Tuesday, October 14, 2008

Health is structured by poverty

Here are a couple of great posts over at the Health Care Blog about poverty being one of the largest determinants of the long term health of children as well as adults. Maggie Mahar discusses a new report from the Robert Wood Johnson Foundation titled, “America’s Health Starts With Healthy Children: How Do States Compare?” See the posts here and here. Money quote:
“Most of our efforts to improve health have focused on improving quality, access to and affordability of care. While these are important, support for better health that is associated with resources and community matters as well,” says Commission Co-Chair Mark McClellan. “As a nation, we clearly need to do better…a large body of research shows that the causes [of poor health among children] are complex,” the report observes, “and that medical care interventions are important but not sufficient.”
Equitable access to nutritious foods, high quality education, and clean, sanitary living conditions are just as important as access to high quality medical care. Here are her suggestions:
  • "We should explore ways to provide jobs that pay a living wage to less-educated workers. For example, in these tough economic times, the government might invest in rebuilding our infrastructure—an investment that also would create jobs.
  • Investments in safe playgrounds and subsidies for green-markets that locate in poor neighborhoods could help improve quality of life—and the health of children
  • Low-income and middle-income children also need scholarships to help them go to college. In recent years, federal funding has favored financing loans that only more affluent families can afford; at the same time scholarship programs for low-income and median-income children have been cut. This trend should be reversed.
  • Finally, we should find new ways to lift the quality of public education for low-income students. Richard Kahlenberg, a colleague at The Century Foundation, has written extensively about innovative programs doing just that."
This sounds a lot like moving toward social and economic rights for everyone. Why is she still against using rights language?


Maggie Mahar said...

First, thanks very much for
addressing the importance of poverty.

On the question of healthcare as a "right"--I have written that I prefer to talk about healthcare as a moral obligation that we owe to each other in a civilized society.

The language of "rights" tends to look at healthcare from an individual perspective: "I and my family have a Right to heatlhcare."

I prefer to look at it as something that we, as a society, owe to each other--becuase we recognize each other as equals, and equally human This means looking at the problem collectively.

It's not about "me and my family" --it's about "us".

And finally, while I am not at all religous, I think that our "moral obligations" to each other are far more powerful than our individual "rights."

Rights are defined by man-made laws, and can change with changing political times. (For example, the right to bear arms.)

. Moral obligations are defined by "Do unto others as you would have them do unto you" and do not change.

jshaffer said...

Hi Maggie,

Thank you so much for taking a look at my blog! It has been fun to get to learn how to use this platform to discuss the important issue of global health equity and role students can play in the solution.

I completely agree with you that those of us who have benefited directly from the unjust and unfair social order in which we live, have a moral obligation to provide basic life-sustaining services to those less fortunate. But, using the language of "moral obligation" just seems a little flaky to me.

Why do we have rights in the first place? Our Bill of Rights was created based on the realization that individuals cannot guarantee that our collective moral obligations are upheld. They realized that by using the democratic process to write the rights into law - by making our social contract explicit - they were indeed providing the only way that things that we value as essential (aka rights) could be guaranteed.

By refusing to discuss health as a fundamental human right, you are essentially throwing the moral obligation ball into the "individual perspective" court. In our society, unless something is written explicitly as law, individuals can choose how to act. If access to health care is not an explicit right, then I may choose whether or not to subscribe to subjective "morality" of providing health care. That is the beauty of the United States: that we have the freedom to have our own moral tenets. The things that bind us as a society are our laws which hopefully and ideally reflect some kind of collective definition of "right" and "wrong".

Finally, our nation has a strong tradition of individualism and competition. Unfortunately, we lack deep sense of national solidarity, especially with regards to social and economic goods. I think that if our goal is to honestly try to create the most just society, where all people have the ability to live healthfully, it is foolish to rely on the subjective language of moral obligations. Instead, we must adopt rights language to describe health because it is the only pragmatic way, in our society, to make sure that our moral obligations are upheld to one another.