When Misfortune Becomes Justice

When Misfortune Becomes Justice: Evolving Human Rights Struggles for Health and Social Equality. By Alicia Ely Yamin. Stanford, Stanford University Press, 2020

Reviewed by, Raúl Márquez Porras, University of Barcelona

Alicia Ely Yamin offers a journey through a half a century of struggle for the recognition and expansion of human rights in their social, economic and cultural dimensions, focusing on the right to health and, more specifically, on the sexual and reproductive health rights of women. This chronological journey examines laws and regulations, decision-making forums and legal cases that have been milestones in the global history of human rights—events that the author selects from her vast direct knowledge and involvement.

To point out some elements of this complex history—which the author summarizes in just over 200 pages—it begins with the Declaration of Human Rights (1948) that recognized civil and political rights, rights linked to individual freedom and to the image of Western men. It was not until the late 1970s that this initial formulation began to be questioned, and when economic, social, and cultural rights, such as the right to health, were included, and women, children, and people with disabilities were also included as fully recognized subjects. However, this search for universal human rights continued to be an unfinished project; it later coexisted with the consolidation of neoliberal globalization, its patterns of unequal development and the growing power of the market and its actors. In the same vein, there have been constitutional reforms and actions by judicial bodies that strengthened human rights in their expanded version. But there have also been setbacks in the enforcement of these rights, especially those related to health and women. Backlashes linked to the very nature of pro-human rights instruments, such as their formal character and vague definitions; as well as to the influence of biomedicine, the marketization of services and the persistence of patriarchy, among other factors.

The main conclusion to be drawn from Yamin’s book is that the struggle for the extension and implementation of human rights has had mixed results. As the author notes, “a critical lesson about using human rights for progressive social change is that the process is iterative, messy, and nonlinear” (p. 101). This partial success in a hard-fought struggle includes re-appropriations of the very discourse of human rights by conservative and reactionary forces (consider the use of the pro-life label by anti-abortion movements).

Yamin’s book thus raises a number of substantive issues of interest to anthropologists and other social scientists. The first deals with the nature, scope, and limitations of legal instruments. The history of human rights confirms the idea, broadly accepted in legal anthropology, that law is a social field (as Bourdieu defended), a “loci of contestation” (Yamin, p. 13), and that rights are “contested bundles of relationships negotiated within social spaces” (p. 185). The result of this negotiation ultimately serves the interests and agendas of some actors at the expense of others, and is determined by several extra-legal factors (power, participation in networks, the socio-cultural context, among others). This idea helps us to understand the tortuous path that human rights have followed, the inconclusive struggle for their extension and effectiveness. It also clarifies why some conventions and judicial decisions have been “game-changers” while others turn out to be a dead letter.

Likewise, many of the problems affecting health—the focus of Yamin’s book—have to be considered on the basis of their socio-cultural nature. The author refers to the well-known distinction in anthropology between disease and illness: the clash between biomedical and phenomenological conceptions of health. The former has gained ground in recent decades, hand in hand with the commodification and technocratization of health services driven by the neoliberal agenda. With the growing impact of this agenda, inequalities have also increased: “Never before have life chances—and life choices—been so unevenly determined by the arbitrariness of where one is born in this world,” states Yamin (p. 15). This statement has been extensively corroborated in the current pandemic situation.

Moreover, a central thesis of the book is that health should be treated as a social issue, one determined by social institutions and government policies (by the organization of services, the control of pharmaceutical companies, property laws, among others) rather than as a matter of chance and individual responsibility. If one accepts this view, it can be argued that health problems are injustices and not misfortunes (as the title of the book points out), and that public authorities can and should intervene so as to solve health issues.  

Finally, Yamin’s book illustrates another issue related to neoliberal governance: the growing influence of metric indicators (“indicatorization”) in the measurement of human rights’ standards and public affairs more generally. As Yamin argues, this leads to depoliticizing and removing the causes of problems and their solutions from the public debate, legitimizing technical and vertical interventions.

To conclude, When Misfortune Becomes Injustice may be of interest to anyone looking for an overview of human rights history, one that focuses on their contested and unfinished expansion towards health and women’s rights. This is a story centered on the role of transnational institutions that includes specific cases (in Argentina, Brazil, Peru, India, South Africa and the USA) which allow for a better understanding of the limitations and possibilities of the judicialization of human rights issues. The presentation of some of these cases is somewhat schematic. On another note, the book may be difficult to read at times, due to the profusion of acronyms in a narrative focused on the formal and institutional sphere. Nevertheless, it provides the necessary background and the legal framework that has determined the development of human rights. In addition, the particular case studies can shed light on key theoretical issues that would be of interest to anthropologists and other social scientists.

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