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On Health, Human Rights, and the Social Determinants of Health

Posted: 03 Jan 2011 05:28 AM PST

Health & Human Rights, an international journal based out of the Harvard School of Public Health, has published a theme issue (vol. 12, no. 2) on the social determinants of health.

The articles are available full-text, open-access, and are almost uniformly well-written and worthwhile. In particular, three of the articles, under the heading "Critical Concepts," address key conceptual issues regarding health equity, human rights, and the social determinants of health. More after the jump.

I view these articles as particularly important because of my belief that the ethical and policy implications of the SDOH evidence base have been underdeveloped for too long, which matters because even the best evidence does not speak for itself. As I have remarked elsewhere, policy is never self-executing, and each of these three articles contributes to the task of translating the SDOH evidence base into just public health policy.

Although I have no hesitation in recommending each of them, I should note here my general skepticism regarding the merit and utility of human rights talk. Such talk often seems to me to raise concerns of postcolonialism and neoliberalism; moreover, I am in general dubious of universalism in applied ethics, of the search for moral Esperanto. For further elucidation of some of the drawbacks of human rights talk, I highly recommend Makau Mutua's fine work on the subject.

In any event, here are the abstracts for the three articles in the Critical Concepts section:

The right to sutures: Social epidemiology, human rights, and social justice

Sridhar Venkatapuram, Ruth Bell, Michael Marmot

Abstract

The article examines the convergences and contrasts between social epidemiology, social medicine, and human rights approaches toward advancing global health and health equity. The first section describes the goals and work of the WHO Commission on Social Determinants of Health. The second section discusses the role of human rights in the Commission's work. The third section evaluates, from the perspective of social epidemiology, two rights-based approaches to advancing health and health equity as compared to a view that focuses more broadly on social justice. The concluding section identifies four areas where social epidemiologists, practitioners of social medicine, and health and human rights advocates can and must work together in order to make progress on health and health equity.

The social determinants of health, health equity, and human rights

Audrey R. Chapman

Abstract

This article explores the benefits of a rights-based approach to health according greater attention to the social determinants of health, health equity, and the power structure. It uses the report issued by the World Health Organization Commission on Social Determinants of Health (CSDH), Closing the gap in a generation: Health equity through action on the social determinants of health, as a lens through which to address these issues. After presenting a brief overview of the CSDH report, the article compares the document with a rights-based approach to health on three topics: 1) the social determinants of health and the underlying determinants of health; 2) health inequalities and inequities; and 3) power, money, and resources. The article argues that the right to health requires greater attention to the social determinants of health, health inequalities, and power dynamics than these topics have received to date.

Social conditions, health equity, and human rights

Paula Braveman

Abstract

The fields of health equity and human rights have different languages, perspectives, and tools for action, yet they share several foundational concepts. This paper explores connections between human rights and health equity, focusing particularly on the implications of current knowledge of how social conditions may influence health and health inequalities, the metric by which health equity is assessed. The role of social conditions in health is explicitly addressed by both 1) the concept that health equity requires equity in social conditions, as well as in other modifiable determinants, of health; and 2) the right to a standard of living adequate for health. The indivisibility and interdependence of all human rights - civil and political as well as economic and social - together with the right to education, implicitly but unambiguously support the need to address the social (including political) determinants of health, thus contributing to the conceptual basis for health equity. The right to the highest attainable standard of health strengthens the concept and guides the measurement of health equity by implying that the reference group for equity comparisons should be one that has optimal conditions for health. The human rights principles of non-discrimination and equality also strengthen the conceptual foundation for health equity by identifying groups among whom inequalities in health status and health determinants (including social conditions) reflect a lack of health equity; and by construing discrimination to include not only intentional bias, but also actions with unintentionally discriminatory effects. In turn, health equity can make substantial contributions to human rights 1) insofar as research on health inequalities provides increasing understanding and empiric evidence of the importance of social conditions as determinants of health; and, more concretely, 2) by indicating how to operationalize the concept of the right to health for the purposes of measurement and accountability, which have been elusive. Human rights laws and principles and health equity concepts and technical approaches can be powerful tools for mutual strengthening, not only by contributing toward building awareness and consensus around shared values, but also by guiding analysis and strengthening measurement of both human rights and health equity.

(h/t SDOH listserv)