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By Pamela Philipose Isn’t there something wrong with the fact that there is one Indian doctor available for every 1,325 Americans in the US, but only one Indian doctor for every 2,200 Indians, asks Mary Robinson, former president of Ireland and human rights activist
 Former President of Ireland, Mary Robinson is Chair of the
'Realising Rights: The Ethical Globalisation Initiative' Do you see the current global crisis as an opportunity for the world? I heard a very wise statement once: This crisis is much too important to waste. I think that is the way to look at it. It shows that a purely market-based approach does not bring about equity and fairness, particularly for the poor. We are now witness to multi-crises: global warming, financial meltdown, the food and fuel crises, and so on. What do you consider the most important? The problem is that we can’t really separate these various crises. They are interlinked. At the start of this century, we committed to bringing about more fairness through the Millennium Development Goals. We have not stuck to achieving them in a focused way. They have been sidelined by the so-called ‘war on terror’ and security concerns that have not made us safer. I believe the Obama administration recognises this and is seeking a more multi-polar approach. Meanwhile, the financial crisis inflicted by rich countries is doing a lot of damage and we have just begun to appreciate that the climate change impacts are worse than expected. I am very involved now in developing, along with others, the principles of climate justice. I think we have to have shared values to address this cumulative combination of crises. You have argued that human rights are the only shared values that the world has. Every government has stated that the Universal Declaration of Human Rights is acceptable to them. That doesn’t mean one size fits all in how you apply it. I believe that human rights flourish more in democracies, but even non-democratic States have to accept human rights, and we will have to work towards achieving that. The spiritual culture of a country is very important. We have learnt that if we try to ignore that, we will not have a deep appreciation of human rights that is embedded in the local culture. You head the Ethical Globalisation Initiative. How do ethics impact human rights? Well, take the principles of climate justice. We are, in fact, basing them on existing principles of justice, fairness and dignity. For example, the polluter-must-pay principle. It makes sense because if you cause something, there are consequences of that causation. The more you are responsible for creating the problem, the more you are responsible for mitigating it. The right to health has emerged as a major concern. The right to health is not a new concept. The Supreme Court of India, for instance, has delivered a number of notable judgments linking the right to health with the right to life. I believe it is important to take Article 25 of the Universal Declaration and make it very practical. What this means is that we should try to evolve systems of security for the poorest so that they don’t suffer the shocks of illness. The poor pay the most for food; they also pay the most for health. And it is possible to set up a system to address this. Why has the right to health remained so under-legislated? Liberal economic philosophy approaches health as a cost rather than as a necessity for economic and social development. It is important that governments recognise the value of health in terms of its contribution to GDP. Unless governments commit a significant percentage of GDP to health, there will not be the right structures for healthcare. One of the great human rights violations, which don’t get much attention, is maternal mortality. If I look at my own country, Ireland, if a mother dies in childbirth in a hospital, the whole hospital mourns. It is a real tragedy. But over 600,000 women die during childbirth every year. I’m very glad that Amnesty International is expanding its approach to human rights issues to include social rights, and they are particularly going to look at the need for safe motherhood. You’ve spoken about the asymmetrical movement of health workers from resource-poor to resource-rich countries. How should this be addressed? Take India: 75-80% of medical schools in India are publicly funded. India has the largest number of doctors of any nation migrating to Organisation for Economic Cooperation and Development (OECD) countries. The US alone has over 50,000. If you work that out, there is one Indian doctor available for every 1,325 Americans in the US. But in India there is one Indian doctor for every 2,200 Indians. Approximately 30% of doctors in the National Health Service of the UK are Indian expatriates. Inevitably, public health services in rural India are understaffed by over 50%. Of course, we must recognise the human right to migrate to further one’s prospects. At the same time, there is an imbalance that we must address. In the United States, for instance, visas for nurses are fast-tracked and people there do not perceive that when they get doctors or nurses from poorer countries, they are getting professionals fully trained by their country of origin. It costs to train such people, so we need a way to address the issue. The first step is to pay for the education of such personnel. That would be a practical way of addressing the problem. There was a comment in the newspaper recently that when Madonna adopts a baby in Malawi, it signals the state of maternal mortality in that country. I agree. If you look at the situation in Malawi, there are more doctors from Malawi in Manchester, England, than in the whole of Malawi. How can you have good medical care under such circumstances? But Malawi is also one of the countries where we have evidence-based work on the fact that mid-level providers, especially those trained in emergency obstetric care, are carrying out the majority of Caesarean sections and doing so very well. But would that mean compromising the quality of healthcare? That is a very important concern. We don’t want second-class medical services in the poorest countries, but we do want to redefine delivery of services. I have met some very highly trained obstetricians who say we must look at what can deliver the best care, and that does not mean that every single woman needs a highly qualified obstetrician. She needs somebody who is competent. Today, we can have such health deliverers in rural areas being assisted by qualified professionals at the district, regional, national and international levels. We should be designing medical systems using the best technology available, including communications technology like mobile phones, so that every country has access to adequate healthcare. -- Women’s Feature Service, April 2009
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