BEHAVIORAL HEALTHCARE Issue Date: July-August 2011 Departments—Manderscheid Report Reflecting on Social Justice Despite tough times and tight budgets, we cannot fail to value life, health, and equity for all
by Ron Manderscheid, PhD
President Franklin Roosevelt gave his annual State of the Union address from the White House instead of the Capitol in 1944. A few minutes later, he went into the Oval Office and recorded a second address on human rights. He stated clearly that good health is a basic human right. Ever since, we have sought to fulfill the vision he laid out that winter day two generations ago.
As we think about this important right, we must ask whether it is grounded in the foundational documents of our Republic. Clearly, the answer is yes. The Declaration of Independence identifies inalienable human rights, including life, liberty, and the pursuit of happiness. The right to life encompasses the right to good health.
Similarly, our Constitution seeks to promote the general welfare, which includes the good health of our citizens. Hence, it is very important for us to defend good health as a basic right, and to promote it through the venues available to us.
One does not need to look very far to find poignant examples of poor health. Compared to those with the best health, worse health can be found among those in poverty, among minorities, and among those with disabilities. In each case, an underlying factor is wealth: Those with more wealth have better health. From observation of these differences, we have developed the concept of health disparities. A health disparity exists when a more advantaged group has better health than a less advantaged group.
If we are to address these health disparities, we must value all people equally. We must value a homeless person the same as the CEO of a large corporation. Undoubtedly, this will not always be easy for many of us. Sometimes our own culture regarding dress, cleanliness, and speech will stand in the way. If we recognize these impediments, then we can overcome them. In fact, I suspect that the more we work with persons who are poor or homeless, the more that we will value them.
How can one address these health disparities to promote good health for all? We must be equitable in our distribution of needed resources-skill, time, and treasure. Equity does not mean equal; it means disproportionately applying resources where they are needed most. For example, if breast cancer is more prevalent among a minority than among white females, then relevant health resources should be devoted disproportionately to minority females.
Collectively, the three principles-good health is a right; people are valued equally; and resources are distributed equitably-constitute an essential paradigm of social justice regarding health. Social justice is not an ethereal notion, but a living goal that we can address all day, every day in our day-to-day lives. It can range from very simple steps, such as volunteering to work in a homeless shelter, to very large steps, such as distributing resources through a large federal program.
In this endeavor, there are a few guides that we should remember:
Do be attentive to social justice
, lest it erode away quickly. This can happen through neglect, greed, personal ambition, or political advantage. Social justice is very easy to lose, but much more difficult to maintain.
Don't become distracted by false arguments
, such as "we cannot afford it." If we think we cannot afford to promote good health for our population, we must examine what we do think is important to us. Usually, we will find that other agendas have come to the fore-some type of gain for a particular group or some type of personal gain. When one questions these agendas in a very bald way, for example, "Why don't you value young black mothers who have a mental illness?" their self-serving nature quickly becomes transparent. If we can't afford to care for the weakest