Ethics and human rights as a framework for tackling socially determined health inequities

Human rights provide a useful framework for efforts to identify and respond directly to the underlying determinants of health, i.e. the “conditions in which people can be healthy”.

The General Comment on the Human Right to Health published in 2000 by the UN Committee on Economic, Social and Cultural Rights explains this by stating that the right to health must be interpreted broadly to embrace key health determinants, including (but not limited to) “food and nutrition, housing, access to safe and potable water and adequate sanitation, safe and healthy working conditions, and a healthy environment.” The General Comment echoes WHO’s Constitution and the 1978 Declaration of Alma-Ata in asserting governments’ responsibility to address social and environmental determinants in order to fulfil citizens’ rights to the highest attainable standard of health.

A human rights-based approach to addressing the social determinants of health means supporting the collective action of disadvantaged groups to analyse, resist and change social structures and policies, assert their shared power and alter social hierarchies towards greater equity. A human rights-based approach argues that the primary responsibility for protecting and enhancing health equity rests with national governments. When inequalities arise systematically as a consequence of individuals’ social positions, governance has failed in one of its prime responsibilities, i.e., ensuring fair access to basic goods and opportunities that condition people’s freedom to choose the life they value.

These human rights arguments are important for policy-makers and advocates: “A human rights perspective removes actions to relieve poverty and ensure equity from the voluntary realm of charity… to the domain of law” .