“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” -World Health Organization 2018
The ethical basis of the right to health has received acceptance internationally and was enshrined in the World Health Organization (WHO) Constitution over fifty years ago (WHO, 2018). Constitutional rights have overriding importance over any other laws that create opposition. Formulating constitutional rights in essence provides a necessary ranking of policy priority.
It is no surprise that the right to health has received such distinction. Good health is fundamental to human happiness and well-being. It is also an important factor for successful economic progress as healthy populations are more productive and financially sound. Successful governments recognize the importance of tending to population health maintenance as a means to maintain sovereignty and prosperity.
There are many factors that contribute to a person’s current state of health. These factors may be genetic, socioeconomic, behavioral, or social in nature. Scientists generally recognize five determinants of health of a population:
- Biology and genetics. Examples: sex and age
- Individual behavior. Examples: alcohol use, injection drug use (needles), unprotected sex, and smoking
- Social environment. Examples: discrimination, income, and gender
- Physical environment. Examples: where a person lives and crowding conditions (CDC, 2014)
These determinants converge and accumulate over time to shape the health of population groups. When there are systemic differences or disparities in population health outcomes an injustice exists: health inequity
Health Inequity vs Health Equity:
Urban planning shapes the physical and social environments of populations. U.S. Policy makers need to be aware of the direct link that environment has towards poor health outcomes. Urban planning that promotes physical activity such as walking, and biking recognize the important environmental determinants of health.
The injustice of health inequity is also of major concern. Policies that promote the right to health in an equitable fashion will lead to successful economic progress while maintaining the ethical imperative of social justice.
“A more effective way of increasing life expectancy and improving health would be for every government policy and programme to be assessed for its impact on health and health equity; to make health and health equity a marker for government performance.” – WHO 2008
References:
Centers for Disease Control and Prevention. (2014). NCHHSTP social determinants of health: Definitions. Retrieved from https://www-cdc-gov.ezproxy1.lib.asu.edu/nchhstp/socialdeterminants/definitions.html
World Health Organization. (2008). Inequities are killing people on grand scale, reports WHO’s commision. Retrieved from http://www.who.int.ezproxy1.lib.asu.edu/mediacentre/news/releases/2008/pr29/en/
World Health Organization. (2018). Constitution of WHO: Principles. Retrieved from http://www.who.int.ezproxy1.lib.asu.edu/about/mission/en/
World Health Organization. (2018). Social determinants of health: Key concepts. Retrieved from http://www.who.int.ezproxy1.lib.asu.edu/social_determinants/thecommission/finalreport/key_concepts/en/
One Health 
It can definitely be seen as an ethical situation. Too often I see parents allowing their children play on tablets or even their cell phones to entertain them. When I see this I don’t think it’s right, especially when I see it for the wrong purposes. I see it often at places such as restaurants where parents are trying to have a conversation with others but then their kids do not stop interrupting them, to get them to stop parents bring out the electronic device pacifying the children.
Such tendencies can lead to childhood obesity. Continuous trends in overweight and obesity among children in the United States have alarmed health care clinicians and public health practitioners (Lopez &Hynes, 2006).
Creating an environment build around social connectivity (such as with tablets and phones) only opposes stimulating interaction with others decreasing social interpersonal skills that for example prohibit these children from wanting to take a walk or ride their bikes on sidewalks.
Lopez, R.P. & Hynes, H.P. (2006). Obesity, physical activity, and the urban environment: public health research needs. Environmental health, 25(5), 1-10.
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I would agree that having walkable/bikeable communities would help decrease the sedentary behaviors that we see in children today. Social connectivity through physical interaction with others is one of the many health benefits of walking and biking within the community. Thank you for sharing the open-access article from Lopez and Hynes (2006) that highlights the important relationship between built environment and obesity. I have added a direct link to the article here:
https://www-ncbi-nlm-nih-gov.ezproxy1.lib.asu.edu/pmc/articles/PMC1586006/
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Debra, I love your proposal and agree that policy for this topic would improve social justice to include health equality. Changing the environment in which one lives can improve social determinants of health, but public health policy must factor in many considerations for policy change. A conceptual model that is often used in public health is the Social-Ecological Model to introduce change starting with the individual, relationships, communities, and society (1). The CDC uses this framework to propose methods to prevent violence. I have found through interviews with pediatric patients and their families that those who feel that they live in unsafe neighborhoods will not participate in outdoor recreational or fitness activities. When approaching this policy change, I encourage you to consider this.
There is also an article that is very relevant to the discussion this week that speaks this above idea of “reciprocal determinism” and the authors flip the Social-Ecological Model so that public health and environmental policy influences health-changing behaviors (2). Hope that you find this helpful and good luck to you!!
(1) Centers for Disease Control. (2015). The Social-Ecological Model: A Framework for Prevention. Retrieved from https://www.cdc.gov/violenceprevention/overview/social-ecologicalmodel.html
(2) Golden, S. D., McLeroy, K. R., Green, L. W., Earp, J. A. L., Lieberman, L. D. (2015). Upending the Social Ecological Model to guide health promotion efforts toward policy and environmental change. Health Education & Behavior, 42, 8S-14S. doi: 10.1177/1090198115575098
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There are many factors that reduce opportunities to incorporate the health benefits of daily walking and biking within urban communities. Thank you for highlighting the issue of violence as this is a major deterrent for establishing daily walking/biking habits. It is unfortunate that for many urban dwellers, travel options are invariably reduced to sedentary choices such as personal vehicles to mitigate the risk of physical harm from violence. In essence people are having to choose immediate safety against the cumulative lifelong benefits of daily walking/biking. I was not aware of the Social Ecological Model and appreciate the Golden et al. (2015) reconfiguration to place health related and other social policies and environments at the center. The best solutions are collaborative and your input is greatly appreciated!
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