Integrating theories of social justice into public health intervention planning

Public health practice is typically guided by epidemiological explanations of the causes; the causes being act upon through behaviour or environmental change strategies.  This approach has been repeatedly criticized on practical and ethical grounds.  For one thing, the causes, i.e. risk factors, identified are often oblivious of enduring socio-economic determinants of health and entrenched inequalities. Consequently, there is a need to move from a strict bio-medical approach to public health problem resolution to one that would also account for and be integrative of dimensions of fairness and justice.  We propose the first elements of an approach to public health intervention guided by a theory of social justice.  Our claims are based on the seminal work of Amartya Sen whose capability approach has generated a growing body of works on welfare and public health programs.  The approach rests on two central pillars.  One is the acknowledgement of the differing needs, entitlements and capacity to convert resources that transcend populations.  The other is that interventions should increase the freedom to achieve of individuals (their capabilities). Using examples from disease prevention programs, we demonstrate that the capability perspective to public health program planning calls for: 1) a conceptualization of public health problems as instances of capability deprivation (i.e. individuals enjoying few options on what they can achieve), 2) a shift of the program focus on the achievements in health and well-being to one looking at the expansion of the freedom to achieve and, 3) a renewed participation of the public in the identification of the relevant capabilities.