Health Justice: An Argument from the Capabilities Approach

This fascinating book introduces the concept of health as capability and in particular as a meta-capability or, as the author explains, an ‘over-arching capability permitting one to be and do’ from which follows an ethical case for the human right to health. Venkatapuram presents a highly persuasive philosophical argument that the capability to be healthy needs to be recognized as a basic moral entitlement in the same way as other fundamental human rights. The author extends the principle of the capabilities approach of Amartya Sen and Martha Nussbaum to include the moral entitlement to the social bases of the capability to be healthy. Sen's emphasis on the importance of health equity and its relationship to social justice is strongly endorsed by the author and he argues that this is in contrast to Rawl's analysis of health as a ‘natural good and subject to random variation’. He provides an analysis of the capabilities approach in relation to health and social justice and explores its relationship with social epidemiology and disease causation together with links to existing evidence on health inequalities. While there is increasing evidence of the impact of social arrangements and income inequalities on health and the capability to be healthy, he argues that this frequently goes unrecognized, due, possibly, to the persisting emphasis in health policy on medical care and the focus on changing individual risk behaviour. In terms of limitations, he acknowledges that ethical theories need to be able to be used at a population or aggregate level and accepts that this has not been covered in this book. This is a stimulating read, which, while presenting a challenging philosophical argument, is rooted in the real world and as such deserves a wide readership among the public health community.