A panel discussion held this week at Harvard Law School with Professor Jennifer Prah Ruger about her new book, “Global Health Justice and Governance,” with Professor Michael Stein and Petrie-Flom Center Executive Director Carmel Shachar, provided a stimulating space for transdisciplinary discussion of critical justice imperatives in today’s world.
The challenges facing global health justice—from forced displacement, to climate change, to ever-changing technologies and evolving epidemiological profiles—are far too complex for one discipline to explain or resolve alone, which makes these kinds of discussions all the more essential.
What does a human rights perspective add to telling us what health inequalities (within and between countries) are inequities and injustices—as opposed to disparities?
First, the right to health is, as all rights are, shorthand for longer conversations about distributive justice. The content of health rights requires, among other things, fair financing and democratically legitimate processes to define its contours in context, in line with normative principles of non-discrimination, and so on.
In turn, the idea of recognizing a right to health also implies health systems should be understood not as technical apparatuses but as fundamental social institutions in a democracy—which include structures of financing, “accountability for reasonableness” and participation by affected communities in priority-setting, and relationships of entitlement and accountability between patients and providers.
A right to health does not — cannot — mean “everything for everyone now.” But it does open space for the normative oversight role of courts in health systems. Indeed, an array of courts are now using innovative remedies and experimentalist regulation regarding health systems, pollution, food, and the like, to catalyze action from the political organs of government, in addition to enforcing individual entitlements.
Nevertheless, we see dysfunction in national political institutions, as well as the deepening economic integration, the growing influence of transnational actors, and sweeping privatization of health sectors (and development agendas) that impair the ability to realize health and other social rights in practice. Further, the human rights regime has not addressed the egregious global inequalities between countries adequately, including in health. And UN-based health institutions are increasingly controlled by private interests, which exacerbates the deficit in democratic decision-making in global health.
In short, global health justice cannot be defined by human rights law, or public health or philosophy, or any one field.
Ruger emphasized collaboration and shared health governance. I agree and would argue for experimentalist and networked governance that will enable curbing the influence of transnational actors, as well as changing the rules of trade and investment and the other shapers of the political economy of avoidable suffering.