Tlaleng Mofokeng: Special Rapporteur on the Right to Health

Benjamin Mason Meier and Tamira Daniely

The United Nations Human Rights Council appoints Special Rapporteurs on specific human rights themes, with these independent experts holding an official mandate to monitor violations and promote rights. Facilitating accountability for human rights realization, Special Rapporteurs support rights advancement through country missions, government communications, public statements, and Council reports. To advance the right to health, the Commission on Human Rights (the predecessor to the Council) established a Special Rapporteur mandate in 2002 on “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” Where the United Nations has elaborated the scope and content of the right to health, the Special Rapporteur holds a mandate to examine efforts to implement the right to health through healthcare services, health promotion, and underlying determinants of health.

On July 3, 2020, the Human Rights Council appointed Tlaleng Mofokeng as the fourth Special Rapporteur on the right to health.

Mofokeng obtained her Bachelor of Medicine and Bachelor of Surgery degrees from the University of Kwa-Zulu Natal in South Africa. She went on to practice as a medical doctor for 13 years­, working to advance adolescent sexual and reproductive health and leading to her bestselling book, Dr. T: A Guide to Sexual Health and Pleasure. Thereafter appointed by the President of South Africa to the Commission on Gender Equality, her work has promoted human rights in health policy and health service provision to realize gender equality, advancing health equity in South Africa through the United Nations human rights system. Mofokeng reflected on her past work and future vision with the Health and Human Rights Journal. This conversation, edited for length, is included below.

HHRJ:  How has your work as a physician and advocate in South Africa framed your understanding of the right to health?

Growing up in a Bantustan in the Apartheid era, I remember very clearly what riots look and smell like. Yet being a young person in a newly democratic South Africa, I still felt that my identity, everything about me, everything I was, hadn’t found expression. That started the activism in me. It’s that lived experience of knowing that people that look like me don’t have it easy. And the fact that I am who I am today, and occupying the spaces that I occupy, means that I bring those stories with me.

As a young medical doctor, I realized that there are some underlying forces and issues that we are not paying attention to. We had a lot of health messaging directed at young women. I was that young woman, and I felt—even with everything that I already knew as a medical student—that the public health messaging was not affirming for young persons.

I was drawn to sexual and reproductive health specifically. When I would come out of the community clinics, young people would be waiting for me. We would discuss so many important issues, and I asked them: why are you not coming in? Young people don’t feel that these spaces are for them. You can brand all the clinics “youth friendly,” but if you don’t change the health care professionals’ attitudes toward young people, if you don’t change how you speak to young people, then of course, they’re not going to feel seen and heard. And that’s how I came into radio, television, and a book.

I had a radio program for about four and a half years, and then the Sunday Times newspaper approached me for a column, which was fantastic because then I was reaching a very different audience—policy makers. The book was a culmination of those experiences. People write books about sex all the time, but there wasn’t a Black woman who looks like me who was talking about sex and writing a book about sex in the manner that I did in Africa.

It was important because for many Black girls, Black women, when things go wrong for us, in terms of sexual and reproductive health, some of those consequences are lifelong. States think they have a right to control women’s bodies—when and how, what to do, what not to do with our bodies. I know the power that lies when there is healing, and the book is like a collective healing.

Leaving the medical consultation room, there was so much work that needed to be done around how public health systems are designed, how young people are spoken of and about and to, and the politics necessary to address the structural causes of illness because—let’s be honest—health is very political.

Becoming a Commissioner at the Commission for Gender Equality was important to bring my own experience and my own expertise to a national human rights institution. The Commission can advance gender equality in policy through sexual and reproductive health and rights (SRHR). Having worked with UN agencies, I was responsible for international instruments and assisted the CEDAW Committee as they prepared to review South Africa.

That is how I see my role as a human rights defender—and why we can’t be quiet about how race, gender, class, and medicine intersect to either promote or violate people’s human rights. We still have to do the hard work of affirming and normalizing and locating issues—transgender health, intersex children, access to safe abortion—within a human rights perspective. If we locate those discussions within the human rights framework, suddenly people see there are obligations.

HHRJ: What human rights advancements do you hope to achieve in your role as Special Rapporteur?

Everyone is focused on advancing the sustainable development goals (SDGs). It’s about those low hanging fruit because it’s the language that people understand. They already have commitments to some of these targets, but it’s necessary to bring a different lens—to deepen the conversations on things that are left behind. I hope to bring a different lens, a different analysis, but I’m not starting from scratch. I’m building on to the work that has been done by other Special Rapporteurs, and for me, it’s about centering marginalized people in vulnerable situations.

How do we elevate the issues that seem to be minuscule, minute, small things and actually be like, “guys, it’s a big deal!” It’s a big deal that in sub-Saharan Africa, despite vast international funding assistance, we are still leading the world in new HIV infections among young women. It’s not enough to just keep blaming young women. Safe communities are a human right and have a direct impact on health outcomes. When we understand how things are linked to health, we can talk about restoration of dignity in a much better way.

That’s what COVID-19 is showing us. Without health, we all have nothing. We have nothing. It doesn’t matter how advanced and sophisticated economies are. Without health, we have nothing. All of us benefit if we promote and respect all human rights because all of those rights have a direct impact on our health.

We have to be honest about what causes what, and name them for what they are—if we’re talking about racism, if we’re talking about sexism, if we’re talking about capitalism. When we understand how all of these systems interlink to produce certain results, we can be worried about those who face dire consequences when their human rights are violated.

So for me, it’s about centering the fact that vulnerability is part of the human experience. Vulnerable people—whether vulnerable by age, race, gender, class, sexuality, geography, undocumented migrants, a young person born with HIV—deserve to have their rights respected, protected, and fulfilled. And all of the solutions that we are coming up with—law reform or policy updates, procurement or services, or public health, communication, philanthropy—have to be centered around restoration of dignity.

HHRJ: What health issues do you expect to prioritize throughout your term as Special Rapporteur?

I’m trying to move away from having a hierarchy of illnesses, where some are more important than others. And that’s why I want to prioritize the theme of vulnerability and restoration of dignity, because then it doesn’t matter whether you’re talking about HIV or TB or malaria. If we are driven by that vision, then I can support you in whatever you are doing.

COVID-19 is showing us that, even at our best, we were never prepared. It’s saying so much about the strength of community health and how a lot of our health systems are not protecting healthcare workers. When one or two nurses or doctors go off sick, whole facilities collapse. The anxiety and the trauma that our healthcare professionals and allied health professionals are experiencing at this moment is quite intense. It’s important for us to talk fundamentally about how our health systems are designed, how they are funded, and how we provide universal health coverage.

COVID-19 taught us things that we thought we already knew. People are now saying, “we are learning from HIV.” What are you actually learning from HIV? Because if you were learning from HIV, you would have fixed health systems. You wouldn’t need COVID-19 to show us the major gaps in human rights yet again.

In balancing individual freedoms and liberties versus public health, how do we make sure that we all come out of this alive? Because I think we’ve forgotten that we need to survive this. We can rebuild economies, we can rebuild whatever we need to rebuild, but we can’t do any of those things without people. Ultimately, people don’t just want to survive—they also need to thrive. How can we reimagine societies to make people thrive?

By starting with what it takes for the most vulnerable among us to thrive, we can build healthier and more just societies for all of us. This is why the concept of intersectionality is so important. We need to resist silos. Intersectionality isn’t a competition across identities. It’s an issue of understanding how vulnerable situations and systems of oppression express themselves onto certain people.

That’s why intersectionality is the bridge to justice. We are not inherently vulnerable; it’s situations of injustice that make us vulnerable. To correct that, we have to be committed to ending systems of oppression that create those situations. You can only do that through justice—social justice, reproductive justice, economic justice. And the framework to get to justice is human rights.

Benjamin Mason Meier is an Associate Professor of Global Health Policy at the University of North Carolina at Chapel Hill, USA. 

Tamira Daniely is a research assistant on the right to health, University of North Carolina at Chapel Hill, USA.