Health, solidarity and justice : a discourse theoretical perspective

Abstract

This thesis analyses the relationship between health, solidarity, and justice from a discourse theoretical perspective. Jürgen Habermas links justice to free, uncoerced, and inclusive processes of discursive consensus building. The realisation of these rational discourses, however, depends on a sense of solidarity between participants: solidarity is the counterpart of justice. Yet, in modern capitalism solidarity is the scarcest social resource. This leaves societies with the task of reconstructing the conditions that would make solidarity, and therefore justice, sustainable. This thesis argues that health offers an important contribution to this project. Habermas‟s universal pragmatics is used to analyse different concepts of health, and in adopting the perspective of the participant an intersubjective understanding of health is proposed. Placed within Habermas‟s theory of society, health is conceptualised as a sub-system of the lifeworld that contributes to social reproduction at the cultural, normative, and personality levels by: reproducing lay and medical knowledge; nurturing social solidarity through nets of formal and informal healthcare; and contributing to the development of personalities capable of and motivated to joining relationships of mutual recognition. These last two contributions reveal the relevance of health in fostering conditions for justice. The growing literature on the social determinants of health is explored to the conclusion that the relationship between health and justice is reciprocal and closer than commonly assumed. This insight is then applied to the context of the right to health. The thesis refutes different liberal challenges to the right to health and explores the right from the perspective of Habermas‟s reconstruction of the system of rights and procedural paradigm of law. The thesis concludes that discourse theory provides a better understanding of the relationship between health and justice, and therefore, better grounds for interpreting health as a legitimate human right.