Despite leaps in biomedical innovation in the developed world, inequalities in global health outcomes persist, as well as systemic barriers to public health and health services. However, the struggle for health rights and global health justice continues.
The Petrie-Flom Center for Health Law Policy is therefore thrilled to announce the launch of the Global Health and Rights Project (GHRP), which will promote theorization of a “right to health” under international law as well as applicable domestic law, challenges to using human rights frameworks to advance global health justice, the relationship between global economic and health governance, and more.
Alicia Ely Yamin is the Project’s inaugural Senior Fellow in Global Health Justice. Currently a Senior Scholar in Residence at the Global Health Education and Learning Incubator at Harvard University and an Adjunct Lecturer on Global Health and Population at the Harvard T. H. Chan School of Public Health, Yamin is a pioneering scholar and advocate for economic and social rights, sexual and reproductive health and rights, and the right to health.
I asked Yamin some questions about GHRP, and what she’s most looking forward to working on.
This exchange was lightly edited for clarity.
Alex Pearlman: What are some of the main aims of GHRP, and why is now the right time to launch this project?
Alicia Yamin: It’s important to say that I see GHRP not as a platform for human rights cheerleading, but rather as a space, and opportunity, to engage in critical reflection on many of the assumptions and methods that have guided human rights work as it relates to health.
The human rights edifice is under critique, not just from conservatives, but also from progressives. Far from being an era of operationalization of so-called “human rights based approaches to health,” I see us in a struggle over the soul of the human rights idea. The failure to stem burgeoning social inequalities within and between nations, in health and beyond, has been on the radar for many of us within the human rights movement for quite a while. But it is a great privilege to have the opportunity through the Global Health and Rights Project (GRHP) to collaborate with colleagues on new approaches to these old challenges, as well as on emerging challenges to the very meaning of health rights, such as genetic technologies.
As you have seen them first hand around the world, what are some challenges of using human rights frameworks to promote justice in health law policy?
I think there are three principal challenges. First, health (not being healthy) has to be recognized as a legal right. This is increasingly the case in constitutions as well as legislation around the world, but even when there has been judicial enforcement it has not always enhanced equity in the ways we would like to see.
Second, the implications for institutionalization of a “right to health” need to be worked out. No country, no matter how wealthy, meets all health needs–which are constantly evolving in any case. So the demands of rights, of justice, require specifying the choice situation in which health entitlements (public health conditions and medical care) can be met fairly–including those of marginalized groups. That is enormously ethically, politically and socially complex in the real world. It requires addressing financing, priority-setting, appropriate regulation and enforcement, and so on. Third, and finally, we need to demonstrate that treating health as a right can contribute to fairer health systems, more just societies, and help to curb global health inequity.
There is this intersection between power and human rights that you explore in your book, out last year. Can you give your favorite example of how a human rights approach has confronted power in a way that was surprising to you?
The achievements of People Living with HIV (PLHIV) movements around the world are the best-known testament to how rights discourse and tools can be used, not just to effect normative change, but to push scientific research and reshape institutional architectures at national and global levels.
But similarly “impossible” battles have been won in sexual and reproductive health and rights. My favorite examples tend to relate to subaltern groups who come to see themselves as subjects of rights, and in turn to act as agents of change. One example in the book, which has come to mind recently given our current political situation, involves women who were involved in the Nuestro Texas campaign in the lower Rio Grande Valley. Many of these women were undocumented, despite having lived in Texas for years by 2015, when I met them. They were not just seeking packages of reproductive health care; they were seeking inclusion in the communities and society to which they had been contributing for so long. These women were inspirational, and they had achieved major successes then; I have no doubt they are continuing to mobilize along with broader struggles for immigrants’ rights today.
How do you see economics impacting the use of human rights frameworks and justice globally? How will GHRP confront injustice in economic systems?
It would be absurd to pretend that one project could confront unjust economic systems, but it will be central to GHRP’s activities. Economic inequality — and the hegemonic hold of neoliberalism on national and global economies more specifically — is the critical challenge for human rights in my view, if the language is not to become, as Sam Moyn might suggest, “window dressing” on the degradation of dignity. On a national level, when health systems are treated just as markets that allocate care according to price, it is antithetical to the idea of institutionalizing a right to health I described above. More broadly, inequalities in wealth within and between countries are not only reflected in inequalities in patterns of social determinants of health and access to care . I would argue that within countries, they undermine the possibility of sustaining a meaningful democracy, which is necessary for health rights — and all rights. On the global level, we are seeing a crisis in the very concept of multilateralism, which is fundamental to human rights, as ever-deepening economic integration has not been aligned with the aspiration that multilateralism would propagate norms of equal dignity.
As technology such as AI becomes ubiquitous in health care and public health, how can human rights based frameworks adapt? Should they? Will they?
This is a complicated question, which I hope to think more deeply about through GHRP’s work.
On the one hand, I am hopeful that AI can be very useful, among other things, in addressing some primary care gaps, as health systems evolve to meet needs for chronic care— not just in the US but elsewhere as well. On the other hand, human rights requires that decision-making be transparent and justifiable. This applies not just to the outcome of decisions, but the reasoning and criteria applied. The widespread use of AI, and the opaque algorithmic logic on which much of it is based, challenges these premises in ways that we have yet to fully recognize, let alone address.
What are you most looking forward to working on through GHRP?
I’m very excited for the opportunity to explore all these questions with colleagues from different disciplines! That GRHP is a joint collaboration between the Petrie-Flom Center and the Global Health Education and Learning Incubator (GHELI) at Harvard reflects my long-held view that the complex challenges we face require multi-disciplinary analysis and action.