Why human rights can be transformational – Lucy Mulvagh

One of the Academy’s Five Provocations, Emphasising Humanity, is described as the need “to emphasise the humanity and human rights of the people accessing and providing support and services, to create relationships that enable people to flourish.” Here, Lucy Mulvagh explains why she thinks human rights can help achieve transformational change.

 

It was love at first sight (or should that be sound?) when I first heard about human rights. I can’t really remember a time as an adult when they haven’t figured somehow or another in my life and it’s usually a subject that’s knocking around my head on most days.

I’ve got many reasons for this passion, but primarily it’s because human rights can identify and challenge the myriad power imbalances that currently exist. I firmly believe that if we were to adopt a truly rights-based approach – as widely as possible in everyday life – then many of society’s ills and injustices could be overcome.

Using rights to support decision-making – at the individual, community, regional or national level – means it’s based on fairness, transparency, equality and proportionality instead of (political) ideology, decisions around who is ‘deserving’ or ‘undeserving’, and (unwittingly or not) prejudice, bias and stigma.

I’m thinking of decision-making that can apply anywhere and at any time: how resources and budgets are allocated and disbursed; homes and public spaces are designed, built and sustained; health and social care services; income and social protection; good quality food, heating and clothing; transport; education; employment; … you name it!

I’m very sad that there is still such a great deal of suspicion and unease about human rights in some quarters. While this is due, in part, to genuine misunderstandings about rights being purely associated with lawyers, court cases and punitive action, I’m pretty sure that some is deliberate misinterpretation and misinformation by those who are challenged by the idea of greater equality in the distribution of power.

We all have human rights, simply by virtue of being human, and it’s a bit of a personal mission of mine to help raise awareness about rights and support efforts to increase our understanding about how truly revolutionary they can be – for all of us.

I welcome the growing appreciation – and name-checking – of human rights in national policy, but there’s still a long way to go to bridge the (growing) gap between rhetoric and reality and translate rights into everyday life. In the meantime much of the focus, including in health and social care, has been on concepts like ‘person centredness’, ‘compassion’ and asking people what’s important to them.

Don’t get me wrong, of course I agree we need as much compassion, kindness, listening and understanding as we can get. But I can’t help feeling that it’s a sad indictment of how we currently relate to each other – irrespective of where our interactions take place – that these could ever be seen as transformational.  Aren’t they the basic minimum that we should expect when we relate to each other?

And what happens when, say, a service says that they listen to what’s important for people, but then they either don’t, or do but then don’t actually act on what they’ve been told?  Very often this sort of practice is deplored and decried as unacceptable, and a (public) apology may be offered, but what difference does that really make to the people and institutions involved, and are we sure there are adequate concrete measures in place to ensure it never, ever, happens again?

We can’t, and indeed shouldn’t, legislate for compassion, but we can legislate for human rights and rights-based approaches – like the right to free, meaningful and active participation in decision-making – which means that when things go wrong there will be an open and honest approach to accountability, remedy and redress.

But it’s not just about the ‘stick’ of holding people or services accountable when things go wrong. Taking a human rights-based approach to decision-making means we can start with the ‘carrot’ and conceptualise and deliver support in very different ways, nip issues in the bud at a much earlier stage, and even avoid things going wrong in the first place.

I’m committed to spreading the love about human rights – who’s with me?

@lkmulvagh

 

lucy-blog

What is transformation in health and social care?

On International Human Rights Day read the first blog in our series of ‘What is transformation in health and social care?’. In this instalment, from an anonymous blogger, the concepts of person centredness, compassion and the ‘patient’ as the expert, in a human rights based context are explored. human-rights-day


 

With International Human Rights Day on 10 December and a continuing focus on health and social care integration, this seems a good time to find my voice on a subject that has been bothering me for some time.

That subject is the extent to which the current health policy landscape in Scotland is awash with concepts such as Person Centredness, Compassion and the ‘Patient’ as the Expert.

I completely understand the intent behind these concepts as shifting the power in care from the clinician/service giver to person accessing services. I believe that intent is very genuine.

However, I do not believe that for all their intent they are or will achieve the outcome intended. The reason is this: most policies/most intents are qualified by the context in which they are applied.  Being person-centred can be compromised by a lack of resource, or a lack of time. Being compassionate can be compromised by a strain in the care giver because of lack of time or other stressors. The expertise of people accessing services in their own needs and wants may need to be qualified by the care giver because of clinical expediency, resource constraints, etc.

So, concepts such as Person-Centredness, Compassion and the ‘Patient’ as the Expert can all be qualified by the context in which they are enacted. The problem for me is that I see them being espoused and promoted as if they are not. And what that masks is that the power to decide when to withhold an element of compassion, or be less person-centred or to not go with the expert opinion of the person accessing services still rests with the care giver or the decision/policy maker in the background. So, do these concepts really lead to an equal sharing of power? And how do we hold people to account when it is not?

So, I would like us to stop offering these concepts as the underpinning concepts of care. I just want us to talk about rights.

Human rights have stood the test of time for longer than all these other concepts. They are internationally accepted.  And there is a key difference. The difference is not that human rights are not unqualifiable. Most human rights are absolutely qualifiable. The key difference between rights and these other concepts is that there is no unilateral position. In person centredness, by putting one person ‘in the centre’ you are instantly putting the other parties somewhere else. By describing one person as the expert, you are again by default assigning a different role to other parties. What is that role? It is never fully defined and therefore the power behind that role is not fully understood or visible, but it may well still be there.

With a rights based approach, the basis of everyone’s role is equal because it is based on one role for everyone – that role being one of a human being.  Care givers have a right to be there, to have knowledge, to have it listened to, to have it valued, to be understood as human beings who may have worries and pressures that affect how they act. People accessing services have a right to be there (whoever they are), to be listened to, to be valued wherever they are, to have choices.

If all of that is recognised then the default is to negotiate in the moment of what is wanted, what is possible, what is sustainable and what capacities each party has. I think that is true power sharing.

We shouldn’t be afraid of a human rights based approach to care. We also shouldn’t delude ourselves that other approaches offer the same thing. They don’t, because they don’t shift the balance of power openly and right into the centre so that all parties can see it, use it and negotiate around it openly. It is about basing care on the rights of all, not the needs of the needy.

Latest Academy Podcast: Think Tank on Creating Wellbeing

The latest Academy podcast features Dr David Reilly, Director of the WEL Programme, Professor Alan Miller, Chair of the Scottish Human Rights Commission, and Cath Cooney, Citizen blogger for the Academy who each contributed to the Academy’s Think Tank event, held in Edinburgh’s Assembly Rooms on Tuesday 27 October 2015.

Read More “Latest Academy Podcast: Think Tank on Creating Wellbeing”

Academy Masterclass with Michael Rowe. An easy relationship? Citizenship and human rights.

The Academy in partnership with Strathclyde University International Public Policy Institute, NHS Health Scotland and Turning Point Scotland are hosting a Masterclass with Michael Rowe on Citizenship and Human Rights.

Michael Rowe is a medical sociologist, Associate Professor of Psychiatry, and Co-Director of the Program for Recovery and Community Health at the Yale School of Medicine, Department of Psychiatry.

His areas of study and writing include citizenship as a framework for the social inclusion and participation of people with mental health problems and homelessness, peers as providers of direct care and researchers, and medical humanities. He is the author of many books, articles, and other publications including Citizenship and Mental Health and Transforming Mental Health Care.

In this Masterclass Michael will:

  • Explore citizenship framework for people who are homeless or have experience of mental health and explore links between mental health and the criminal justice system.
  • Test this framework in relation to research and human rights theory.
  • Consider the relationships between citizenship theory and practice and its potential to ‘reform’ community mental health care for and support the full community participation and membership of people with mental health problems.
  • Offer insight into an approach that could support work towards Scotland’s National Action Plan for Human Rights (SNAP)

Please email event@alliance-scotland.org.uk to register your place. Please include any access requirements.

A dignified approach

What is the true value of caring and supporting others?  Of late I’ve realised more and more that our society tends to assign a monetary value to everything – including the role of carers of disabled people and people who live with long term conditions.

But that doesn’t need to be the case.

I was recently at an event organised by the Glasgow Centre for Population Health, on “the economics of dignity”.  The seminar was addressed by an academic Dr Marilyn Waring, a feminist academic who has spent the last 25 years working to empower woman and men to challenge the priorities that are imposed upon them by economists.

Read More “A dignified approach”

Academy Being Human Podcasts Launched with Global Perspective on Health and Human Rights

On 10 December 2014, the United Nations’ Human Rights Day, the Health and Social Care Academy brought to you the first podcast in a series of thoughtful considerations of how to achieve transformational change in Scotland’s health and social care system.

Read More “Academy Being Human Podcasts Launched with Global Perspective on Health and Human Rights”

Citizen Bloggers – Cath Cooney: 2015 – a year for human rights to flourish

Looking back as 2015 begins the issue of human rights and health is much in my mind.

I´ve been in Sweden over New Year, the birthplace of the founder of the Nobel prize, and the 2014 Nobel Laureates for Peace Malala and Kailash have been recognised for their courageous human rights work with children and received much coverage in closing year reviews here.

Read More “Citizen Bloggers – Cath Cooney: 2015 – a year for human rights to flourish”

Health and Social Care Academy masterclass explores a global perspective to health and human rights

On 20 November 2014, the Health and Social Care Academy, in partnership with the Scottish Human Rights Commission, NHS Health Scotland and the Strathclyde International Public Policy Institute held a pop-up masterclass to explore a global perspective to health and human rights.

Read More “Health and Social Care Academy masterclass explores a global perspective to health and human rights”

Health and Human Rights: A Global Perspective – Pop-Up Masterclass


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The Health and Social Care Academy and partners would like to invite you to a masterclass with Jonathan Cohen, Deputy Director of the Public Health Program at Open Society Foundations on global work on health and human rights.  Jonathan will discuss international efforts to integrate a human rights approach to health care and to support civil society organizations to use human rights tools in their health-related work.  Drawing on his experience of embedding human rights in the HIV response, he will consider lessons for other areas of public health.

In the context of Scotland’s National Action Plan for Human Rights, and in advance of the International Human Rights day on 10 December, this event will consider international perspectives on enhancing respect, protection and fulfilment of human rights to achieve high quality health and social care.

About the speaker:

  • Jonathan Cohen is Deputy Director of the Open Society Foundations Public Health Program in New York.  He has written extensively on the importance of a human rights approach to healthcare.
  • From 2002 to 2006, Jonathan was a researcher with the HIV/AIDS and Human Rights Program at Human Rights Watch, where he conducted numerous investigations of rights violations linked to the AIDS epidemics in sub-Saharan Africa, southeast Asia, and North America.

How to register: email event@alliance-scotland.org.uk or call 0141 404 0231

@HandSCAcademy > #hscacademy

Part of the Academy’s Being Human Series of events the pop-up masterclass is being held in partnership by the Health and Social Care Academy, Scottish Human Rights Commission, the Centre for Health Policy at Strathclyde University, NHS Health Scotland and the Open Society Foundations.