“Rights Require Resources, But Resources Require Rights As Well”: Attiya Waris, UN Independent Expert on foreign debt, other international financial obligations and human rights
“Rights Require Resources, But Resources Require Rights As Well”: Attiya Waris, UN Independent Expert on foreign debt, other international financial obligations and human rights
Newsletter Edition #192 [The Files Interview]
Hi,
Global health demands a cross-sectoral, multi-disciplinary approach for effective governance. Yet for far too long it has been constrained by straitjacketed disciplinary boundaries.
Come a pandemic, these artificially-imposed water-tight compartments burst, pushing for a broader policy response to a complex crisis. Take the case of health financing. It is kind of a taboo to speak about health financing in the context of Geneva, given the accepted preeminence of Washington D.C. - home to the World Bank and the IMF. And yet, health and finance could not be more inextricably linked.
It is my pleasure today to bring you a comprehensive interview with Attiya Waris, who is the UN Independent Expert on foreign debt, other international financial obligations and human rights.
This interview was part of a report published late last year by the Geneva Global Health Hub: Financial Justice for Pandemic Prevention, Preparedness and Response [November 2022]. I first spoke with Waris for this interview, on behalf of the Geneva Global Health Hub. (And reconnected with her here in Geneva one summer afternoon recently!)
I hope you enjoy reading this detailed interview that casts a much-needed light on taxation and health, at a time when discussions on financing for pandemic preparedness and response are often relegated to “domestic” efforts.
Also check out another recent briefing on the financialization of health by the Society of International Development. (See the INB Bureau’s Text with some language on debt relief and a new financing mechanism).
Like our work? Consider supporting our journalism that ensures nuance, detail, and accuracy. Readers paying for our work helps us meet our costs. Thank you for reading.
Until later!
Best,
Priti
Feel free to write to us: patnaik.reporting@gmail.com or genevahealthfiles@protonmail.com; Follow us on Twitter: @filesgeneva
I. THE GENEVA HEALTH FILES INTERVIEW
“Rights Require Resources, But Resources Require Rights As Well”
Why did the disciplines of finance and health evolve separately? Is debt relief a valid policy measure to raise resources? Why is it important to have a global tax body and a global multilateral tax treaty? In an expansive interview, Attiya Waris, UN Independent Expert on foreign debt, other international financial obligations and human rights, tackles these questions head on with characteristic candor.
Waris is also Commissioner, Lancet-O’Neil Commission on Racism and Structural Discrimination in Health; and is Associate Professor of Fiscal Law and Policy, University of Nairobi. Read on to get deep into the politics of fiscal spaces and its implications for funding health.
[G2H2] Q1. Since the Report of the WHO Commission on Macroeconomics and health (2001) and the World Health Report 2010 on “Health systems financing”, there has been an emphasis on devising an “investment case” for health. Countries are expected to raise resources domestically or expected to support each other through more effective “aid”.
However, the issues of financial justice and related international obligations (financial flows, tax evasion, debt cancellation, terms of trade etc) are mostly discussed and explored in other international fora. These issues have not been on the radar of the WHO and not addressed adequately in WHO hosted processes such as the INB. Why is this so?
[Waris] I love the question because I think it's a really interesting approach. I think that health system financing is probably much further along than other areas, such as education financing or social services financing. But I know that the WHO are looking at it to a certain extent. We published an article, where we talked about the financial structure of the WHO, but I think that these separate fields became silos. But for things that are technical or complicated, you have to actually make a connection to these issues. They became so overwhelming at a philosophical level, that I think people just made a decision and said it wasn't their area. I heard from many people that it is not an area of expertise, ‘I don't really understand these spaces. This has given people, I think, a lack of understanding. [As a result] then it is left to the technical spaces. But the problem is, the moment you leave that space to the technical spaces, it then becomes a technical issue. And yet we haven't dealt with the philosophical issue or the underpinning thinking that should come around it. This is also because of how people are trained on issues of financing.
So, financing and health, these disciplines have developed separately. Unfortunately.
I think it [financing for health] sort of almost naturally took a course of a business case. And that is because, the training in fiscal circles is about the business case. And unfortunately, there have been repercussions. You have these two spaces that are working; one that is working on spending the finances, improvement of lifestyles and living standards. Then on the other side you have: how do we collect it; who are we collecting from…And these spaces don't always talk to each other. So, the fact that they didn't talk to each other, meant that the automatic pick was the one of the investment case.
It is not a bad choice to use an investment case. However, the problem with using the investment case is when you don't make the connection to the achievement of the rights. The effect it has on the living standards of that person whose health is improved upon, and how they then contribute to the economy which is also part of the investment case. But there is no direct link. This means that you then actually end up losing out on the whole purpose of financing anyway.
From my perspective, I often say that rights require resources, but resources require rights as well. So, the rights are there and they need the finance. But even when you are collecting the finance, it cannot be in a vacuum. The two-way street for me becomes very, very important and I think sometimes the investment case hasn't yet been developed enough to be inclusive.
[G2H2] Q2. The G20 countries initiated the Financial Intermediary Fund for Pandemic Prevention, Preparedness and Response (the FIF). There have been some concerns around governance. The amounts pledged so far fall far short of the estimated funding gap. How do you see the creation of this new global instrument? What are the chances, in your view, that the FIF will address priorities for pandemic prevention, preparedness and response in the global South?
[Waris] Finances have been such a challenge in improving health and improving standards of living. I think any mechanism that can get money to people who are poverty-stricken, who are unable to finance their own health, is a good thing. So, in principle, I believe it is a very good fund. The problem becomes when you now try to roll out. So, then the question is less about: Is this a good idea? It is a great idea, but how do we now roll it out and how should to enforce it and how do we structure it? And from a financial perspective, we have always put the people who give the money are the ones who call the shots. He who pays the piper calls the tune.
And unfortunately, if you look even at a domestic tax system, if you give that same power at a domestic level to say the highest paying tax payer, for example, or the debtor who has given you the largest amount of debt, which happens very often. Then it is the priority of that high-end taxpayer that comes through the system, similarly it will be the priority of the donor that comes through the system. So, now you have a fund that has a clear altruistic purpose and it is supposed to be on, you know, pandemic prevention, preparedness and response. But even in prevention, preparation and response, policy priorities can get influenced by those that provide the finance. As a result, you lose out on the value of the people that understand the problem on the ground. So, for me, the struggle should not be mostly about the person who gives the most, but it should be about the person who understands the problem the most and who understands where we have to go to improve that position.
So, the UN Declaration [on Human Rights] talks about raising of living standards. So, if we look at pandemic prevention, preparedness and response, it is a part of raising of living standards, it is also about maintaining living standards. It is also about making sure it doesn't go backwards. And then it is about trying to push it upwards. The person that gives the money, doesn't always know where the living standard is. That's not the person who necessarily knows how badly off an indigenous person living in the Amazon is or who the most vulnerable person in the world is.
And this is where we have to find a balance between the politics and the lobbying, and the technical expertise.
[G2H2] There is seems to be a lot of skepticism around World Bank’s fund….
[Waris] These are the problems that we inherit when we use existing institutions. And unfortunately, each institution and each stakeholder come with their reputation, whatever it is, whether it is a real reputation or it is a perception, it comes with the reputation. And it comes also with its mandate. Many issues had to do with the pandemic and with emergency responses. Even in the creation of some of the funds, I think there should always be time, and I think we have time now, generally, to really reflect on that positioning of stakeholders and where institutions are housed, how they are being housed. And I think it is important to reflect because of the criticism. And I think that when you get criticism of this nature, the reflection process also helps validate. So, it is not to say it will be moved away necessarily, but because you opened that space and you have the conversation going. It means that it gets validated if you still continue to house the space,.
I see this happening very often, because a lot of people had a lot of question marks, for example, about the United Nations and its ability to do things, but at the end of the day, it is like the most globally democratic space that you can find. It has its problems. It's not perfect, but it is democratic, and it's open and all countries have access to it.
And for me, spaces like that are becoming more relevant, and more important, because we have to move away from the power dynamic of wealth calling the shots. And we have to move away from the power dynamics of predetermined global leadership on issues, because many countries around the world are becoming more empowered and people around the world are more empowered. So, it is like shifting sands in a sense and there is a need to make sure that these spaces are very inclusive.
I think that's the other part of the problem is big names are what are trusted, but often big names are not what will take to get the job done. So, finding that balance is important. I think reflection is never a bad thing. Give it a time for reflection, say, we're going to rethink this for a month, let's come back to the table and then continue.
[G2H2] Q3. Every year, countries are losing a total of USD $483 billion in tax to global tax abuse committed by multinational corporations and wealthy individuals. It is estimated that annually multinational corporations are shifting US$1.19 trillion worth of profit into tax havens, causing governments around the world to lose USD $312 billion annually in direct tax revenue. It is the OECD countries, not the palm-fringed islands, that enable most of the tax abuse.
Why don’t these trends, for which there is massive evidence and which global South governments know particularly well, get featured in the WHO discussions about financing for public health? Do you think these will be addressed in the context of financing the pandemic preparedness and response?
[Waris] Those are many big questions. So, let's start with the first one. There is a very famous phrase, “Never waste a good crisis". And I think it's for us in fiscal circles, it resonates with us.
During COVID-19, you couldn't have medical tourism and not just about COVID, I mean you couldn't even leave the country, if you broke your hand or you needed a heart transplant.
Suddenly you had a scenario, where privatization of healthcare became quite important without a doubt, but also strengthening of the public health care system became incredibly critical. And when people were reflecting on it, there was this understanding that there was a need to make sure that these systems were in place, that they were strengthened, that everybody could access them because suddenly you couldn't turn around and say: "Well, I don't need any public health care, because I can go wherever I want.” You couldn't move, you couldn't get out of your country because of lockdowns. And I think it did open up that conversation for a lot of people.
There are some countries, like Argentina, that implemented or tried to implement taxation on the wealthy during COVID-19 in order to fund a lot of their healthcare activities as well, which was fantastic. There were solidarity funds and taxes that popped up. These were important and new. Nobody worked on who is already evading and avoiding taxes and how do we control that. So, the emergency got reactions from a fiscal perspective. These were good reactions. But when you are now going to look at issues around pandemic preparedness, this is now a long-term strategy we are looking at, we cannot rely on emergency bonds, emergency taxes, solidarity funds. So, what do you do?
The best place to start is actually to make sure that your fiscal system is robust, that you have enough in place now to cater for that emergency should it come again. And that you actually protect the financing in those phases for the emergency and don't misuse it. It is a lot about making sure your systems are fiscally legitimate. For me, fiscal legitimacy means that you have robust, transparent, responsible and an accountable system that is also efficient and effective, but also fair, just and inclusive.
COVID-19 also showed us that this is justice not just for poor people, it was also justice for rich people, because it didn't matter if you were wealthy or not. If your country couldn't get vaccines, it didn't matter how much money you had, everybody was dying. So, joining and uniting people in understanding what that bare minimum is and then say "well, if you don't pay your taxes, this is where we're going to lose out". That reality I think is a very important one.
And I think we shouldn't waste the good crisis. We need to remind our populations on that domestically. So that they continue to make sure that people do get through this. It would be remiss of me not to mention the fact that in many parts of Africa, where I live, vaccination is not gone beyond 10 or 15%. And it's not because people don't want vaccines, because we don't have access to vaccines. This is heartbreaking. So, in some parts of the world, they are saying we are beyond the COVID-19 conversation and in others, we are still neck-deep in it.
[G2H2] Q4. There is a constant overlap between fragile or non-existent public healthcare systems and debt in low-and-middle income countries. As many as 64 countries spend more on external debt payments than on public healthcare. Cancelling all external debt payments due in 2020 alone by the 76 lowest income countries would liberate USD $40 billion, USD $300 billion if cancellation included 2021. Releasing such gigantic amounts would be in itself much more than the financial availability to enable investments in pandemic preparedness and response. Why don’t countries demand such a cancellation at the WHO? What, in your view, needs to be done for countries to politically orchestrate such a request, which would produce an immense impact on health systems and health sovereignty?
[Waris] There is a need to create a global tax body as well as a global multilateral tax treaty. What I think is super important is that up to the point where we are right now, there is no global space where people can talk about fiscal issues that are of a shared concern. Illicit financial flows, digital taxes, cross-border fiscal systems, debt are all shared concerns. And government business is also going to become of shared concern, because government business is also becoming multinational. Now, these spaces of shared concern, of state assets, they need to have a place where we discuss them and they need to have a place that isn't being power-brokered by those that have more, but rather be driven by a fair and just perspective. We need a place to discuss the fact that global finances that are not being properly redistributed. Our distribution process frankly targets the poorest and most vulnerable human being in the world.
I always ask people two questions while talking about fiscal issues. I always ask them who is the poorest person in your country and then I ask them and who is the common person in your country. Because when we talk about being prepared in emergencies, the person we should be looking for is the most vulnerable person. Of course, there are issues of COVID-19 and super spreaders, but most vulnerable can be different, can be the teacher in the school, of course as much as it can be the homeless person, who is moving around a lot. So, we need to define that vulnerability and then we need to ask ourselves, so who is the common person in that space and then move that most vulnerable as close to that common person.
And at the same time, look at the people who are least vulnerable and make sure, that they are also aware of the space that they are in the bubble in which they are protected and show them how we need to, sort of almost like a pressure ball, we need to sort of push it closer together. It is a constant tension all the time. But for me, those are the two things that are key in being prepared in a pandemic, but also in generally getting people out of the bottom.
[G2H2] Q5. Tackling illicit financial flows is indispensable. The 2021 report of the High-Level Panel on International Financial Accountability, Transparency and Integrity for Achieving the 2030 Agenda called for strong measures to curb illicit financial flows, which could feed public budgets to respond to health crises, including pandemic prevention and surveillance. Wouldn’t that work better than any newly designed instrument at the World Bank?
[Waris] You are absolutely right. The thing about a fund, is that people put money into it. The thing about illicit financial flows is, we are picking up what has been lost and we are regaining it. There are many reasons why it is difficult to tap into illicit financial flows. The reason is there is a global rule that tax is a domestic issue and that they cannot be any cross-border enforcement of tax responsibilities. And the result of that is why we have the whole tax treaty network, right? So, then if you don't have a treaty network in place and many countries don't. I mean, there are countries in the world today that have one treaty and probably with their colonial, their imperial state, when they were colonized or none at all. And then you have others that have whole networks of hundreds of treaties.
So, the problem is that there is this dichotomy and difference between these types of countries and because they cannot be cross-border-enforcement of the responsibility, the other country will automatically tell you that no we can't do this, because it is your domestic issue. But tax is not actually a domestic issue.
Taxation should be a concern for everybody across the world and the same is true for financial flows. When the phrase was coined, it became very controversial, because there wasn't a second definition of it. So, it includes tax evasion, but based on the high-level panel at the African Union and UNECA, the African States took a position that illicit financial flows didn't just include the criminal element, but also included the unethical or immoral element where they were loopholes in tax systems.
And I think that, that is part of the problem, that if the world doesn't just sort of come to terms with the fact that there are countries with weaker laws and systems. But we have to focus on the goal, which is to make sure that countries have enough money to survive and to be able to develop themselves. Then we should at a certain point politically be able to overlook weaknesses in legal structures, in order to not be killed by the technicality.
And this is something we see in domestic courts, for example. They will actually make a judgment and say we are not going to be a technical court, we are going to go on substance. And we need, at a global level for countries to think about that, to say that it's not about a technicality or whether you have enforced foreign jurisdiction judgments, it is about the substance of the issue. That your president or your leaders illegally transferred money, and that is not okay. So, we need to send it back. That's one part of it.
But the other part of it is the global banking system, for example. So, there are two parts to this with respect to financial flows. There is the formal system and then there is the informal system. Now the informal systems run, because the formal systems have problems in them. And in formal systems they run because they run on relationships. And they also run on a lack of trust in the government. Amongst other issues, of course, but these are the two issues that have to be bolstered domestically in order to formalize more because criminal elements that are also using it. So, we need informality to be reduced.
But formality can take years. And the reason that people don't engage in the formalities is because you can't get the money back anyway. So, the formality of the system shoots itself in the foot, because the laws and the regulations, do not have that humanity recognized within them on the substantive issues that countries are facing.
I give you like a simple example; "A president transfers money out of his or her treasury into a bank somewhere in the world. That transaction is supposed to have a know-your-banker-client-relationship. You have to know your client, right? So, if it's two billion dollars being pushed, you know, that this is not possible, that there's no way this person has this kind of money, but the transaction is always allowed and then they freeze it. And then the arguments that is used later, is that, we have frozen it. But now the legal system kicks into action, takes 10 to 20 years to get the money back. In the meantime, that other country is benefiting from the money in their economy and they are using it to give loans, they are using it to build infrastructure. I mean, that is the reality on the ground. And one of the things that I argue, is block the transaction and send the money back.
What generally happens is the power shifts to the other country that turns around and says, “oh, you have poor institutional systems, we don't think you are going to use your money right.” Hold on a minute! You took our money, which you shouldn't have done in the first place, because you should know your client and nobody is questioning that part of the relationship. And they are using the argument that by keeping the money in their safe country while you are at war. But actually, what it does is, it incapacitates that country from actually even ending the war earlier, because whoever is in control could probably have used the money and won the war faster. I am being very practical about it.
I am not thinking they are necessarily popular or make people happy. Maybe the money is used to buy bullets. But it is a decision that, that country gets to make and it may be a bad decision. But it is not my country, right, so, why am I making decisions for [another] country and crippling it financially. And then, allowing my country to actually thrive. And I think there is something to be said about the citizens in that country actually allowing this to continue. It is participating by silence.
So, these are issues, I think, around illicit financial flows, where the only solution can be at a global level. Because if you come back to the domestic spaces, the wealthy elites in those domestic spaces are going to make the same argument, they are going to say no, please don't put a tax on this or please allow me to move my money freely. This is being done.
It is going to be an international cooperation and assistance process, where we are all part of the process. And we all understand that it takes the world to do it. If not the whole world, it is going to take geographical blocks and regions. Because I think for me, before you can get to the global space, the whole of Latin America needs to come together, Africa needs to come together. The laws are so diverse, so we need regional efforts and global efforts. Going forward, for me, it is forming parts of these building blocks towards a global fiscal architecture on issues that cannot be dealt with or resolved at the domestic level.
Get in touch with Waris: waris@uonbi.ac.ke
This interview was part of a report published late last year by the Geneva Global Health Hub: Financial Justice for Pandemic Prevention, Preparedness and Response [November 2022].
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