Emily's Worldview

I've been having an interesting email exchange with my friend, "Sam". "Sam" has been thinking a lot about human rights and global justice lately, and agreed to let me excerpt her emails anonymously, and my response. I marked deletions with ellipses.

Sam says;

My basic point about the Human Rights world is that it trivializes
some of the most important issues on earth....It's like the "15
billion women are beaten every minute" campaigns. You exaggerate a
real threat, or you make it too sensational, and it hurts the
credibility of everyone addressing it, and it kills your own. If
it's something that's bad, the simple facts stand on their own better
than overblowing them. It's totally irrelevant that people who
already agree with you are "shocked, horrified"; it's incredibly
relevant that it turns off one person who is generally suspicious of
"liberal" claims…

There's the whole argument about subsantive vs. aspirational rights,
or civil/political vs. economic/social, or first-generation vs.
second-generation, or negative vs. positive, which are all basically
the same thing, and one which I could have for months… Of course, I think that this is a re-definition of the word "right" to begin with; there's something
questionable about the logic of a right which isn't actually
exercised anywhere, and something even more questionable about the
idea of a "right" which can't be defined (aspirational rights). So,
first, we're saying that the right to be free of cruel punishment is
on par with the right to organize a labor union... who genuinely
believes this? Second, if we re-define "right" as something we
really, really WANT everyone to have, it loses its meaning entirely.
Third, if we WANT something to happen, the worst possible strategy is
to concentrate efforts on toothless demagoguery, trying to attain
some sort of moral high ground -- fine, so we've gotten a bunch of
countries/people to agree, despite the fact that they don't really
BELIEVE it, that something is unassailably correct; now we can start
the work that we actually intended in the first place, but with the
huge moral force of a bunch of countries merely paying lip service to
something?

Concentrating on a "rights" framework seems to me the ultimate in
wasted effort. Generally, I prefer the long-term game in trying to
attack huge issues. But creating documents by which no one feels
morally bound devalues the power of treaties in general and causes
people to start distrusting international institutions which depend
entirely on universal acceptance. I've come through this
international law thing with a deep skepticism of the UN. If I have
reversed course this much, you can bet that there's not a prayer in
the world for the UN, or any of its bodies, gaining any moral force
with any of the world who was already suspicious. People lump
themselves easily into camps, and this is driving people in droves
into the Bush camp. Hell, they make better arguments these days;
their conclusions may be wrong, and their logic may be disingenuous,
but it's become less disingenuous than the logic on the left, because
we've stopped even trying to be logical. We're hell-bent on making
an absolutist point, and going for the emotionally appealing image,
and exactly the sort of fear-mongering, alarmist, irresponsible crap
that they've always accused us of (wrongly, in the past, rightly now)
in the first place. And I think this all boils down to righteous
indignation and the unwillingness to be self-critical.

…I guess my
point is that the people on the "right" side end up doing more damage
to their cause by ineffectively pursuing it than people on the
"wrong" side do through direct attacks.

You re-frame the question as "why are resources for the health of
poor people limited?". I think that this is one of those arguments
which is best made as a separate point entirely from the ideas of
cost-effectiveness and sustainability, etc. Sure, these buzzwords
are largely crap. But I think that cost-effectiveness IS an
important point, because our resources ARE limited -- and not just
for poor people. And our resources will always be limited, no matter
how much we change things. So, yeah, your question is more
important, but it defines away the nitty-gritty as irrelevant by
asking that it be answered first. … I think that re-defining the question is
one of those things that, while it may make the most sense, detracts
from the force of an argument. NOT that I'm claiming you shouldn't
use that when talking to me; please don't take it that way. But I
think it's the surest way for the good guys to lose an argument in
the public arena, because it's been over-used to the point of
absurdity…


Emily says;

…I understand the arguments you are making about strategy in the field of
international advocacy for the shafted. And I think we do agree on
the fundamentals, like that the public health/UN infrastructures are
part of the same system that puts people in such a bad position. And that overclaiming
dangers/tragedies/outrages is counter-productive, particularly at the
point where everything is so fucked up already. I'm pretty agnostic
on the rights thing, and pretty uneducated about it…but maybe will make a
tepid argument for them below. And obviously I agree that we have to
work with the big jerks of the world and get them on our side. Oh, and
I agree that protesting globalization or the WTO as a whole is dumb.

But I still fundamentally disagree with the idea that our strategy as advocates
should be to spend
all our time making good arguments, to get the people with the money
"to sway slightly in an egalitarian /
altruistic kinda way", presumably, when being egalitarian/altruistic
happens to line up with their own interests. You're making an
effectiveness argument, but I just don't see any evidence that that
strategy has been effective in making people's lives substantially
better. To me, your strategy is the status quo—people doing good when
it suits them, not when it doesn't—and not only does it result in a
lot of direct screwing, like unfair international trade rules,
predatory investment, child sexual exploitiation, but it also results
in a lot of really ineffective aid. So when there is famine in Niger
we pay American farmers a fair price for corn, pay an American
shipping company a no-bid rate to ship it, and 6 months later, after
the rains have come and the farmers have harvested, a whole lot of
free corn arrives and screws up the market, setting people up for next
year's famine. And the thing is, that's the kind of aid we feel good
about.

I would argue that at its most benign, what your strategy gets us is a
lot of donor-driven, vertical programs that may have a moderate impact
wherever they are targeted, but that end up either straining or
undermining the government and other aid projects in the area…

You say that "re-defining the question is
one of those things that, while it may make the most sense, detracts
from the force of an argument" but I think HIV treatment is a perfect
counter-example. As advocates, people told us we were impractical for
asking the question, "Why should tens of millions of people infected
with HIV be sentenced to die when treatment exists?" 8 years ago, the
head administrator for USAID told reporters that antiretroviral
therapy would never be feasible in Africa because Africans can't tell
time. Public health experts recommended putting all the focus on
prevention of HIV and treatment of opportunistic infections. But
those tens of millions of people were beyond the point of prevention,
and when you have HIV, treatment of OIs only makes you feel a little
better and then you die. Partners in Health started treating people
with antiretrovirals at their clinic in Haiti and they showed that
they could get high adherence rates and that people got better, and
they did it despite the "riptide of cost-effectiveness arguments"
(that's Paul Farmer, my hero). Other advocates used that evidence to
make their arguments and now, just a few years later, there are
literally billions of dollars for HIV treatment for poor people. If
we as advocates had spent all our energy asking for palliative care
for sick people and jumpropes for orphans, that's what we would have
gotten, and Bush would have been just as self-congratulatory as he is
now; it would have been just as much in his interest as the money he
put up for antiretroviral therapy.

That logic also justifies supporting a lot of really bad policies.
Food aid in the status quo is just one example, but so are malaria programs
that provide cheap drugs in regions where the malaria is already
resistant to the cheap drugs. I want to give an example from the
research I am working on. So, right now for the prevention of mother
to child transmission of HIV in Africa, they are implementing 2-dose
nevirapine. The mother takes a pill when she goes into labor and the
baby gets a dose within 72 hours of both. It's cheap and it's easy
for the mothers to do themselves, and when implemented properly, it
cuts the rate of transmission during delivery in about half. But in
the US and other developed countries, the standard of care for years
has been a short course of combination antiretrovirals or at least AZT
for a month before delivery. This is harder to do, and it's more
expensive, but mother to child transmission in the US is now virtually
0. So what should our strategy be? Should we be scaling up the easy
intervention because it is the most feasible and realistic and be
satisfied that even if we had 100% coverage about 30% of the babies
will still get infected? Or should we be working to provide African
mothers with the same standard of care that American mothers have been
enjoying for years? I don't think that asking that question
undermines the current program, and I think it provides a better
direction for the future.

And I don't think a more expansive/fundamental view is impossible
because I think we are seeing a change in the way the public debate is
framed now. Look at Warren Buffet—he didn't give 34.7 billion dollars
to one of [those] business-as-usual
NGOs; he gave it to Gates because they are one of the organizations
that can actually change the world because they are willing to invest
in what critics say is impractical or too expensive.

I think it is more effective to advocate for what we want in the long
run, and negotiate for what is required in the meantime. So let's not
limit ourselves to saying that we want everyone in Kenya to get a
grade 6 education, let's say that everyone deserves access to a
complete education and start with the primary schools. It's true that
we need money to do what we want to do, but that is in the short term.
If we don't have and push our long-term vision, whose plans for the
future will prevail.

You say, "If we re-define "right" as something we
really, really WANT everyone to have, it loses its meaning entirely."

I just don't see why. ...Just because children don't have schools to go to
doesn't mean they don't have a right to education, or because there
are no hospitals, women don't have the right to give birth safely.
I'm really against this idea that we should set a bare minimum and
make sure that we achieve that and then in some rational future move
on to the next order of business. There's no waiting for some day
when no one is being tortured so we can start talking about housing.
Let's not confuse advocacy and declarations with action (ahem, UN) but
let's build our policy now around a set of ideals for the long-term
future… South Africa's model is "progressive realization of rights" or something like that, and I think that's what I'm for.