4 social health justic

Unit 4: Social Health Justice
Draft Version 2
(7 hrs.)
Upendra Raj Dhakal
Lecturer: Valley College of Technical Sciences, Kathmandu
989110689
Social Health Justice Draft version 2(Feedback Welcomed) 1

Introduction
• It is just a fair relationship between individual and society
• It is measured in terms of distribution of wealth, personal opportunities,
social privileges, social roles, dignity of individuals,
• It was practiced even during the time of Plato, Aristotle and Socrates
(Before 300 BC), and was traced through the theology of Saint Augustine
of Hippo and the philosophy of Thomas Paine (After 300 AD).
• The word Social Justice was coined in 1840s and spread in 1848
• From early 20th century, it was embedded in international law and
institutions
• In late 20th Century, it was understood as a philosophy in social contract
• In 1993, Social Justice was considered as human rights education

Concept
• It is a process of ensuring that individuals fulfill their social roles and
receive what was their due from the society.
• Presently, breaking of barriers for social mobility, safety nets and economic
justice are taken into consideration.
• It defines rights and duties of an institution of society (Like: taxation, social
insurance, public services, labor law, regulations, equal opportunity, …)
enabling basic benefits and burdens of cooperation.
• It is seen through Philosophical Perspectives and Religious Perspectives
• Social justice movements: Liberation theology, Health Care (bioethics), and
human right education.

Philosophical Perspectives
• Cosmic Values: If you want to cultivate peace, protect creation
• John Rawls: Representative population holds powers as a trustee for
the citizen. It includes Freedom of thought, Liberty of conscience,
political liberty, freedom of association, rights and liberties covered
by law.
• Thomas Pogge: Institutional cosmopolitanism. E.g. Third party should
not recognize or enforce slavery.
• United Nation: Strong and coherent policies should be conceived and
implemented by public agencies

Religious Perspective
• Hinduism: Jati hierarchy. Cast hierarchy, gender, Senior Citizens
• Islam: Wealth, poor has a right to assist from the more fortunate,
safety and security of minority populations: women, children, elderly,
disabled, …
• Judaism: charity, every person is born with equally good and evil
powers, any power can dominate other. Anger is considered as bad.
• Christianity: preferential options for poor and vulnerable, …
• Jain: The jewels, are right belief, right knowledge and right conduct.
The supreme principle of Jain living is non violence (ahimsa)

Contd …
• The concept of Social Justice arise when there was discrimination and
imbalance in the society.
• Imbalance were in terms of gender, sexuality, religion, political
affiliation, age, race, belief, disability, location, social class, socio
economic circumstances, etc.

Definition of Social Justice
The distribution of good (advantages) and bad
(disadvantages) in society, and how these things
should be distributed in society. It is concerned with
the ways that resources are allocated to people by
social institutions. David Miller
Assuring the protection of equal access to liberties,
rights, and opportunities, as well as taking care of the
least advantaged members of society. John Rawls

Contd …
"... promoting a just society by challenging injustice and valuing
diversity." It exists when "all people share a common humanity and
therefore have a right to equitable treatment, support for their human
rights, and a fair allocation of community resources."
(Toowoomba Catholic Education, 2006)
(https://www.huffingtonpost.com/epaminondas-farmakis/social-justice-and-econom_b_6977098.html)

Social Justice and Health
• Bioethics
• Allocation of health resources
• Lack of multiple compounding factors in developing world (medical
equipment, health professionals and hospitals)
• Lack of drinking water, during famines.
• Disease conditions: TB, Malaria, HIV/AIDs
• Unfair distribution of scientific infrastructure in different countries.
• Access of health services only for rich
• Less importance given to PHC, declaration of death of PHC.
• Promoting privatization in Health.
• Considered the moral and ethical foundation of public health, i.e., distributive
justice.

Distributive justice
• It is is a concept that addresses the ownership of goods in a society. It
assumes that there is a large amount of fairness in the distribution of
goods.
• Equal work should provide individuals with an equal outcome in
terms of goods acquired or the ability to acquire goods.
• Distributive justice is absent when equal work does not produce
equal outcomes or when an individual or a group acquires a
disproportionate amount of goods.

Scope
• Constitutional guarantees and safeguards relating to health and
demarcation of legislative responsibility
• Health related international Treaties, Conventions and Similar Instruments.
• Regulations of different systems of medicine
• Organizational and administration of health care, health care facilities and
services
• Economic aspect of health care
• Inter sectorial cooperation
• Community participation
• Health research and health education
• Human recourse for health

Contd …
• Disease control and medical care
• Public health with particular reference to sanitation
• Family health and welfare
• Human reproduction and public policies
• Care of special groups
• Mental health
• Dental health
• Control of alcoholism, drug abuse and smoking
• Ethical issues and professional responsibility

Contd …
• Transplants, death and related issues
• Nutrition and food safety
• Consumer protection
• Pharmaceuticals, cosmetics and medical devices
• Poisons, pesticides and other hazardous substances
• Occupational health and safety
• Environmental pollution
• Radiation protection
• Accident prevention
• Veterinary products and plants
• Sports and recreation
• Health Information and statistics

Importance
• Helps in equitable distribution of health resources
• Helps in practicing ethical research activities
• Provide quality in health service delivery
• Control of disease
• Control over bio and other forms of weapons
• Promotion of comprehensive aspect of Public health
• Eliminating partiality and discrimination in terms of health
• ………….

Injustice in Health Care Delivery
• Racism: ….
• Geography: …
• Ethnicity: …
• Education: …
• Gender: …
• Caste: …
• Age: …
• Disability: …
• Class: …
• Approach and accessibility: …

Health Law
• Broad and interdisciplinary field that involves any law which affects the
health of individuals and the public.
• Includes specific laws that regulate the health industry, the public’s health,
and the delivery and financing of health care services.
• It also includes more general laws that can impact health and health care,
such as corporate and tax law, environmental law, tort law, bioethics and
law, constitutional law, family law, juvenile and elder law, administrative
law, intellectual property law, social welfare law and international law.
• Focus areas in Health Laws are: Law, medicine and Bio ethics, Regulation of
Health care business, Health and Social Justice, Public health and the
environment, International Health and Human rights, Health Science and
technology.

Nature of Health Law
• Generalized in nature
• Focuses on preventive, promotive, curative and rehabilitative approach.
• Protects the health rights
• Equity and equality
• Interlinked and collaborated with other laws
• Participatory
• Impartial and bias-less
• Promoting ethical practices
• …….

Types of Health Law
• Acts regulating drugs, and medicinal and related substances
• Acts regulating biosafety and bio security
• Act regulating health care professionals
• Act concerning disease and other medical conditions
• National registry of disease act
• Acts concerning medical practice and research
• Global acts
(https://www.moh.gov.sg/content/moh_web/home/legislation/legislation_and_guidelines.html)

Public Health Law
• Public Health Law is one of the section under Health Law.
• Public health law generally focuses on preventing injury and disease
by lowering health risks among populations.
• It examines the authority of government to improve public health
within societal limits and norms.
• It focuses on duties of government to achieve goals, limits on power
and population perspective.
• It also focuses on legal issues in public health practice and on the
public health effect of legal practice.

Bio ethics
See previous slides (Unit 1)

Implementation strategies of health law
• Government Options: Federal Government must centralize
governance in terms of legislation.
• Funding power: sharing cost between federal, local or regional
governments.
• Intergovernmental agreements: different governments and levels of
governments. Regional, local or central; between different countries.
• National guidelines
(http://www.who.int/bulletin/volumes/86/3/07-042838/en/)

Contd …
Governance
strategies
Advantages Disadvantages Potential area of use
Legislation • enforceable
• clear designation of roles and
responsibilities
• clear lines of accountability
• dependent on existence of
appropriate constitutional authority
• may damage relations with other
levels of government
• inflexible
• authority to oversee and guide
response to a PHEIC
• mechanism to ensure transfer of
epidemiological data to national
level
Funding
arrangements
• enforceable
• links capacity development
to governance strategy
• respects constitutional
boundaries
• may be changed unilaterally by
national government
• may be viewed as coercive
• creates some ambiguity as to
accountability
• surveillance capacity development
in combination with meeting IHR
reporting requirements
Agreements • respects constitutional
boundaries
• limits to enforceability • mechanism to ensure transfer of
epidemiological data to national
level
Guidelines • respects constitutional
boundaries
• flexible
• least enforceable • standardization
(http://www.who.int/bulletin/volumes/86/3/07-042838-table-T2.html)
23

Challenges in implementing health law
• War between comprehensive and selective approach in health
• Increased autonomy in local recourse mobilization and utilization
• Lack of TIA in governing organizations (bureaucratic procedures)
• Bottom up Vs top down planning
• Conflict in commitments done by different countries
• Political instability and polarizations,
• Fragmentations, duplications and lack of coordination.
• Health law as less prioritized
• ……

Difference between ….
Basis for
Comparison
Law Fund. Right Hum. Right Justice
Meaning
See in Ethics
part (Unit 1)
Fundamental Rights means the primary
rights of the citizens which are
justifiable and written in the
constitution.
Human Rights are the basic rights
that all the human beings can enjoy,
no matter where they live, what they
do, and how they behave, etc..
See in Ethics
Part (Unit 1)
Includes Basic Rights Only Basic and Absolute Rights
Scope It is country specific. It is universal.
Basic Principle Right of freedom Right of life with dignity
Guarantee Constitutionally guaranteed Internationally guaranteed
Enforcement Enforceable by the court of law.
Enforceable by United Nation
Organization.
Origin
Originated from the views of
democratic society.
Originated from the ideas of civilized
nations.
http://keydifferences.com/difference-between-fundamental-rights-and-human-rights.html

Critiques of Justice
• Critique: It is a method of disciplined, systematic study. Commonly it is
understood as fault finding and negative judgement, but moreover is equal
evaluation of positive and negative aspects. It evaluates thoughts, and is
never personal.
• It is a social mechanism to maintain social harmony and decrease conflict.
• Marxist intellectuals: Conflict theory - develops society: It always promotes
critiques.
• Critiques provides feed backs for the evaluation and correction and
saturation of laws/Justice.
• Critique is a form of communication, and always must be constructive.
• Critique Vs Criticism: Criticism more related to literature/art.

Components of Justice
• Equity: Fairness or Justice in the way people are treated. It involve trying to
understand and give people what they need, even if it is not equal. It is a
principle of fairness.
• Equality: The quality or state of being equal; the quality or state of having
the same rights, social state, etc.. It is ensuring individuals and
communities are offered the same opportunity and treated no less
favorably. It is a principle of sameness.
• Fairness: Fairness can be in the form of equity or equality. There is always a
debate as defining equity and fairness as same or different. Fairness is a
quality of having an unbiased disposition, without discrimination or
partiality. It is the absence of prejudice (partiality).
Equity is the process; equality is the outcome

Equality, Equity and
Fairness
(1 Vs 2 Vs 3)
28

Components of Justice …Contd …
• Inclusion: it is a process of strengthening the privileged/disadvantaged group to
main stream. After inclusion, every people feel valued, individual differences are
respected, creates national unity, industrialize democracy, manages social conflict
and maintains social justice, increases participation in governance system. It
provides legal protection. We have reserved quota for social inclusion.
• Opportunity: It is a chance or probability to get included in a system. Nepal, after
being a federal state, has created lots of opportunity for privileged group through
inclusion quotas.
• Rights: Selection in inclusive groups has become right after the bill was passed as
act. Similarly, the correction as disable to differently abled, old aged to senior
citizen, etc.. can enjoy their optimum right presently. Rights that has been decided
by the government is justifying the community.

• Moral Agency: It is an individuals ability to make moral judgements based
on some notion of right and wrong and to be held accountable for these
actions. Moral agent is “a being who is capable of acting with reference to
right and wrong.” Normal adult humans are widely considered to be
paradigms (example) of moral agents.
• Action: Activities that a community performs after verifying and as per the
social recommendation is an action. It is based on equity/fairness or
equality, inclusion, opportunity, rights, morality, etc.. These actions is not
necessary to become as per the rules, regulations or act. As the
community decides this, the overall impact is also the responsibility of the
community. Since the representatives of community do it, it is also
considered as a component of justice in a community.

• Equal treatment as natural law: Nature does not do bias to any of its
components. It just balances. Certain rights are inherit by virtue of human
nature, endowed by nature. Moral law and ethics should not do biasness.
Natural law finds universal standards in morality and ethics and thus treats
equally.
• Removing Barriers: Exclusion of outliers and including
privileged/disadvantaged groups. E.g.. Gender, ethnicity, race, religion,
social status, disability, etc.. It includes creating/removing barriers to
upward mobility. Effective participation in political process and civil action.
• Impartiality: It is aka evenhandedness or fair – mindedness. It says,
decision should be based on objective criteria, rather than on the basis of
bias, prejudice, or performing the benefit to one person over another for
improper reason.

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