Health, Equity, and Human Rights

Panel at the UConn Law School: “Health, Equity, and Human Rights: What’s the Added Value of a Rights-Based Approach?”

Author: Marie Brault, PhD (UConn alum, currently an Associate Research Scientist with the Global Health Leadership Institute, Yale University)

On March 2nd, 2016, the Research Program on Global Health and Human Rights at UConn’s Human Rights Institute (HRI) convened a multi-disciplinary panel at UConn Law School to unpack the question, “What is the added value of a human rights-based approach in conducting community-based health work?” Panelists included Alice Miller (Yale School of Law), Grace Damio (Hispanic Health Council, a community-based organization in Hartford, CT), Alicia Ely Yamin (Harvard University and Gladstein Visiting Professor at HRI), and Audrey Chapman (UConn School of Public Health). As Sarah Willen, Director of HRI’s Research Program on Global Health and Human Rights, explained in her introduction, the panel’s purpose was to challenge human rights scholars to explain how a human rights based approach (HRBA) can have value to people involved in the daily realities of public health and community organizing. As a medical anthropologist who works in communities and with public health practitioners, this is a question I struggle with as well.

Grace Damio initiated the conversation by introducing the Hispanic Health Council (HHC)’s history, mission, and work as an organization with deep roots within the Hartford community, that embeds social justice perspectives in its mission and everyday work. She explained that HHC has four core strategies: community-based participatory research, evidence-based direct service provision, policy and advocacy, and healthcare provider training. Damio also described the organization’s key values and strategies, highlighting social justice, advocacy, and equal partnerships. Also briefly discussed were projects and ongoing work the HHC was engaged in. Damio ended her presentation by stating that HHC’s strategies were not developed with a specific human rights framework, and that their staff were not trained in human rights theory and approaches. She then offered the question: Would it make a difference in terms of impact if HHC institutionalized a formal human rights framework?

Yamin, a world-renowned Health and Human Rights scholar, was the first to respond. In her 2016 Gladstein lecture as well as her recent book, Power, Suffering, and the Struggle for Dignity: Human Rights Frameworks for Health and Why They Matter, Yamin argues there is no single, formulaic approach to human rights. It is not necessary to explicitly frame one’s work as “human rights,” she explained, as long as core principles of human rights-based approaches are present. Yamin did, however, note that HRBAs add a dimension of accountability by identifying the obligations the state has to its citizens, and that this dimension is a defining feature that makes human rights unique and distinct from needs-based approaches.

Chapman provided additional insight into the unique contributions of human rights approaches, arguing that HRBAs could provide communities with a sense of empowerment at both the individual and political levels. First, Chapman noted that the Vermont Workers’ Center’s campaign to establish universal healthcare explicitly employed human rights discourse to empower individuals to claim their right to healthcare. The campaign raised people’s awareness of their rights and empowered them to respond to policy proposals. The second reason Chapman encouraged the Hispanic Health Council to explicitly incorporate human rights is the benefit that a human rights approach can have for whole communities. Chapman stated that human rights advocacy is well-suited to respond to marginalized communities’ “hunger for systemic change” by promoting a sense of shared community and highlighting the obligations individuals and systems have to each other.

Miller noted that the HHC provides an example of an organization that has “organically” developed and employed many of the pillars of an HRBA without explicit recourse to human rights as a legal instrument. Miller also raised the question of whether an organization working in the United States can safely use the language of human rights for purposes of empowerment without antagonizing those who feel that human rights are predicated on confrontational demands. Relatedly, the concept of “accountability” has to be framed in a way that does not evoke legal language. Miller referred to Friedman’s concept of “constructive accountability” as a useful alternative way to discuss the way a human rights framework can establish an “authorized call and response mechanism” to ensure that different partners are heard.

After additional remarks by the panelists, the floor was opened to questions and discussion from the audience, who raised many pragmatic and philosophical questions concerning HRBAs. Individuals with previous experience in the private and non-governmental sectors described  challenges associated with securing funding and support for rights-based approaches, particularly in the U.S., where many human rights conventions have not been ratified (including many with explicit right to health commitments) because such approaches can be viewed negatively by potential funders. Instead, many funders are more comfortable with “basic needs” frameworks that are less oriented towards social justice and correcting inequities. Other questions centered on how the HHC or other organizations might introduce and present human rights-based approaches to the communities in which they work. To these questions, Damio stated that it would be important to break the concept down and determine how to translate and present it to the community. Yamin and Damio made the concluding remarks, commenting on the need to continue pushing HRBAs further, even in challenging political and economic environments. Willen closed the panel with an invitation to all to reflect and continue the conversation.

The evening’s discussion answered some of my questions and raised new ones. I have often struggled to articulate HRBAs in low-income communities where notions of claiming human rights do not always mesh easily with lived realities and constraints. Thus, I found the discussion of “organic” HRBAs and Damio’s discussion of the need to “meet people where they are at” to be particularly useful to my own work as I consider how to adapt HRBAs to local communities. Yet the panel revealed that the question of how best to translate HRBAs to funders and organizations within the United States remains an important challenge. The speakers made clear the need to continue to advocate for rights-based approaches both within and outside academic circles, but noted that the acceptance of such approaches may take time and persistence.