Public Health Ethics: Social Health Justice

Public health ethics involves a systematic process to clarify, prioritize and justify possible courses of public health action based on ethical principles, values and beliefs of stakeholders, and scientific and other information...Read More...

Components of Social Justice in Health

The components of social health justice are as follows:

• Equity, Equality, Fairness, Inclusion, Opportunity, Rights
• Moral agency, action
• Equal treatment as natural law
• Removing barriers
• Impartiality

                                         

• Equity, Equality, Fairness, Inclusion, Opportunity, Rights

Health equity cannot be concerned only with health, seen in isolation. Equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically. Health inequities, therefore, involve more than inequality with respect to health determinants, access to the resources needed to improve and maintain health or health outcomes. They also entail a failure to avoid or overcome inequalities that infringe on fairness and human rights norms.

Equality is guaranteeing people or groups are not treated contrastingly/differently or less favorably, on the basis of their specific characteristics, including areas of age, race, sexual orientation, gender, religion or belief, disability, etc.

Understanding the difference between equity and equality is a key component in the effort to reduce health disparities among vulnerable populations. Thus, equality is not equitable.

Example of Equality	Example of Equity
All mothers are provided with the same amount of transportation incentive after institutional delivery.	Considering geographical locations and transportation condition, mothers are provided with transportation incentive after institutional delivery respectively: Himalayan region  : Nrs. 1500 Hilly region            : Nrs. 1000 Terai region           : Nrs. 500

• Moral Agency, action

Moral agency in terms of health is also considered as enacted justice. It is an individual's ability to make moral judgments, based on some commonly held idea of right and wrong and to be held accountable for these actions; to become increasingly capable of making decisions and taking action themselves. A moral agent is a being who is capable of acting with reference to right and wrong. For e.g. If a patient is referred for physical therapy treatment, then there should be some kind of coherence between therapist and patient. There should be freedom for exercise choice and opportunity for change.

• Equal Treatment as Natural Law

Natural Equality is found among all humans solely by the constitution of their nature. Equal treatment as natural law is the principle and foundation of liberty. It is clear according to natural law that one must value and treat other people as so many individuals who are naturally equal to oneself. For example, one can demand preferential services, and must not claim more than others but, on the contrary, allow them to enjoy equally the same rights that one assumes for self.

• Removing Barriers

Removing Barriers mainly aims advocacy, understanding, collaboration on inclusion and diversity within the healthcare system. We advance social justice when we remove barriers that people face because of age, gender, ethnicity, race, religion, culture or disability.

• Impartiality

Impartiality as such is not a virtue. It assumes its morally worthy nature in the context of rights and duties. Furthermore, impartiality in relation to equity is something more than and other than the mere consistent application of rules of behavior. Actions, in order to be good ones, must treat persons appropriately as persons. This is the base of all good actions and, therefore, of all good just actions.

Bibliography

1. https://www.cdc.gov/od/science/integrity/phethics/index.htm
2. http://www.who.int/healthsystems/topics/equity/en/
3. http://www.who.int/bulletin/volumes/89/1/10-082388/en/
4. BENJAMIN, G.C. Health Equity and Social Justice: A Health Improvement Tool
5. Edwards, I., et al., Moral Agency as Enacted Justice: A Clinical and Ethical Decision-Making Framework for Responding to Health Inequities and Social Injustice. Physical Therapy, 2011. 91(11): p. 1653-1663.
6. McLachlan HV Justice and the NHS: a comment on Culyer Journal of Medical Ethics 2005; 31:379-382.
7. Peter, F., Anand, S., Sen, A. “Public Health, Ethics, and Equity” (2004).
8. Ruger, Jennifer Prah. “Health and Social Justice.”(2004).