Eager to move forward … but hitting speed bumps in the road
I concluded yesterday’s report by noting how at the end of the day, participants seemed eager to move forward: to work in the next days not to debate why public health and rule of law programs need to work together, but how they can do so in practice. Today, however, participants realized they had to slow down and figure out some practical issues before they could move forward together.
Challenges to collaborationOn this rainy day, participants started in their working groups, familiarizing themselves with the strategic priorities of the Soros network’s public health and law programs. The objective was for all partic
ipants to identify the benefits of combining legal and health approaches in their respective work. To do this, public health staff were put in the shoes of law program staff, and vice versa.
Knowledge of fundamental issuesSome problems quickly became apparent that will have to be addressed if collaboration is to become meaningful. The first one is a lack of knowledge about fundamental issues and concepts that, while they are familiar to staff in one program, are not known at all to staff in the other program. Public health staff gasped in horror as some law program staff admitted candidly that they had no idea what the UN Declaration of Commitment on HIV/AIDS is. At the same time, some law program staff noted that, “while some public health staff seem to be committed to using legal tools, they don’t know much about how they can or cannot be used in practice.” Many staff noted that they do not know much about palliative care or harm reduction, two of the priorities of the Public Health Program, or some of the priorities of the Law Program. “We would have appreciated hearing a presentation about some of these issues to learn more about them and understand them better – what is in the resource guide and workshop manual is not enough, or we have not had time to read it.” Strikingly, even some of the legal tools developed or funded by the Public Health Program, such as the model legislation on drug use and HIV/AIDS [
Canadian HIV/AIDS Legal Network (2006). Legislating for Health and Human Rights: Model Law on Drug Use and HIV/AIDS. Available via www.aidslaw.ca, in English and Russian], was only known to public health staff, not to most of the law program’s staff or executive directors.
Time, funding, and staff limitationsParticipants mentioned other potential barriers and challenges, particularly that “staff already have a lot to do, and there is limited capacity and funding to take on new issues.” One participant said that much will depend on whether coordinators and boards at country level will be supportive. Noting that health work often deals with sensitive issues of sex and drugs, another wondered how willing staff outside the Public Health Program would be to take on work involving marginalized and often vilified communities. More fundamentally, one participant noted how different the various national foundations are, and how different their responses to the challenge of working together for health and human rights, particularly for marginalized communities, likely will be. “The reality is that when the foundations were new, they were cutting edge, but some have had a tendency to become more comfortable and less willing to confront governments on things governments do not want to do.” Public health program work is of necessity cutting edge, and it embodies the spirit of OSI as a human rights organization – but can we expect all national foundations to buy in?
Potential solutions
Ivanka Ivanova, Law Program Coordinator, Bulgaria, urged participants to move to finding concrete solutions: “I don’t have to be convinced. We have done things together. What is missing is an analysis of very practical things inside the Network that are preventing us from collaborating more often, or that are making it more difficult for us.” She pointed out how simple things, like the fact that planning cycles for law programs and public health programs are rarely coordinated, make it difficult to plan joint activities.
Introducing the first panel presentation, Jonathan Cohen stressed that “collaboration is already happening: the integration of rule of law and public health programs has been successful for a number of Soros foundations.” Participants then heard about how rule of law and public health staff from two foundations [the Open Society Initiative for Southern Africa (OSISA) and the International Renaissance Foundation (IRF) in Ukraine] have closely collaborated for a number of years and found institutional arrangements that have made collaboration effective. Sisonke Msimang and Sami Modiba from OSISA and Mariya Savchuk and Roman Romanov from IRF explained how they regularly come together to identify potential areas of collaboration, discuss strategy and approaches in joint staff meetings, review project proposals together, and undertake joint initiatives. Importantly, they highlighted that everything they do, whether public health, law, or other initiatives, is rights-based, and that this approach makes it easier for them to understand the relevance of working together for health and human rights.
During the discussion and question and answer period that followed, presenters and other participants highlighted the need to be practical, to identify concrete areas of common interest to law and public health staff in which collaboration makes immediate sense, and to start with reasonable expectations. Roman said that law and health staff “should not expect everything, but rather focus on achieving concrete results in concrete areas.” “One example is the issue of alternatives to imprisonment, one of the priorities of the criminal justice program. I simply don’t understand why we have not linked public health and law efforts, when it is clear that HIV/AIDS, TB, and drug policy are among the primary reasons why alternatives to imprisonment are needed more than ever.”
Rather than focusing on how collaborations could be effected, the discussion then veered into the never ending puzzle of how human rights organizations and lawyers can be convinced to become more supportive of issues related to HIV/AIDS, harm reduction, palliative care, and other priorities of the Public Health Program. For a moment, participants seemed to forget that this workshop was about collaboration between law and health initiatives
within OSI, not about the much larger and more complicated issue of how to engage others.
LAHI rocks!
Participants agreed on one thing: the creation of the Law and Health Initiative (LAHI) represents a unique opportunity to facilitate collaboration between law and health programs, under the inspired leadership of Jonathan Cohen. “LAHI should receive all the support it needs to be able to catalyze more strategic initiatives to advance health and human rights.”
The debate about the right to healthAt the end of the day, participants were treated to a riveting panel discussion on the right to health, featuring a group of distinguished, brilliant (and funny!!) judges and advocates. Françoise Girard introduced the discussion by pointing out that “it is often said that social and economic rights are a poor idea” and that “courts are poorly placed to make decisions about resource allocations.” “When courts get in the mix, there may be bad results.” She therefore asked whether “the right to health is dangerous?” The panellists acknowledged that, when interpreting and enforcing these rights, judges often face the unenviable task of weighing the critical needs of individual citizens against the legitimate budgetary constraints of the state. They argued, however, that South Africa’s Constitutional Court has successfully enforced the constitution’s provisions for social and economic rights while balancing the state’s interest in managing its political affairs. Although this balancing approach is not always easy, they concluded that the South African experience has been largely successful and that other countries might reconsider their courts’ approach to the question of social and economic rights.
Collaboration? We are already doing it! Introducing the rapporteur’s team
The rapporteur’s team shows how collaboration between public health program and law program staff can work in practice: two staff from the Human Rights and Governance Grants Program in Budapest (Andrea Simonits and Herta Toth), and four staff from the Public Health Program (Marina Smelyanskaya, Budapest; and Helena Choi, Eleonora Jimenez, and Rachel Thomas, New York) are working with me to provide you with this daily update, and are having fun bouncing off ideas, reflecting on what is happening, and debating how collaboration can be fostered and sustained. We could not do this without the assistance of Ellen Liu and Paola Deles. Our thanks also go to Lila Elman who is working with us to make sure that there is not only a written, but also a photographic record of this historic event that will forever change OSI.
We want you!
We want to hear from you. Please send your comments to rjurgens@sympatico.ca.
- Ralf Jürgens, Chief Workshop Rapporteur
Quotes of the day
“What is of particular interest to you [among the other program’s priorities and activities]? What excites you? That is where collaboration should start.”
Roxana Bonnell, Deputy Director, Public Health Program
“Is the right to health dangerous?”
Françoise Girard, Director, Public Health Program
“I personally think the right to health is essential – otherwise, you can think about health in utilitarian, bureaucratic ways.”
Colm O’Cinneide, Faculty of Laws, University College London
“The fight against apartheid was not only a fight for the right to vote, but also for a decent life. Social and economic rights, and the right to health in particular, are about the sort of society we believe in”
Geoff Budlender, Advocate in the High Court of South Africa
“I am obsessed by this topic.” [using the right to health or other rights to bring complaints of denial of health care]
Colm O’Cinneide, Faculty of Laws, University College London
“Lawyers are more organized than health people.”
Comment by a lawyer – who did not want to be identified – comparing the worksheet filled out by a group of law program staff to that of the public health staff.
“We only had one person in our group [the group discussing harm reduction] who knew anything about this issue, because we were all lawyers.”
Magda Adamowicz, Program Coordinator, Human Rights and Governance Grants Program
“Vision, passion, and action are needed. If lawyers have thus far failed to come on board as partners to fight for the health and rights of marginalized populations, we should not blame them. Maybe we health advocates have failed to make our points, to be clear about what the health implications of bad laws are, and how we can and should work together to advance common goals.”
Robert Newman, Member of the Global Health Advisory Committee, New York
“Our health program is also a human rights program.”
Sami Modiba, OSISA
“We cannot expect any deep collaboration without understanding each other.”
Roman Romanov, IRF
“This is not about collaboration between doctors and lawyers, but about the needs of people.”
Roman Romanov
“We are just at the beginning, we can go anywhere, we can use our expertise, working together, to make a difference.”
Mariya Savchuk, IRFActivities
09:00 – 10:45 Activity 1: In Your Shoes: Health and Human Rights Programming (Working Groups)
10:45 – 11:15 Networking Break
11:15 – 12:30 Activity 2: Health and Human Rights: OSI’s and SFN’s Engagement (Panel Presentation) - DOWNLOAD MP3/AUDIO RECORDING (PART 1 & PART 2)
- Sisonke Msimang, HIV and AIDS Programme Manager, Open Society Initiative for Southern Africa (OSISA)
- Sami Modiba, Programme Manager, Human Rights and Democracy Building, Open Society Initiative for Southern Africa (OSISA)
- Mariya Savchuk, Public Health Program Director, International Renaissance Foundation – Ukraine
- Roman Romanov, Rule of Law Program Director, International Renaissance Foundation – Ukraine
- Moderator: Jonathan Cohen, Project Director, Law and Health Initiative, OSI Public Health Program
12:30 – 14:00 Issue Table Lunch with Poster Presentations
The issue table lunch will provide an opportunity for poster exhibitors to speak informally and engage in an interactive discussion about their health and human rights project. Participants are encouraged to join an issue table of interest, and actively participate in the open, unmoderated discussion to learn how the health and human rights model could apply and be replicated in their own local context.
14:00 – 16:00 Activity 3: Mapping Health and Human Rights Issues (Working Groups)
This mapping exercise will enable participants to examine the connections between health and human rights issues in OSI programming. The process will involve participants identifying examples of health-related concerns in each of OSI’s six priority health and human rights areas:
- Human Rights in Patient Care
Resource Person: Dmytro Grosman - HIV/AIDS and Human Rights
Resource Person: Delme Cupido - Harm Reduction and Human Rights
Resource Person: Balázs Dénes - Palliative Care and Human Rights
Resource Persons: Frank Brennan and Liz Gwyther - Sexual Health and Human Rights
Resource Person: John Fisher - Health and Human Rights in Minority Communities
Resource Persons: Martin McKee and Willem Odendaal
These six priority areas will be mapped against the following key rights issues:
- Policing and Law Enforcement
- Closed Institutions (e.g. prisons, drug treatment centers, mental health institutions)
- Discrimination
- Privacy
- Access to Information
This exercise will form the basis for developing joint health and human rights programming ideas.
16:00 – 16:30 Networking Break
16:30 – 18:00 Activity 4: The Right to Health: Perspectives from Judges and Advocates (Plenary) -
DOWNLOAD MP3/AUDIO RECORDING (PART 1 & PART 2)
This presentation will consist of a judges and advocates’ panel that will discuss the most current thinking on the right to health, giving it content in practice, and grappling with implementation questions.
- Geoff Budlender, Advocate of the High Court of South Africa
- Iain Byrne, Commonwealth Law Officer, International Center for the Legal Protection of Human Rights (Interights)
- Colm O'Cinneide, Senior Lecturer in Laws, Faculty of Laws, University College London and the European Committee of Social Rights (ECSR)
- Catherine Mumma, former commissioner, Kenya National Commission of Human Rights
- Moderator: Françoise Girard, Director, OSI Public Health Program
19:00 – 22:00 Wine Country Dinner at
Simon’s, Constantia Valley
Groups report back in plenary on their Hot Topics.
