In the mid-1990s, Mann expatiated on his agenda in a series of articles. He deplored the contemporary concentration on therapeutics and expensive technical interventions, favouring instead the old truism of social medicine that poverty and social disadvantage were the chief generators of illness and death. But that was both too easy and too hard—no one was grandiose enough to make plans to eliminate poverty. 'The identification of socio–economic status as the “essential condition” for good health,' Mann and his colleagues wrote, 'paradoxically may encourage complacency, apathy and even policy and programmatic paralysis.'⁷

      If you think this impertinent or hyperbolic, take a look at the last annual report of the Bagnoud Center, now directed by Jim Kim from Partners in Health. Previously, Kim controlled the AIDS prevention and treatment activities of the World Health Organization, an intergovernmental organisation with nongovernmental tendencies. At the WHO, he was especially dedicated to ensuring better access to AIDS drugs in Africa. Since taking over the Bagnoud Center, Kim has greatly expanded training programs in health and human rights for organisations like the United States Agency for International Development (USAID). More generally, the goal is to enlist and mobilise health professionals in the global struggle against violation of human rights. In April 2007, Kim described the mission of the Center as the generation of 'global health leaders who can implement and scale up successful interventions guided by human rights principles.' He imagined Harvard creating a 'new science of Global Health Delivery,' which would 'analyze and overcome implementation gaps.' A proposed web-based network would allow 'global health practitioners to collaborate and engage in real-time problem solving on line.'¹⁸ Thus goes the declension from Thomas Paine's Rights of Man to brisk global instrumentalism.

      But surely these are welcome developments? Provocatively, Nancy Scheper-Hughes, another Berkeley anthropologist, urges caution. In her controversial study of the Cuban government's coercive measures to prevent the spread of AIDS, Scheper-Hughes argues that complaints about violation of 'human rights' usually assume a masculine perspective, putting poor heterosexual women at risk. The NGO demand for 'human rights' thus exported from the United States certain expectations of who counts as a sexual citizen, endangering other social bodies. According to Scheper-Hughes, the conventional emphasis on education and voluntarism in global AIDS prevention, along with the fetishising of condoms, is founded 'on a phallocentric sexual universe that ignores the especially vulnerable position of women, children, transvestites and other sexual “passives”.' In contrast, Cuba's violations of privacy and liberty protected the most vulnerable.¹⁹ So, she asks, when we assert 'human rights,' what sort of human do we have in mind? What sort of rights?

      I think Scheper-Hughes is criticising not the notion of rights as such, but the neo-colonial projection onto the world's population of a specific North American model of human rights. That is, she objects to the meretricious representation of a specific type of individuality or civic identity as universal. This bears a family resemblance to what Gayatri Spivak called the 'epistemic violence' of colonialism—but Scheper-Hughes, like the legendary anti-colonial psychiatrist Frantz Fanon, points to real damage to people's health from the unreflective imposition of Enlightenment categories.²⁰ We are left wondering how to complete the treacherous crossing from the supposedly universal to the particular—or whether even to embark on it at all.

The way in which we have developed this proposal, the human rights section … has assumed an Aboriginal focus. Initially I thought that the proposal would be better if it separated the Koori health and the health and human rights components more clearly. But the more I think about this, it would seem that forging a fundamental linkage between these two aspects adds considerably to the value and innovation of the proposal…. There is no Aboriginal health research with such a focus.³³

Acknowledgements

Notes

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^{1. Paul Farmer, AIDS and Accusation: Haiti and the Geography of Blame (Berkeley: University of California Press, 1992). See also Tracy Kidder, Mountains Beyond Mountains: Healing the World, the Quest of Dr. Paul Farmer (New York: Random House, 2003).}

^{2. On the tradition of social medicine, see Dorothy Porter, Health, Civilization, and the State: A History of Public Health from Ancient to Modern Times (London: Routledge, 1999).}

^{3. Rob Moodie, “The Continuum of Health and Human Rights Issues,” Health and Human Rights 1 (1995): 295–7. Bebe Loff, a human rights lawyer in the Department of Epidemiology and Preventive Medicine at Monash, and Diane Otto, director of the International Human Rights Law Program at Melbourne, were also among the presenters. By the time I arrived in Melbourne, Moodie was in Geneva, directing country support for the United Nations Programme on AIDS.}

^{4. Anon., “In memorium: Jonathan Mann, 1947–1998,” Health and Human Rights 3 (1997): 127–36.}

^{5. Warwick Anderson, Notes on conversation with Rhonda Galbally, 14 March 1997, in author's possession. See also Rhonda Galbally, Just Passions: The Personal is Political (Sydney: Pluto Press, 2004).}

^{6. Jonathan Mann, Daniel Tarantola, and Thomas Netter, eds, AIDS in the World (Cambridge MA: Harvard University Press, 1992).}

^{7. Jonathan M. Mann et al., “Health and Human Rights,” Health and Human Rights 1 (1994): 6–23, 20.}

^{8. Jonathan M. Mann, “Human Rights and the New Public Health,” Health and Human Rights 1 (1995): 229–33, 231.}

^{9. Jonathan Mann, Seminar, Department of Social Medicine, Harvard Medical School, 8 April 1997, typescript in author's possession.}

^{10. H.J. Geiger and R.M. Cook-Deegan, “The Role of Physicians in Confl icts and Humanitarian Crises: Case Studies From the Field Missions of Physicians for Human Rights, 1988–1993,” JAMA 270 (1993): 616–20; and Kari Hannibal and Robert S. Lawrence, “The Health Professional as Human Rights Promoter: Ten Years of Physicians for Human Rights (USA),” Health and Human Rights 2 (1996): 110–27. Fine had been active in Physicians for Social Responsibility and International Physicians for the Prevention of Nuclear War.}

^{11. See also Jonathan Mann, Sofia Guskin, Michael A. Grodin, and Geoge J. Annas, eds, Health and Human Rights: A Reader (New York: Routledge, 1999); and Sofia Guskin, Michael A. Grodin, George J. Annas, and Stephen P. Marks, eds, Perspectives on Health and Human Rights (London: Taylor and Francis, 2005).}

^{12. Stephen Marks, “The Human Right to Development: Between Rhetoric and Reality,” Harvard Human Rights Journal 17 (2004): 139–68. See also Amartya Sen, Development as Freedom (New York: Knopf, 1999); and Mushumi Basu, Archna Negi, and Arjun K. Sengupta, eds, Reflections on the Right to Development (New Delhi: Sage, 2005); and Bard Anders Andreasson and Stephen P. Marks, eds, Development as a Human Right: Legal, Political, and Economic Dimensions (Cambridge MA: Harvard University Press, 2006).}

^{13. For example, Arthur Kleinman, The Illness Narratives: Suffering, Healing, and the Human Condition (New York: Basic Books, 1988).}

^{14. Farmer, AIDS and Accusation, Infections and Inequalities: The Modern Plagues (Berkeley: University of California Press, 1999); and Pathologies of Power: Health, Human Rights, and the New War on the Poor (Berkeley: University of California Press, 2003).}

^{15. Charles L. Briggs with Clara Mantini-Briggs, Stories in a Time of Cholera: Racial Profiling during a Medical Nightmare (Berkeley: University of California Press, 2003), 320, 309. See also Arjun Appadurai, “Putting Hierarchy in its Place,” Cultural Anthropology 3 (1988): 36–49; and Giorgio Agamben, Homo Sacer: Sovereign Power and Bare Life (Stanford: Stanford University Press, 1998).}

^{16. For example, Jonathan Mann, The World Health Organization and Global Health: Toward a New World Order? (New York: Columbia School of Public Health, 1994). See Theodore M. Brown and Elizabeth Fee, “The World Health Organization and the Transition From 'International' to 'Global' Public Health,” American Journal of Public Health 96 (2006): 62–72.}

^{17. For example, Michel Foucault, The Foucault Effect: Studies in Governmentality, edited by Graham Burchell, Colin Gordon, and Peter Mitchell (Chicago: University of Chicago Press, 1991); and Colin Gordon et al., trans., Power/Knowledge: Selected Interviews and Other Writings, 1972-1977, by Michael Foucault (New York: Pantheon, 1980). Such analysis has limitations, now that many NGOs have turned their attention also to the rights abuses of transnational corporations, including pharmaceutical companies.}

^{18. New Directions: Summary of Activities from the François-Xavier Bagnoud Center for Health and Human Rights. Harvard School of Public Health, April 1997. Available at www. hsph.harvard.edu/fxbcenter (accessed 2 March 2008).}

^{19. Nancy Scheper-Hughes, “AIDS and the Social Body,” Social Science and Medicine 19 (1994): 991–1003, 995. See also Dianne Otto, “Rethinking the 'Universality' of Human Rights Law,” Columbia Human Rights Law Review 29 (1997): 1–46.}

^{20. Gayatri Chakravorty Spivak, “Can the Subaltern Speak?” in Marxism and the Interpretation of Culture, edited by Cary Nelson and Lawrence Grossberg (Urbana: University of Illinois Press, 1988), 271–313; and Frantz Fanon, “Medicine and Colonialism,” in The Cultural Crisis of Modern Medicine, edited by John Ehrenreich (New York: Monthly Review}

^{21. Press, 1978), 229–51. See also Warwick Anderson, Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in the Philippines (Durham NC: Duke University Press, 2006).}

^{22. But see Gracelyn Smallwood, Colin White, and Michael Kotiw, “The Relevance of Human Rights to Health Status in Australian Aboriginal and Torres Strait Islander Communities,” Health and Human Rights 2 (1997): 127–36.}

^{23. See the website www.who.int/hhr (accessed 2 March 2008).}

^{24. Claude Lévi-Strauss, Introduction to Marcel Mauss (London: Routledge, 1987 [1950]), 63–4.}

^{25. Stephen J. Kunitz, “Globalization, States, and the Health of Indigenous Peoples,” American Journal of Public Health 90 (2000): 1531–9.}

^{26. Peter Jones, “Human Rights, Group Rights and Peoples' Rights,” Human Rights Quarterly 21 (1999): 80–107.}

^{27. Sam Garkawe, Loretta Kelly, and Warwick Fisher, eds, Indigenous Human Rights (Sydney: Sydney Institute of Criminology, 2001); and Ronald Niezen, The Origins of Indigenism: Human Rights and the Politics of Identity (Berkeley: University of California Press, 2003). On new mobilisations of the moral weight of communities and groups, not individuals, see Partha Chatterjee, “Empire and Nation Revisited: Fifty Years After Bandung,” Inter-Asia Cultural Studies 6 (2005): 487–96.}

^{28. Duncan Ivison, “The Logic of Aboriginal Rights,” Ethnicities 3 (2003): 321–44, 328. See also Duncan Ivison, “Emergent Cosmopolitanism: Indigenous Peoples and International Law,” in Between Cosmopolitan Ideals and State Sovereignty: Studies in Global Justice, edited by Ronald Tinnevelt and Gert Verschraegen (New York: Palgrave Macmillan, 2006), 120–31.}

^{29. Judith Butler, “Competing Universalities,” in Contingency, Hegemony, Universality: Contemporary Dialogues on the Left, by Judith Butler, Ernesto Laclau, and Slavoj Zizek (London: Verso, 2000), 136–81.}

^{30. Stephen P. Marks, “The Evolving Field of Health and Human Rights: Issues and Methods,” Journal of Law, Medicine and Ethics 30 (2002): 739–54, 751. See also Paul Farmer and J. Gastineau, “Rethinking Health and Human Rights: Time for a Paradigm Shift,” Journal of Law, Medicine and Ethics 30 (2002): 655–66.}

^{31. Ingrid Barnsley, “The Right to Health of Indigenous Peoples in the Industrialized World: A Research Agenda,” Health and Human Rights 9 (2006): 43–54, 50. Briggs and Mantini-Briggs suggested at least as much in the conclusion to Stories in a Time of Cholera.}

^{32. Ian Anderson and Bebe Loff, “Voices Lost: Indigenous Health and Human Rights in Australia,” Lancet 364 (2004): 1281–2, 1282. The International Symposium on Human Rights and Public Health, organised by Pascale Allotey and Loff, took place 3–5 November 2004. Gruskin was a keynote speaker. More recently Ian Anderson has pointed out that corporate group rights claims can 'frame the relationship between Indigenous people and the state' (“Indigenous Australia and health rights,” Journal of Law and Medicine 15 (2008): 760–72, 770).}

^{33. Tom Calma, “Achieving Aboriginal and Torres Strait Islander Health Equality Within a Generation – A Human Rights Approach,” Australian Human Rights Commission, www.humanrights.gov.au/social_justice/health/health_summary.html#the_human (accessed 18 March 2008), 2005. Significantly, Daniel Tarantola's Initiative for Health and Human Rights at UNSW, unlike the Bagnoud Center, explicitly claims to build on contributions from 'members of communities who are denied access to health and human rights,' including Aboriginal communities. See www.ihhr.unsw.edu.au/initiative.html (accessed 2 March 2008).}

^{34. Ian Anderson, email message to author, 29 June 1997.}

^{35. See Amitai Etzioni, Moral Dimension: Toward a New Economics (New York: Free Press, 1990), and The Spirit of Community: The Reinvention of American Society (New York: Touchstone, 1994); and Robert D. Putnam, Bowling Alone: The Collapse and Revival of American Community (New York: Simon and Schuster, 1980). It would be interesting to explore further the alignment of discourses on human rights and community development with existing local Indigenous activism around self-determination and sovereignty, but such analysis requires greater familiarity with contemporary Koori politics than I possess.}

^{36. When Rob Moodie became chief executive officer at VicHealth in 1998, he made sure the organisation asserted health as a 'fundamental human right,' but its programs changed little, despite sponsorship of a number of conference and seminars on health and human rights.}