United Nations expert Philip Alston tours WV Health Right with clinic CEO Angie Settle. Photo by: Amy Lieberman / Devex

CHARLESTON, West Virginia — Human rights violations and a prevalence of extreme poverty drove the United Nations rapporteur Philip Alston’s recent fact-finding tour across some of the most unequal areas of the United States. But the independent U.N. expert discovered a technical complication to his two-week, cross-country mission, which concluded on Friday.

How does one of the world’s pre-eminent international law experts talk about human rights in a country where basic international law tenets — such as the universal right to housing and clean drinking water — are not legally recognized?

One tactic was to drop all mention of potentially divisive terms — including human rights — that Alston has routinely used in 25 other country visits since the Human Rights Council appointed him to the part-time, unpaid role in 2014. Instead, Alston’s conversations and meetings in the U.S. — on issues such as homelessness in San Francisco and political rights in Puerto Rico — have revolved around the concept of civil rights.

“No one attacks that,” Alston explained to more than 40 civil society members who recently traveled from across West Virginia to a hotel conference room in Charleston, where they shared a complicated web of environmental, health, and economic problems they are working to alleviate.

Alston’s specially tailored approach to examining poverty and human rights in the U.S. seemed to pay off, he told Devex on the final leg of his cross-country American journey, speaking at the only free health clinic in Charleston. Los Angeles, Alabama, and Washington, D.C., were also stops on his trip, packed in with government official meetings and tours of struggling neighborhoods.

“I haven't had any any abuse so far, which I would have expected. I think in a lot of developed countries, a lot of people would say, 'What the hell is the U.N. doing here? Shouldn't you be in Bangladesh or whatever?'” Alston said. “And I'm always happy to answer those sort of challenges because the whole whole idea of the U.N. Human Rights program is that we cover all countries.”

His preliminary findings, released Friday, may still strike a nerve with the Trump administration, which declined to meet with him, Alston said at a Friday afternoon press briefing in Washington, D.C.

The Trump administration’s policies on tax reform and health care could worsen the “entrenched poverty” that now divides the U.S., which ranks as the most unequal high-income country, Alston wrote in his report.

More than 1 in 8 people in the U.S. — or 40 million people — live in poverty, and almost half of these people, or 18.5 million, live in deep poverty, according to government figures.

Poverty in the U.S. can be difficult to quantify, and to consider relatively on a global scale, as a Brookings study found that anywhere from 0 to 15 percent of Americans live on less than $2 a day. Increasingly, though, Americans are faced with health challenges, like high infant and maternal mortality rate relative to other developed countries, more common in lower-middle income and developing countries. Hookworm has resurged in Alabama, Alston noted in his press conference, commenting on the open sewage pools he saw in people’s homes in Montgomery.

More than 140 communities in West Virginia also lack access to clean drinking water at home, according to Katherine Garvey, the director of land use and sustainable development law clinic at West Virginia University’s law school. Demands for safe drinking water have ignited a national campaign in India, Alston told Devex, but have not inspired the same pressure on government in West Virginia or Alabama.

Alston meeting with civil society members in Charleston at a roundtable discussion. Photo by: Amy Lieberman / Devex

As the former chair of the U.N. committee on economic, social and cultural rights, Alston — a U.S. resident for the last 20 years — said he debated U.S. officials for “decades, literally,” on acknowledging these rights. The U.S. has not ratified the international covenant on economic, social and cultural rights, which recognizes the right to social security, adequate standard of living, education, and a high standard of physical and mental health.

“And the United States has always been very reluctant to acknowledge that there is any such thing as an economic and social right that resembles a real human right. So my assumption was that there wasn't much point in coming on this particular mission and saying, ‘Well there is a right to health care, there is a right to housing,’” Alston said.

“But that is what I would say in any other country, because under international law, there is, and I believe under any sort of decent compact between government and citizens those rights would be assured. But that's not the approach I'm taking here.”

In West Virginia, a rural Appalachian state where incomes and quality of life have fallen with the decline of the coal industry, comprehensive health care is considered a luxury for many. About 94 percent of the state’s population is covered by government health insurance, but high payments often still place medical care out of reach. The state also has the highest obesity rate in the nation, with more than 37 percent of the population obese.  

Last week, Alston, flanked by his three advisers and a group of journalists, briskly made his way through West Virginia Health Right, the capital city’s only free health clinic that operates with private funding and grants. With the help of about 400 volunteer doctors and dentists, the center treats about 21,000 patients a year and also provides adult dental care — not covered by Medicaid, unless in emergency cases. Malav Shaw, a resident dentist who showed Alston the organization’s mobile dental clinic, also described a man in his 30s who arrived with no teeth, just roots in his mouth.

“Is Vitamin C the answer?” joked Alston, later going on to praise the efforts of the clinic. Angie Settle, the chief executive officer of the organization, said high demand is pushing Health Right to the verge of having to turn patients away in what she described as the “sickest state” in the U.S.

The WV Health Right free clinic offers health care with no charge to 21,000 patients yearly. Photo by: Amy Lieberman / Devex

Development work, while clearly underway in the U.S., often takes on a different appearance from what is easily identified in developing countries, says Tony Pipa, a senior fellow on global economy and development at Brookings Institution. He studies how U.S. leadership approaches the Sustainable Development Goals, which call for universal access to health care, among other poverty alleviation, economic and health goals, by 2030.

“The U.S. doesn't really do a development plan. If you're in a developing country, you've got a development plan, you're dealing with donors and aid agencies and they're hearing the question all the time: How does this align against the goals?” Pipa said. “It becomes a terminology that's very familiar to both sides — to the government because they're thinking about it in that way and so it's very familiar to civil society.”

“I don't think the SDGs provide that yet in the U.S.”

Alston, who undertakes two to three country visits per year, first requested to visit the U.S. more than a year ago, under the Obama administration. The State Department extended the invitation, which still stood this year. With visits in the last few years to China, Saudi Arabia, and Chile, Alston intends to cast a wide net, showing that poverty and human rights challenges are at play in all nations.

Margaret Chapman Pomponio, the executive director of WV Free, a women’s reproductive health organization, was among the West Virginian civil society actors who seemed surprised, but eager, to welcome a visitor from the U.N.

“At first I was surprised. I had gotten an email from the U.N. and then I spoke to them [Alston’s team] ahead of time and it became very clear. It is easy to understand why West Virginia would be selected. We have such high poverty and it’s really heartening he came to hear from us and lift up the challenges that people on the ground see,” Chapman Pomponio explained.

Alston will present a final report on his U.S. visit to the Human Rights Council in Geneva in June 2018.

Read more Devex coverage on human rights.

About the author

  • Amy Lieberman

    Amy Lieberman is the U.N. Correspondent for Devex. She covers the United Nations and reports on global development and politics. Amy previously worked as a freelance reporter, covering the environment, human rights, immigration, and health across the U.S. and in more than 10 countries, including Colombia, Mexico, Nepal, and Cambodia. Her coverage has appeared in the Guardian, the Atlantic, Slate, and the Los Angeles Times. A native New Yorker, Amy received her master’s degree in politics and government from Columbia’s School of Journalism.