Friday, February 5, 2010

Linking the determinants of health to Sen's "capabilities approach" to development and social justice


Keep your eyes peeled for new writings from Dr. Sridhar Venkatapuram and Sir Michael Marmot (Chair of the WHO's Commission on the Social Determinants of Health) linking Sen's capabilities approach to development and social justice with social epidemiological research on the distribution and determinants of health. If you are new to these ideas, the UNDP website offers an excellent introduction to human development and the capabilities approach, while the WHO website offers similarly brilliant descriptions of the evidence on the social determinants of health.

The capabilities approach is the paradigm of the United Nations system, and argues that human development is best though of in terms of the choices people have to live lives they value. Rather than focusing on economic growth (which can at best be instrumental for health but can also worsen health disparities and population health outcomes), human development focuses on the expansion of peoples capabilities - the range of things that people can do or be in life. This approach also complements Dr. Paul Farmer's writings on social medicine and structural violence, which promote an ethic of pragmatic solidarity as the basis of medicine and public health - a commitment to struggle alongside the destitute sick and against economic and political structures that constrain choice, causing and perpetuating poverty and ill health. Marmot and Venkatapuram's writings are exciting precisely because they make these connections, and strengthen arguments for health equity.