Stakeholder Corruption: An Inexcusable & Unexamined Macro-threat to the Advancement of Global Health Governance

Introduction to the Problem of Global Health Governance Corruption

            The former United Nations Deputy Secretary-General Louise Frechette once proclaimed, “The solution lies not in turning one’s back on globalization, but in learning how to manage it.  In other words, there is a crying need for better global governance...” (World Health Organization, 2000). As the governance of global health issues shifts from a Westphalian to a post-Westphalian paradigm, in which both state and non-state actors respond to transnational health threats and opportunities, it has been increasingly salient to establish a unified understanding and vision of what global health governance exactly entails. The six dimensions of governance have been firmly established and applied to various international legal and business sectors: voice and accountability; political stability and lack of violence; institutional effectiveness; regulatory quality; rule of law; and control of corruption (Lewis, 2006). All of these indicators have been proven to influence the environment within which health care services function in both the developing and developed world, and yet governance indicators for global health have still not been adapted (Lewis, 2006). The integrity that global health governance is founded on is ensured by checks on the accountability and transparency of the thousands of governmental, private, and non-profit stakeholders that span the globe. Arguably the most inexcusable, preventable, and unexamined macro-threat to the state of global health governance has been the lack of legalistic mechanisms and socially just standards that hold these stakeholders accountable for the actions that both directly and indirectly influence the health of humanity. This most often results in rampant institutional corruption, or the exercise of public power for private incentives and gain. It has been noted that “bribes, corrupt officials, and mis-procurement undermine health care delivery in much the same way they do for police services, law courts, and customs whose functions become compromised by the culture of poor governance and corruption” (Lewis, 2006). Dr. Paul Farmer, MD, PhD, a world-renown Harvard physician and prophet of social justice, introduced the theory of “structural violence,” or the presence of powerful societal and governing forces that override individual knowledge and choice, and largely explains how institutionalized corruption has contributed to the widening gap in health inequities globally (Menon-Johansson, 2005). Craig N. Murphy further proposed that “contemporary global governance avoids attacking state sovereignty, favors piecemeal responses to crises, and has emerged at a time when creative intellectual leadership was not matched by courageous political leadership” (2000). As Murphy illustrates, two of the weaknesses in global governance, the absence of challenging the actions of sovereign entities and lack of “courageous political leadership,” have bred widespread institutional corruption, whether or not it was intended.

            The chaos that cripples global health governance is largely due to the failure of governments, non-profit organizations, donor, and private corporations from clearly defining and aligning their goals, objectives, activities, roles, and responsibilities when addressing a specific global health issue (WHO, 2000). Furthermore, the lack of incentives for strong sectoral performance are especially undermined by ineffective management, weak productivity, and poor performance (Lewis, 2006). Measures to analyze the performance of global health’s governing stakeholders simply do not exist, such as hiring qualifications (Lewis, 2006). The absence of monitoring the institutional and sectoral policies and actions of stakeholders have largely escaped scrutiny and censure, most probably due to the stagnant paradigm that any form of public service is morally justified and welcome (Global Health Reporting, 2008). Each type of stakeholder succumbs to its unique obstacles and challenges in terms of corruption. First, whereas the introduction of the corporate world in the field of global health has garnered increased funding, research, and development, it has also brought forth increased corporate authority in global health policy-making through intimate collaboration with international bodies, such as the World Bank (WHO, 2000). This opens the door for unchecked corruption among corporate players and uncertainty of their incentive to promote health in the developing world, especially due to their primary focus on profits rather than health as their outcome objective (WHO, 2000). For example, the World Health Organization has expressed its worry over the tobacco companies’ active involvement in the formation of global tobacco regulation policies, and has warned national governments about the industry’s potentially insincere motives (Collin et al., 2002). Second, in terms of donors as significant stakeholders in global health, “perceptions are powerful factors in shaping behavior. If investors perceive corruption or patients perceive poor quality, it discourages private investment or health demand” (Lewis, 2006). Thus, respected institutions and politically stable governments that base their global health efforts on integrity and transparency are more attractive to private investors and donors. Third, numerous non-profit organizations serve as channels of advocacy and lobbying for certain global health issues often with narrow agendas, and thus possess the potential of supporting governments and private organizations that submit to their needs, but engage in corruption to achieve goal outside those of the non-profit organization’s focus (Thomas & Weber, 2004). Finally, numerous governments lack the skills and/ or incentive to provide effective stewardship over their countries’ health systems. Universities, non-profit organizations, and the local media in developing countries may lack the resources to serve as effective regulators over both their government officials (Global Health Reporting, 2008). It is of utmost importance to note that the absence of governing accountability at the highest levels trickle down to the micro-leadership level of health systems. For example, health professionals and administrators may succumb to under-the-table payments due to low pay, irregular salary payments, lack of government attention, and the need to keep services afloat (Lewis, 2006). Thus, vulnerable patients must pick up the financial slack of corrupt governments who prioritize their personal wealth over the well-being of their constituents (Lewis, 2006).

Evidence of the Association Between Stakeholder Corruption & Poor Global Health Outcomes

             Although the association between government corruption and health has not been studied nearly as robustly as health’s connection to other macro-deficiencies, such as the absence of medical technology in the developing world, it is still an evidence-based one that needs to be highlighted. “Only governments sensitive to the demands of their citizens appropriately respond to needs of their nation” (Menon-Johansson, 2005). The three most influential dimensions of governance related to a country’s public health profile were government effectiveness, the rule of law, and corruption (Menon-Johansson, 2005).  Researchers have discovered that as governments become more ethical, fewer of their nation’s women die in childbirth, more physicians exist per population, access to clean water improves, and life expectancy increases among adults (Menon-Johansson, 2005). Studies have also illustrated that government corruption practices are correlated with health outcomes of child and infant mortality, the likelihood of an attended birth, immunization coverage, and low birth weight (Menon-Johansson, 2005). Improvement in governance also elevates the country’s Gross Domestic Product (GDP), as well as higher investment in health and education, compared to the military (Menon-Johansson, 2005). In addition, the success of public health spending in reducing child mortality depends on a government’s integrity rating (1-5 range based on level of perceived corruption), with higher integrity associated with lower mortality rates (Lewis, 2006). The infectious disease profile of many developing countries is also influenced by their governing standards, as it has been proven that HIV prevalence decreases as the governance improves for each governance indicator (listed previously), as well as mean governance (Lewis, 2006). In terms of specific national governments, Slovakia, Tajikistan, Bangladesh, India, and Sri Lanka rank as possessing the highest association levels between a weakened health care system and corrupt government (Lewis, 2006). A comparative study in five South Asian countries (Bangladesh, India, Nepal, Pakistan, and Sri Lanka) found that in all but Sri Lanka, most health service payments were made under-the-table to submit to the demands from providers, and bribes were mandated in all five countries for admission to the hospital, to secure a hospital bed, and to purchase subsidized medications (Lewis, 2006).

            A more subtle, but nonetheless threatening, level of governing corruption exists among private foundations as well. An unintended form of corruption due to the absence of global health governance monitoring can be exemplified by the most highly regarded private foundation in the field of global health, the Bill & Melinda Gates Foundation. Besides serving as the largest private donor for global health initiatives, the foundation’s advisory board members are included in the decision-making processes of almost all major global health governing institutions, such as the Global Health Council. However, unlike institutions such as the World Health Organization, it is excused from any form of democratic or political accountability (Global Health Reporting, 2008). One of the foundation’s most criticized acts of contradiction in promoting and harming the public health of a country was its investment in the Italian petroleum company Eni (Piller et al., 2007). The foundation garners huge financial rewards from its investments in a company that has initiated an epidemic of adult bronchitis, childhood asthma, and blurred vision among children due to the fumes and soot from over 250 toxic chemicals that are released from its towers (Piller et al., 2007). It was discovered that the Gates Foundation contributed $218 million towards polio and measles immunization and research worldwide, but has invested $423 million in oil conglomerates such as Exxon Mobil Corporation and Chevron Corporation that causes pollution levels in developing countries that surpass standards set in affluent countries (Piller et al., 2007). Researchers also revealed that hundreds of investments by the Bill & Melinda Gates Foundation, totaling at least $8.7 billion (41% of its assets), have been entrusted to for-profit institutions that counter the foundation's socially just goals and philosophy (Piller et al., 2007).

Recommendations & Possible Solutions

            At the epicenter of devising a potential solution to the non-existent regulatory mechanism for global health governance is the principle that “global governance cannot replace the need for good governance in national societies. In fact, in the absence of quality local governance, global and regional arrangements are bound to fail or will have only limited effectiveness. In a way, governance has to be built from the ground up and then linked back to the local conditions” (Lewis, 2006). Thus, since few top-down approaches have proven to be effective in curbing stakeholder corruption levels in global health, the solution may lie in first assuring that corruption ceases at the micro-levels of a country’s health care system. Community-driven campaigns, social media efforts, and community-based organizational advocacy efforts must be implemented in order to hold governments and large institutions from slipping into intended and unintended forms of corruption and misalignment of actions with the needs of patients and communities. Only then do citizens possess the power to monitor its government and corporate capacity to implement sound policies, manage health resources, and provide services efficiently and ethically (Lewis, 2006). For sustainable change to take effect, international legal measures must be coupled with grassroots initiatives, which has been a largely unexplored area for the formation of ensuring governance standards are met by each country (Taylor & Bettcher, 2000).

Works Cited

Bulletin of the World Health Organization (2000). Global public-private partnerships: part II-what are the health issues for global governance?; 78(5).

Collin J, Lee K, Bissell K. (2002). The framework convention on tobacco control: the politics of global  health governance. Third World Quarterly; 23(2): 265-282.

Lewis, M. (2006). Governance and Corruption in Public Health Care Systems. Center for Global       Development; 78: 3-57.

Menon-Johansson, A.S. (2005). Good governance and good health: The role of societal structures in the  human immunodeficiency virus pandemic. BMC International Health & Human Rights; 5(4): 1-10.

Piller, C., Sanders, E., & Dixon, R. (2007). Dark cloud over good works of Gates Foundation. Los Angeles   Times. Retrieved March 28, 2009, from < style="mso-spacerun: yes" class="Apple-tab-span" style="white-space:pre"> gatesx07jan07,0,6827615.story>.

Taylor A.L., & Bettcher D.W. (2000). WHO Framework Convention on Tobacco Control: a global “good” for public health. Bulletin of the World Health Organization. 2000; 78(7): 920-929.

The Global Health Landscape (2008). Global Health Watch: An Alternative World Health Report. London: Zed Books; 210-239.

Thomas, C. & Weber, M. (2004). The politics of global health governance: Whatever happened to "health for all by the year 2000"? Global Governance: A Review of Multilateralism and International   Organizations; 10(2), 187-205.

Natural Disasters: Cyclone Nargis

Veeral Shah

PM 565

Blog paper 1

Potential ASEAN (Association of Southeast Asian Nations) Responses to Cyclone Nargis

A disaster is a serious event that causes an ecological breakdown in the relationship between humans and their environment on a scale that requires extraordinary efforts to allow the community to cope, and often requires outside help or international aid. Disasters can be divided into two major categories – natural and man-made. In natural disasters, a natural hazard affects a population or area and may result in severe damage and destruction and increased morbidity and mortality rates. They usually have a relatively acute onset, but natural disasters are at times complicated by other underlying phenomenona such as the delay of aid to those in need due to deliberate political and miltary policies and strategies.

In early May 2008, Cyclone Nargis tore across southern coastal areas of Burma pushing a tidal surge through villages and rice paddies. The 12-foot wall of water killed tens of thousands of people and left hundreds of thousands homeless and vulnerable to injury and disease. Even in the commercial capital of Rangoon, where structures are more sturdily constructed, winds up to 120 mph sheared off roofs and uprooted trees and electrical poles. The UNFood and Agriculture Organization estimates that the tropical storm rendered 500,000 or more acres of the 3.2 million acres of paddy land in the Irrawaddy Delta, the hardest hit region, unavailable for the monsoon planting season that began in June.¹ After the storm, Burma’s commander-in-chief, Senior General Than Shwe, declared that Burma was capable of handling the relief effort but would allow limited international assistance so long as “no strings were attached.”²

Typically, the public health model for disasters highlights a cycle of preparedness, mitigation, response, and recovery. When a natural disaster strikes, national and, if needed, international relief workers rush to the scene in an effort to save lives by providing 5 essential types of aid: search/ rescue/protection, health, food, water, and shelter.³ At the same time, public health professionals conduct rapid assessments using cluster sampling methods to document mortality and morbidity, emerging epidemics, property destruction, homelessness and displacement, damage to water and sanitation networks, loss of electrical power and livestock, disruption of health care services, and food shortages. They also apply immediate public health measures—removing corpses, managing solid waste, immunizing survivors, disinfecting drinking water, educating displaced survivors about hygienic practices, and developing systems to detect and prevent increases in infectious diseases.

The Burmese government failed to implement these essential measures in any meaningful way during the critical days and weeks following Cyclone Nargis. This failure resulted from the government’s lack of logistical capacity to respond effectively to a disaster of such magnitude and its distrust of the intentions of mainly Western governments and aid organizations. While the Myanmar Red Cross Society set up aid stations in a few affected townships, scores of international aid workers remained grounded in neighboring Thailand waiting for visas. British, US, and French navy ships laden with supplies, heavy-lift helicopters, and other equipment idled in Thai waters while seeking permission to enter Burmese waters to help with the relief effort. On May 21, 3 weeks after the storm struck, UN Secretary-General Ban Ki-moon announced that only a quarter of the 2.5 million people severely affected by Cyclone Nargis had received any form of aid.² Two days later, he traveled to Burma’s new capital of Naypyitaw to meet with Shwe. It was an unprecedented trip: never before had a UNsecretary-general found it necessary to travel to a disaster-affected country to plead with a head of state to open its borders to relief aid and international disaster experts. Ki-moon emerged from the meeting with an agreement that Burma’s military leaders would admit international aid workers “regardless of nationalities” and allow the Association of Southeast Asian Nations (ASEAN), of which Burma is a member, to oversee distribution of relief.² Such progress notwithstanding, cyclone survivors continue to face serious problems. An estimated 55% of families in the storm affected areas have less than 1 day’s worth of food, and 63% of households lack access to clean drinking water, according to an ongoing assessment of the disaster relief effort by the United Nations, ASEAN, and the Burmese government.⁴

The assessment also found that 82% of homes in cyclone-affected areas were totally destroyed (57%) or partially destroyed (25%) and that 22% of households were under psychological stress.⁴ As of July 2008, agencies reported that they still lacked unrestricted access to cyclone affected areas. This situation is exacerbated by the fact that the government declared an official end to the relief phase a month after Cyclone Nargis hit. The regime then began evicting displaced persons who were sheltering in monasteries, schools, and other public buildings and ordered them to return to their homes or military-controlled camps. In both its resistance to supply efforts and in forced population movements, the government appeared to violate several aspects of international law.

Mounting an effective humanitarian response to a natural disaster is difficult in any country. But few countries have been less prepared and less willing to respond to a major disaster than Burma. Ruled by a succession of military officers since 1962, Burma degenerated from a resource-rich country—once known as the “Rice Bowl of Asia”—into an isolated, desperately poor nation of 55.4 million individuals where 26% of the population lives below the national poverty line.⁶ Burma’s health sector now ranks 190th of 191nations,7 outperforming only war-torn Sierra Leone. Malaria continues to be a national priority disease with more than a half million cases reportedly occurring every year.8 Nearly half of malaria deaths in Southeast Asia occur in Burma. Approximately 40% of Burma’s annual spending goes to the military and only 3% goes to health care. The government of Burma spends only 40 cents per citizen each year on health care compared with the government of neighboring Thailand, which spends $61 per citizen a year. In the mid-1990s, UN agencies and international aid organizations began arriving in Burma in an attempt to address these health needs. But it was a difficult relationship from the beginning: Burma’s leaders were suspicious of Westerners, often referring to them in speeches as “neo-colonialists,” while aid workers had to be especially circumspect to avoid angering the generals, who could easily terminate their programs or deny them access to project sites. By 2004, 41 aid organizations were operating in Burma with a combined budget of about $30 million, and tens of millions of dollars more were used to fight infectious diseases.⁶

In light of this troubled history, in the months ahead ASEAN, as the principal steward of international assistance to cyclone-affected areas of Burma, and other organizations and agencies can take several measures to help survivors rebuild their lives and reduce their vulnerabilities, protect basic human rights, and ensure that supplies get to those most in need. First, ASEAN and other donor governments and agencies should put forth a public statement of the principles that will define their engagement with the Burmese government and civil society organizations, as well as set out specific objectives and goals that can be effectively monitored and evaluated. These principles should include the following key elements of successful postdisaster reconstruc-tion: (1) transparency and accountability of aid distribution; (2) protection of vulnerable populations; (3) support and strengthening of civil society; and (4) community participation in reconstruction planning and implementation. The last element is often overlooked but of particular importance. Studies of the behavioral health effects of natural disasters suggest that providing individuals with appropriate support strategies and opportunities to shape their futures and protect their rights can help form the basis for future hazard mitigation and may help reduce long-term psychological effects, including posttraumatic stress disorder (PTSD) and depression. Ultimately, Cyclone Nargis survivors and their communities must be active and engaged participants in—not merely auxiliaries to—rebuilding efforts.

Second, ASEAN and other donor governments and agencies should help Burma develop an early warning system and make other preparations to respond more effectively to future disasters. If climate change brings an increase in cyclonic activity, as some climatologists have predicted, Burma’s heavily populated coastline will continue to be among the world’s most vulnerable regions.⁷ The destructive power of tropical cyclones on human populations can be reduced through a combination of education, early warning, evacuation planning, shelter and public health preparedness, and community change. Several studies suggest that safe shelter is particularly critical. In the high-fatality 1991 Bangladesh cyclone, for example, deaths were reduced substantially among those who reached public shelters: 40% of family members were killed in an area without shelter access, in contrast to 3.4% in an area with available shelters.⁷ In the years since, the Bangladesh government and nongovernmental organizations have worked together to prepare for future tropical cyclones by elevating villages, building shelters, and constructing artificial mounds the size of soccer fields to which whole communities can retreat from floods and tidal surges.

Third, ASEAN and other donor governments and agencies should monitor the human rights situation in Burma and, if and when abuses occur, be prompt and forceful in raising concerns with the Burmese authorities. These institutions should also continue to pressure the Burmese authorities to grant unfettered access for international relief staff who, by their presence and vigilance, can help prevent abuses. Even in the reconstruction phase cyclone survivors and domestic aid groups remain vulnerable to a range of human rights abuses, including arbitrary arrest, human trafficking, forced labor, discrimination, forced resettlement, and confiscation of property. Indeed, such abuses were found in many of the vulnerable populations studied following the Asian tsunami of 2004.

It is natural to hope the destruction wrought by Cyclone Nargis will force Burma’s military junta to reform its ways: to devote its resources primarily to helping the Burmese people live better and more productive lives. Although that may seem unlikely, the cyclone has provided the international community with an extraordinary moment to promote change in Burma from the grassroots up. Four factors could help catalyze a transformation—Burmese civil society’s widespread and generous response to the disaster; ASEAN’s direct involvement in relief and reconstruction efforts, along with the increasing presence of international aid workers; a deepening economic crisis accelerated by the cyclone; and the realization among the Burmese people that government leaders failed to respond swiftly to help cyclone survivors. Ironically, the cyclone’s devastation could serve to reduce Burma’s isolation from the outside world and create opportunities for regional and international collaboration in the nongovernmental sector. Now it is up to governments and philanthropic institutions to extend their largesse not only to cyclone survivors but also to civil society organizations in Burma, using their newfound leverage to promote health, development, and human rights in this troubled country.

References

1. International Regional Information Networks, UN Office for the Coordination of Humanitarian Affairs. Myanmar: food assistance “likely” for up to a year. http: //www.irinnews.org/report.aspx?ReportId=78631.

2. Yangon, Myanmar, 23 May 2008: Secretary-General’s press conference at Hotel Sedona in Yangon. http://www0.un.org/apps/sg/offthecuff.asp?nid=1164.

3. VanRooyen M, Leaning J. After the tsunami: facing the public health challenges. N Engl J Med. 2005;352(5):435-438.

4. Tripartite Core Group (the Government of the Union of Myanmar, Association of Southeast Asian Nations, and the United Nations). Post-Nargis joint assessment. http://www.aseansec.org/21765.pdf.

5. United Nations Office of the High Commissioner for Human Rights. Guiding Principles on Internal Displacement (E/CN.4/1998/53/Add.2). http://www.unhchr .ch/html/menu2/7/b/principles.

6. World Health Organization. Country health system profile: Myanmar. World Health Organization Web site. http://www.searo.who.int/EN/Section313/Section1522.htm.

7. World Health Organization. Statistical Annex: The World Health Report 2000— health systems: improving performance. http://www.who.int/whr/2000/en/whr00_annex_en.pdf.

8. UNICEF. At a glance: Myanmar. http://www.unicef.org/infobycountry/myanmar.html.

Human Right to Health

Human Right to Health Blog


It is a well known fact that the good health of a population and the prosperity of a nation are linked. It is also well known that health is a crucial part of human rights. In the Universal Declaration of Human Rights, Article 25 states:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.” And “Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.”

The World Health Organization states that “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.” Yet despite support of this declaration and many statements regarding the human right to good health, many countries still deprive their citizens of their right to health. They lack basic access to doctors and they are burdened with ill-health leading to lower economic potential. This immoral burden severely limits the potential of a large amount of people.

One need not go very far to see the injustice of the lack of respect to a human’s right to health. The United States spends the most amount of money on its health care system, yet there are close to 47 million uninsured who do not have access to basic care. Recently, the WHO ranked the United State 37th on the overall health system performance. Sadly, the richest nation in the world does not have the means to provide its citizens access to affordable health care and thus denying them their right to health.

Although there are some resources devoted to helping the poor gain access to what some say would be the most advanced medical system in the world, there are severe limitations as to who is eligible to participate and what services are provided to its enrollees. Furthermore, health is deemed not as a right but a privilege by some in the United States. It provides the best medical care to those who can afford it but we need to ask ourselves if that is really what medical care is about.

What is interesting is that the debate about health care is not about the purpose of health care but about economics. The human aspect of health has been completely removed and any efforts to introduce that aspect have been rebuked by ideological arguments. Health care is often seen as a commodity whose distribution should be based on the markets. The proponents of this argument say that charities must step in to provide for those who have fallen through the gaps in the market. They do not see a legal basis for the health care problem. They fear that if health is seen as a right enforceable and defended on a legal perspective, what others may be seen as a right like adequate food (what kind of food is a basic right?) and adequate housing (how big does one’s dwelling have to be in order to be classified as adequate?). The opponents of health as a right say that health is too complicated to be dealt with. Health can be affected by pollution, workplace safety and many others. How is it that a government can address all of these issues without burdening the rest of the country? The answer to this question is we are not going to be defining what good health but that everyone should have basic access to a doctor so they can get medical checkups. While it is true that good health is a result of many complex factors, basic access to medical care is not. It is just our will to fund for those who are unable to fund for themselves.

The United States government has, for the most part, resisted the promotion of social rights. Surprisingly, the United States has not ratified the International Covenant on Economic, Social and Cultural Rights and there does not seem to be a movement to advocate for the adoption of this rights document due to the current economic and political climate. One way to reshape the debate in this arena is to reframe the argument in an economic framework that shows that most people will benefit from the extension of health care benefits to every citizen. The public perception that health care is a commodity must shift in order for meaningful implementation of the human right to health. There needs to be efforts to show where the money that is currently spent on health care goes in order for the public to see that the inefficiency of the markets is not contributing to the equitable distribution of health care.

It is also important to note that poor access to health care tends to be very expensive in the long run. Many of the diseases that can be treated and prevented at early stages are postponed until either funds are available to seek medical care or until the situation worsens until the individual is forced to seek treatment.

After the implementation of Medicare and Medicaid in the mid-1960s, these programs have significantly helped those that were most vulnerable. They are highly popular and any efforts to revoke these programs will be political suicide for any politician. Yet, there is a lack of political will to expand these programs for the rest of the population thus guaranteeing every citizen has access to adequate health care.

In many other parts of the world, the primary reason for the lack of access to medical care is the lack of funds. Those countries do not have strong, viable economies that provide income to the government or the people so they can pay for basic care. But in this country, we can not use that excuse because we already spend $2.2 trillion on health care every year.

WHO states that the “vulnerability to ill-health can be reduced by taking steps to respect, protect and fulfill human rights.” This fight is linked with the fight to promote human rights. The United States has been an advocate of human rights for decades yet it overlooks its own shortfalls and has done very little to rectify this injustice. There is no limitation as to whether the health system is public or private but as long as everyone is equitably treated. For the United States, it seems that a partnership between public and private institutions is required to further the health of the population. The most important aspect of health as a human right is the ability to have access to quality care regardless of ability to pay. Unfortunately, the United States rations its health care based on an individual’s ability to pay for their care.



References

Farmer P. Rethinking Health and Human Rights. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley: University of California Press; 2005: 213-247.

Gostin L. The Human Right to Health: A Right to the “Highest Attainable Standard of Health”. The Hastings Center Report. 2001; 31(2): 29-30.

Gruskin S, Trantola D. Human Rights and HIV/AIDS. HIV InSite Knowledge Base Chapter: University of California San Francisco. 2002.

Mann JM. Health and Human Rights: if not now, when? Health Human Rights. 1997; 2(3): 113-120.

Roseman MJ, Gruskin S. HIV/AIDS & Human Rights: In a Nutshell. Program on International Health and Human Rights. Boston, MA: Harvard School of Public Health. 2004.

Skolnik R. The Principles and Goals of Global Health. Essentials of Global Health. Sudbury, MA: Jones and Bertlett Publishers; 2008.

Stone L, Gostin LO. Using Human Rights to Combat the HIV/AIDS Pandemic. Human Rights Magazine. 2004.