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Human rights and nursing

by Jean McHale, Ann Gallagher
Revista De Enfermeria Barcelona Spain (1987)

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Available from eprints.kingston.ac.uk
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Human rights and nursing

1
Millennium Development Goals
and Human Rights
Dr Georges Tadonki
December 2008-12-01

Lecture to the Human Rights and development Course 2008
Good Governance Programme

Centre for Human Rights (University of Pretoria)
Norwegian Centre for Human Rights (University of Oslo)


Introduction

It is an honour and a pleasure to be here again to deliver this lecture at the
prestigious University of Pretoria. The Good Governance Programme developed by
the Centre for Human Rights touches a fundamental question to modern societies,
often neglected by hardcore thinkers of development. The Good Governance
paradigm is a global one; it raises important challenges, particularly when the
current global economic turbulences indicate that so many things still need to
be fixed in a world economic system which is very imbalanced.

I am not an economist, neither a specialist of law. I will therefore approach
the question of Human rights and MDG from the point of view of the Geographer
and field practitioner of both active geographic research and development
response in the last two decades, which is just half the reference period of all
analysis ad predictions of development trends, post 60‘s. I will also base this
lecture on the discussion of two critical pillars of good governance which are
poverty and social vulnerability. Indeed, this will be contextualised to sub-
Saharan Africa mainly and to some extent to emerging economies of South East
Asia.

I. About Uneven Development and Governance

In 1962, René Dumont published an iconoclast book titled ―L‘Afrique noire est
mal partie‖. Dumont used to say ―to respect Africa is to tell it the truth,
without which the continent will not be able to find a way out of disasters‖.
Today, this remains valid, as the spectrum of famine, cholera, drought, poverty
in all aspects implacably continue to affect African societies four decades
after Dumont‘s warning signal. In the middle of the independence cha-cha
euphoria, the French professor of Agronomy then declared that Africa was not
ready for development or that it will not happen so soon. I belong to the
generation of Africa‘s hope and sadly concur that the Professor‘s predictions
can be validated and that the symptoms are still prevalent.

No amount of international aid or technical assistance will take Africa out of
poverty except the dynamics of its own societal contradictions. The
developmental challenge must be faced by African themselves, but African cannot
be responsible if they are not free. Freedom has a deep meaning when it relates
to our ability to chart our own destiny. An American writer, Henry Lamb said
―Freedom and sustainable development are mutually exclusive ideas. Freedom
encourages people to do what they want to do; sustainable development dictates
what people may, or may not do. Freedom empowers people to control government;
sustainable development empowers government to control people.‖1 This is true
for Africa, as we are still to see true participatory developmental approaches
in the continent. People do not only have to be free to choose their leaders,
they should also be free to prosper, to migrate get access to education,
adequate health care and protection from basics abuses of human rights that
deprive them of the confidence that makes successful entrepreneurs.

1 Henry Lamb, Sustainable Development ; unsustainable freedom, 2004
(http://www.enterstageright.com/archive/articles/0604/0604sd.htm)
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Currently, foreign assistance to chart Africa‘s future come trough arms deals
and political influence, the scramble for the mineral resources, a limited FDI,
as well as development and humanitarian assistance. For the last forty years,
all social sciences have failed to understand the root causes of governance
failure in Africa, beyond the classic enunciation of the ingredients of failed
states or disruptive changes in affected communities. We are still discussing
development when it is dead. The question goes beyond the development paradigm,
when contextualised with decades of failure to deploy sustainable changes. What
do we aim at developing today, where and how? This is a crucial geographic
question, as it adds the challenge of global connectivity to the Hegelian curse
of Africa. In global shocks, Africa has been a four century looser, can this be
changed?

The global competition for resources, market dominance and wealth is raging,
despite serious turbulences in the current world economic financial systems. The
amount of development and humanitarian aid is likely to be affected, raising
again the issue of effectiveness, beyond Paris 21 Declaration2. There is a
strong correlation between development and good governance. But what is good
governance? This goes beyond this lecture and, Lets see how MDGs and Human
Rights go together.

―I like arguing rather than dispensing privileged advice, but I also think
social change comes best from public argument,‖ Amartya Sen3. This discussion
goes trough social choice theory as the foundations of democracy. What is the
best way to measure social progress? One of the key challenges poses to classic
economic work relying on income statistics and which form the basis of the Human
Development Index is their failure to capture international welfare issues.
Another famous finding of Sen, was that no famine had ever occurred in a
democracy. For example, communist China succumbed to a disastrous famine between
1958 and 1961 in which some 30 million people starved to death. However,
postindependent India, although poorer, has never again had a famine. Sen argued
that, in a democracy, information spreads more quickly and public criticism
comes more easily, making a quick response by the government to extreme events
essential Sen‘s intensive and prolonged study of inequality, especially gender
inequality, led to his analysis of the ―missing women‖: the millions of women in
China, India, North Africa, and West Asia who die prematurely every year as a
result of inequality of health care, domestic neglect, or social negligence.
―While the excess female mortality has been moderated or reversed in many
countries of the world,‖ he says, ―there is a new and powerful contributor to
‗missing women‘ through selective abortion of female fetuses.‖

Sen also broke new ground in the study of famines, a subject that had long
interested him after he witnessed the 1943 Bengal famine as a child. His work
focused on the understanding that people starve when they do not have money to
buy food — a seemingly obvious point, except that most commentators and
policymakers were convinced that the problem had to be related to a decline in
food supply. In his 1981 book Poverty and Famines, which examined famines in
India, Bangladesh, and sub-Saharan African countries, he proved that there had
been many famines in which the food supply had not declined—such as the one in
Bangladesh in 1974, a peak year of food production. He also showed that the
people who suffered were not only those on the lowest rung of the economic
ladder but also those whose economic means had suddenly declined for one reason
or another. As a result, governments have since concentrated their famine

2 The Paris Declaration on Aid Effectiveness was developed at a forum in Paris in February - March
2005. It looks at the responsibility of developed and developing countries for delivering and
managing aid in terms of five principles:
1. Ownership: Partner countries exercise effective leadership over their development policies,
and strategies and co-ordinate development actions
2. Alignment: Donors base their overall support on partner countries' national development
strategies, institutions and procedures
3. Harmonisation: Donors' actions are more harmonized, transparent and collectively effective
4. Managing for Results: Managing resources and improving decision-making for results
5. Mutual Accountability: Donors and partners are accountable for development results
3 Amartya Sen, Nobel Price 1998, Economics
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interventions on replacing the poor‘s lost income rather than on simply
distributing food.

James Wolfensohn turned a poet for a ―Our Dream is a world free of poverty‖ but
in reality it eluded, many key factors of uneven development4.


II. World Summit Outcome: MDGs

The importance of achieving the MDGs was reaffirmed at the highest level in
September 2005 at the World Summit. At that meeting, the largest-ever gathering
of world leaders also agreed to promote the rights of women more broadly by:

1. Eliminating gender inequalities in schools
2. Guaranteeing the free and equal right of women to own and inherit property
3. Ensuring equal access to reproductive health
4. Promoting women's equal access to work
5. Eliminating all forms of discrimination and violence against women and girls,
in particular during and after armed conflicts
6. Promoting increased women's representation in government decision-making
bodies

Leaders at the World Summit also advanced the cause of reproductive rights by
endorsing the ICPD goal of universal access to reproductive health by 2015.
Universal and equal access to reproductive health and the elimination of all
forms of discrimination and violence against women are now at the top of
political agendas of all countries in the world.


III. Similarities and complementarities
between MDGs and human rights


Human rights and MDG are not to be seen as mutually exclusive: they are two sets
of interdependent and mutually reinforcing commitments.


MDGs and human rights: a reciprocal relationship

MDGs can provide relevant benchmarks for the progressive realization of human
rights. For example the specific target set by MDG 4 - reducing by two-thirds,
between 1990 and 2015, the under-five child mortality rate - can provide a
relevant milestone for the realization of the child‘s right to health under the
CRC. Of course the MDG targets – as with human rights targets or benchmarks –
must be ‗localised‘ or tailored to the national situation and resource
availability. Economic, social and cultural rights (including the right to
food, health, housing and education) are for the most part required to be
realised to the maximum extent of available resources in any particular country.
Accordingly ‗localised‘ MDG targets can generally be expected to furnish more
relevant national milestones for the progressive realisation of economic, social
and cultural rights than the global MDG targets. Human rights benchmark
selection, as with the process of customising MDG targets, should be carried out
in as participatory fashion as possible.

A human rights-based strategy provides more effective and sustainable means for
achievement of MDGs. Focusing on individuals as key actors in their own
development, rather than passive recipients of commodities and services, a
rights-based strategy is more likely to foster efficient national ownership and
people's empowerment, both key to achieving the MDGs. Human rights standards
and related principles provide minimum standards and strengthen processes for
the achievement of development goals. Human rights sharpen strategies for

4 Eric Reiner, How Rich Countries Got rich … and Why Poor Countries Stay Poor, Constable, London, 2007
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realising MDGs by addressing the discrimination, powerlessness, and weaknesses
in systems of accountability that lie at the root of poverty and other
development problems (Part II).


A. Similarities between MDGs and human rights

MDGs and human rights share a common ultimate objective and commitment to
promoting human well-being, recognising the inherent dignity, freedom and
equality of all people.

MDGs and the human rights legal framework each provide tools to hold governments
accountable. Each relies upon a process of periodic reporting and
accountability at both national and international level.

Overall resource constraints are relevant to the pace of realisation of both
MDGs and human rights. As already seen, economic, social and cultural rights
are – for the most part – required to be realized progressively, to the maximum
extent of available resources, and monitored over time.

There are similarities in the guiding principles for the realization of both
MDGs and human rights, notably in connection with: participation, empowerment,
national ownership and the importance of partnerships. Human rights standards
are nationally owned, establishing minimum standards for participation,
empowering people as actors for human development. Partnerships at all levels –
local, national and international – are necessary for effective implementation
of human rights obligations. Similarly, the customising of MDG targets at
country level should take place through a broad-based and inclusive dialogue and
debate. MDG reporting and monitoring at the sub-national level provides the
opportunity to take the MDGs to community level, helping to strengthen ownership
and empower people to better articulate their local needs within the framework
of a nationally and internationally agreed development agenda.


B. Complementarities between MDGs and human rights

MDGs and human rights have different but complementary purposes. MDGs are a set
of numerical targets established for the purpose of raising awareness among the
public, and for social mobilization. The fact that the MDGs are small in number,
quantifiable and time-bound facilitates the simplicity and clarity of key
messages. By contrast, the international human rights framework embodies a more
extensive international consensus on the minimum prerequisites for a life of
dignity, with more comprehensive and specific performance standards. For example
MDG 3 highlights just a few of the essential aspects of ‗gender equality and
empowerment,‘ namely, parity in enrolment rates in primary and secondary
education. But this should not be taken as excluding the many inter-related
human rights facets of gender empowerment strategies, including equality of
opportunity in employment and exploring structural barriers to women‘s
participation in public life.

Universality vs. developing country focus: The MDGs are focused upon a number of
priority development issues which are particularly relevant for developing
countries. International human rights standards are of comprehensive content and
universal application, applicable equally to all people in all countries.

MDGs are mainly quantitative (defined numerical targets), whereas human rights
also reflect explicit qualitative dimensions: Whereas MDG 1 targets at halving
the proportion of people who suffer from hunger between 1990 and 2015,
implementing the right to food does not only encompass the right of every
individual to be free from hunger. It, in addition, requires food to be of
adequate nutritional value, culturally appropriate and safe – three qualitative
dimensions of the right to food.

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Human rights standards are matters of legal obligation: While MDGs and human
rights standards share a common aim of strengthening government accountability
for results, the performance standards established by the human rights framework
are legally binding. These standards help to identify ‗no go areas‘ (for
example, the deliberate or arbitrary retrogression of some rights at the expense
of others) and unacceptable policy trade-offs in the development equation.
However, human rights are not ‗trumps‘ in all situations, and can not be
expected to reveal clear solutions to all development problems.

Institutions and mechanisms of accountability: Accountability for MDG
realization lies principally at the political level, through the preparation of
periodic progress reports, national and international campaigns, and the
mobilisation of public opinion. Accountability for human rights realization is
backed by a different and broader range of institutions and mechanisms at
national level (including courts, national human rights institutions, informal
or community-based mechanisms) and international level (including the treaty
bodies).

Dealing with disparities: At the global level, the MDGs are based upon ‗average‘
attainments. While they give a good sense of overall progress, average numbers
can be misleading. Improvements on the average number of years of school
attendance in a country can, for example, be the result of dramatic improvement
in access to education for girls from privileged groups, with a slight reduction
in years of schooling only for the poorest. Similarly, apparent improvements in
per capita income do not necessarily reflect an improvement in poverty
reduction; they can even hide an increase in income inequality and absolute
poverty. By contrast the human rights framework compels us more immediately and
explicitly towards the eradication of discrimination and the prioritisation of
action in favour of the poor, vulnerable and marginalized. Pursuing equity and
narrowing disparities within countries – along gender, ethnic, racial and
geographic lines – consequently requires looking behind country averages. MDG
Reports and national campaigns need to find a workable balance between this
concern and the practical need to keep messages clear and simple. MDG 3 (gender
equality) should be seen as an integral and cross-cutting element of strategies
for achievement of all MDGs, with data disaggregated accordingly.

Process and outcomes: Consistent with their limited purpose, the dominant focus
of the MDGs is upon poverty reduction outcomes. Within the human rights
framework, process is equally important as outcomes. While there are some
commonalities, noting for example the need for popular participation for
localising MDGs and for effective campaigning, human rights standards establish
baselines (even if not blueprints) for meaningful and informed participation in
policy making, along with criteria for inclusive and sustained progress, and
accessible means of redress in the event that human rights standards are
violated.

Rights-based strategies for MDG realisation: Rights-based strategies for MDG
realisation recognize people as key actors for their own development, rather
than passive recipients of commodities and services, treating poverty reduction
as a matter of entitlement (and correspondingly, obligation) rather than
discretion or charity. Human rights empower people to make claims against those
with a duty to respond, strengthening accountability for development outcomes.
Rights-based strategies for MDG realization seek to identify the immediate,
underlying and basic causes of development problems. As such, they reveal
structural constraints impeding human development, a factor too often overlooked
in the past. Finally, rights-based MDG realization uses in synergy both top-down
and bottom-up approaches in which strategic partnerships are developed and
sustained.

The [MDGs] reflect a human rights agenda – rights to food, education, health
care and decent living standards: The need to ensure all these rights confers
obligations on the governments of countries both rich and poor.‘
UNDP, Human Development Report 2003, p.29.

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Millennium Development Goal Key Related Human Rights Standards

Goal 1: Eradicate extreme poverty and
hunger
Universal Declaration of Human Rights,
article 25(1); ICESCR article 11
Goal 2: Achieve universal primary
education
Universal Declaration of Human Rights
article 25(1); ICESCR articles 13 and 14;
CRC article 28(1)(a); CEDAW article 10;
CERD article 5(e)(v)
Goal 3: Promote gender equality and
empower women
Universal Declaration of Human Rights
article 2; CEDAW; ICESCR article 3; CRC
article 2
Goal 4: Reduce child mortality Universal Declaration of Human Rights
article 25; CRC articles 6, 24(2)(a);
ICESCR article 12(2)(a)
Goal 5: Improve maternal health Universal Declaration of Human Rights
article 25; CEDAW articles 10(h), 11(f),
12, 14(b); ICESCR article 12; CRC article
24(2)(d); CERD article 5(e)(iv)
Goal 6: Combat HIV/AIDS, malaria and
other diseases
Universal Declaration of Human Rights
article 25; ICESCR article 12, CRC
article 24; CEDAW article 12; CERD
article 5(e)(iv)
Goal 7: Ensure environmental
sustainability
Universal Declaration of Human Rights
article 25(1); ICESCR articles 11(1) and
12; CEDAW article 14(2)(h); CRC article
24; CERD article 5(e)(iii)
Goal 8: Develop a global partnership
for development
Charter articles 1(3), 55 and 56;
Universal Declaration of Human Rights
articles 22 and 28; ICESCR articles 2(1),
11(1) , 15(4), 22 and 23; CRC articles 4,
24(4) and 28(3)
* ICESCR (International Covenant on Economic, Social and Cultural Rights)
ICCPR (International Covenant on Civil and Political Rights)
CERD (International Convention on the Elimination of All Forms of Racial Discrimination)
CEDAW (International Convention on the Elimination of All Forms of Discrimination Against Women)
CRC (Convention on the Rights of the Child)


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ifferences Between Human Rights and MDGs Table 2
Differences Between Human Rights and MDGs
Human rights MDGs
Reflect universal values for all people Focused on certain countries/groups
Wide spread coverage (including poverty) Focused on poverty
Not quantified Quantified
Mandatory Voluntary
Minimum standards Achievable targets
Not time-bound Time-bound
Legally binding Not Legally binding

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