Options for Providing Justice and Guarding the Rights of the Marginalized in Health Policy - Essay Example

 Options for Providing Justice and Guarding the Rights of the Marginalised in Health Policy. Introduction: World Health Organization (WHO) is the most influential organization working within United Nations. Its main objective is to improve the living conditions and environment of the people by providing practical support to countries, witnessing, and monitoring health projects (WHO, 2011). World Health Organization established a Commission on Social Determinants of Health (CSDH) in 2005 to study the cause for health inequalities, and ways to overcome them. The commission published its report in 2008 named “Closing the gap in a generation: Health equity through action on the social determinants of health”. This report also thoroughly explained the recommendations and analysis of the policy on health equity (CSDH, 2011). The report is in three parts; the first part of the report is a debate about the social determinants of health and health equity. According to the first part, poor health of the poor, the health disparities between the people and countries are due to the inadequate distribution of authority. However, income, goods, and facilities both nationally and globally also affect health and health equity. The inadequate distribution of health resources is not a natural phenomenon; it is the result of deadly mixture of poor social strategies with biased economic activities and corrupt politics. Second part of the report points out a new developmental approach. In that approach, health equity holds a fundamental place in all social policies while the principal significance given to economic growth policy. It is impossible to achieve growth without proper social policies because equal distribution of goods, services, power and income brings rational fairness of benefits among all modes of life. However, there is little allocation of health equity benefits where the poor are left out in health equity. The third part of the report is about closing the gap between the generations by providing pleasant surroundings in which people grow and live, and properly tackling the unbalanced supply of money, supremacy, and resources. The last recommendation of the report sheds light on measuring and understanding the problem and evaluating the effect of action (CSDH, 2008). The Adelaide statement on health: The Adelaide statement evolved after the United Nations Summit held a discussion on developing goals that relate to the well-being of the society, in April 2010. It is now a portion of a global procedure to improve and support the approach established on equity, and a number of countries have adopted this approach. It embarks on a serious discussion and now the members of World Health Organization (WHO) are part of it. It also engages leaders and lawmakers at various governmental levels such as regional and national. The Adelaide statement summarises the necessity for a fresh social bond among all the segments to progress in human improvement, sustainability, and fairness. The statement delivers appreciated contribution to the World Conference on Social Determinants of Health in Brazil, the eighth Global Conference on Health Promotion in Finland-2013 and planning for the Millennium Development Goals (MDGs) post-2015 (The Adelaide statement on health in all polices, 2010). This involves a different practice of governance that consists of a mixture of guidance within governments, through all sectors, and amongst all levels of government. The statement highlights the influence of health sector in solving intricate problems across the government. It also aims to improve health outcomes, advance human development by creating a new social network between all sectors, and improving on equity and sustainability in health (Oxford University Press, 2011). The report says that good health improves the value of life, develops workforce productivity; escalate the capacity for learning, supports families and communities. It also contributes to safety, decline in poverty, and social inclusion. For this purpose, governments can develop policy making by evolving calculated plans that have mutual goals, assimilated replies, and improve accountability through government divisions. This involves cooperation within the public and private sectors. The “Health in All Policies” approach supports the leaders and plan makers to assimilate contemplations of equity, welfare, and health throughout the improvement, implementation, and assessment of strategies and services. Social justice and human rights Life and death depends on social justice and human rights. Forces in the political, social and economic arena significantly influence the conditions in which people live and die. The conditions in which a child is born can determine if the child lives a flourishing life or he grows to his full potential. This is especially with the social and economic policies that the society in which the child grows implements (WHO, 2011). It affects people’s lifestyles, their subsequent risks of illness, and the danger to premature death. The social justice practiced in a given country means that basic needs such as shelter, food, clothing and appropriate medical care must be offered to all citizens. There should be no discrimination in the distribution of resources and all citizens should have access to all the resources without discriminating or criticizing the citizens who make poor choices (Haughton and Khandker 2009). Social justice, therefore, determines the life expectancies of individuals in a given country. Research has shown that prospects of life and dependable health increases tremendously in some developed countries and decreases constantly in developing countries. Globally, there are obvious inequalities in areas such as employment, taxation, gender, income, class, race and ethnicity (Waters and Devine, 2004). Countries that lack the basic social facilities such as decent living conditions, clean sanitation and appropriate medical care have lower life expectancies and poor health conditions. For example, a girl in a developed country will live up to 85 years while one in an underdeveloped country lives less than 45 years (CSDH, 2008). This explains the discrepancies in the social justice systems practiced in these countries. Global Health inequity and governance The WHO report shows that the poor and less privileged in the society are the marginalised people in terms of health equity. Health is the biggest challenge to global governance in terms of giving rights and justice to the people. Development in the health sector is necessary in order to make it equitable and universal. Some of the developments include making provisions of health insurance coverage for different households that are at a poor level. In addition, the health sector can undergo development by availing financial support for the health programs (Asian Development Bank, 2011). Ultimately, the report elucidates that the low-income countries require financial boosts in the health-care system to improve the health sector. Moreover, the report also recommends investing in recruitment and training of health workers may improve the health care sector in the various countries with health inequities. However, various health workers opt to migrate to better paying countries; hence, the report calls for better payment of the newly recruited and trained health staff. Social, political and economic forces profoundly influence health equity. Unequal distribution of income, power, goods and services contributes to the poor health of the underprivileged in the society. The poor cannot access decent health facilities, schools, homes, and social facilities. Concurrently, there is the lack of adequate, trained personnel at the health facilities; thus, the people are in denial of proper health care. On the other hand, lack of financial support in the health sector deprives people quality services and commodities such as medicines. This exposes them to health risks and diseases. Commercialization of the health sector by the high and mighty in the society has led to health inequity (CDSH, 2008). Gender inequity is another contributing factor to health inequity. Improving the well-being of girls and women is necessary to improve global equity. Provision of decent places to give birth, improve on the living and working conditions, emphasize on early child development and offer health education to all can facilitate gender equity. Creation of social protection policy and favourable conditions in older life is also necessary. Emphasis on equity in norms, values, property and power is also crucial since they contribute immensely to the health of individuals. The WHO report aims at implementing ways in which to bring about health equity. These include ways such as developing equitable ways of providing regional fair-share housing programmes, fair distribution of tax credits to provide social amenities like schools, hospitals and commercial centres (WHO, 2008). It is crucial to address inequalities between men and women due to the organization of the society. Daily living conditions also have a significant impact on health equity. There is a need for quality housing with clean drinking water, sanitation and electricity facilities, and properly built roads. Growing children need safe and healthy living environments in order to lead a healthy, disease-free life. All these factors lead to the establishment of well-developed places where healthy people live. Provision of quality health care and preschool education program for children will promote the well- being of the children, disease prevention, survival and illness recovery. In order to achieve such a healthy living condition, the government and global societies need proper planning and design (Bauknecht and Kemp (eds). Upgrading of slum dwellings, provision of affordable urban housing, water and sanitation services, electricity and paved streets for all households are part of proper planning and design strategies. In order to curb these inequities, provision of health care is necessary for the poor since they need it the most. It is necessary to incorporate the marginalised in health care into the health care system, and appropriate health services offered to them. Implementation of appropriate social policies is vital in order to distribute the health care resources equally. The condition in which people, live, work, born and bred should improve in order to ease the burden of illness. The government, civil society, local communities and international agencies should be part of the implementation program. Global governance is a system made up of political interactions that address problems that affect more than one region. Such problems include gender inequities. The CDSH claims that a strong, committed, and adequately financed government backed up by a capable private sector is necessary for effective changes (CDSH, 2008). The United Nations developed an approach to human development. This is the right-based approach to development. Development is as a procedure that the state community maintains by building domestic bodies that produce capital for the whole population, and decrease poverty, and vulnerability of the weakest section of the people. The prevailing problems in the society, whether related to health, gender discrimination, or improper living conditions, rights-based approach provides solutions to such problems. Some of these solutions include a country providing better health facilities that are accessible even by the poor. In relation to gender discrimination, the governments should provide equal opportunities to both men and women in all sectors such as education and health. United Nation defined the right-based approach to development as a theoretical outline for the procedure of human development, constructed on global human rights principles and focused at stimulating and shielding human rights (UNDP, 2006). Right-based approach to development bases its practices on the importance to the method as well as the results. It ensures the home-grown ownership of the improvement processes by providing support for the accountability of all the performers (UNDP, 2006). World Health Organization has a role to play in adept governance development. In recent years, development cooperation practices have gone through significant changes. Local and international parties fuel cooperation and development (Patrick, Els & Wanyama, 2005). For attaining sustainable development, governance can constitute different types of concepts. One concept is reflexive governance, which depicts an open system. While another concept is multi-level governance, which presents a system grouped into levels with each level having a leader. Reflexive governance addresses the level of difficultly in determining societal improvement in the light of reflexive developed strategies and thus poses questions to the foundation itself. These questions are about the ideas, performance and establishment of structure that governs societal improvement and development (Voss & Kemp, 2006). This governance focuses on the marginalised people in the community and the problems that they are facing. It incorporates an open system of problem- solving strategy. This system is of little benefit to the marginalised since it does not integrate them in the processes of decision- making, which could result in inequity of distribution of health care resources. The lowly people in the society do not have their problems addressed accordingly because they lack a close political figure to address their problems. The open system does not have a representative to whom they can convey their problems; thus, the top figures in the government are not aware of the predicaments of the marginalised. This way, their problems are not addressed since they are not presented to the government. The system could be of benefit to the marginalised by reducing complexity of governance. This could be achieved by appointing a representative of the people who can convey the problems to the top figures in government for their problems to be solved. This way, they be allocated resources that help them to solve their problems. However, WHO has adopted multi-level governance concept for development. The multilateral system ensures that all countries, regardless of their economic status, receive an equal share of the resources (Gurría 2011). It draws concepts from political science sub-disciplines that contribute to creating awareness regarding numerous contemporary matters and problems requiring analysis that transcends the conventionally distinct boundaries. All countries are part of the decision-making process regarding health equity where all people have access to conditions that promote health. The main value of this concept is that it gives understanding of complexity at and between hierarchies within the multilevel governance. It helps to understand the significance between the relationships of state-owned and non-state actors, and new arrangements for public-private partnerships (Stubbs, 2005). WHO surpasses the conventional boundaries of domestic and international politics, and highlights the problems related to health. It follows multi-level governance and focuses on globalization, as mentioned in the report, ‘Closing gap between a generation’. Challenges of Good Global Governance Good governance constitutes characteristics like accountability, participation, responsiveness, equitable and inclusive, transparency, effectiveness and efficiency and follows the rule of the law in the management of public affairs. It is the process of decision-making and implementation. The international community should commit to a multilateral form of governance where all countries and all people regardless of their class and background engage with an equitable voice. Coherent health equity is only possible if such a system of governance is adopted since it places fairness at the heart of development and genuine equality in decision-making (WHO, 2010). If society failed in achieving these characteristics, the goal of good governance would not be achievable (UNESCAP, 2011). Participation in governance is the backbone of sound governance. Its role in the provision of justice and guarding of human rights of the marginalised people is vital. All the members of a community should participate in the decision-making process so that their concerns considered. This is especially the most vulnerable and marginalised in the community. Through participation, the marginalised get to express their concerns and their views aired. This way, they get an equitable share of resources. The marginalised could also appoint representatives or intermediate institutions to fight for their rights. This is not an effective way of providing justice and guarding the rights because their concerns are not fully and appropriately represented in the system. This could lead to denial of justice and deprivation of their human rights. However, there are barriers that create hurdles in reaching the purpose of good global governance and depriving the poor of their rights. Some of the barriers are discussed below. Poverty is one of the challenges. By definition, it is “definite scarcity in well-being”. The orthodox view connects well-being mainly to possession of commodities, so the people in the poor category are those who do not have sufficient income or resources to place them above some adequate threshold. This interpretation of poverty is in monetary terms (Haughton & Khandker, 2009). The quality of governance is critical to poverty reduction. The poor appreciate the efficient provision of the basic life requirements of life; therefore, weak governance harms them excessively (Poverty Reduction in ADB). It is the expectation of many that both the State governments and the politicians actively involve themselves in the improvement of public welfares, but this is not the case. The political figures do not have any respective duties and they do not even know the rules and regulations that govern their respective department or organization (Beck, 2006). This negligence leads to the poor management. Poor or inept management in the public sector is also a hurdle to achieve good global governance. Cost management is the key challenge the public sector is facing. In the public sector, the structure and behaviour of the organization is the barrier in managing project cost. Public sector schemes face restrictions due to public law and administrative rule. Those cost restrictions can be a limit to the budget, workers’ salaries, and sometimes, purchasing the required equipment. Mostly, public projects are functioning on the standard that employees are free to do anything, since they get their pay after all (Wirick, 2009). Because of such an attitude of employees and management, the public sector is going down, and the poor and marginalized people consider it as their only hope. Corruption is also another major challenge in achieving good global governance. Transparency International (2011) defined corruption is the using power and authority for own gain. Dr. Kargbo (2006) defines corruption as the misuse of civil office for personal gain. By definition, corruption scope is limited to public office, but in a broader perspective, corruption covers the abuse of confidence for personal gain in all offices, both public and private sectors. Corruption occurs in various ways like personal corruption (private gain) and governmental corruption (political gain). Whether it is personal or political gain, corruption is increasing by every passing day and creating long-lasting hurdles in achieving good global governance (Kargbo, 2006). The WHO report points out that there should be more implementation of more rules and procedures that combat corruption within the countries affected. Moreover, The UN Convention Against Corruption, set up in 2005, needs to undergo ratification and implementation as a soon as possible as a different way of combating corruption. Deprived accountability system also poses a challenge to good governance. The term accountability is used in various ways, but the meaning remain same for public and private sector. The form of accountability is the compulsion of administrative institute to provide the documents of what it has done. An external, self-governing organization evaluates the documents. The accountability could be in terms of services provided and the success or failure of the program (Shah, 2007). Accountability exists in society when there is stability in the environment because it requires formal procedures to anchor accountability in the central, state institutions. The government should be accountable to all those affected by its decisions or actions. Good global governance is not achievable if the core state institutions lack the sense of accountability. The public also remains deprived of the basic needs (Burnell, 2000). Overcoming the challenges of global justice-in the light of World Health Organization report: The following are the some of the suggestions made by the WHO report in order to overcome the obstacles in light of the principles of multi-level governance. 1. Through the guarantee of impartial employment and decent working environments, government, employers, and workers can help to exterminate the poverty and social injustices. Government should make sure that fair employment and decent working environments are the heart of national and international economic policy-making. 2. In order to reduce the gap in health and poverty, governments should develop a system that allows a healthy living standard, and nobody falls below the threshold standard without their control. Social protection schemes can contribute a lot in achieving developmental goals. They can be effective and beneficial in plummeting poverty and domestic economies. 3. The Government should encourage public investment at all economic development levels across the social determinants of health, whether it is child development and education or working and health conditions. Public finance or investment will lead to the development of progressive taxation procedures, and it will help eliminate poverty and boost the economic growth. 4. The Parliament and corresponding equivalent bodies should promote a goal of refining health justice through activities on social determinants of health as a measure of government performance. The national government should establish a commission and pass legislation that the Member of Parliament or even the highest chaired politician is accountable to the commission. 5. WHO should support the growth of knowledge and abilities of national ministries of health to work inside social determinants of health agenda, and a stewardship role in a social determinant approach across the government (CSDH, 2008). References: Asian Development Bank 2011. “Health Sector Development Project (HSDP)Philippines.” Indigenous Peoples. viewed on 24 November 2011 from >http://www.adb.org/Documents/IndigenousPeoples/PHI/phi-health-sector-dev-program.asp< Beck, U 2006, Reflexive governance: politics in the global risk society. Brunell, J, P 2000. Democracy assistance: international co-operation for democratization, Frank Cass & Co Ltd, London. CSDH 2008. Closing the gap in a generation: health equity through action on the social determinants of health, Final Report of the commission on Social Determinants of Health, World Health Organization, Geneva. Gurría, A 2011. Improving global governance in a changing world – A view from the OECD, viewed on 24 November 2011 from >http://www.oecd.org/document/25/0,3746,en_21571361_44315115_46135513_1_1_1_1,00.html< Haughton, H, J, and Khandker, R, S 2009. Handbook on poverty and inequality, The World Bank, Washington, DC. Kargbo, H, A 2006. Corruption: Definition and concept manifestation and typology in the Africa context, In The Training for members of parliament and members of Civil society from English speaking West Africa: Gambia, Ghana, Nigeria, Liberia and Sierra Leone, 4-8 September 2006 Aberdeen, 2-9. Patrick, D, Els, H, and Wanyama, F 2005. The emergence of Multilevel Governance in Kenya. Working paper no. 7, viewed 24 November 2011 from >www.ggs.kuleuven.be/nieuw/publications/working%20papers/.../wp07.pdf< Shah, A 2007. Performance accountability and combating corruption, The World Bank, Washington, Dc. Stubbs, P 2005. Stretching Concepts too far? Multi-Level Governance, Policy transfer and the politics of scale in South East Europe, Southeast European Politics VI (2), Pp.: 66-87. Transparency International, 2011. Frequently asked questions about corruption, viewed on 24 November 2011 from >http://www.transparency.org/news_room/faq/corruption_faq#faqcorr1< United Nations Development Program (UNDP), 2006. Applying a Human Right-Based approach to development corporation and programming, viewed on 24 November 2011 from >http://www.undplao.org/whatwedo/bgresource/demogov/RBA%20indicators-users%20guide(UNDP06).pdf< United Nations ESCAP 2011. What is Good Governance, viewed on 24 November 2011 from >http://www.unescap.org/pdd/prs/projectactivities/ongoing/gg/governance.asp< Voss, P, J, and Kemp, R 2006. Sustainability and reflexive governance: introduction. In: J. P. VoB, D. Bauknecht and R. Kemp (eds), Reflexive governance for sustainable Development (Pp.:3-30), Edward Elgar Publishing Limited, UK. Waters, M,C, and Devine, F 2004. Social inequalities in comparative perspective, Wiley-Blackwell, Massachusetts. Wirick, W, D 2009. Public-Sector Project Management: Meeting the Challenges and Achieving Results. Hoboken, John Wiley & Sons, Inc, New Jersey. World Health Organization 2010. The Adelaide statement on health in all polices, viewed on 24 November 2011 from >http://www.who.int/social_determinants/hiap_statement_who_sa_final.pdf< Oxford University Press, (2011). The Adelaide Statement on Health in All Policies: moving towards a shared governance for health and well-being. Oxford JournalsMedicine Health Promotion International Volume25, Issue2Pp. 258-260. Retrieved on 25th November 2011 from > http://heapro.oxfordjournals.org/content/25/2/258.extract Read More