Discrimination: The True Barrier to Clean Water

“We have to use the water from the stream which is very dirty. Children vomit and get diarrhoea very often” (Amnesty 2011:40).

These words belong to Silvana Hudorovac, recorded by Amnesty International in their 2011 report ‘Parallel lives’. In 2011 Silvana was living in a community without access to clean running water and basic sanitation. In this report Silvana explains how her family are forced to defecate in trenches behind their homes (Amnesty, 2011).

Silvana’s experience is not uncommon.  According to Water Aid 783 Million people are living without access to clean running water. A further 2.5 billion people are without the use of a proper toilet or basic sanitation. Water Aid describes this situation as a ‘water crisis’ and for good reason. The impact on global health is devastating as an estimated ‘3.4 million people die each year from a water related disease’ (Water Org, 2013).

The human right to water was officially recognized by the Human Rights Council in 2010 with ‘The human right to water and sanitation’ resolution. Article (1) of the resolution ‘ recognises the right to safe and clean drinking water and sanitation as a human right that is essential for the full enjoyment of life and all human rights’.

Since 2010 any state that has ratified the International Covenant on Economic, Social and Cultural Rights ‘can no longer deny their responsibility to provide safe water and sanitation to all people’ (Right to water, 2013). Yet this entitlement is not being provided and individuals, such as Silvana’s human rights are being violated.

Improving water and basic sanitation has been a focus of international development initiatives over the last ten years. It is also a target of the seventh Millennium Development Goals (MDGs). The MDGs were devised by the World Bank, International Monetary Fund and the Organisation of Economic Co-operation and Development. The MDGs focus on eight global targets aimed at alleviating global poverty. They range from the eradication of hunger to ensuring environmental sustainability (UN, 2013).

In September 2000 the largest ever meeting of world leaders took place at the ‘UN Millennium Summit’. At this summit leaders signed the Millennium Declaration and agreed to achieve the eight goals by 2015. The expiry date of the MDGs is looming in the not so distance future.  One target of the seventh goal ensuring environmental sustainability has been achieved and is triumphed as a development success story.  The target that has been met is to ‘half the proportion of the population without sustainable access to safe drinking water and basic sanitation’ (UN, 2013).

The UN  2012 MDGs report states that since ‘2010  89% of the world’s population was using improved drinking water sources up from 76% in 1990’. This sounds like a grand achievement particularly in conjunction with the statistic that ‘more than two billion people gained access to improved water sources’ (UN, 2013). However it is hard to assess whether the MDGs have impacted on the increased proportion of people who have improved water sources. This is because over half of global development in improved water sources is attributed to India and China (UN, 2013). And efforts to improved water sources started before 1990 with economic growth of these countries.

Data is also not available to measure how much water sources have improved and if they now provide safe drinking water. The statistics are less optimistic for the global improvement on sanitation. This has only measured to have increased from ‘36 per cent in 1990 to 56 per cent in 2010’ (UN, 2013). The lopsidedness of the gains made by access to improved water sources and not by sanitation are concerning as water does not stay clean for long without sanitation.

What is also apparent from the UN report is that global improvements in drinking water are by no means evenly spread. This is in-between regions and within countries.

Data compiled from 35 Sub-Saharan African states in the UN report shows that ‘over 90 per cent of the riches quintile in urban areas’ is using improved water sources. Whereas ‘piped- in water is non-existent in the poorest 40 percent of households, and less than half of the population uses any form of improved source of water’ (UN ,2012).

Even when the MDG target for improved access to drinking water has been met it remains that clean water is still out of reach for the poorest members of society. This also disproportionately affects the lives of women who in regions such as Sub-Saharan Africa bear the brunt of water collection.

When interviewed, Silvana Hudorovac was living in Slovenia where according to Amnesty nearly 100 percent of the population have access to clean water.  Silvana is a member of the Roma minority group.  Roma communities face widespread discrimination across Europe in access to resources such as clean water.

The MDGs as a development framework have not impacted on this deep-rooted discrimination or exclusion from water and the effect is felt from Slovenia to Sub-Saharan Africa.

Access to water and sanitation is denied to the Roma because of multi-generational discrimination.  Amnesty reported that the Roma in Slovenia cannot access government or private rented housing. They are forced to live in segregated, unpermitted and secluded settlements without running water, toilets or electricity. The Slovenian government does not provide water to housing without building permits (Amnesty, 2011).

Access to water and sanitation is thus denied through a series of discriminatory practices.  The situation of the Roma in Slovenia is reflected in much of the developing world. Water Org state ‘for the vast majority of the nearly one billion people without safe drinking water, today’s water crisis is not an issue of sacristy but of access’.

It is the systematic social exclusions that are not challenged in the developed or developing world in regards to access to clean drinking water (Melamed and Samman, 2013).

The MDGs have not managed to invoke behaviour change of the government of Slovenia to prioritise the individual’s human right to water and sanitation or ensure the equitable distribution of clean water.

Discussion between the UN and civil society is already taking place to devise a post-2015 MDG development framework (Melamed and Samman, 2013).  It waits to be seen if there will be a real attempt to challenge the barrier of discrimination so communities, such as the Roma in Slovenia will no longer be denied their human right to water.

Anna Keane

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Abortion Laws in Mexico: A Women’s Rights Issue

The lack of access to free, high quality and equitable sexual and reproductive health services is real problem in Mexico and constitutes a violation of the rights of women.

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Graffiti in San Cristóbal de las Casas, Mexico

In 2007 the federal district of Mexico City passed a law allowing abortion for women in the first trimester no matter what the circumstance. Abortion is permitted in all 32 states if a woman becomes pregnant from rape and in 29 if the woman’s life is at risk (Guttenmacher Institute, 2008). Abortion services are provided free in Mexico City for residents and at a fee for non-residents. This is discriminatory against women who are faced with practical, social or economic obstacles preventing them from reaching Mexico City. A human rights based approach (HRBA) to the provision of sexual and reproductive health services in Mexico would ensure more effective implementation and help women across the country to enjoy the rights they are entitled to.

The HRBA approach to development identifies “rights-holders”, people whose rights are not being met, and “duty-bearers”, who are responsible for ensuring these rights. While this may all sound complicated, the clear link between human rights and developments has led many organisations, such as the UN, Actionaid and the UK’s Department for International Development (DFID) to use this approach. The HRBA approach aims to empower “rights-holders” by improving the capacity of “duty-bearers” to fulfil their obligations.

This can be achieved through legal policy reform and healthcare reform in Mexico, as per the standards set out in following two human rights treaties, the International Convention on Economic, Social and Cultural Rights (ICESCR) and the Convention on the Elimination of All forms of Discrimination against Women (CEDAW), both of which Mexico ratified in 1981. The healthcare standards set out by the World Health Organisation (WHO) are another useful guide.

International Women’s Day, a day to celebrate woman hood and “press for demands”, took place on the 8th of March. It coincided with the 57th session of the UN Commission on the Status of Women which took place from the 4-15th of March. Both events brought the issue of gender equality in developing countries, and the potential for change, to the attention of international community.

Furthermore Mexico has made a commitment to the Millennium Development Goals. Goal 3, to promote gender equality and empower women, and goal 5, to improve maternal health both have targets to be met by 2015. Both goals are inhibited by abortion laws that remain restrictive in most of the country, affecting women from disadvantaged social and economic backgrounds he most.

Improvements in the public sector also hint at the possibility for change. The recent overhaul of the healthcare system in Mexico has culminated in near universal health coverage but comprehensive sexual and reproductive health for women is still not being provided.

The discriminatory abortion laws in Mexico must be addressed. The right to health, life, self-determination and choice are just a few of the many human rights that women in Mexico are prevented from enjoying.

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“Careful! Machismo Kills” – Picture taken in Mexico City

Let’s consider the figures. Studies carried out by the Guttmacher Institute in 2012 found that 95%of the 4.4 million abortions in Latin America were unsafe and that 12% of all maternal deaths were a result of unsafe abortions.

Unsafe abortions are also expensive for the State. Women who undergo an unsafe abortion are highly likely to need medical care later on. Figures from the Guttmacher Institute show a 40% increase in the need for women to be hospitalised with complications following an unsafe abortion between the 1990s and 2006. Hospitalisations are more prevalent for poorer women in rural areas who can neither afford to travel to Mexico City nor pay for the “safest” of the unlicensed abortion clinics. Complications and death from unsafe abortions are preventable!

Legal policy reform and health care reform are both needed stop the violation of these women’s rights. The national decriminalisation of abortion up to 12 weeks, which has already proved successful in Mexico City is required first and foremost.

To decrease maternal mortality, morbidity rates and the level of unwanted pregnancies, women should be provided with comprehensive family planning and abortion counselling and services, which include access to modern contraception.

Education for men and women, particularly young women, and the training of medical professionals is also vital. Tackling the problem of gender inequality in this way is a key part of HRBA.

Women’s Global Network for Reproductive Rights (WGNRR) is leading an international campaign calling for global access to safe and legal abortion. Campaigns for the fulfilment of sexual and reproductive health rights will culminate on May 28th, International Day of Action for Women’s Health. Find out more about how you can get involved with the campaign: http://www.wgnrr.org/current-campaigns.

Georgia Booth

Resources

Guttmacher Institute (2008) ‘Facts on Induced Abortion in Mexico’ [online] Available at http://www.guttmacher.org/pubs/2008/10/01/FIB_IA_Mexico.pdf [Accessed 23/02/2013]

Guttmacher Institute (2012) ‘Facts on Abortion in Latin America and the Caribbean’ [online] Available at http://www.guttmacher.org/pubs/IB_AWW-Latin-America.pdf [Accessed 25/02/2013]

International Women’s Day (2013) [online] Available at http://www.internationalwomensday.com/about.asp#.US9W6jA7164 [Accessed 28/02/2013]

Kane, G. (2008) Abortion Law Reform in Latin America: Lessons for Advocacy Gender & Development Vol. 16, No. 2

Women’s Link Worldwide (2012) ‘Human Rights: The Foundation for a Comprehensive Sexual and Reproductive Health Counselling Service’ [online] Available at http://www.womenslinkworldwide.org/wlw/new.php?modo=detalle_proyectos&dc=64 [Accessed 26/02/2013]

World Health Organisation (2012) ‘Safe Abortion: Technical and Policy Guidance for Health Systems’ [online] Available at http://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241548434/en/ [Accessed 05/03/2013]

How Much Are You Worth?

Yusef Hamied, the founder and retired CEO of Indian pharmaceutical company, Cipla, was once asked if he had an ulterior motive for giving away AIDS medicine for free. He replied “Yes, I do…I want to do some good before I die”. Hamied’s battle against large pharmaceutical companies in the 1990s in an attempt to provide low-cost, life-saving medicine has been brought to light in Dylan Mohan Gray’s documentary, Fire in The Blood. It is a battle to protect the basic human rights of so many, a battle which is far from over.

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Yusef Hamied

The Case

As the Indian Supreme Court handed down their verdict on April 1st 2013 for the India v. Novartis case, the question of whether a company’s profits should be prioritised over a person’s health again rears its head.

Swiss pharmaceutical company, Novartis, were not successful. They argued for India to change its patent laws, so as to protect their oncology drug, Glivec. Public health laws in India prioritise the human right to health by allowing Indian pharmaceutical companies to produce drugs like these at a lower cost. Novartis sold Glivec for $2600 a month, per person. This is a huge leap from the generic version being produced in India, sold for $200! The Novartis verdict is a promising development in the campaign for corporate accountability but problems persist.

The Problem

The right to life and to the ‘highest attainable standard of health’ are enshrined not only in the Universal Declaration of Human Rights but also in the legally binding treaty, the International Covenant on Economic, Social and Cultural Rights. Most countries have ratified. How then, did a company manage to argue in court that their profits should trump the human rights of so many?

There is an obvious gap between the theoretical rights that are codified in these legal instruments, and the practical protection and promotion of human rights. One reason for this implementation gap is the economic and political power of transnational corporations, like Novartis.

How did it come to this? Why are tens of millions of people dying from lack of access to medicine purely because they can’t afford it? Putting a high price on lifesaving medicine is asking people to question the worth of their lives or the lives of their family members.

Selling someone back their health and the possibility to live a longer, more dignified life is wrong on so many levels. Companies like Novartis argue that patenting laws protect new medical discoveries, promote innovation and prevent the manufacture and sale of bad quality medicine.

Yusef Hamied refutes this. He argues that because 90% of revenue comes from the global North, sales of low cost medicine in the global South do not affect research and development. Companies are not creating new, innovative drugs. Instead, many pharmaceutical companies are guilty of “evergreening” patents. In the field of pharmaceuticals this involves slightly altering a drug before the patent expires, prolonging the monopoly over it. The impact of evergreening is a direct prioritisation of profit over health and runs contrary to the 2010 Doha Declaration on the Agreement on Trade-Related Aspects of Intellectual Property Rights and Public Health. The Doha Declarations states that patent rules should be interpreted with the protection of public health at the forefront.

The argument that patents promote innovation is a tired one. It also becomes weaker when one considers the human rights implications.

The documentary, Fire in the Blood, showing at the Sundance Film Festival next month, further disputes this line of reasoning. The film explores the effects of medicine prices for HIV/AIDS sufferers in Africa. It demonstrated the positive effects of one good practice company, Cipla. Based in India, the “pharmacy of the developing world”, Cipla put their money where their mouth was and sold antiretroviral medicine at cost price, a practical demonstration of their “Caring for Life” mantra. Their bold move made a clear point to the profit-driven pharmaceutical companies who were monopolising the drug market; the right to health should come first.

In 2011 the UN Human Rights Council adopted the Guiding Principles on Business and Human Rights, more commonly known as the Ruggie Principles. The voluntary principles acknowledge the responsibilities of corporations to respect human rights, the environment and labour rights by setting basic standards. Over 7000 businesses have signed up in 145 countries. They are a positive step forward but there is still much to be done.

There are a number of inadequacies to be considered. Critics claim that adoption of the principles is merely an opportunity for “blue washing”- a derogatory reference to the reputational benefits of partnering with the UN. The reliance on self-evaluation is another problem. Novartis’ most recent Communication of Progress report prescribes just four pages to evaluate their human rights impact. In the review regarding their lack of complicity in human rights abuses, Novartis focused on labour rights but failed to mention their complicity in the violation of the right to health with high pricing of medicine.

What Needs to Change

For the Ruggie Principles to be effective in protecting human rights, the corporate structure needs to be modified. Legal obligations to maximise profit for company stakeholders results in human rights falling by the wayside. A study carried out by the International AIDS Society endorses the implementation of a Medicine Patent Pool which would make patent licences temporarily available to allow others to produce low-cost generic drugs for sale in developing countries. The Pool is funded by the organisation, UNITAID, which is seeking innovative ways for markets to operate effectively and in the interest of public health. The Pool is an interesting and useful mechanism but does not address the fact that companies are not legally bound to respect human rights.

Companies must recognise their responsibility. They should be legally required to adopt the Ruggie Principles, and governments must put mechanisms in place to monitor their implementation. Governments are primarily responsible and must prioritise the health and lives of people and fulfil their treaty obligations.

The last twenty years have shown the value of political activism and the potential for change. The international community must continue to demand accountability from companies who have a social responsibility. The Novartis verdict has shown that this is possible.

What You Can Do

Cipla’s actions showed the value of doing genuine good. We must aspire to one day live in a world where the health and lives of people are put before the profits of a company. You can be a part of this!

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Protesting against Novartis

The intrinsic relationship between business and human rights is being realised globally. Global networks and initiatives are pioneering research on the subject.  International NGOs, such as Amnesty International, Human Rights Watch (HRW) and Peace Brigades International are joining the campaign for greater accountability of companies. HRW dedicated a  large section of its 2013 World Report to the issue, calling for improved government monitoring of corporate actions; Senior Researcher, Christopher Albin-Lackey criticised the regulation vacuum and its impact on human rights worldwide, saying governments had “failed to keep pace”.

Focused on the right to health, Médecins Sans Frontières (MSF) are leading an access to medicine campaign against companies like Novartis. Find out more and get involved on the ‘MSF Access’ website: http://www.msfaccess.org/novartis-drop-the-case.

Raise the issue by writing to your MP: for a sample letter and more information, visit http://fireintheblood.com/write.

Georgia Booth

Resources

http://www.cipla.com

Grugel, J. and Piper, N. (2009) ‘Do Rights Promote Development?’ Global Social Policy Vol. 9(1): pp 79–98

Hoen, E., Berger, J., Calmy, A. and Moon, S. (2011) ‘Driving a Decade of Change: HIV/AIDs, Patents and Access to Medicine, Journal of the International AIDS Society, [online] Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3078828/ [Accessed 08/04/2013]

Human Rights Watch (2013) ‘World Report 2013’ [online] Available at https://www.hrw.org/sites/default/files/wr2013_web.pdf [Accessed 04/04/2013]

India Knowledge (2009) ‘Cipla Pharmaceuticals’ Yusuf Hamied: ‘I Am Not Against Patents … I Am Against Monopolies’, Interview with Yusef Hamied [online] Available at http://knowledge.wharton.upenn.edu/india/article.cfm?articleid=4374 [Accessed 05/04/2013]

Ruggie, J. (2011) ‘Guiding Principles on Business and Human Rights: Implementing the United Nations “Protect, Respect and Remedy” Framework’ [online] Available at http://www.business-humanrights.org/media/documents/ruggie/ruggie-guiding-principles-21-mar-2011.pdf [Accessed 05/04/2013]

www.unglobalcompact.com