Abstract - Beyond compassion: The central role of accountability in applying a human rights framework to health

When I give food to the poor, they call me a saint. When I ask why the poor have no food, they call me a Communist.

The rich will accept talk of aid: for those of their own country and even for the Third World. But it is “not done” to talk too much about justice, rights, and structural changes.

— Dom Hélder Pessoa Câmara, late Roman Catholic Archbishop of Olinda and Recife, Brazil

Introduction

Compassion is undoubtedly a great virtue. But it is also notoriously unstable and, historically, reliance on it has ill-served the interests of the oppressed. Particularly in times of great economic crisis — like the present — the needs of the poorest and most marginalized tend to get short shrift regardless of such sentiments. Sharp economic downturns are inscribed in the bodies of malnourished children and other vulnerable members of society. Yet unfortunately, failures of beneficence and “compassion fatigue” do not trigger accountability; human rights violations do. Indeed, from anti-discrimination laws to labor protections, national struggles for human rights — civil and political as well as economic, social, and cultural (ESC) rights — have claimed as entitlements what those in power preferred to leave to largesse. Recent efforts to apply human rights to development, including health-related aspects of development, have argued that the principal added value of a rights framework lies precisely in identifying individuals as claims-holders and states and other actors as duty-bearers that can be held to account for their discharge of legal, and not merely moral, obligations.¹