November 21, 2014
In a blog for Open Global Rights, Alicia Ely Yamin argues that the Ebola crisis shows the necessity of a human rights approach to public health. Ms Yamin is Lecturer on Global Health, and Policy Director of the François-Xavier Bagnoud Center for Health and Human Rights at Harvard University.
Ebola, human rights, and poverty – making the links [excerpt]
The Ebola crisis shows the necessity of a human rights approach to public health that focuses on discrimination and accountability, and the crisis itself has been driven by deep inequities in access to basic rights and a legacy of conflict and mass human rights abuse.
The catastrophic Ebola crisis unfolding in West Africa offers many lessons, not least for global anti-poverty efforts. These will culminate in a set of targets, to be agreed by the United Nations in 2015, known as the Sustainable Development Goals (SDGs).
First of all, the crisis should lead to a re-think of the triumphalism that has marked some of the global health debate in recent years, with some projecting a “grand convergence within a generation” between North and South, rich and poor countries, based upon the “end of preventable mortality, including from infectious diseases”.
Second, neither universal health insurance, without real access to public health as well as effective care, nor cash transfers, without connections to functioning systems, would have thwarted Ebola or the social devastation it is wreaking. Yet both are highly touted solutions to global poverty, and likely to be part of the SDG agenda. Nor would “pay for performance”, whereby health workers are supposedly incentivized to be more productive by having compensation linked to quotas and outcomes.
All of which brings us to a third lesson from the crisis: silver-bullet solutions that focus on short-term outcomes, and often produce so-called ‘vertical’ interventions (that is, those de-linked from the broader context), actually do not work in the long term, or in the face of crises.
Human rights advocates have argued that there is a need to shift power relations to promote greater equity, to invest in strengthening institutions, to open spaces for meaningful participation by the people who are affected by health and development policies, and to construct effective and accessible accountability mechanisms. Though often dismissed as airy-fairy, unmeasurable and utopian in mainstream public health and development circles, the Ebola catastrophe illustrates exactly why these investments are crucial.