Global Justice and the Social Determinants of Health

Public scrutiny and deliberation are central to both the sciences and ethical reasoning. In the sciences, research findings and analyses are put forward in the public arena not simply to announce new evidence but also for public examination, to be either corroborated or disputed. In ethics there is a similar process, whereby reasoned arguments are put forward about what is the good or right thing to do. In either domain, knowledge is expanded through the coherence and acceptance of the analyses and arguments, which depends on their being able to withstand public scrutiny. Therefore, when scientific and ethical arguments are brought together, the task of public deliberation is twofold, as it must encompass the empirical and the normative; and when the arguments concern an issue of such enormous scope as global health inequalities, public deliberation has to include national and global domains.

It is precisely this kind of twofold public deliberation that the World Health Organization's (WHO) Commission on the Social Determinants of Health (CSDH) anticipated when it released its final report at the end of 2008. In that report, the commission combined epidemiological analysis of health inequalities within and across countries with an essentially cosmopolitan ethical argument for motivating global social action to mitigate ill health and health inequalities. By doing so the commission brought together the consideration of scientific evidence, the centrality of global public deliberation to global health, and a view on global social justice.

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