Below are highlights from the interview with Eduardo Arenas Catalán. 

[Could you] talk about your 2021 paper "Chile's New Constitution: What Right to Health?" and the Chilean constitutional rewrite and the ways in which it did and did not incorporate what I might call a “contemporary public health stance” on human rights and the right to health?

The constituent process originated from a social revolt that occurred in 2019. [The revolt] caught the political elites off guard, despite several signals indicating a significant degree of discontent with neoliberal policies. I myself, as a law student, had actively participated in several academic activities seeking to discuss the issue and even in supporting the idea of creating a new constitution. I think many Chileans had mixed feelings about Pinochet’s legacy expressed in the Constitution of 1980.... My text suggested the existence of a mainstream perspective on the human right to health.... This mainstream perspective on the human right to health emphasizes elements such as access to the courts and issues related to minimum social services. The problem, when it comes to the increasing social inequalities as it pertains to the right to health, is that the healthcare institutions that are part of the new constitution are not organized under a core objective of public health as a human right. My thought was if you’re simply going to import this mainstream perspective on the human right to health that emphasizes access to court rather than free access to healthcare services, I wonder to what extent people are actually going to get their social justice expectations satisfied. 

Do you tend to find that there are some fundamental elements that tend to make up a “state of the art” public health- and social justice-informed formulation of the right to health? Would you say any countries are doing a good job with this approach?

As to a model, it can be hard to speak of one in these convoluted times, but I’ll try and make the question easy to answer for myself. If you were to present two different models, one which is highly commercialized and one which has greater public health considerations, to some extent what you might call a European model, the research tends to ultimately show that a stronger focus on public services is essentially more cost-effective. So, if you look at trackable statistics like ‘years of healthy life expectancy at birth,’ and you compare the US and nations in the European region, Europeans tend to have better outcomes. Moreover, when you also look at domestic government health expenditures as a percentage of general governmental expenditures, you ultimately end up concluding that Europeans spend less and get more. So really, it’s not a very complicated story to put forth and politicize.

You discussed the Chilean constitutional rewrite and mentioned the Dutch health system reform of 2006, both efforts towards more fair systems. What insights can people who work in and advocate for public health take away from this?

One of the big lessons from the Chilean constitutional rewrite process was the essential role of the media. Journalists ultimately have a crucial position in these processes. In Chile it became very difficult to move forward in progressive ways and address the negative factors that leave a society lagging behind in the absolute absence of a media that engaged with those ideas (rather than merely ridiculing them). It’s very important to create and leverage a progressive media that sticks to facts and provides analysis in a creative way that works for the limited time people have. Many people are increasingly dependent on news that comes from huge multinational media conglomerates with vested interests [in undermining said progress]. Or even YouTubers with vested interests. So this task seems essential to me.

How can the facts and a good argument be packaged up to be convincing and compelling to people who don’t have the access or time to read the journals and papers?

Absolutely, and the challenge is a beautiful one. Command of language is critical here. When I look at the human rights field, there are lots of lawyers involved. This is for good reasons, but it does come with a level of professional deformation, which I see when it comes to policy proposals. Law is what lawyers do, it’s the language we comprehend, and is also the language courts operate with. Like the idea of a class action lawsuit as a primary means of complaint or attaining social justice. But public health is not a legal discipline, it is a holistic discipline. Using the very patrimonial and bilateral world of law to try to solve it all, I’m just not so sure. As lawyers, we need to learn to listen more and to give the space for a broader conversation. After which public health experts with their more holistic view on things can examine the issue. So, I would encourage human rights experts working in the field of health to actually work more interdisciplinary and learn what actually works outside of the court system.