The Sexual Rights Initiative made this submission to the Committee on the Elimination of Racial Discrimination to inform the elaboration of General Recommendation no 37 on racial discrimination and the right to health in collaboration with the National Council of Women Leaders (NCWL), the Dalit Human Rights Defenders Network (DHRDNet), the International Dalit Solidarity Network (IDSN), AWID, Her Rights Initiative (HRI) and Alisa Lombard.
The main argument of this submission is that a tripartite approach is necessary in order for states to meet their obligations under CERD Article 5 (e)(iv) concerning access to health and healthcare of all people. First, states must ensure that healthcare is publicly funded through progressive taxation; second, states must adopt a systems approach to fulfil the right to health; and, third, states must take an intersectional approach in all aspects of healthcare provision. The absence of any of these will compromise people’s rights to health, bodily autonomy and non-discriminatory services, especially among the marginalised. Racialised and gendered people everywhere will be excluded and oppressed unless they are actively included through such an approach. This approach is in alignment with human rights treaties and their respective committees’ General Comments and Concluding Observations on the right to health.
Privately funded healthcare has failed to provide for the needs of the marginalised in every instance and in every national context. Between low or absent accountability and the overriding profit motive that dominates corporate ideology, privately funded healthcare as well as private-public partnerships sacrifice the interests of those who lack the social or economic clout to demand the attention of service providers and privilege those whose health needs or wants yield the greatest profit.[i] Only the presence of a universally accessible publicly funded healthcare system will ensure that health and healthcare do not become commodities (instead of public goods) that only ‘paying customers’ can afford.[ii]
In accordance with human rights principles of universality, interdependence, indivisibility and inalienability, a systems approach to health is vital. This approach ensures that health is treated as one piece of a larger mosaic instead of as a stand-alone right fractured away from other entitlements that determine people’s ability to live decent lives. Thus, good quality and publicly funded education, equitable access to adequate and nutritious food and clean water, supportive and sustainable physical and natural environments (including adequate sanitation), social security, community participation and decision making that enhance self-worth and belonging for all people are all essential elements of a system in which people can thrive and come closest to realising their capabilities.[iii] A systems approach is a precondition for ensuring that individual sectors will deliver quality goods and services to all.
This submission further argues that only an intersectional approach can generate a holistic understanding of both the nature and the effects of oppression and exclusion on different groups and individuals. This concept is explored in detail in this submission.
[i] “COVID-19 pandemic shows how India’s thrust to privatise healthcare puts the burden on the poor.” T Sundararaman, Daksha Parmar and S Krithi. 11 January 2021. https://scroll.in/article/983344/covid-19-pandemic-shows-how-indias-thrust-to-privatise-healthcare-puts-the-burden-on-the-poor
[ii] The ‘solution’ of providing low-cost healthcare to economically depressed classes within a country without dismantling privatised healthcare – through government insurance, for instance – has also been shown to fail in both rich countries such as the United States and in a country with high rates of poverty, such as India. Ibid.
[iii] Martha Nussbaum, 2011, Creating Capabilities: The Human Development Approach, Cambridge, Mass.: HUP.