Social justice and human rights as a framework for addressing social determinants of health Final report of the Task group on Equity, Equality and Human Rights Review of social determinants of health and the health divide in the WHO European Region Karien Stronks Brigit Toebes Aart Hendriks Umar Ikram Sridhar Venkatapuram Social justice and human rights as a framework for addressing social determinants of health Final report of the Task group on Equity, Equality and Human Rights Review of social determinants of health and the health divide in the WHO European Region Karien Stronks Aart Hendriks Professor of Social Medicine, Professor of Health Law, Department of Public Health, Leiden University/ Academic Medical Centre, Leiden Medical Centre, University of Amsterdam, Netherlands Netherlands Umar Ikram Brigit Toebes PhD student, Associate Professor Department of Public Health, of International Law, Academic Medical Centre, University of Groningen, University of Amsterdam, Netherlands Netherlands Sridhar Venkatapuram Wellcome Trust Fellow (Ethics), London School of Hygiene & Tropical Medicine and Affiliated Lecturer, Cambridge University, United Kingdom Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website (http://www.euro.who.int/pubrequest). © World Health Organization 2016 Please note that the recommendations contained within this report are not recommendations by WHO but rather represent external expert guidance. 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Text editing: David Breuer Book design and cover design: Christophe LANOUX Photo credits: © World Health Organization Contents Acknowledgements .............................................................................4 Glossary .............................................................................................5 Conclusions and recommendations ......................................................6 Executive summary ...........................................................................10 1 Introduction ......................................................................................12 2 The injustice of health inequalities ......................................................15 2.1 Introduction ................................................................................15 2.2 Health equity as part of a broader theory of egalitarian justice ���������� 16 2.3 Conflicts with other societal aims ..................................................20 2.4 Conclusions ................................................................................23 3 The role of human rights law in addressing social determinants of health ..........................................................................................25 3.1 Introduction ................................................................................25 3.2 What are human rights? ...............................................................26 3.3 Health and human rights: a general introduction ����������������������������� 27 3.4 The conceptual link between human rights and social determinants of health inequalities ................................................33 3.5 Analysing the framework of the right to health and the other health-related rights ...................................................................33 3.6 Linking the rights framework with the goals of the Commission on Social Determinants of Health ..................................................39 3.7 Conclusions and challenges ..........................................................42 4 Implementation of human rights approach in the context of health inequalities: 15 case studies ..............................................................44 4.1 Introduction ................................................................................44 4.2 Accountability mechanisms and case studies.................................. 44 4.3 Judicial accountability .................................................................47 4.4 Quasi-judicial accountability .........................................................51 4.5 Administrative accountability ........................................................53 4.6 Political accountability .................................................................55 4.7 Social accountability ....................................................................59 4.8 Discussion ..................................................................................61 5 Conclusions ......................................................................................64 References .......................................................................................65 Acknowledgements Based on academic arguments, this report Center Amsterdam, Netherlands), Paul Hunt develops an ethical and human rights (University of Essex, United Kingdom), David framework that can serve as a basis for Ingleby (University of Utrecht, Netherlands), developing policies to address social Jacques van der Klink (Tilburg University, determinants of health. It has been produced Netherlands), Ron Labonte (Institute of by members of the cross-cutting Task Group Population Health, Ontario, Canada), Maria on Equity, Equality and Human Rights and Stuttaford (University of Warwick, United invited external reviewers as part of the Kingdom) and Suzanne van de Vathorst European review of social determinants of (Erasmus Medical Center, Rotterdam, health and the health divide commissioned to Netherlands). In addition, we thank Ruth Michael Marmot by the WHO Regional Offi ce Bell and Peter Goldblatt (Institute of Health for Europe. Equity, University College London) and Johanna Hanefeld and Sarah Simpson (WHO) It refl ects the fi ndings of an interdisciplinary for continual support. Finally, we are grateful research group, consisting of researchers from to the external reviewers, Sofi a Gruskin both public health and law. A major obstacle (Harvard University, USA) and Marcel Verweij in this research has been to overcome (Wageningen University, Netherlands), who differences between these two disciplines, critically reviewed a draft of the report. especially for human rights. We strongly feel that such differences, which could lead to For the selection and description of case misunderstandings, can only be overcome studies (Chapter 4), we thank: Henry through collaboration and cross-fertilization Asher (Nordic School of Public Health, to enhance the mutual understandings of our Gothenburg, Sweden), Alain Brillon (Alcohol frameworks and tools. To ease the reading of Treatment Unit, Amiens University Hospital, this report, and to avoid confusion about the France), Jonathan Cohen and Tamar Ezer various interdisciplinary terms used in this (Open Society Foundations, New York, NY, report we have inserted a glossary of terms. United States), Fons Coomans (University of Maastricht, the Netherlands), Rhonda The main text has been written by Karien Ferguson (University of Galway, Ireland), Stronks (Professor of Social Medicine, Pim Fischer (Fischer Advocaten, Haarlem, Department of Public Health, Academic Netherlands), Jernej Letnar (Faculty of Law, Medical Centre, University of Amsterdam, Slovenia), Roddy MacTaggart (Aberdeen City Netherlands) (all chapters), Brigit Toebes Council, United Kingdom), Claire Methven (Associate Professor of International Law, O’Brien (Danish Institute for Human Rights, University of Groningen, Netherlands) Copenhagen, Denmark), Jurga Poskeviciute (Chapters 3 and 4), Aart Hendriks (Professor (I Can Live Coalition, Lithuania), Claudio of Health Law, Leiden University/Leiden Schuften (People’s Health Movement, Medical Centre, Netherlands) (Chapter 3), Viet Nam), Maria Stuttaford (University of Umar Ikram (PhD student, Department of Warwick, United Kingdom) and Simone Wijte Public