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The Right to Health: (Human) Rights v Social Justice

The Right to Health: (Human) Rights v Social Justice. Which Standards Apply?. Human Rights Violations?. 1000s of members of the population per hospital? Numbers of deaths in road traffic accidents? Company take-overs causing unemployment?

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The Right to Health: (Human) Rights v Social Justice

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  1. The Right to Health:(Human) Rights v Social Justice Which Standards Apply?

  2. Human Rights Violations? • 1000s of members of the population per hospital? • Numbers of deaths in road traffic accidents? • Company take-overs causing unemployment? • Health differentials between social grade As and social grade Es? • Bio-fuel rush causing food shortages? (“a crime against humanity” Jean Ziegler)

  3. Methodology: the “Distinctiveness Approach” to Moral Concepts • Standards: judgement and guidance • Point and Purpose • Role • Non-redundancy • Special practical contribution • Added value • Practical consequences…

  4. Social (Distributive) Justice • Terms of social cooperation • Distribution of social costs and social benefits (human goods and human burdens) • Special Agent of Assignment • With power to assign rights and duties • Background-adjustment (for accumulated effects of innocent choices) • Continuously maintaining a pattern of distribution of costs and benefits • According to REGULATIVE or MASTER VALUES (cooperative values e.g., Reciprocity; Fairness; Equal Concern)

  5. All obscured by debate over “The List”

  6. Who ignores the distinction? Why? • Most commentators • Campaigners • Development Projects (and UNDP) • “Rights-based approaches” to… • UN generally • International Law

  7. The Culprit: The “Outcomes View”A cause of confusion • Identifies: States of affairs • And, Their value for persons • → Presumption in favour of all enjoying those states of affairs OV: A human right can be understood simply by reference to the importance of some human good (of some outcomes)

  8. “… we can give a pretty clear and definite account of what all the world’s citizens should have, what their dignity entitles them to, prior to, and to some extent independently of, solving the difficult problem of assigning duties.” M. Nussbaum • “One’s goal is for everyone to enjoy everything they have a right to enjoy. One’s next task is to figure out how this can be arranged and how to allocate the tasks involved in the establishment and operation of the arrangements.” Henry Shue • Other ‘users’ include…UNOHCHR, UNDP, Special Rapporteurs on the Right to Health and Food; most NGOs

  9. What does “entitlement” mean? Human goods are distributables: Enjoyment of conditions for life; Enjoyment of conditions for security; Enjoyment of access to health resources (N Hospitals per 1000 persons) • Entitlement that X should supply you with these? Implies obligations… • Who is responsible? • Agency and Costs?

  10. Agency? • Any agent with a capacity to affect these outcomes • Agent which is best placed to affect these outcomes • Agent with powers of assignment • Positively or negatively • Imposing costs on whom?

  11. Costs? • Highest attainable level of… • Whatever the costs? • Falling on all and any agent capable of bearing the costs? • But the costs too will be in terms of human goods… So… • To the extent that it is fair to impose costs on them? • Need a reasonable distribution of costs and benefits…

  12. Factor-in those Questions? • Factor-in Costs • Need principle for distributing costs and benefits • Tells us how the costs and benefits are to be distributed • How much should X contribute/bear towards Y being better off (in health terms)? • i.e., A principle of social justice →Collapse into Social Justice

  13. Practical consequences • Types of accountability mechanisms • State to individual • State to political community • Different types of indicators and benchmarks involved • Simply looking at health outcomes not sufficient to decide which type of accountability mechanism is appropriate

  14. Keeping Rights aspect of Human Rights Distinctive • The point and purpose of a moral/ethical concept • Accountability of Political Agents • Aims in use of political power of assignment (rather than outcomes) • Accountability to individual persons for actions with specific intentions • Accountability not in terms of sustaining pattern of distribution of costs and benefits

  15. Conclusions • It is better to focus on Social justice as a moral standard for • health outcomes • accumulated effects • Social justice is no less important than rights • Some abuses engaging health goods are indeed (human) rights abuses • But not singled out in terms of outcomes alone

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