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 These rights grew out of numerous religious and political traditions, historical documents, and social movements.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
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.
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.
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.
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.
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.
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.
1. Everyone has the right to freedom of peaceful assembly and association.
2. No one may be compelled to belong to an association.
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.
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...