Social solidarity and the right to health: essential elements for people-centred health systems.

The right to health has been advanced as one of the key elements to creating pro-poor people-centred health systems (Hunt and Backman 2008; Gruskin et al. 2012). However, one of the challenges for realizing the right to health is the seeming conflict between public health utility and the entitlements afforded by a human rights approach to health. This dichotomy begs two sub-questions, both of which have relevance for building responsive health systems. Firstly, human rights affords individuals important protections against state victimization; yet where the state is acting to advance a public good, including action to realize the right to health, its actions may well infringe on individual rights. How to balance these competing rights imperatives in ways that are justifiable and fair, so that health policies and programmes are responsive to people’s individual freedoms presents one set of challenges to building people-centred health systems. A second, and related challenge for rights-based approaches to health systems, is one more related to the normative content of the right to health and how it is interpreted. Here, a tension exists in the nature of the entitlement. When the right to health is interpreted and operationalized as an individual entitlement to a health benefit, it may undermine or even contradict public health efforts aimed at realizing health benefits for collectives, and so potentially limit the contribution possible to building people-centred health systems. It is this second problem that this article principally seeks to address, drawing on the experience of the Learning Network for Health and Human Rights (LN) to reconceptualize the right to health in its collective dimension. However, because there is a tremendously strong and deeply rooted utilitarian ethic in Public Health that appears to render public health decision makers deeply suspicious of claims that might redirect resources in ways inconsistent with maximizing public utility, we start by reflecting on how a human rights approach can manage the trade-off between individual freedoms and efforts to advance public health good. We then map out the contours of a debate over the nature of the entitlement contained in the right to health, drawing both on our experience through structured reflection and on the literature to problematize the individualist framing of rights in the construction of responsive health systems. We draw also on non-Western philosophical perspectives to argue that a more useful framing of health rights involves foregrounding social solidarity in claims to collective health (Stuttaford et al. 2012a), a perspective more consistent with the principles of public health, which emphasize ‘collective action by society’ as essential to ‘the art and science of promoting and protecting good health’ (Last 2007). Lastly, we conclude that if claims to the Right to Health are framed as strengthening the collective agency of the most vulnerable, then recognizing the importance of social solidarity within the right to health can be an important strategy for building responsive health systems (Hunt and Backman 2008; Meier et al. 2010).