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Speech at The Human Right to Health Conference

NUI Galway, 6th February 2015

President of the University,

Professors, Esteemed Speakers,

Ladies and Gentlemen,

Tá fíoráthas orm a bheith anseo libh ar fad chun ábhar chomh tabhachtach le cearta sláinte a phlé, agus ba mhaith liom buíochas a ghabháil le Michael O’Flaherty agus le Diarmuid O’Donovan as ucht a gcuiridh caoin labhairt libh ar maidin.

It is always a great pleasure for me to return to NUI Galway, and I am especially pleased to participate in this important conference hosted by the College of Medicine, Nursing and Health Sciences and the Irish Centre for Human Rights, where I was an adjunct professor for many years.

The question of health and the right to health is a subject of great currency and it is most appropriate that this conference should be one of the final university events under the President of Ireland’s Ethics Initiative, which has been running now for over one year.

When I was elected as President in November 2011, I committed to a “Presidency of Ideas” that would seek to develop a public discourse that places human flourishing and an ethic of active citizenship at its heart. The Ethics Initiative has sought to contribute to this wider goal by encouraging universities and civic society to host events and projects aimed at stimulating discussion on a broad range of ethical issues. There have been over 50 university events held around the country under the Initiative and there are also additional projects being hosted by national civic society organisations. The Initiative is due to conclude with a national seminar at Áras an Uachtaráin in the coming months.

In both the university and community events, themes of social justice and access to basic human rights such as the right to health have been prominent. This reflects an increasingly lively debate on the possibility of affording constitutional protection to economic, social and cultural rights in Ireland. While the Constitution Review Group recommended against such protection in its report in 1996, there has been growing interest in this area in the past decade, with important contributions from the Irish Human Rights Commission (as it then was), Amnesty International, FLAC and a wide range of NGOs. This culminated in the consideration of the question by the Constitutional Convention, who ultimately recommended for constitutional protection of a number of economic, social and cultural rights, including a recommendation by 87% of its members that the Constitution should include a right to essential healthcare.

To me, this provides a neat illustration of a current and unavoidable contradiction – the dilemma of elected governments within democratic systems seeking to respond to citizens’ articulated needs, and at the same time forced to stay in the lock of the invisible fist of markets that are neither democratic or indeed accountable.

As President, it is not appropriate for me to take a position on whether the Constitution should be amended in the manner proposed by the Convention, but I do welcome the rich debate that has flowed from these discussions as to which social goods should be considered essential or fundamental and hence recognised as such in our legal system. I do note, too, the reluctance of legal scholars, including the human rights component of that scholarship, to engage with exogenous factors such as the economic frame within which they theorise. This reluctance can have the effect of tacitly granting the status of inevitability to a context that should be questioned at a moral and ethical level.

Leaving aside the question of constitutional protection of economic, social and cultural rights at the national level, the international obligations on Ireland in this area are clear. There is a right to health under international law, set out in treaties to which the State is a party, including of course the International Covenant on Economic, Social and Cultural Rights, which Ireland ratified in 1990 and under which Ireland will be examined before the UN Committee on Economic, Social and Cultural Rights later this year.

There can be no doubt that our interaction with this Committee and the other relevant treaty monitoring bodies under the UN and Council of Europe treaties has enlivened our legal discourse about rights such as the right to health. However, it is also fair to say that, up to this point, the national discourse around the concepts of economic and social rights has been largely conducted within the disciplines of law and human rights.

There is a pressing need, I would suggest, to deepen the connections between the human rights discourse in these two fields and a wider emerging discourse in the fields of economics and social policy about health and related social goods. The complex questions of justiciability and how policy-making can address the financial challenges of realising these rights can provide the starting point for a productive conversation between human rights, economics and social policy.

The absence of this conversation threatens democracy itself. This was a point developed by Armin Schafer and Wolfgang Streeck in their recent book Politics in the Age of Austerity, which looks at the nature of the threat to democracy facing European States in the current financial conditions and political context they find themselves embedded in.

In October, I participated in a seminar hosted by the Institute for International and European Affairs with Edward and Robert Skidelsky to discuss their recent work, How Much is Enough? The book is essentially a conversation between a political economist and a philosopher – a joint exercise between a father and a son –, who look at the distinction between basic human “needs” and human “wants”, arguing that in its economic policy and structures, the State should approach and regulate both categories in different ways. How Much is Enough? reminds us of a time when Western political economy was grounded in philosophical and ethical thought, and economic policy conceptualised primarily in relation to the social objectives at which it was aimed.

The Skidelskys, and a growing cohort of economists and political theorists, are turning to re-examine and re-configure the manner in which we view the essential social goods within our economic theory. We are emerging from an era characterised by a diminution, and even at times, a fundamentalist rejection, of the role of the state in meeting social needs. However, the dominance of a model of unregulated markets dominating all spheres of human life is, I believe, coming to an end.

It is my conviction that the discourse of human rights has a great deal to offer as new models of economy and society are constructed, particularly as economics is pushed to rediscover its ethical grounding. This has particular relevance to the specific question of the right to health, which is so inextricably linked to considerations of human dignity and engages all dimensions of life and community as well as questions of equality and respect for diversity.

As we will hear from the speakers and panellists this morning, consideration of health and healthcare involve questions of science and questions of economics, as well as questions of ethics. A human rights framework provides a paradigm where these perspectives can all be considered in a transparent and rational manner. During my recent visit to the Republic of South Africa I had the opportunity to visit its Constitutional Court and meet with some of its members. I was greatly interested to observe how judicial protection of the right to health has been used in that country to engage with complex issues such as healthcare, budgeting and the provision of retroviral care.

Of course, the South African experience also shows that formal legal protection of the right to health will not, in itself, resolve profound poverty and structural inequality. The realisation of the right to health, and of related rights such as the rights to housing, adequate food and nutrition, the rights to access to clean water and sanitation, and to a clean and safe environment – all these remain essentially political matters. Legal and constitutional rights can be the tools for the achievement of human dignity, but political leadership and democratic debate is also required.

This year, in particular, we will witness the central role that governments have in addressing these issues as the leaders of the world’s nations come together to forge new agreements on climate change and on sustainable development. It has been suggested that 2015, with the Post-2015 Development Conference scheduled for September in New York and the Climate Change Conference in December in Paris, will be the most important year for the future of humanity in a generation.

For those processes to succeed, a new approach is required in how the “North” addresses the “South” through the multilateral system, but also in the globalised economic system. Success will also depend on reconciling the discourse of rights with the discourse of development; and reconciling those discourses in a way that makes space for the voices and perspectives of the marginalised on our planet, who experience the sharp-end of both climate change and global inequality. These are great challenges, even defining challenges, for all of us who are concerned with human rights, development, justice and solidarity.

I wish you all well for today’s seminar, which I view not just as part of a national discussion in Ireland about ethics, but as part of a wider international discussion about the values and priorities of human society as we aim to set global standards for the next generation.

Go raibh míle maith agaibh go léir.