Sebastian Laukötter

Sridhar Venkatapuram's Health Justice: A Collection of Critical Essays and A Response from the Author.

Given the increasing wealth of work on issues of global health in bioethics, it is almost surprising that less than a decade ago, it was still possible to accuse the field of a narrow focus on individuals and Western medical care. Individual risk factors and patient behaviours, issues of rationing in national health systems, and the many ethical challenges of bioscientific technology development far outstripped the work done on, for example, the relationship between health and social arrangements, or local and global health inequalities. Also, in debates on global justice, health did not play a prominent role. This has changed; the social determinants of health now play an ever-greater role in public health and bioethics and, increasingly, the immense differences in health and wellbeing between populations are the subject of both global justice discussions and policy initiatives. This is not astonishing: the more we know about the social determinants of health, and particularly about how health intersects with deprivation and poverty, the more the question gains urgency whether such health inequalities (and if so, which), fall under the remit of global justice. In other words, what we owe to each other – locally and globally – in terms of entitlements to health, now sits at the centre of a fast-growing debate. To address such issues needs interdisciplinary work that bridges fields such as social epidemiology, theory of health and health measurement, global justice theory, public health and bioethics, and other related areas – a truly tall order. In addition, to have real world impact, practical guidance for policy-making has to be developed. A systematic and theoretically robust approach must also be applicable within the messy political world of public policy and global health initiatives. In his recent book, Sridhar Venkatapuram has delivered such an account. Health Justice – An Argument from the Capabilities Approach, published late in 2011 (Cambridge: Polity Press), has fast become a classic contribution to this growing field. With an expert eye for the necessary level of detail, the book brings together broad lines of scholarship on the social determinants of health, public health, health sociology and epidemiology. Venkatapuram combines these findings with the influential capabilities approach (CA) of Amartya Sen and Martha Nussbaum, thereby not only extending the CA towards including health, as others have done before, but, with his decidedly global scope, providing a conceptual framework for a theory of global health justice. Importantly, in order to bind the elements of this theory together, he draws on longstanding yet oft-ignored debates on the concepts of disease and health in the philosophy of medicine. The result is a complex and compelling argument for a global entitlement to health. Venkatapuram s argument proceeds in three steps. In contrast to Christopher Boorse s biostatistical theory of health as species-typical functioning, he posits his theory of human health as the capability to be healthy (CH). The CH is a meta-capability to achieve, exercise or express a cluster of basic and inter-related capabilities and functionings (Venkatapuram 2011: 31). In line with Lennart Nordenfelt s normative theory of health as the ability to achieve vital goals, he integrates this with Martha Nussbaum s account of central human capabilities, to give content to Nordenfelt s vital goals. Venkatapuram firmly rejects the biostatistical model of health causation and distribution. Considering a very wide set of causal influences on health and well-being, with a

Humanity and Justice in Global Health: Problems with Venkatapuram's Justification of the Global Health Duty

One of the most ambitious and sophisticated recent approaches to provide a theory of global health justice is Sridhar Venkatapurams recent work. In this commentary, we first outline the core idea of Venkatapurams approach to global health justice. We then argue that one of the most important elements of the account, Venkatapurams basis of global health duties, is either too weak or assumed implicitly without a robust justification. The more explicit grounding of the duty to protect and promote health capabilities is based on Martha Nussbaums version of the capability approach. We argue that this foundation gives rise to humanitarian duties rather than duties of justice proper. Venkatapurams second argument from the social determinants of health thesis is instead a stronger candidate for grounding duties of justice. However, as a justificatory argument, it is only alluded to and has not yet been spelled out sufficiently. We offer plausible justificatory steps to fill this gap and draw some implications for global health action. We believe this both strengthens Venkatapurams approach and serves to broaden the basis for future action in the area of global health.

Moral und Gerechtigkeit

Abstract The article shows that an ethics of distant emergencies can justify duties of assistance under recourse to reasons of humanitarian morals as well as corrective justice. After providing a notion of severe emergencies, I argue that such duties of assistance have global scope. But a comprehensive conception of duties of assistance could be understood neither as a conception of moral duties of assistance alone nor as a mere conception of duties of corrective justice. It rather has to combine duties of humanitarian morals and corrective justice to cover all cases of severe emergencies. Three principles to specify responsibilities resulting from such duties of assistance for different cases of emergency are suggested.

Geschichte der Menschenrechte

Die Suche nach einem Aquivalent neuzeitlicher Menschenrechte in der griechisch-romischen Antike wirkt zunachst wie ein Anachronismus. Weder existierte im Altertum ein prazises Aquivalent fur den Ausdruck ›Menschenrechte‹, noch gibt es einschlagige theoretische Reflexionen bei einem der Philosophen, noch finden wir eine politisch-soziale Bewegung, die sich der Idee der Menschenrechte verschrieben hatte. So wurde etwa ein Abolitionismus, also die Forderung nach grundsatzlicher Abschaffung der Sklaverei, in der Antike weder philosophisch noch politisch je vertreten, nicht einmal von aufstandischen Sklaven (Welwei 2005, 81). Menschenrechtskataloge liegen uns aus dem Altertum weder im Sinn von Abwehrrechten gegen den Staat vor noch von politischen Teilnahmerechten noch von Sozialrechten. Immerhin lasst sich eine Belegstelle bei Marcus Tullius Cicero angeben, die unserem Ausdruck ›Menschenrechte‹ bemerkenswert nahe zu kommen scheint.