You previously purchased this article through ReadCube. Institutional Login. Log in to Wiley Online Library. Purchase Instant Access. View Preview. Learn more Check out. Citing Literature.
- On Your Mark, Get Set, Laugh! #13 (Katie Kazoo, Switcheroo).
- Global Health & Social Justice MSc at King's.
- Jennifer Prah Ruger.
Volume 18 , Issue 2 Pages Related Information. Close Figure Viewer. Browse All Figures Return to Figure. Previous Figure Next Figure. Email or Customer ID. Furthermore, according to Venkatapuram 1 , all areas of public health assume social justice, even if that is not made explicit. The problem identified by Venkatapuram consists of the lack of theoretical development of the notion of health justice in the discipline of public health. According to him, this situation has serious consequences for public health praxis because the failure to consider social justice can lead to a proliferation of orientations and actions that perpetuate conditions of injustice.
The object of this study is to promote thinking about social justice in the area of public health to contribute both to the theoretical development of the discipline and to the preparation of proposals for action consistent with building a more just society as a necessary condition for advancing the health of both individuals and groups. To do this, I will defend the following theses:. Theorizing public health from the perspective of social justice means understanding health as life beyond that of the individual human being and, in the case of human life, as "intersected" by human flourishing.
Public health and the social justice mainstream have rendered the concrete subject invisible to the degree that public health and social justice are based on dichotomous visions of reality, assume an uprooted subject, and are located in rational frameworks unaware of feelings. This situation has an impact on the development of a public health praxis that is committed to social justice and health understood as life and human flourishing. To limit thinking on social justice, human rights, and equity to the field of public policies, health systems, and the role of the State constitutes a reductionism of public health; thus, defining what is public about public health is a part of the struggle for social justice.
Assuming a public health praxis based on a theoretical proposition of social justice that does not render the concrete subject invisible, and a consequent conception of health based on life and human flourishing means a profound change in what we consider as the goal of public health, our criteria for setting priorities, and how to take action. The argument that I will present is composed of three major categories of analysis. The first is an epistemological reflection that addresses the topics of reality, reason, and especially, the relationship between subject and society.
The second analyzes some components of justice, ethics, and morality. The third reflects on the concept of health.
Health Care Reform, Health, and Social Justice
Finally, I will take the growth and development monitoring program in children as an example to analyze the consequences of assuming a justice perspective that does not render the subject invisible with regard to public health praxis. According to Rawls, social justice refers to the way in which great social institutions distribute fundamental rights and responsibilities, and determine the division of the advantages stemming from social cooperation; institutions favor certain initial positions over others 2 , which generates deep inequalities and "affects humans in their initial opportunities in life" 2.
Marxists prioritize considering how the conditions of production are distributed from a structural perspective that analyzes property and control over the means of production, that is, the hierarchy of power and exploitation 3. The social justice discussion depends on recognizing the oppression that some human groups and subjects impose upon "others" who are subordinated by conditions of, inter alia, social class, race, ethnicity, gender, sexual preferences, knowledge, and social position.
It is important to emphasize a particularly important manner in which domination is exercised: symbolic control.
According to Bourdieu and Passeron 4 , dominant groups impose their way of seeing the world subjectivities, meanings, and legitimate values, that is, their culture to maintain social order. Symbolic control is performed not only through the use of mass media but also through formal and informal education, such as that provided in the health sector - the latter legitimated by biomedical scientific discourse that regards popular knowledge as a series of cultural beliefs and ties. We need to draw on Foucault's 5 approach to power to understand it as networks of relationships that are organized, hierarchized, and coordinated beyond the repressive and legal level, linked to ways of knowing, disciplinary techniques, and economic relationships that also involve processes of resistance.
This concept of power is required to analyze the relations that take place at the clinic, in public health programs, and in research in the health field. It is also true that the manner in which a more just and equitable society is understood varies depending on historical, sociocultural, economic, and political conditions.
What we understand as just is related to our values and therefore is a moral matter. I understand morality as a series of self-imposed, binding norms and values in the form of obligations or prohibitions, which deserve general recognition and call on the community of acting subjects. I understand ethics as thinking about morality, that is, the analysis of the conditions under which norms and moral values are both imperative and binding 6.
Thus, justice has been a topic of constant debate. Below, I present some theoretical elements from the debate about justice that are needed for the discussion that I hope to conduct. I will begin with Rawls' critique of utilitarianism and of radical liberals such as Nozick and Hayec. Maximization of well being at the cost of some persons and groups constitutes a form of instrumentalizing them and thus would contradict the Kantian concept of dignity.
In response, the American philosopher proposes access to a sufficient level of primary goods - rights, liberties, income, and the social basis of self-respect. This constitutes a proposal for distributive justice based on just procedures that would characterize a fair and well-ordered society. Sen, in asking "what kind of equality? Disabled individuals may need more assistance and support to fulfill their necessities and aspirations.
This concept is related to the maxim popularized by Marx 8 "from each according to his abilities, to each according to his needs". The focus should not be on goods but instead on persons, on the particular subject 9 , 10 , and should guarantee equality of abilities, understood as opportunities or freedoms that require development, not only of certain skills or human functions, but also of goods. Nussbaum proposes ten basic capabilities based on what a life with human dignity would mean 10 , which together amount to a basic fundamental human right to human development.
This list of capabilities is commensurate with the proposal for human development presented by Max Neef et al.
The individual, social justice and public health
Along this line, Honneth argues that justice is not a matter of goods distribution but instead the recognition of dignity for all Symbolic struggles for legitimacy and struggles for distribution are essentially struggles for recognition. According to Benhabib, mainstream theories of justice have caused the concrete subject to become invisible The Kantian vision of a universalist justice is based on an ahistorical subject without sociocultural roots, a universal subject: a subject who is adult, white, male, healthy, and autonomous.
The veil of ignorance, the theoretical experiment upon which the impartial justice of Rawls is based, assumes a subject who is without gender, social class, race, age, health status, abilities, aspirations, and subjectivities. It is a subject like me, deracinated, who loses his identity: it is the generalized other of which Mead speaks In contrast to this generalized other, it is necessary to recognize a concrete other, who has a concrete history, identity, and affective-emotional makeup.
This subject is different from me and has specific needs, motivations, and abilities. I recognize the other in confirming both his humanity and his individuality, and thus, I recognize his alterity in moral experience, which requires the construction of a shared vision This corresponds to a concept of the human being as dependent and fragile, that is, heteronomous. According to Levinas 14 , autonomy as an ideal that guides human morality is only possible precisely due to the heteronomous condition of the human being.
In Kantian universalist morality, moral judgment is rational and unconditioned, and it does not consider either consequences or interests. In addition, it of course does not account for feelings. This morality fits well within a contractualist concept of the State that assumes a rational and calculating human being.
These moralities are strongly criticized by feminism, which reasserts moral judgments conditioned by caring relationships and which considers the results of moral action, as suggested by Gilligan This is a morality of care for the other, like that which guides child rearing, or care for nature, of which I am part and which is incumbent upon me beyond my own benefit or fulfillment of duty. Benhabib thus demonstrates a problem within these universalist morals: dualistic reasoning that separates justice from the good life as antagonists; the public sphere of justice historical from the private sphere of the home, the family, care, and intimacy ahistorical ; the law from reasons underlying natural inclinations; the brilliance of knowledge from the obscurity of the emotions; autonomy from child rearing; independence from the bond; and the sovereignty of the self from relationships with others These moralities exclude from public life the relationship with the cosmos, the intimate domestic family circle, child rearing, relations of kinship and friendship, love, and sex.
Overcoming this dualistic reasoning requires, according to Benhabib, assuming universalism as a regulative ideal that does not deny our materialized and rooted identity The "general good" would thus be an organizing ideal and not a point of departure. This is a reasoning crisscrossed by conflicts and tensions to the degree that one recognizes the impossibility of obtaining ideal consensus.
Furthermore, one will always need to confront the disjuncture between the social validity of norms and normative institutional arrangements as seen from a local perspective and its hypothetical validity with respect to criteria of justice, equity, or impartiality from a universal perspective. This idea thus corresponds to a process of moral and political struggle that assumes a justice supported by morality rather than legality as the basis for defending human rights. This justice subverts the duality between the ethics of justice and law with an ethics of care and responsibility.
It is configured in the framework of a morality of interaction based on a debate that exposes all of its supporting assumptions to criticism. From a critical perspective, this justice recognizes that politics cannot be neutral and avoid moral constraints; in this series of ideas, the conceptions of being, reason, society, ethics, and politics are inseparable. Finally, Benhabib notes that determining that which is in the public sphere is always a struggle for justice.