This interview, conducted by by Nat Thomson, Simmons MSW graduate, runs abridged in the June 2025 issue of the Simmons MPH Monthly.

Eduardo, thank you for taking the time to do this! First, I was looking over a paper you wrote in 2021 "Chile's New Constitution: What Right to Health?" and I was wondering if you could talk about 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. On one hand, I think many people of different political views could have agreed that the constitution of Pinochet had been instrumental in opening up the economy, and this was widely regarded as a positive thing. At the same time, however, many viewed it as something that encroached on the possibilities of further social development, and that something needed to be done regarding the increasing social inequalities in the country. 

My text suggested the existence of a mainstream perspective on the human right to health; one that emerges from an international discussion with experts, especially in the context of what the United Nations puts forth. This perspective has also been embraced in several courts, both national and regional, like the Inter-American Court of Human Rights or the European Court of Human Rights (the European Court holds its perspective on the right to health indirectly because it is a court that deals only with civil and political rights, not social rights). 

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. 

On this topic, 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?

When it comes to countries like the US or European countries, the first question is, “Do you have money in your pockets to pay for the service?” This is what I mean when I say accessibility. In this model, without money, you do not have access to health. This is the first layer in global capitalism. When you run healthcare based upon an ability to pay, as opposed to just the need for healthcare. So for many, this is the first question and then also the last question. I wish the human rights discussion would be more oriented towards issues of accessibility. Issues of accessibility are pretty critical, because, in the context of our current political economy, the global economy of global capitalism, these issues of accessibility are the first ones to be assessed. 

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. Unfortunately, in the US, this kind of analysis and associated political orientation only really entered the debate when Bernie Sanders ran for president in 2016. I think this is a debate that should be much more prominent in American politics.

You highlighted how questions around health care accessibility often come down to, ”And how will you be paying today, cash or credit?” Knowing that capitalism is a social construct, was there ever a model that tended to do well in terms of ensuring financial accessibility to health care?

Well, American politics have, at times, had very progressive moments where it could have become something else. From Ronald Reagan onwards it’s been a different story. Prior conservative leadership tended to consider welfare oriented services as something not to be removed or changed from what being a citizen entailed. Now Americans find themselves in a radically different situation. Individual responsibility has become the default option. While this might seem depressing today, there is also a motivating element to it, in that hegemonic ideas of the day can seem like they will stay forever, but they don’t. Things do change. Bernie Sanders has done a terrific job with laying out the benefits of a single-payer healthcare system, although the campaign had some other challenges. Perhaps a younger progressive leader will come forward and [the country] will end up on a path that’s better. These things are not as written in stone as it may seem.

That’s a great point, it is not written in stone by any means. Are there any nations that people in the US might look to for different approaches in public health?

I live in the Netherlands, so I can speak a bit about the Dutch healthcare system. In 2006 there was a big reform to the Dutch healthcare system. Previously they had created a two-tiered healthcare system where the majority of people, around 60% of the population, utilize a public healthcare system and then the more affluent segments could rely on private sector health and care, which is all based on private contributions. The system did provide a degree of social cohesiveness thanks to the significant size of the public sector, however with the reform of 2006, a new healthcare system based on universal social insurance was established. It's a very complex and interesting healthcare system. Both praised and criticized. It’s an approach that seeks to get the best of both worlds; on one hand engage a powerful private healthcare sector into the Dutch healthcare system, while on the other hand establishing a set of public values that become reflected in concrete approaches and policy options with a strong emphasis on avoiding detrimental socioeconomic discriminations.

Every adult is obliged to purchase health insurance. This insurance is provided by an insurer, and these insurers compete against each other charging different prices for the premium (about 150€). But even if you are choosing under (limited) market conditions among different options, the benefits of this basic package are the same for everyone and defined by the government. Also, the deductible is fixed for (almost) everyone at 385€. Moreover, the basic health insurance contains a number of benefits that are regarded as essential, and which are, relatively speaking, rather generous. Furthermore, the insurers cannot ask about any precondition you may have, so if you are really sick, they cannot deny you insurance. There is an equalization fund that ensures that those insurers that end up taking more sick persons receive amounts of money, while those that have less sick persons need to contribute more, and in that way some degree of stability is created. Individuals can also take additional insurance if they like. 

But at the same time, lower income and chronically ill people have become increasingly vulnerable in this system, not least because of the fact that they need to administer the way in which they access their social benefits. This is a larger characteristic of a so-called participation society that has been taking place in the Netherlands since 2015, under the 10 years of the previous center-right liberal cabinet (we now have a far-right cabinet in power which failed on June 3.). This ‘liberal’ is different from American “liberal” label, it’s worth pointing out (in the US it is associated with being left-wing, whereas in Europe, it mostly means economically liberal and politically at the center-right)

All in all, even with the limitations of this system, I think for Americans to move into a system like the Dutch one, would be a tremendous step forward.

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.

Another important front is in the field of public health itself. During the COVID-19 pandemic we saw how undervalued public health professionals and health care practitioners were. In cities around the world, these essential workers were applauded every night, but this did not translate to better treatment in the workplace. To what extent can these career choices become more valued by society? How do we see reflected in society the fact that health workers are truly essential? What does that look like in terms of social value? This is a huge challenge and it should not just be the object of moral reflection but instead I would argue it needs to be politicized. I don’t know completely what this looks like but I think that putting more emphasis on primary care and prevention, organizing access to healthcare more locally as social medicine suggests, could allow us to refocus on the needs of common people and their common needs. I think this is perhaps one of the important challenges that public health is currently facing.

You made a point about the role of journalism and the media. 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.

And what is on the horizon for you, Eduardo?

Some months ago I sent a proposal to a research organization, proposing to look at human rights law, but less from the point of view of the so-called “demand” for human rights and more on the side of the “supply” for human rights. The human rights discussion has been led very much by what has worked the best so far for the most people and that tends to be non-discrimination efforts and policy. This has done great things for us, but not so much when the point is to ensure the provision of services based on need rather than the ability to pay. Non-discriminatory orientation has tended to work better for racial discrimination than for issues of economic inequality. This is why I tend to think that we should focus more of these debates on the supply side of the equation, fed by an epidemiological analysis that tells us what actually works. 

I am interested in looking at the rules that presuppose both human rights as well as quality of life. To establish human rights while at the same time building more socially cohesive societies. Under this would sit things like courts of law prohibiting the privatization of hospitals or rental unit price fixing, public procurement of healthy food for school children, requiring pension funds to invest in “green” or social good endeavors, full employment policies or price freezes on essential foods. My approach is less about giving marginalized people court access to make their case, but instead looking at the society as a whole and saying that certain things should simply not become commodities. Similarly, not everything should be done by the state either. More complex forms that draw on what has worked thus far, with a mix of public, private and non-profit. I would be looking at the countries who have had success with this type of approach in all their different sets of national and cultural contexts.

Thanks to Eduardo for taking some time out of his day to chat with us!