First principles of health justice: a human right to be healthy | Sridhar Venkatapuram | TEDxLSHTM



philosophy really can you think of a new exciting philosophical idea that's come out recently what could philosophy do to possibly help solve our grotesque health problems in the world today let me take child mortality for example every year 7 million children under the age of 5 die in the world half of those children die in sub-saharan African countries one in five children under five that dies dies in the single country of India we know what the problem is right 7 million children are dying every year we know what the solution is right we need more money we need more vaccines we need more infrastructure like roads buildings fridges we need more health care staff as my teacher and hero Paul Farmer and colleagues frequently say we need more stuff staff spaces systems so really our problem is one of implementation how do we get things to the people who need them but the stuff belongs to somebody or somebody's gonna have to pay for this stuff so we're gonna have to give reasons we could say saving children from dying is good for economic growth we could say saving children under five from dying now will save us lots more money in the future we could say it's good to make people happy let's do it to make more people happy some of you might not really care about what reasons you give you just want to give whatever reason in order to get the stuff to the people I think that this is a grave mistake being strategic opportunistic or mercenary with the reasons that you give to address such a fundamental issue such as health is bad for a number of reasons the biggest one being is that if people see you saying whatever you want to say or need to say in order to get those things to people it just becomes another thing on the bargaining table I'm going to tell you an argument that the best the most defensible reason to address the health of people is that every human being has a right a human right to health and I'm going to do it in three parts I'm going to do it by telling you how I think we should conceptualize the human right to health I'm going to tell you why it's morally important and I'm going to tell you why it makes a difference first a human right to health is more than just a right to things it's a right to the capability to be healthy so you understand what I mean by capability I want to take you back 20 years if you were a student in this building now if you were working or teaching in this building the overwhelming health issue that was on everyone's minds was the spread of the hiv/aids epidemic without a cure without a vaccine the only and the most effective way at preventing HIV infections was to take every individual one at a time and help them understand their biological emotional and psychological vulnerability to becoming infected with HIV but it wasn't just about individual behavior and working with the individual through community mobilization and activism social conditions were changed in order to make it a supportive environment for individuals the combination of taking that individuals specific vulnerability and changing the environment in order to make it supportive join together to make that person able to stay alive but the idea of being able or capable to be healthy is not just about HIV or infectious diseases it wasn't then and it isn't now it can also be applicable to many other health issues including for example the reproductive and sexual health of girls and women around the world specifically in developing countries it's not just about getting things to these girls and women it's about helping them get more control over their body and behavior in their environment it's about not only getting them things but also changing the environment in order to make it a supportive environment for them to be able to stay alive and healthy stuff staff space systems are crucial to helping people be healthy they're necessary but not sufficient we have to go beyond stuff to think about it in terms of the ability or capability of people to be healthy why is it morally important because to be healthy is a kind of freedom to be free from disease and impairment and pain throughout the world human beings want to be free and if you think about health as helping people being free or is a kind of freedom then it becomes one of these central fundamental values that we as societies want to protect for our people what difference does this make I'm gonna tell you two reasons the first difference that we'll make is that thinking about health as a capability allows us to understand and recognize the full range of factors that impact our health let me give you an example I was in Omaha Nebraska recently West Omaha is really nice very wealthy nice roads nice buildings beautiful houses North Omaha is not and it's also where the african-american population lives it's also where there's a high prevalence of diabetes health intervention programs in that community every year have an annual health fair people go to the health fair because that's one of the if only times in the year that they have a health check-up because they might not have access to health insurance or healthcare and these health fairs catch people with diabetes these health care workers also do the traditional things they talk to people about food they talk to people about alcohol they talk to people about getting them more exercise and etc but if you talk to them about health capability something else happens they start talking about the fact that there's no paths for people to go walking they talked about the fact that people don't have bicycles or bicycle lanes they talk about the fact that parks don't feel safe for them to be in they talk about how the food at community gatherings such as churches is really unhealthy what was thought to be peripheral to health and health intervention suddenly becomes central and in fact legitimate to talk about talking about capability legitimizes the real sometimes overwhelming factors that are often excluded from health the second difference health and health inequalities become questions of social justice you see bad luck happens tragedy happens people make bad choices you don't choose your genetic makeup however if thousands of people are dying on road traffic accidents because we are neglecting Road Safety if women are starving while they were pregnant because they don't have access to food if women are stressed because they're in fear while they're pregnant if governments are censoring information about sexual and reproductive health then people will make bad choices and we are implicated in the unfreedom of people that is a question about justice not about personal choices or bad luck so my conclusion 7 million children are dying in the world every year not just because of a lack of things they're born being born into conditions in which there is ignorance poor health policies bad reason and loads and loads of self-interest thinking about the capability to be healthy of these children allows us to see all the different factors that are implicated in their deaths and it elevates the question beyond just health care and poverty into questions about basic justice some of you I'd say I have so many objections to what he's saying there's so many things wrong with what he's saying let me give you one critique that someone might say they say this guy jeez he's making everybody into healthy people he's forcing people to be healthy I didn't make that argument I said that if we think about people's ability to be healthy we should ensure the conditions in which people are able to be healthy what they do with that ability how they use that freedom is up to them there could be many many more objections many more questions what I hope I have done at this point is show you how I think we should conceptualize the human right to health how it's morally important and what difference it makes to what we do and how we think about it importantly philosophy in the age of discoveries scientific discoveries pills poly pills genetic discoveries DNA interventions right philosophy can offer something to solve our grotesque health problems in the world it can clarify the true nature of the problem and the causes and it can also transform what we thought was a problem of nature or bad behavior into central questions about social justice so as we keep giving things to people that need them we need to go beyond the things to thinking about their abilities to be healthy if we can do that I think we can make a dramatic difference in the health issues of today in fact whenever we do that we make significant sustained effects and results the human right to the capability to be healthy it's my emerging idea thank you

5 Comments

  1. This is an excellent context with illustrations for Health Care for All on our world.

  2. A right to health care could improve public health.

  3. There was absolutely no substance to what he said. Everyone wants to bring safety and security in all things to all people. The fact that it hasn’t happened is not because people are “self interested”. Next time try offering solutions.

  4. Powerful idea!

  5. It is not a human right to be healthy! If it was, the state would have to force abortion on my mother when being pregnant with my brother and sister, because they were born unhealthy. So it can't be a human right, and if you make it a human right, the state would have to kill every unborn unhealthy child. Rights of the people are duties of the state…
    WTF happend to TEDx anyways?? Used to be very interesting and diverse, but now you only put on speakers that are well schooled in Marxist theories…

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