The weight of social determinants in the right to health
Summary
On World Day of Social Justice, celebrated on February 20, it is essential to remember the importance of the social determinants of health on people's basic rights. Access to universal healthcare is not enough.
In this pandemic, social inequalities have resurfaced more than ever: those who suffer the greatest social inequality are the ones who are least able to protect themselves and take care of their health.
According to the World Health Organization (WHO), the social determinants of health are the circumstances in which people are born, live, work, and age, including the broader set of forces and systems that influence the conditions of daily life. These systems include the health system.
These circumstances are a result of the distribution of money, power, and resources, which in turn depend on the policies adopted.
In this COVID-19 pandemic, this is an aspect that has taken on great relevance since those who suffer greater social inequality are the ones who are least able to protect themselves and take care of their health.
José Leal Rubio
The social determinants of people's health include factors such as work, social support, access to decent housing, income availability, education, and coverage of basic needs.
These factors explain why the groups with the greatest social inequality are also those with the greatest health inequality.
For the right to health to be fully exercised, there must be equity in the social determinants of the population.
Therefore, universal access to the healthcare system is not enough to guarantee the right to health. Social determinants are key to the enjoyment of this right.
The right to a dignified life
Jeremy Waldron (1991), in his conception of the right to be, delves into one of the most important social determinants for guaranteeing the right to health: the right to a place, a home. He argues that vital human functions are situated; they require a place to be carried out. If these functions cannot find a place to be performed due to external impediments, then the individual is simply being denied the opportunity to live.
Jonathan Wolff (2013) also advocates for health as a human right. For him, any theory of justice inevitably faces the need to define who has the duties of distributive justice. According to Wolff, the language of rights aims to transform unjust realities beyond simply assisting victims. Rights do not merely address people's basic needs; they also grant victims a legitimate claim against the power that oppresses them—that is, the right to demand justice , to link their unmet needs to a violation of their fundamental freedoms and opportunities.
In recent years, we have witnessed cuts in public spending on social services, the healthcare system, and equality policies, among other sectors. The right to health exists, but not all states recognize it in a meaningful way.
Organizations such as the Food and Agriculture Organization of the United Nations (FAO) or the WHO should be strengthened and given more resources and powers so that they can guarantee food and health services worldwide.
Without legal recognition of social rights, we can hardly overcome this barrier that condemns millions of people in the world to poverty, disease, and death.
The COVID-19 pandemic has highlighted the protective role of social factors in health. The most vulnerable people will be the least able to cope with the health and social crisis if robust social policies are not established, and will therefore suffer the greatest negative impact on their health.
Living on the street or in substandard housing is preventing many people from taking care of their health in adequate conditions; according to the latest census by Arrels Fundació in November 2020, 22% of the people interviewed had not been homeless before and they spent the toughest months of confinement on the streets (without access to water, without being able to enter toilets, with public services closed, etc.).
The right to health also implies the subjective right to dignified living conditions. Therefore, if the social determinants of health cannot be addressed, the right to health cannot be demanded either. Without social justice there are no social rights, and vice versa.
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