Public Health and Social Justice

Martin T. Donohoe

• Publisher: Jossey-Bass
• Year: 2012
• ISBN:
  9781118236765
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Praise for Public Health and Social Justice

"This compilation unifies ostensibly distant corners of our broad discipline under the common pursuit of health as an achievable, non-negotiable human right. It goes beyond analysis to impassioned suggestions for moving closer to the vision of health equity."
—Paul Farmer, MD, PhD, Kolokotrones University Professor and chair, Department of Global Health and Social Medicine, Harvard Medical School; co-founder, Partners In Health

"This superb book is the best work yet concerning the relationships between public health and social justice."
—Howard Waitzkin, MD, PhD, Distinguished Professor Emeritus, University of New Mexico

"This book gives public health professionals, researchers and advocates the essential knowledge they need to capture the energy that social justice brings to our enterprise."
—Nicholas Freudenberg, DrPH, Distinguished Professor of Public Health, the City University of New York School of Public Health at Hunter College

"The breadth of topics selected provides a strong overview of social justice in medicine and public health for readers new to the topic."
—William Wiist, DHSc, MPH, MS, senior scientist and head, Office of Health and Society Studies, Interdisciplinary Health Policy Institute, Northern Arizona University

"This book is a tremendous contribution to the literature of social justice and public health."
—Catherine Thomasson, MD, executive director, Physicians for Social Responsibility

"This book will serve as an essential reference for students, teachers and practitioners in the health and human services who are committed to social responsibility."
—Shafik Dharamsi, PhD, faculty of medicine, University of British Columbia

Part One

Human Rights, Social Justice, Economics, Poverty, and Health Care

In the wake of the Nazi atrocities of World War II, the newborn United Nations (UN) established a commission on human rights to enumerate the fundamental rights of mankind. This group completed the Universal Declaration on Human Rights, which was adopted by the UN in 1948. The thirty rights laid out in this seminal document form the basis for many subsequent national laws as well as international treaties and agreements. These rights grew out of numerous religious and political traditions, historical documents, and social movements. The declaration is the first chapter in this collection because the rights elaborated therein provide the foundation for all the social justice issues discussed in this reader.¹

Chapter Two (by Dan E. Beauchamp) was originally presented at the American Public Health Association's annual meeting in 1975, yet it remains relevant today because it provides an ethical framework for the relationship between public health and social justice. The author defines justice as the fair and equitable distribution of society's benefits and burdens. He contrasts the dominant model of American justice, market justice,with its opposite, social justice. In the spirit of Rudolph Virchow (the father of social medicine, discussed in the reader's final chapter) and others, he emphasizes the right to health, prevention, collective action, and the importance of political struggle in achieving justice.

Chapter Three (by Vicente Navarro) provides an overview of the importance of class, race, and gender power relations within and between countries. The author argues that an alliance between the dominant classes of developed and developing countries is responsible for many of the neoliberal policies carried out by market-oriented countries and by global institutions such as the World Bank and the International Monetary Fund. These organizations, a product of the Bretton Woods Conference of 1944, are supposed to stabilize world economies while ensuring that aid to developing nations promotes sustainable economic growth and poverty reduction. Unfortunately, neoliberal policies have increased class divisions, damaged the environment, encouraged the profitable (for a few) privatization of public resources, and impeded the development of national health care programs and other public health interventions, subverting social justice and contributing to suffering and death. Navarro examines different governmental traditions in terms of their contributions to developing a public health infrastructure based on principles of social justice.

The next two chapters describe extremes of life faced by the bitterly poor and the über-rich. Matthew Power's evocative Chapter Four on trickle-down economics in a Philippine garbage dump documents the miserable, hard-scrabble existence of those who struggle to meet life's most basic needs while living and working atop a hundred-foot mountain of trash in a country where nearly half the population lives on less than two dollars a day. This is followed by Chapter Five (by Martin Donohoe), which describes the phenomenon of luxury (also known as concierge or boutique) health care, a relatively recent development currently available to the wealthiest citizens. Although most Americans live under a mediocre health care system that provides middling outcomes, our wealthiest citizens can take advantage of luxury care, often in clinics associated with academic medical centers. These centers are widely recognized as the arbiters of cost-effective medical testing, and have been the traditional providers to the poor and underserved. However, their concierge clinics often promote excessive, clinically unsupported testing, catering to patients' fears of unrecognized disease, which can lead to worse outcomes. Furthermore, while supporting luxury care clinics, many have limited their provision of services to the medically needy. Not covered in this chapter are other forms of “health care” available to the rich, such as transplant tourism (which often uses organs obtained through illegal and immoral means from the desperately poor). To learn more about luxury care, visit the luxury care/concierge care page of the Public Health and Social Justice website at http://phsj.org/luxury-care-concierge-care/.

Notes

¹ Leaning, J. (1997). Human rights and medical education: Why every medical student should learn the Universal Declaration of Human Rights. BMJ, 1997, 315,1390–1391. Retrieved from http://www.bmj.com/content/315/7120/1390.full

Chapter 1

Universal Declaration of Human Rights

Preamble

Whereas recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world,

Whereas disregard and contempt for human rights have resulted in barbarous acts which have outraged the conscience of mankind, and the advent of a world in which human beings shall enjoy freedom of speech and belief and freedom from fear and want has been proclaimed as the highest aspiration of the common people,

Whereas it is essential, if man is not to be compelled to have recourse, as a last resort, to rebellion against tyranny and oppression, that human rights should be protected by the rule of law,

Whereas it is essential to promote the development of friendly relations between nations,

Whereas the peoples of the United Nations have in the Charter reaffirmed their faith in fundamental human rights, in the dignity and worth of the human person and in the equal rights of men and women and have determined to promote social progress and better standards of life in larger freedom,

Whereas Member States have pledged themselves to achieve, in cooperation with the United Nations, the promotion of universal respect for and observance of human rights and fundamental freedoms,

Whereas a common understanding of these rights and freedoms is of the greatest importance for the full realization of this pledge,

Now, therefore,

The General Assembly,

Proclaims this Universal Declaration of Human Rights as a common standard of achievement for all peoples and all nations, to the end that every individual and every organ of society, keeping this Declaration constantly in mind, shall strive by teaching and education to promote respect for these rights and freedoms and by progressive measures, national and international, to secure their universal and effective recognition and observance, both among the peoples of Member States themselves and among the peoples of territories under their jurisdiction.

Article 1

All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.

Article 2

Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Furthermore, no distinction shall be made on the basis of the political, jurisdictional or international status of the country or territory to which a person belongs, whether it be independent, trust, non-self-governing or under any other limitation of sovereignty.

Article 3

Everyone has the right to life, liberty and security of person.

Article 4

No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all their forms.

Article 5

No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.

Article 6

Everyone has the right to recognition everywhere as a person before the law.

Article 7

All are equal before the law and are entitled without any discrimination to equal protection of the law. All are entitled to equal protection against any discrimination in violation of this Declaration and against any incitement to such discrimination.

Article 8

Everyone has the right to an effective remedy by the competent national tribunals for acts violating the fundamental rights granted him by the constitution or by law.

Article 9

No one shall be subjected to arbitrary arrest, detention or exile.

Article 10

Everyone is entitled in full equality to a fair and public hearing by an independent and impartial tribunal, in the determination of his rights and obligations and of any criminal charge against him.

Article 11

1. Everyone charged with a penal offence has the right to be presumed innocent until proved guilty according to law in a public trial at which he has had all the guarantees necessary for his defence.

2. No one shall be held guilty of any penal offence on account of any act or omission which did not constitute a penal offence, under national or international law, at the time when it was committed. Nor shall a heavier penalty be imposed than the one that was applicable at the time the penal offence was committed.

Article 12

No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence, nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law against such interference or attacks.

Article 13

1. Everyone has the right to freedom of movement and residence within the borders of each State.

2. Everyone has the right to leave any country, including his own, and to return to his country.

Article 14

1. Everyone has the right to seek and to enjoy in other countries asylum from persecution.

2. This right may not be invoked in the case of prosecutions genuinely arising from non-political crimes or from acts contrary to the purposes and principles of the United Nations.

Article 15

1. Everyone has the right to a nationality.

2. No one shall be arbitrarily deprived of his nationality nor denied the right to change his nationality.

Article 16

1. Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage and at its dissolution.

2. Marriage shall be entered into only with the free and full consent of the intending spouses.

3. The family is the natural and fundamental group unit of society and is entitled to protection by society and the State.

Article 17

1. Everyone has the right to own property alone as well as in association with others.

2. No one shall be arbitrarily deprived of his property.

Article 18

Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.

Article 19

Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers.

Article 20

1. Everyone has the right to freedom of peaceful assembly and association.

2. No one may be compelled to belong to an association.

Article 21

1. Everyone has the right to take part in the government of his country, directly or through freely chosen representatives.

2. Everyone has the right to equal access to public service in his country.

3. The will of the people shall be the basis of the authority of government; this will shall be expressed in periodic and genuine elections which shall be by universal and equal suffrage and shall be held by secret vote or by equivalent free voting procedures.

Article 22

Everyone, as a member of society, has the right to social security and is entitled to realization, through national effort and international co-operation and in accordance with the organization and resources of each State, of the economic, social and cultural rights indispensable for his dignity and the free development of his personality.

Article 23

1. Everyone has the right to work, to free choice of employment, to just and favourable conditions of work and to protection against unemployment.

2. Everyone, without any discrimination, has the right to equa...