Defining core values: Equity, Social Justice and health as a Human Right

The framework of core values below is based on the paper written by Solar e Irwin (2007)* which can be downloaded from Links Links, Full Texts. Its major concepts are outlined here to help you reflect upon SDH.

Equity in Health is an ethic founding concept of the SDH approach. The WHO Department of Ethics, Poverty, Trade and Human Rights defines health equity as ‘the absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically or geographically.” In essence, health inequities are health differences which are:socially produced, systematic in their distribution across the population, and unfair. Identifying a health difference as inequitable is not an objective or material description, but necessarily implies an appeal to ethical norms.

Primary responsibility for protecting and enhancing health equity rests in the first instance with national governments, as explained by renowned figures of contemporary political thought. According to Amartya Sen (2002), “health equity cannot only be concerned with inequality of either health or health care, and must take into account how resource allocation and social arrangements link health with other features of states of affairs.” Anand (2004) points out that health is a special good, whose equitable distribution merits the particular concern of political authorities. There are two principal reasons for this: health is directly constitutive of a person’s well-being and health enables a person to function as a social agent.

Basically, inequities in health compromise freedom, social justice and human rights, and when there is inequity; governance has failed in one of its prime responsibilities. But the causal linkages between health and social agency are not unidirectional: equity in health is the result of public policies and it is also a pre-requisite for social groups to participate in the strengthening of their own rights and the control over their work and lives.

The international human rights framework, based on the 1948 Universal Declaration of Human Rights, is the appropriate conceptual structure within which to advance towards health equity. It holds that the right to health must be interpreted broadly, including (but not limited to) medical care, food and nutrition, housing, access to safe and potable water and adequate sanitation, safe and healthy working conditions, and a healthy environment. It also comprises the responsibility for the social determinants with a view to fulfilling the citizens’ right to the highest attainable standard of health.

Human rights offer a conceptual armature connecting health, social conditions and the principles of civilian participation in political rights. As Braveman and Gruskin (2003) argue, the human rights perspective removes actions to relieve poverty from the realm of charity to the domain of law. Over recent years, the work of the UN Special Rapporteur on the Right to Health has been instrumental in advancing the political agenda around the right to health at national and global levels.

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