Gianni Tognoni
The last 50 years coincide with a process of radical transformation of society: from a horizon of promotion of the universality of individual and collective rights to a system that sees humans as a variable dependent on “property rights”. A story narrated by the Permanent Peoples’ Tribunal.
What can it say about a health-care system whose crisis situation does not need further diagnostic efforts, the experience of the Permanent Peoples’ Tribunal (TPP), an organization with certainly non-health roots, conceived and established in the same years as the national health system (1976-1979) and with very similar values? The hypothesis that guides the answer to the question is very simple: The almost fifty years that have passed coincide with a process of radical transformation of society: from a horizon of promotion of the universality of individual and collective rights to a system that sees humans as a variable dependent on “proprietary rights”.
The 1970s concludes the “glorious thirty years” that seemed to have taken the Universal Declaration of Human Rights seriously. Even with many limitations, the colonial period came to an end; the victory of Vietnam over the United States seemed to confirm the realism of the dreams of ’68; the WHO, owner of the translation into daily realities of the common good, health and healthcare, in 1977 extended its competences to the critical area of the economy with the report on essential drugs; the solemn declaration in Alma Ata places communities and not technologies as an essential condition for health care consistent with the definition of health as an indicator of a life in dignity. In the meantime, Italy had become exemplary also at an international level with its struggles-laws on the rights of work, of the family, of women’s autonomy, and law 180 changed the history, not only in Italy, of psychiatry: it is in this context that the Law 833 was born which in December 1978 sanctioned the establishment of the NHS.
The story of those years narrated by the Permanent Peoples’ Tribunal is obviously “other”, but complementary (1,2): its statute, the Universal Declaration of the Rights of Peoples, adopted in 1976 in Bologna, diagnoses a time of legal identity crisis: the community of states that accepted decolonization, albeit with infinite resistance, has however, it has already indicated its evolution, not opposing the fall of all of Latin America into the hands of military and economic dictatorships which dominated the decade of the ’70s. The United Nations project to place human rights as an inviolable check on the claims of transnational economic actors is nipped in the bud.
The “compulsory nature” of human and peoples’ rights is the question with which the 1980s begin. The international community, and national societies, must make a choice: the reformulation of law must be adapted to scenarios that have peoples and their concrete rights, beyond their State-Governments, as subjects capable of self-determination.
The last 80s and the 90s saw the contrast between the stories narrated by the States, i.e. the point of view of the world primo (HIC: high income countries), and the stories of “other” peoples (LMIC: low and middle income countries).
The struggles for liberation then coincided more and more with those linked to the models of economic-political development. Examples and hopeful situations, such as Italy, or those that had historical NHS traditions such as in the United Kingdom are also beginning to be directly affected: private subjects, multinationals or not, economic and increasingly financial, enter into competition with, and downgrade the role of guarantor of the rights of the States. Health services can indeed maintain their formal qualification but their corporate nature defines their institutional, economic, and therefore operational future.
The chronological coincidence from which we started (foundation of the NHS and foundation of the Court) translates into a confluence without ifs and without paths: in 1994 the World Trade Organization (WTO) joins a WHO which is less and less politically, economically and culturally autonomous; in 1996 , the report-acronym GBD (Global Burden of Diseases), which has as joint authors the WHO and the World Bank (WB), declares that diseases more than humans are the object of the new epidemiology, global and more complete, because it also takes into account the costs: health is a nice word, but it is the diseases that allow us to quantify how big the “economic debt” is. Real peoples can therefore be subjects of law only if “recipes” much more authoritative than health ones certify it.
The story, on the part of the peoples, narrated by the Tribunal is that of its sentences, (by now more than 50) which are his “scientific publications” and the authors of them are the witnesses of the peoples, and the experts and judges are the interpreters of their “evidence”. The Tribunal can only continue its obstinate work of calling everything that happens by name, to avoid illusions or manipulations, juridical, cultural, political:
- in 1988, in Berlin, on the eve of the fall of the wall, the International Monetary Fund and the World Bank are held responsible for a development that coincides with “crimes against humanity”;
- the 500th anniversary of the discovery of America (1992) is analysed, with a text that is also doctrinally very original, as the justification of the conquest of the “other” world, the true original sin of the claim to bring salvation-humanity-democracy;
- the degradation of peace in Iraq, Afghanistan (and the re-admission of war as an instrument of civilization!);
- the impunity of the cancellation of the self-determination of the peoples of Latin America and Asia, in the perfect connivance between transnational private powers and state and regional authorities, up to real genocides, crowd the increasingly documented sentences of the Court up to the present day.
Furthermore, there are two elements that deeply affect our democracies as well High Income Countries:
- the resistance of the community of Val di Susa to a meaningless “great work”, repressive up to militarization and prison, is the reminder that the time of “post-law” does not only concern “other” peoples;
- the transversal and global population of migrants documents that universal law has expired, not because its norms have been abolished, but because migrants, many or few, by sea or by land, or “at home”, are not human but goods without a market, disposable, for an economy that has re-introduced slavery.
The pandemic is the summary of how the coincidences between the stories narrated by the Court and that of the Healthcare (not only Italian) are constituted as a single story, with protagonists faithful to the roles assigned to them: to humans non-High Income Countries (the ‘unequal’ of all countries) that of victims-rejects; health care has the task of proclaiming that it is on the side of the citizens; multinationals (pharmaceutical or otherwise) have the duty to enrich themselves in ways recognized as indecent and to prohibit human rights from disturbing the rules of the market; finally, the mission of conniving with the various powers at stake is confirmed to the States (3).
Beyond any reasonable doubt, health–health today means:
in society, a low priority sector but subject to insistent political marketing, disguised in the language of proximity, care, continuity;
an undisputed and exclusive sector of the economy, attractive for quick and risk-free earnings;
a very didactic communication opportunity, to get everyone the message that health as a right is a topic to be discussed in many contexts, but with too many intersecting and untouchable interests to try to translate it into real changes.
The most important contribution of the Court, at least in this reflection, is methodological.
The “evidence” of violations of inviolable rights can only arise from the direct testimonies of subjects who are holders of fundamental rights. It is an ancient truth: legitimate law is the product of a disobedience that makes visible and gives the voice to those with unfulfilled needs, before and against the holders of a legality that has detached itself from the life of the populations to which the role is instead assigned to be waste. Basaglia’s “…And I don’t sign” which reverses the gaze and the relationships between the holders of power and the holders of rights is the key to understanding an 833 which must be reformulated so that its principles correspond to the concrete application of rights and , if necessary, the “negation of institutions”.
The conclusions are simple.
- Health is not a medical problem. Instead, it is the universal right to life in dignity that has been declared obsolete. The entry, as a growing protagonist, of inequality (with its indivisible sister, inequity) into the most qualified medical and public health literature says it with even surprising clarity: the increasingly detailed and qualified (epidemiologically and politically) denunciation of causes is rigorously separated from any judgment, research and institutional involvement in the direction of an avoidability that is not limited to invocations of paradigm shifts. It is basically the same mechanism by which the “evidence” of crimes against humanity corresponds to impunity: for conflicts of power, or for the absence of “competent courts”.
- The constitutional reference is unquestionably in article 3, which has one of its indicators in article 32. The LEA, LEAS, LEP or any acronym are unfortunately a sub-chapter, the evidence of which is only the economic one which has the untouchability of inequality as its reference criterion.
- Finding these roots after decades of degradation of the credibility of rights in all areas is not easy and even less guaranteedabove all by invoking, with the irresponsibility of the PNNR, digitizations and algorithms that reproduce the logic of sustainability derived from models that classify, in order to declare them non-avoidable, inequalities, whether health or economic.
- An epidemiology contextualized with the most diverse communities, aimed at clarifying and making visible the “gaps” of information and the ability to care for the many fragilities, as real legal voids, is the most urgent chapter to be developed, as an essential tool for creating communities that participate and interact, and not just more or less centralized statistics that observe and recommend from above and beyond.
- A “new” that concerns only Italy, or Europe, is unthinkable.
The highly contagious pandemics-syndemics of inequality have revealed what was known: the processes of liberation from the “common evil” can only be the expression of a civilizational project and a long process of struggle. The “One health” project (4), as resistance and liberation from the third world war fragmented in time and space. By restoring the right of visibility and speech to the peoples, the Tribunal learned that rights do not “are” but can only “become” inviolable, as a product of a permanent laboratory of research, including doctrinal research, and generated by the real terrain.
Gianni Tognoni. Secretary General of the Permanent Peoples’ Tribunal
BIBLIOGRAPHY
- Permanent Peoples’ Tribunal. Rights of peoples and global inequalities. Altreconomia Editions, Milan 2020.
- Statute of the Permanent Peoples’ Tribunal (TPP). content/uploads/2019/05/Statuto-TPP-IT-FINALE.
- Tognoni G. Our health, a counter-current reminder for the aftermath of the pandemic. GruppoAbele Editions, Turin 2022.
- One Health.