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Equity, Participation, and Power

Achieving Health Justice Through Deep Democracy

Published online by Cambridge University Press:  01 January 2021


This article explores how health governance has evolved into an enormously complicated—and inequitable and exclusionary—system of privatized, fragmented bureaucracy, and argues for addressing these deficiencies and promoting health justice by radically deepening democratic participation to rebalance decision-making power. It presents a framework for promoting four primary outcomes from health governance: universality, equity, democratic control, and accountability, which together define health justice through deep democracy. It highlights five mechanisms that hold potential to bring this empowered participatory mode of governance into health policy: participatory needs assessments, participatory human rights budgeting, participatory monitoring, public health care advocates, and citizen juries.

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Copyright © American Society of Law, Medicine and Ethics 2020

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I draw this simple four-point framework from several complementary models: the grassroots Healthcare Is a Human Right framework developed by the Vermont Workers’ Center and Partners for Dignity & Rights, the health justice framework developed by Lindsay Wiley and other scholars, the capabilities framework articulated by Amartya Sen and Martha Nussbaum, and international human rights law (particularly the Universal Declaration of Human Rights, International Covenant on Economic, Social and Cultural Rights, and Declaration on the Right to Development).Google Scholar
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