Health and Social Justice

The right to health bears most centrally on a theory of health and social justice. However, it would be difficult to find a right that is more controversial or nebulous. Prevailing frameworks - libertarian, communitarian, equal opportunity and utilitarian perspectives – do not give special moral importance to health or provide theoretical grounding for this right and have left us mired in inaction as regards health and social justice. I present an innovative approach - the health capability paradigm - which offers philosophical justification for a right to health, and considers not just health care, or the right to health alone, but health and the capability for health itself as moral imperatives. The health capability paradigm is grounded in the Aristotelian perspective of human flourishing and Sen's Capability approach. It fills gaps in the interdisciplinary intersection of medical ethics, international relations, human rights law, health policy, and public health law. Key tenets of the paradigm - emphasizing responsibility and choice for health in a theory of social justice - include health agency; shared health governance; incompletely theorized agreements and internalized public moral norms to guide social choice; a joint scientific and deliberative approach to decision-making, incorporating medical necessity, medical appropriateness and shortfall equality. In the absence of a unique view of health, or a right to health, as the basis for evaluating health and social justice, this paradigm provides guidance for relieving shortfall inequalities in the central health capabilities - avoiding premature death and escapable mortality - as efficiently as possible.