries in the process of expanding access to care, and where sufficient additional resources are not available, shifting resources from urban to rural areas to enhance equity could well slow overall expansion of coverage, leading to more maternal deaths in the near term. How far should this reallocation to a more equitable distribution go? There is no right answer.
But there is a right process to figure out the answer, a process that will give that answer legitimacy. That is a process guided by the human right principle of participation, with a fully informed public discussion and meaningful participation in decision-making, including and especially by the people whose lives will be most affected; in this example, rural and urban women who rely on public health services.
Meaningful participation, then, should be a constant guide for those involved in health policymaking, whether in allocating health resources within a community, developing a national health strategy, or seeking to secure a global treaty based in the right to health – that is, in securing the Framework Convention on Global Health (FCGH). And this is the most significant area where the initiative to establish an FCGH has fallen short. I write as someone who has been quite involved in FCGH efforts for the past six years, beginning when a small coalition in 2010 established what was known as JALI, which later evolved into the Platform for an FCGH, where we are today.
It is not that we do not recognize the critical importance of this participation. We do. I have myself written of the importance of having the FCGH reflect, above all, the voices and concern of the people who most experience health inequities and health injustice. We know that participation is vital. This is a matter of principle. The processes related to developing a treaty based on the right to health, including in the present more formative stages, should themselves follow human rights principles. Inclusive participation is also a strategic necessity. Without broad-based support, requiring genuine engagement and a shared sense of ownership, we won’t achieve the FCGH, much less an FCGH that countries will ratify and implement.