Democracy and Health: Situating Health Rights within a Republic of Reasons

Alicia Ely Yamin & Tara Boghosian

ABSTRACT. Patterns of population health are keen reflections of structural inequities in societies, yet they are rarely subject to the requirements of democratic justification that other systemic inequalities provoke. Nor are health systems generally subject to societal scrutiny regarding fidelity to normative commitments of dignity and equality. Increased recognition of social determinants of health has challenged the narrow biomedical view of health as a stochastic phenomenon. More recently the sweeping devastation of the COVID-19 pandemic has laid bare structural injustices across many democracies, which contributed to widely disparate rates of infection and mortality. However, a lack of clarity remains regarding the conceptual linkages between the right to health and the institutional arrangements required for diverse people to live flourishing lives in a plural democracy. Here we attempt to contribute to a deeper understanding of the right to health by examining the implications of three related claims: (1) the content of a right to health (public health preconditions and care) reflects the arrangement of social institutions and the negotiation of difference in a plural democracy; (2) health systems are democratic institutions that should be organized around showing diverse persons equal moral consideration; and (3) democratic accountability can enhance health protections across borders. We argue that understanding the connections between health and democracy has profound implications for health system financing, priority-setting, and the organization and delivery of health goods and services, as well as oversight. Further, underscoring the connections between health and democracy inexorably calls upon us to enlarge our conception of the way legal determinants of health function and health rights are theorized.

AUTHOR. Alicia Ely Yamin, J.D., M.P.H., Senior Fellow on Global Health and Rights, Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics, and Senior Advisor, Bergen Centre on Ethics and Priority Setting. Tara Boghosian, J.D., 2020, Harvard Law School; B.A., 2016, McGill University.

RECOMMENDED CITATION. Alicia Ely Yamin & Tara Boghosian, Democracy and Health: Situating Health Rights within a Republic of Reasons, 19 Yale J. Health Pol'y L. & Ethics (2020).