Social justice and human rights as a framework for ...

1 Social justice and human rights as a framework for addressing Social determinants of health Final report of the Task group on Equity, Equality and human rights Review of Social determinants of health and the health divide in the WHO European Region Karien Stronks Brigit Toebes Aart Hendriks Umar Ikram Sridhar Venkatapuram Social justice and human rights as a framework for addressing Social determinants of health Final report of the Task group on Equity, Equality and human rights Review of Social determinants of health and the health divide in the WHO European Region Karien Stronks Professor of Social Medicine, Department of Public Health, Academic Medical Centre, University of Amsterdam, Netherlands Brigit Toebes Associate Professor of International Law, University of Groningen, Netherlands Aart Hendriks Professor of Health Law, Leiden University/ Leiden Medical Centre, Netherlands Umar Ikram PhD student, Department of Public Health, Academic Medical Centre, University of Amsterdam, Netherlands Sridhar Venkatapuram Wellcome Trust Fellow (Ethics), London School of Hygiene & Tropical Medicine and Affiliated Lecturer, Cambridge University, United KingdomAddress requests about publications of the WHO Regional Office for Europe to.

2 Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen DenmarkAlternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website ( ). World Health Organization 2016 Please note that the recommendations contained within this report are not recommendations by WHO but rather represent external expert rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

3 Dotted lines on maps represent approximate border lines for which there may not yet be full mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader.

4 In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health editing: David BreuerBook design and cover design: Christophe LANOUXP hoto credits: World Health Organization Contents Acknowledgements ..4 Glossary ..5 Conclusions and recommendations ..6 Executive summary ..101 introduction ..122 The injustice of health inequalities ..15 introduction .. 15 Health equity as part of a broader theory of egalitarian justice ..16 Conflicts with other societal aims ..20 Conclusions .. 233 The role of human rights law in addressing Social determinants of health.

5 25 introduction .. 25 What are human rights ? .. 26 Health and human rights : a general introduction ..27 The conceptual link between human rights and Social determinants of health inequalities .. 33 Analysing the framework of the right to health and the other health-related rights .. 33 Linking the rights framework with the goals of the Commission on Social Determinants of Health .. 39 Conclusions and challenges .. 424 Implementation of human rights approach in the context of health inequalities: 15 case studies ..44 introduction .. 44 Accountability mechanisms and case Judicial accountability .. 47 Quasi-judicial accountability .. 51 Administrative accountability.

6 53 Political accountability .. 55 Social accountability .. 59 Discussion .. 615 Conclusions ..64 References ..654 AcknowledgementsBased on academic arguments, this report develops an ethical and human rights framework that can serve as a basis for developing policies to address Social determinants of health. It has been produced by members of the cross-cutting Task Group on Equity, Equality and human rights and invited external reviewers as part of the European review of Social determinants of health and the health divide commissioned to Michael Marmot by the WHO Regional Offi ce for refl ects the fi ndings of an interdisciplinary research group, consisting of researchers from both public health and law.

7 A major obstacle in this research has been to overcome differences between these two disciplines, especially for human rights . We strongly feel that such differences, which could lead to misunderstandings, can only be overcome through collaboration and cross-fertilization to enhance the mutual understandings of our frameworks and tools. To ease the reading of this report, and to avoid confusion about the various interdisciplinary terms used in this report we have inserted a glossary of main text has been written by Karien Stronks (Professor of Social Medicine, Department of Public Health, Academic Medical Centre, University of Amsterdam, Netherlands) (all chapters), Brigit Toebes (Associate Professor of International Law, University of Groningen, Netherlands) (Chapters 3 and 4), Aart Hendriks (Professor of Health Law, Leiden University/Leiden Medical Centre, Netherlands) (Chapter 3), Umar Ikram (PhD student, Department of Public Health, Academic Medical Centre, University of Amsterdam, Netherlands) (Chapter 4)

8 And Sridhar Venkatapuram (Wellcome Trust Fellow (Ethics), London School of Hygiene & Tropical Medicine and Affi liated Lecturer, Cambridge University, United Kingdom) (Chapters 1 and 2). We are grateful to the following people critically reviewing earlier drafts of the main text: Audrey Chapman (University of Connecticut, USA), Mari l Droomers (Academic Medical Center Amsterdam, Netherlands), Paul Hunt (University of Essex, United Kingdom), David Ingleby (University of Utrecht, Netherlands), Jacques van der Klink (Tilburg University, Netherlands), Ron Labonte (Institute of Population Health, Ontario, Canada), Maria Stuttaford (University of Warwick, United Kingdom) and Suzanne van de Vathorst (Erasmus Medical Center, Rotterdam, Netherlands).

9 In addition, we thank Ruth Bell and Peter Goldblatt (Institute of Health Equity, University College London) and Johanna Hanefeld and Sarah Simpson (WHO) for continual support. Finally, we are grateful to the external reviewers, Sofi a Gruskin (Harvard University, USA) and Marcel Verweij (Wageningen University, Netherlands), who critically reviewed a draft of the the selection and description of case studies (Chapter 4), we thank: Henry Asher (Nordic School of Public Health, Gothenburg, Sweden), Alain Brillon (Alcohol Treatment Unit, Amiens University Hospital, France), Jonathan Cohen and Tamar Ezer (Open Society Foundations, New York, NY, United States), Fons Coomans (University of Maastricht, the Netherlands), Rhonda Ferguson (University of Galway, Ireland), Pim Fischer (Fischer Advocaten, Haarlem, Netherlands), Jernej Letnar (Faculty of Law, Slovenia), Roddy MacTaggart (Aberdeen City Council, United Kingdom), Claire Methven O Brien (Danish Institute for human rights , Copenhagen, Denmark), Jurga Poskeviciute (I Can Live Coalition, Lithuania), Claudio Schuften (People s Health Movement, Viet Nam)

10 , Maria Stuttaford (University of Warwick, United Kingdom) and Simone Wijte (Utrecht University, Netherlands).As the Task Group chair, I thank all participants for their collaboration. In addition, the Task Group is grateful to the WHO Regional Offi ce for Europe and the Institute of Health Equity of the University College London for supporting this StronksTask Group Chair5 GlossaryAvailability, accessibility, acceptability and qualityAccountability CapabilityCapability to be healthyCore obligationsFree choiceHealth inequalitiesHealth inequities human rightsHuman rights approachHuman rights lawHuman rights mechanisms human rights obligationsLibertarian paternalismNon-discrimination Positive freedom Public health Respect, protect.