Global health care justice: the demands of the basic right to health

Every year approximately 18 million people, largely among the world’s poorest, die of preventable or treatable diseases like tuberculosis and malaria. They die because, unlike their wealthier counterparts, they lack access to even basic medicines.

Justice theorist Henry Shue has argued that if we are to have rights to anything, we must first have rights to three categories of ‘basic rights’, which are necessary for the enjoyment of all other rights. These basic rights to security, subsistence, and liberty, Shue argues, are the absolute minimum morally acceptable set of entitlements owed to all persons: ‘they specify the line beneath which no one is to be allowed to sink’. For example, the right to security is basic because in its absence, violence can be used to prevent right holders from enjoying any other rights. One cannot enjoy a right to education or anything else, Shue argues, if violence can be used to deprive you of the goods to which you are entitled.

Disease and injury are not discussed in any depth by Shue, yet can restrict liberty as effectively as imprisonment; harm, like assault or murder; starve as efficiently as famine, and render the enjoyment of other rights impossible. Therefore, without guaranteed access to at least basic health care services, our ability to enjoy any other goods or to have even a minimally decent life is tenuous at best.

Where Shue does not argue for a basic right to health care, my research provides a justification for this important right and analyses its requirements. In this research, I argue that deprivations of health, which are caused by conditions that we can prevent or treat (like those mentioned in the opening paragraph), are not merely unfortunate or tragic, but are matters of injustice.

Establishing the precise demands of a basic right to health care is extremely complex, not least because rights to health care are by no means universally accepted. Some dispute the existence of any rights to health care, for example, while others fail to acknowledge what those rights require. Another of the more common objections to health care rights is that they are too expensive, or impose duties which are impossible to fulfil.

While guaranteeing perfect health for everyone is beyond our current medical capability, a right to health care would not necessarily demand such a lofty goal. However, providing protection against the most common and harmful threats is achievable at relatively low cost. As such, while it may be very difficult to establish precise boundaries of a right to health care, or to define exactly what duties are owed by which persons; it is reasonable to suggest that when we are able to prevent the deaths of millions of people at relatively little cost, we have an obligation to do so.

Peter West-Oram
Doctoral Researcher, Department of Philosophy, University of Birmingham