Thursday, August 20, 2015

Toward making sense of the structural constraints of health & illness in the neoliberal variation of advanced (or late-) capitalist society … (3)

…[E]very human being experiences different types and durations of physical and mental impairments, or different periods of health and illness, and lives for varying lengths of time due to the combined interactions of her internal biological endowments and needs, behaviours, external physical environment and social conditions. [….]

The centrality of human health and longevity to social justice is so patently obvious to some people that they simply take it as a starting point. This is particularly apparent in the remarkable history of physicians becoming social and political reformers, and even armed revolutionaries because of their understanding of manifest injustice in such aspects as the causes, consequences, persistence through generations, or distribution patterns of preventable ill-health and premature mortality in a population. But such an understanding is not limited only to physicians or those who work in the front lines of healthcare and public health. For example, Amartya Sen, the economist and philosopher, begins a lecture by stating, ‘In any discussion of social equity and justice, illness and health must figure as a major concern. I take that as my point of departure.’ He then continues, ‘…and begin by noting that health equity cannot but be a central feature of the justice of social arrangement in general.’ [….]

... John Rawls, perhaps the most renowned modern philosopher of social justice, has seemingly put forward the opposite position. Rawls believed that human health is a ‘natural good’ and subject to random luck over the life course; he sees health not as something significantly or directly socially produced, so it does not even come within the scope of social justice, let alone is central to it.” — Sridhar Venkatapuram, in the Introduction to his impressive and urgent book, Health Justice: An Argument from the Capabilities Approach (Polity Press, 2011) 

Venkatapuram goes on to note that, in his later writings, Rawls at least came to agree with Norman Daniels that justice produces entitlements to healthcare [emphasis added] in order to keep people above a minimum health threshold. Of course Daniels himself progressively extends the Rawlsian conception of “justice as fairness in two books: Just Health Care (Cambridge University Press, 1985), and Just Health: Meeting Health Needs Fairly (Cambridge University Press, 2008).


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