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Demchenko Ivan Serhijovych

DOI: https://doi.org/10.25040/medicallaw2017.01.011

Med. pravo., 2017; 1(19): 11-19

UDС: 341.232.7:340.143

DEMCHENKO IVAN SERHIYOVYCH

Doctoral degree candidate at Legislation Institute of the Verkhovna Rada of Ukraine, Candidate of law sciences

Social determinants of health and law: relationship, the essence and significance

According to WHO (2015) statistics, life expectancy (at birth for both sexes) in Ukraine and the same region countries issignificantly different. What might explain this difference in life expectancy? Why is there such a difference in human health in different countries? And can contribute to improving the jurisprudence of these indicators? Among factors, which influence human health – social factors are the most important. The emphasis on social factors are the basis of the concept of "social determinants of health."

The concept of "social determinants of health" is complex and covers issues of social policy, employment policy and labor, family policy, health care policy. If social conditions play such an important role in determining health, efforts to improve health shouldn’t focus only on the traditional health sector.

Legal definition of social determinants of health does not exist. The most common approach, under which the social determinants of health are the conditions in which people are born, grow, live, work and grow old and how inequalities in the distribution of power, money and resources affect these conditions in society. Such conditions may include: food (quality, safety, utility); education; working conditions; access to drinking water and health standards; health care; living conditions. Whereas, in the discussions on the social determinants of health, we focus on their legal component, it should be noted regarding the essence of States "core obligations" that arise on the basis of the right to health. In fact, to generalize these "core obligations" they are directed at regulating the social determinants of health, forming a minimum standard. Despite the fact that the overall goal for legal regulation is public health, it’s possible to achieve results by using available toolkit of human rights law. Human rights law serves as a starting point, according to which national strategies for health are developed.

Eestablishment of social justice in health care is core goal of social determinants of health concept. Traditionally, society expects, that problems associated with health and disease could be solved by health sector. Social justice in healthcare - is understood differently. The most common understanding of social justice in health care - as equality in access to health care. This concept of "individual responsibility" for their health impact on life, not on social conditions - social determinants of health. A person who is in the low socio-economic levels will not necessarily lead bad life, and vice versa - a wealthy person can be exposed to unhealthy lifestyles. That is why - inequality of social conditions, in our opinion, is the problem that should be solved through legal mechanisms. We believe that equality in relation to health, mainly depends on providing individuals (and groups especially vulnerable) rights and opportunities confidently and effectively assert their rights and needs.

In Ukraine, as in most countries - access to health care is guaranteed by the Constitution. Accessibility for all citizens means that every citizen of Ukraine is guaranteed access to defined and assured set of health care services, according to their needs, regardless of social status, place of residence, income level, and so on.Article’s 49 of the Constitution of Ukraine guarantees the availability of health services consist of two components: medical care free of charge in state and municipal institutions; and that the existing network of such institutions cannot be reduced. Are these guarantees enough to ensure accessibility for all citizens to medical care? The question is more than debatable. In our view, this Constitutional article requires a change in emphasis on: a guaranteed minimum level of free medical care for all citizens (including access to medicines). It does not matter whether such aid will be provided in the state / municipal health care institutions; at the existing network of health care providers or any other; using compulsory health insurance or tax, as a mechanism to finance the functioning of the health system.

The most effective impact on the "social determinants of health" may at primary health care. This effect must necessarily include: effective primary care, disease prevention, health promotion.

It’s impossible to reach through the mechanisms of legal regulation all social determinants of health. Keep in mind that so-called social stratification will be a key factor in evaluating the impact on the social determinants of health. Depending on the nature of the impact on different social groups will react in different ways to such impact.

Using a variety of mechanisms of legal regulation, setting a specific goal – it’s possible to change the specific social determinants of health. At such, it’s possible to combine mechanisms of hard and soft law. Legal regulation could be subjected to the whole population or its specific group.

The importance of social determinants of health concept for the further development of domestic legislation are following: First, social determinants of health are the specific marker of law efficacy. Social determinants of health allow to analyze the effectiveness of different legal mechanisms at various categories of the population: children; teenagers; women; disabled; people with non-communicable diseases; people with different income levels; persons representing different social groups with different culture, religion, etc.Second, the law and the legislation was and remains perhaps the main mechanism by which is possible organize social relations. Creating an efficient and effective regulatory framework for the functioning of the health system - is only the first step for the realization of human's right to health. From the state perspective – to regulate and/or restrict factors that may harm human health - second step. What, in particular, will have a consequence and improvement of public health.Thirdly, the principle is enshrined inter alia in the Association Agreement between Ukraine and the EU - "health in all policies" - as the basis for policy development, including social determinants of health. Fourth, from legal science perspective, using social determinants of health concept is possible to identify weak areas in terms of "inequality" at healthcare sector.Fifth, health and public health - are among the most significant and important objects which is possible influence through mechanisms of legal regulation.

Emphasis on the relationship between the development of national legislation and the dynamics of social determinants of health is important for Ukraine, especially in the reforms period of the national health system.

Key words: Social determinants of health, social justice, the mechanisms of legal regulation, health

Reference list 

1.     Healthy life expectancy HALE at birth WHO, 2015 Retrieved from www.who.int/gho/mortality_burden_disease/life_tables/hale/en

2.      Marmot M. (2012) WHO European review of social determinants of health and the health divide. Marmot M. et al. The Lancet. T. 380. No 9846. p. 1011
https://doi.org/10.1016/s0140-6736(12)61228-8

3.      Zamechanie obschego poryadka 14 (2000). Pravo na naivyisshiy dostizhimyiy uroven zdorovya.statya 12 Mezhdunarodnogo pakta ob ekonomicheskih, sotsialnyih i kulturnyih pravah Komitet po ekonomicheskim, sotsialnyim i kulturnyim pravam OON. Zheneva 25 aprelya.12 maya 2000 goda. UN Doc. E.C.12.2000.4.

4.      Hunt P. (2007) Report of the Special Rapport euron the Right of Every one to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health. UN Human Rights Council. UN Doc. A.HRC.4.28

5.      Commission on Social Determinants of Health. WHO. Retrieved from: www.who.int/social_determinants/thecommission/en

6.      Tyler E. T. (2012) Aligning public health, health care, law and policy Medical legal partnership as a multi level response to the social determinants of health. E. T. Tyler. J. Health Biomedical L. T. 8. p. 211.

7.      Declaration of AlmaAta (1978) WHO. Retrieved from http.www. euro.who.int/data/assets/pdf_ file/0009/113877/E93944.pdf

8.       Burris S. (2011) Law in a social determinants strategy a public health law research perspective. S. Burris.Public health reports. p. 22.

9.      Kontseptsiya Derzhavnoyi tsilovoyi sotsialnoyi prohramy.Tsukrovyy diabet na period do 2018 roku. Retrieved from http://www.moz.gov.ua/docfiles/pp5023_2013_dod1.pdf

10.  Ruger J. P. (2004) Ethics of the social determinants of health J. P. Ruger. Lancet. T. 364. No 9439. p. 1092.
https://doi.org/10.1016/s0140-6736(04)17067-0

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