Can we afford justice and equity?
Article by Frances Baum, Commissioner from Australia
One of the arguments used to support the slave trade in the 19th century was that society could not afford to abolish the trade because of the cost. These arguments contrasted strongly with those of the abolitionists such as William Wilberforce who opposed slavery on the grounds that it was contrary to the principles of justice and humanity. From our twenty-first century perspective the cost argument in relation to slavery seems hollow, morally bankrupt and untenable. The benefits of hindsight tell us that principles and morals obviously go ahead of costs and economic considerations. Yet arguments of cost are frequently used to oppose social justice and equity concerns in the early 21st century.
The massive and growing inequities of wealth, income, life expectancy and resource use are increasingly acknowledged . Their existence has led to global campaigns to "Make Poverty History", calls for re-distribution of wealth and income and the provision of effective health services, drug therapies and basic public health infrastructures including water, sanitation and housing.
One of WHO’s response has been to establish the Commission on Social Determinants of Health to consider how action on the upstream causes of illness and inequity can be implemented by governments and international agencies. A crucial question for the Commission will be whether we adopt the vision of the slave abolitionists or the short sightedness of those who block vision with the spectre of cost. Vision was at the heart of the foundation of the welfare state in Britain following the Second World War. The inequities revealed through the war experience (and especially through the evacuation of poor children to middle class rural homes) gave a determination among British people that the post-war world would be fairer. It was this atmosphere that enabled William Beveridge (one of the founders of the welfare state) to talk of the moral absolutes that should govern government policy above considerations of cost. He argued for "bread and health for all before cake and circuses for anyone" and stressed that it was better to incur debt than "to let children go hungry or sick and old unattended."
There is growing evidence that we have to make a more equal and fair world if we want to promote health and well-being. Many commentators have pointed out that the fuel for the action of violent extremists is the existence of massive global inequities. It is certainly true that the larger the gaps in wealth the higher the crime and social dislocation. Richard Wilkinson in his The Impact of Inequality. "How to Make Sick Societies Healthier" quotes study after study to support this point and concludes unequivocally that "redistributing income from rich to poor improves health no matter the mechanisms". The processes appear to be that more equity leads to less envy, more social solidarity and a greater sense of community and harmony. This is the type of world that is envisioned by the CSDH.
Achieving this world will seem an impossibility if we imagine all the reasons (and cost will be near the top of the list) why it is not possible. Instead, we need a justice imagination that learns from Nelson Mandela who reminds us that poverty and the sapping of the human spirit and potential it brings is "not a preordained result of the forces of nature or the product of a curse of the deities. But the consequences of decisions which men and women take or refuse to take." The CSDH is in an ideal position to take decisions in favour of equity, health and the right of all people to a reasonable standard of living – not to take these decisions will cost us all dearly.
Note: WHO and the Commission take no responsibility for the views shared in this opinion section. This space has been created for analysis and to stimulate debate on issues related to the work of the Commission. Readers are welcome to send their contributions.
