PRESENTATION OF CATHERINE ALBISA AT LATINA HEALTH SUMMIT, APRIL 25, 2004 (Precursor to March for Women’s Lives April 26, 2004)

There is a growing HR movement in the US. I don’t mean a movement in the US concerned with HR violations abroad – although that is also certainly the case. I mean there are growing numbers of organizers, educators, lawyers, policy advocates, and other activists who are calling upon the US government to meet their obligation to the people within its borders under international standards of human rights.

This year alone a US Human Rights Network was launched and in the space of a few months there are over 100 organizations that have become members of that network. This Network include advocates for civil, political, economic, social and cultural rights working in a number of contexts, from on the ground to in the courts and beltway – what they have in common is a belief that now is the time for a cross-cutting integrated human rights movement that can provide a vision and unifying strategy to counter the decades long sustained attack on the rights of people in the United States. This attack has resulted in weaker protections against discrimination, restrictions on reproductive health care services, over incarceration of Black and Latino communities – with women being the fastest growing prison population, the admitted use of torture by the US in the so-called war on terror, the racial profiling of Arab-Americans, the dismantling of the safety net, the weakening of the Medicaid system, increasing profiteering by health insurance companies and pharmaceuticals, and the virtual freezing of salaries of low wage workers and increased frequency of sweat shop hours and unhealthy working conditions – all in the face of increasing costs for ordinary people for basic needs such as housing, transportation and healthcare.

So why should that be of concern at a panel on reproductive equity for Latina women. There are two compelling reasons that make it a question of great concern. First, because reproductive equity is a human right, and the building of a strong human rights movement and culture in the US across the board is the best guarantee of achieving reproductive equity. Second, because there are not enough Latina and Latino voices in this growing movement. There is a human rights agenda being shaped in this country from the ground up, and as the fastest growing ethnic population in this country – a population that faces enormous economic, political and cultural obstacles to exercising the full range of our human rights – including the right to equality in the political, economic and cultural sphere – we need to have a voice.

What I hope to argue in this short talk is that the Latina reproductive rights community needs to start thinking in human rights terms, and demonstrate both why that is and what that means in terms of how we articulate our rights and what strategies we pursue to secure them.

Human rights involve a complex set of international legal standards that would take many presentations to detail and explain, but there are some basic principals that form the foundation of human rights, and apply to all the individual rights that make up the framework. One of the most valuable principals is that human rights are indivisible and interdependent – this is a recognition, for example, that without adequate housing the right to health is also imperiled, and that without access to education the right to political participation is seriously undermined. Underlying this principal is the important and accurate assumption that you cannot guarantee civil and political rights without guaranteeing economic, social and cultural rights and visa versa.

Two other important and interrelated principals are that human rights are universal and must be protected equitably and without discrimination based on, among other things, gender, race, ethnicity, class, and sexual orientation. Another key principal is that governments are not only obligated to respect rights – meaning that governments cannot interfere with an individual’s exercise of a right – but also must ensure rights. This means governments have an obligation to take positive action to ensure all people can exercise their rights by protecting against interference by private actors – such as hospitals refusing to provide services such as abortion or health insurance companies refusing coverage for necessary care – and by creating the conditions that allow for the realization of rights – such as creating a healthcare finance system that guarantees universal and affordable access to quality care.

I will focus on the health care finance system as an example of a structural violation of the human right to health that should be of great concern to the Latina reproductive rights community. One-third of all Latinos lack health insurance, and over half of Latina immigrants lack insurance.

Like other uninsured people who are denied the ability to access affordable care, Latinas often forgo treatment for acute illness and injuries unless they become severe. Consequently, they experience a decline in health status over time as compared to those with insurance. In 2003, almost half of the uninsured postponed seeking medical care because of cost, 35% needed care but did not get it, 37% did not fill a prescription because of cost, 36% had problems paying medical bills and 23% had been contacted by a collections agency because of medical bills¹. Because they have less access to preventative health care services, such as mammograms, and pap smears they are at greater risk of being diagnosed with late detected, fatal cancers. They are frequently hospitalized for conditions or illnesses that may have otherwise been avoided if they received care earlier. Once hospitalized, they often receive lower quality care and services, and are more likely to die than people with insurance².

Uninsured women who are pregnant have poorer outcomes during pregnancy and delivery than do insured women. They are more than twice as likely not to receive the standard number of prenatal checkups before delivery and 15% of them are refused prenatal care when looking for a provider³. They also receive fewer expensive perinatal procedures, such as cesarean sections, and their newborns, when sick, have average shorter hospital stays than newborns covered by health insurance. Uninsured newborns are at greater risk for low birth-weight and are more likely to die prematurely as babies⁴.

Families with uninsured members tend to have lower income, fewer assets, and limited financial resources such as savings and lines of credit to pay medical expenses⁵, which often consume an extraordinary percentage of their income⁶. And because people paying for health services without insurance do not have the financial might of insurance companies in negotiating for lower fees, people with the lowest income and no access to health insurance are often charged more for the same services than those who are insured⁷. One study found that half of all personal bankruptcies are the result of health problems or unmanageable medical bills

The primary reason over 43 million people in this country cannot access affordable care is because health care dollars are being used by insurance companies and pharmaceuticals for wasteful administrative costs and for advertising – not to mention for thousands of highly paid lobbyists to protect their profits. In short, people are losing their health and sometimes their life due to profiteering off of human rights violations by the most profitable industries in this country. Both the first Bush Administration and the Clinton Administration, via the GAO, acknowledged that every person in this country could be covered with the same amount of health care dollars currently spent if we had a public universal insurance system. It is not a question of resources.

Because the health care financing system in the U.S. puts profits ahead of human rights, the uninsured suffer from restricted access to care, which under international standards must be universal and equitable; face unnecessary sickness and premature death due to inability to secure preventive care and other necessary care, and are then penalized for the state’s disregard their human right to health care when the high cost of medical services results in their bankruptcy and drives them into poverty. These represent violations of the right to health, life and to an adequate standard of living.

So why has the Latina health community, and particularly the Latina reproductive health community been so absent from the universal health care debate. Why have we not spoken to the deep inequities in our health care finance system that leave a 1/3 of our communities without access to affordable care, and over _ of our immigrant communities in that situation.

I believe there are three reasons:

• We are working in isolation from broader movements:

Latina reproductive health advocates do usually join forces with other women of color efforts, and also regularly support both the feminist and racial equality agendas. However, we (and this isn’t always the case) are too often absent from broader movement building. I don’t think this is just the case for Latina health advocates, however, I think that a wide range of activist movements in the US work in parallel ways but often in isolation from one another. The human rights framework, because of its emphasis on the indivisibility and interdependence of rights can serve as a strategic and conceptual tool for domestic advocates to work in a more integrated and strategic way.

• We tend to focus on the equity to the exclusion of the universality.

Ironically, I think that we have failed to bring our voices into the universal health care debate because the violations in our health care finance system are so widespread that Latinas do not appear to be a particular target. The violations literally affect so many people that particular communities do not become invested in advocating against these violations. Considering that far more Latinas are affected by lack of health insurance than almost any other issue that our advocacy community has targeted with its considerable energy should be enough to galvanize us to demand universal access to affordable and quality care. Particularly since a just universal health care system would also address almost all these other issues, such as contraceptive equity.

By re-conceptualizing our struggles in human rights terms, and giving equal weight to the principal of universality as well as the principal of equity – we can clarify and re-assess our agendas. Latinas are disproportionately affected by lack of health insurance, but even if that were not the case, discrimination cannot be our only lens through which we do our work. We cannot just fight for a “piece of a pie” that is shrinking for all people in this country at alarming rates. We must fight for a bigger pie altogether, for all people, with an equitable share for our communities. Particularly when that pie is shrinking to benefit large multi-national corporations and to feed the alarming trend of concentration of wealth in this country and around the world.

• Despite our grave concern with economic justice, we have not adequately or sufficiently recast economic issues in rights terms.

We understand civil and political rights in this country as rights, with the right to be free from discrimination one of the most developed and supported right within our communities and across the cultural landscape of conscientious and moral people in this country. But we still, despite rhetoric to the contrary, fail to fully grasp the fundamental nature of economic and social rights. When a member of our community is assaulted by a police officer, we articulate our outrage at the discriminatory nature of that attack and at the violation of the basic right to be free from assault from the authorities (in human rights terms the right to security, and the right to be free from cruel, inhuman or degrading treatment or torture depending on the severity of the attack). But when women in our community cannot access contraception due to economic reasons, we understand it primarily in terms of discrimination (a civil and political right) not also in terms of a failure to protect the fundamental right to access health care (an economic and social right) – despite the fact that nothing in our domestic law protects against either de facto disproportionate impact discrimination in access to care or against failure to guarantee healthcare. It is not a legal difference, but rather our cultural understanding of rights that makes the difference. Again, this is not always the case in every instance or with every organization, but it is a general tendency that a human rights approach can help us reverse.

There is so much more to say about why and how we can think about approaching our work in human rights terms. But I will stop here in the hopes that some of us might start a conversation about a Latina voice and agenda as part of the growing human rights movement in the US. The next time I come to a march like this, I have the hope that it will be identified as march for human rights in this country, that we acknowledge through our organizing and our work that our domestic standards are inadequate and we must demand more than we have allowed ourselves to become accustomed to in our current political climate. The human rights framework is, I believe, a good place to begin.

¹ Kaiser Family Foundation, Kaiser 2003 Health Insurance Survey.

²Care Without Coverage: Too Little, Too Late, Institute of Medicine, National Academy Press, 2002.

³Howard Bell, “The Uninsured: Myths & Facts,” American Medical Student Association, printed in The New Physician, September 2000, also at http://www.amsa.org/tnp/myths.cfm.

⁴Health Insurance is a Family Matter, Institute of Medicine, National Academies Press, 2002.

⁵Health Insurance is a Family Matter, Institute of Medicine, National Academies Press, 2002.

⁶In 1996, 4% of uninsured families had health care expenses that were greater than 20% of their income. Amy K. Taylor, Joel W. Cohen and Steven Machlin, “Being Uninsured in 1996 Compared to 1987: How Has the Experience of the Uninsured Changed Over Time?” Health Services Research 36(6, Pt. II), 2001.

⁷“Medical Fees are Often Higher for Patients without Insurance,” New York Times, April 2, 2001. See also Irene Wielawski, “Gouging the Medically Uninsured: A Tale of Two Bills," Health Affairs, Sept./Oct. 2000.