Rcomendado pela AMICOR Maria Inês Reinert Azambuja
Offline: Liberty vs equity in global health
Published: 24 March 2018
s equity the defining objective of global health in the 21st century? Equity is hardwired into every definition of global health. It would be insane to argue otherwise. But global health is too important to allow this assumption to go unchallenged. Global health is about who we are, who we want to be, and how we want to live together on this wounded world of ours. Global health is about everything we hold dear in life. So if we ask what is wrong with our societies today, is the answer really that we have too little equity?
Equity is a situation in which everyone is treated fairly and equally. I wish that equity could be global health's principal concern. But it cannot be. Global health is not about equity. It is about power. Whether you are black, female, or poor, indigenous, homeless, or unemployed. Global health is about the power of the few over the many. The power of the rich over the poor. The power of the advantaged over the disadvantaged. Equity certainly matters to be sure. But equity is not directly concerned with power. Indeed, the very idea of equity itself risks perpetuating disempowerment and injustice by disregarding the forces that damage and distort our lives, our communities, our ecologies. If equity is not the defining objective of global health, then what is? The answer is liberty. Liberty is anterior to equity. Fairness can never be achieved unless each of us has realised our aspiration for self-determination. Liberty is necessary to enable any kind of association on equal terms. The liberty to think, desire, create, express, and live without interference or coercion—this is what it means to be human. And health has an explicit connection to liberty. Ill-health restricts and depletes our liberties. If we are sick, our freedom to enjoy our lives, to achieve our hopes, to reach our objectives is compromised. Creating health in a society protects and advances our liberty. Health is an instrument to create the motive force—liberty—for justice and equity. But why liberty really matters is far more because of dignity. Dignity demands that each of us is an end in ourselves, not a means to someone else's end. We are not objects that can be tied by the unjust ropes of society. We will not be humiliated by those with power over us. Dignity is our right to live in a decent society, and liberty is our shield in that struggle. The sovereignty of the individual is the precursor of human dignity. And without dignity there can be no equity.
Identifying liberty as the touchstone of global health has important consequences for our conception of justice. If the objective of global health is dignity, we have a duty to hold accountable those sources of power that deprive peoples of liberty—authoritarian regimes, religious fundamentalists, and transnational corporations, with their tools of exploitation, repression, and censorship. Equity without liberty leads us to oppressive conformity. The death of the human spirit. The annihilation of all that it means to be human. Liberty as the path to equity is emancipation from enslavement. The rebirth, in Emma Goldman's words, of the “social soul”. Those who advocate for equity underestimate the forces in society that limit our freedoms to be active agents for social change. To be for liberty is not to be for libertarianism. Liberty is no excuse for populism or xenophobia. If liberty is viewed as freedom from social evils, as well as freedom to be the person we want to be, one can understand that the project for liberty is encouragingly broad. Liberty leads us, if not to paradise, then at least to the possibility of realising our full humanity, finding better ways to discover truths about ourselves and the world, improving our governance through robust debate, and embracing our diversity. The goal of global health is not equity. It is to remove the chains that enslave the human mind. The chains that subjugate us to the humiliations and punishments of others. The chains that allow those with unaccountable power to strip away our dignity. Liberty is the acid that will dissolve those chains. Liberty enables us to engage with one another in deeper and more intimate exchange. To imagine a different world. To motivate us for a future that can indeed be based on equity. Equity as the defining objective of global health? Yes. But tomorrow, not today.
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