The centrality of asking when does misfortune become injustice?
We are pleased to present an adapted excerpt from When Misfortune Becomes Injustice: Evolving Human Rights Struggles for Health and Social Equality » .
The sweeping disruption of the COVID-19 pandemic has generated broad public concern with the connections between population health, health systems, and democracy, on the one hand, and between our neoliberal global order and the realization of health and other human rights, on the other. Students across geographic regions and disciplines—law, public health, nursing, sociology, gender studies, anthropology, and the like— are grappling with how to understand the suffering we ourselves and close friends and family are experiencing, as well as diverse people across our societies and the globe—and what are appropriate legal, political and economic responses?
These questions are not new. Having spent a career interviewing the loved ones of women who died in childbirth, and others who have died painful deaths in abject poverty, including from HIV and untreated cancer, I have come to believe that how we understand the relevance of human rights to health is inextricably shaped by how we understand individual versus societal responsibility for the drivers of disparities in health, and in turn what is misfortune versus injustice.
Even before the pandemic, it was clear that there was a need to disrupt our traditional strategies in human rights to address the drivers of scandalous inequalities across global health.
When we reexamine what it means to say that something causes someone’s illness or condition, we are forced to look at what produces certain distributions of power and privilege within and across societies. For example, is the cause of enormously disproportionate COVID-19 mortality among people of color in the United States really due to individual biological differences and co-morbidities? Or is it more accurate to understand them in light of structural dynamics and social determinants, such as unequal exposures as essential workers, and housing conditions, and poor access to public health and medical care in a marketized health system? When we call on ourselves and others to ask these questions, it quickly leads to de-naturalizing both the biological individualism of the medical and health fields and to questioning prevalent narratives about poverty, inequality, and population health which so many societies take for granted in our neoliberal world.
Even before the pandemic, it was clear that there was a need to disrupt our traditional strategies in human rights to address the drivers of scandalous inequalities across global health. So I wrote When Misfortune becomes Injustice » not as a traditional text but to encourage critical reflection about what is required of societies, and of our global governance, for diversely situated people to live lives of dignity , including effective enjoyment of health rights. In the devastation wrought by this sweeping pandemic, it has become even more essential for students grappling with these questions not just to learn a fixed set of skills but to assess critically how we got here in order to devise transformative ways forward, and to connect human rights to broader struggles for health and social justice, including climate justice.
Encouraging students to engage in critical analysis of our current predicament requires examining how historical responses to the social problems underlying health and social inequality could have been different. One central theme of When Misfortune becomes Injustice: Evolving Struggles in Health and Social Equality,is that developments over the last fifty years that constructed the current architectures of both global health and human rights law, were not inexorable. By including narrative throughout, the book seeks to encourage readers, especially students and younger practitioners, to engage in self-reflection and to locate themselves critically in relation to socio-historical processes and the implications of diverse understandings of when misfortune becomes injustice.
Tracing the intersections of these fields and the application of human rights to global health over these decades, I argue that on the one hand, evolution in legal norms in both international human rights law and much constitutional law has been extraordinary in respect of health and other ESC rights, and perhaps nowhere more so than in sexual and reproductive health and rights. Over these decades human rights advocacy and scholarship advanced efforts to curb traditional forms of tyranny and discrimination, as well as to create new discourses of equality, the purposes of the welfare state, and the boundaries of inclusive societies. On the other hand, just as health and social rights claims were being theorized and articulated, the global embrace of neoliberalism, and the economic integration of markets and adjustments to internal laws and institutions that ensued, crippled the potential for democratic responses to those claims, nowhere more evidently than in health.
The chapters of the book are divided into time periods, with some inevitable overlap. By adopting a temporal approach to the development of the intersections between health and law and rights, with a focus on women’s health and rights, the book provides a kind of historical axis, while showing that shifts along the way might have been different. When Misfortune becomes Injustice does not pretend to be comprehensive or ‘neutral’. Indeed, implicitly the book questions the possibility of providing a single objective account of the development of these overlapping fields, which as Pierre Bourdieu argued tends to produce a kind of knowledge that is ignorant of its own limitations. In so doing, I hope it gives readers permission to question the truths that I present, along with orthodoxies in global health and human rights law.
In using When Misfortune becomes Injustice in teaching, additional materials should supplement the text to provide information on diverse topics that will always continue to emerge which tailored to the learning objectives of a given course. These materials –from exponentially growing jurisprudence and soft-law to methodological and empirical analyses—will ineluctably vary across subjects , as well as geographic contexts. Further, these supplemental materials can and should challenge arguments in the book. Indeed, my hope is that the book will inspire critical discussions among students, and across disciplines, as to how to deploy human rights in order to produce meaningful progressive social change in health and beyond, and for how different countries and our inter-connected world can emerge from this pandemic with more global justice.
Critique is the opposite of fatalism; it is a precondition for transformative action in my view. When Misfortune Becomes Injustice was published in early 2020, just before COVID-19 swept across the globe, and underscored that apathy and cynicism are our worst enemies in progressive social struggles. Indeed, as I conclude in the book:
No doubt we live in unsettling times, with chaotic and disconcerting shifts wreaking upheavals around the world in virtually every domain. Further the threats that challenge health rights today are often not [intimate forms of domination]; they are the result of complex interactions between social, political, and economic—and environmental—realities that operate on multiple levels simultaneously. Nonetheless, this period of massive transition may shatter some of the false inevitability of neoliberal tenets, which have exercised an ever-greater grip on our collective imaginations since the 1980’s—with the cascade of effects on health rights and social justice recounted in these pages. As the French critical theorist Jean Baudrillard notes, domination is overthrown from without, but hegemony is only inverted or reversed from the inside.1 Trump and company have—in addition to everything else—pulled away the curtain on the masquerade performance of “the way things need to be done” in the post-World War II order which the US played a fundamental role in designing. In sum, the sheer outrageousness of our current political spectacles in the US and elsewhere ironically has opened the door to new possibilities for progressive transformation— which we must now seize.
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Notes
- Jean Baudrillard, The Agony of Power (Cambridge, MA: MIT Press, 2010).
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