In this reflective work, drawing on her journey as a scholar and activist for health and human rights, Alicia Ely Yamin makes a compelling case for why the praxis of human rights—human rights for social change—must be rethought to meet the challenges of hyper-globalization in the twenty-first century. Capitalism in this century is markedly different from that in the twentieth century. As many economists have pointed out, it is not only about the liberalization and privatization that drove globalization in the last century. Today’s capitalism is driven by financialization, monopoly, and monopsony structures. It is characterized by a new power dynamic: the increasing power of banks and financial actors, holders of monopoly power, leading to extreme concentrations of wealth. Incentives and rewards go to financial transactions, rather than to creation of real economic value, and to the acquisition of intellectual property. These structural changes have shifted the political economy of policy-making, increasing the influence of corporations and shrinking the space of national governments to protect the public interest. The COVID-19 pandemic has exposed and perhaps even exacerbated these dynamics, as illustrated so clearly by vaccine inequity. While national governments rushed to invest in vaccine development through the private sector, the rules were written to give corporations monopoly ownership and the power to decide how much to manufacture and who should be first when buyers lined up. The spectacle of prime ministers and presidents calling on the CEOs of Pfizer, Moderna, AstraZeneca, and other pharmaceutical companies brings home the reality of the shrinking space that governments command to prioritize public interest and protect human rights. This book calls on human rights advocates, scholars, and institutions to shift their priorities to the economic rules that govern the world and are the source of persistent human rights abuses such as unequal access to COVID-19 vaccines and treatment.
Alicia brings to life the history of human rights law as it relates to the exacerbation of extreme inequity and wealth disparity and their direct impact on health and prosperity, especially amid the recent COVID-19 pandemic. Through a careful analysis that weaves together historical evolutions beginning in the 1970s with developments in human rights law, She describes the increase in socioeconomic inequality over these decades and sees it not just as an issue that affects health outcomes but as a gross social injustice at a time when many economists, human rights lawyers, and philosophers cannot take a stand as to whether inequality is intrinsically undesirable. She balances an understanding of differential, gendered, and other impacts of shifts in economic governance and legal frameworks over the years, with a plea to embrace our common humanity and our shared responsibility for this planet.
I was privileged to work with Alicia for many years on the board of the Center for Economic and Social Rights (CESR), when we were collectively engaged in thinking about CESR’s strategy in advancing social justice through human rights. We also worked closely on research projects to understand how indicators employed in the Millennium Development Goals (MDGs), and later the Sustainable Development Goals (SDGs), established both knowledge and governance discourses that in turn produced a wide array of unanticipated consequences. We share an understanding of human rights as consonant with human development, where these rights are guaranteed not only for their intrinsic value but also for their instrumental value in promoting agency, both individual and collective.
When Misfortune Becomes Injustice powerfully articulates concerns about the evolution and perpetuation of top-down processes that have historically determined how development priorities and conceptions of justice and equity are formulated. As the book discusses, these top-down “solutions” have often been coupled with a lack of accountability mechanisms, an inadequate reflection of human rights principles, and narrow agendas for mitigating the effects of extreme poverty that neglect urgent attention to inequality, as was made starkly apparent during the pandemic. We need to reclaim a role for national states to be responsible for the provision of public services, including essential public health infrastructures in sustaining human rights in relation to health. That in turn requires addressing global governance that limits the capacity of states in the global South.
Yet it appears that the world is not learning these lessons. Naïvely, I had thought that this existential threat would convince corporations to put aside their pursuit of profit and shareholder value and instead prioritize public interest. I had thought that they would share the technology that could prevent deaths, illness, and the devastating consequences of the pandemic with the world. But this was not the way it worked out. Corporations became even more emboldened in their opposition to technology-sharing and were deaf to calls to do all they could to help end the pandemic. As this volume goes to print, the TRIPS (Trade-Related Aspects of Intellectual Property Rights) waiver at the World Trade Organization (WTO) tabled by India and South Africa over a year ago is yet to be agreed on, with leaked texts from negotiations indicating that they may be leaning toward taking accessibility backward. Governments—predominantly those in the North—seem increasingly unwilling to protect the public interest to end the pandemic when it conflicts with the priorities of the corporations that they host.
Global health security measures have continued to privilege colonialist governance by states in the North and rent-seeking pharmaceutical and other commercial interests. Prevailing models continue to focus on disease-related surveillance and detection, but fail to prioritize equitable trade agreements or to reassess metrics for examining health, poverty, and inequality. A human rights praxis for global health must meet head-on global governance structures that have allowed substantial institutional policy change to stagnate and extreme inequality to thrive.
Especially after the horrors the world witnessed during the COVID-19 pandemic, we should all challenge ourselves to think of new ways and directions to go in to bring more justice to global health. Throughout this highly readable account, which draws on her many experiences and accomplishments in global health and human rights, Alicia does not hesitate to call out the inadequacy of formalistic rights interpretation that too often accommodates neoliberal conceptions of health (and health rights) at the expense of disruptive change. Despite the glaringly evident lessons of the last several decades of increased global health emergencies and disparity, Alicia is one of few human rights scholars in global health who have long challenged the devastating effects of neoliberal policies and the unfettered power of private actors to control the infrastructure of health provision, including pharmaceutical companies. Long before the pandemic so broadly exposed the inadequacies of bureaucratic approaches to human rights, she rejected the reduction of political and legal struggles to exercises in policy guidance. At the same time, she is a fierce advocate of what dynamic human rights praxis can achieve in global health, and she convincingly explains why this matters. As in her other work, in this book Alicia elevates moving stories that show the power of human rights language and the tenacity of human rights advocates, especially from the global South, in promoting political and social reform, freedom, dignity, and agency.
If human rights is to remain a relevant framework in our post-pandemic world, advocates and scholars would do well to incorporate the reflections Alicia provides in this exceptional book.