Values, Policies and Rights

This paper argues that the human rights framework does provide us with an appropriate understanding of what values should guide a nation's health policy, and a potentially powerful means of moving the health agenda forward. It also, however, argues that appeals to human rights may not necessarily be effective at mobilizing resources for specific health problems one might want to do something about. Specifically, it is not possible to argue that a particular allocation of scarce health care resources should be changed to a different allocation, benefiting other groups. Lack of access to health care services by some people only shows that something has to be done, but not what should be done.

Habitat III – the United Nation’s global conference on the future of cities – came to a close in late October. About 30,000 people gathered in Quito, Ecuador, to discuss the key issues facing cities today and sign off on the New Urban Agenda – the global strategy which will guide urban development over the next 20 years. The author describes the event: Efforts to make the conference inclusive – it was free and anyone could register – materialised in a big jamboree of all kinds of people interested in urban affairs (as well as complaints about long queues). The overall message of the conference emphasised the need to address social, economic and material inequalities in cities and urban areas. Yet - he notes- international experts often appeared oblivious to the enormous progress that the poorest urban communities have made to organise themselves and finance their futures. The main outcome of Habitat III was that UN nation states agreed on the New Urban Agenda (NUA): a non-binding document, which will guide policies over the next 20 years with the goal of making cities safer, resilient and sustainable and their amenities more inclusive. The NUA itself emerged from a consultative process, whereby UN-Habitat collected the inputs of a diverse community of urban scholars, leaders, planners and activists. Its key message was “leaving no one behind”. Its vision for the future of cities was one where aspirations of prosperity and sustainable development are linked to a desire for equality. Yet the document did not escape criticism: How far did it grassroots perspectives? How far did the consensual approach and redrafting exclude key issues? How will it be put into practice? Some proposed, for example, that 20% to 25% of global finance for development – in instruments such as the Green Climate Fund – should be allocated directly to cities. The author calls the consensus around the “right to the city” – an idea championed by Ecuador and Brazil – historical. The “right to the city” generally refers to the capacity of urban citizens to influence processes of urban development, and make a city they want to live in. Social movements promoted this right to denounce urban processes that generate injustices, such as gentrification, privatisation of public spaces, forced evictions and the mistreatment of urban refugees. But as it is not explicitly recognised as a universal human right, the NUA merely encourages governments to enshrine it in their laws.

The High-level Global Thematic Consultation on Health brought together representatives from governments, non-governmental organisations, academic and research institutions and the private sector to debate how to advance health priorities in the post-2015 development agenda. The consultation took place in Gaborone, Botswana from 5-6 March 2013. UNAIDS Executive Director Michel Sidibé encouraged participants to seize the opportunity to adopt a bold, transformative vision and goals to guide global health in the post-2015 agenda. He argued that the global community needs to completely rethink how global health will engage on issues from intellectual property to the production of essential medicines and the central role of countries and communities. He also called for stronger attention to critical social enablers such as gender equality, human rights and equity. Health goals and indicators can be used to help track progress in these cross-cutting issues, he added.

A judgment handed down in May 2016 in the South Gauteng High Court in the case of Bongani Nkala and 68 Others v Harmony Gold Mining Company Ltd and 31 Others is reported an important step toward providing just compensation for the many thousands of miners who contracted silicosis or tuberculosis on South Africa’s gold mines. The court certified two classes. The first and larger is gold miners and former gold miners who have contracted silicosis and the second is those who have contracted TB. The class requires that a person has worked underground in the mines for at least two years since 1965 and contracted either disease. The lawsuit, unless settled, will now proceed into trials in which common issues relevant to all class members will be determined. The court confirmed that for mineworkers, “it is class action or no action at all. Class action is the only realistic option open to mineworkers and their dependents. It is the only way they would be able to realise their constitutional right of access to court bearing in mind that they are poor, lack the sophistication to litigate individually, have no access to legal representatives and are continually battling the effects of two extremely debilitating diseases.” [para 100] The judgment is also important for all vulnerable people in South Africa. A class action is a powerful mechanism by which poor or vulnerable people can access justice. It is however not commonly used in South Africa. This judgment is argued to help those who do not have resources on their own to pool efforts in order to access justice. The authors argue that it recalibrates the balance of power to give the poor a better chance of holding the powerful to account.