A social justice approach to health
Policymakers need to make health a political priority by taking a social justice approach to investments in health and care – and the ILO is developing a coalition that encourages a wide range of multilateral bodies and stakeholders to do just that
Health is a basic human right. It is an essential requirement for the achievement of decent work and a fulfilling life. However, health goes far beyond having access to health care that is timely, affordable and acceptable. It also relates to factors that ensure our overall well-being. These include access to safe drinking water and sanitation, safe food, adequate nutrition and housing, healthy working and environmental conditions, health education and information, income and social protection, and gender equality. Other important dimensions of health and well-being relate to income security when people are sick, and health care without hardship – as outlined in the International Labour Organization’s social security conventions.
Despite progress in past decades, disparities and inequities in health persist, many of which are linked to the conditions in which people are born, grow, work, live and age. These are the social determinants of health, which influence the health outcomes of individuals and communities. These inequities have been exacerbated by the Covid-19 pandemic and the multiple and interconnected crises we are currently facing – climate change, conflicts and global cost of living challenges.
For these reasons, we need a social justice approach to health that addresses inequalities, achieves more inclusive and sustainable socio-economic development, ensures healthy lives and promotes well-being for all, as set out in Sustainable Development Goal 3.
The ILO promotes social justice in health through its decent work mandate. Its work on social protection, occupational safety and health, and decent working conditions for healthcare workers are key areas.
A crucial step
Extending social protection to all is a crucial step towards achieving health equity and access to adequate health care without hardship. It ensures a level of income that allows people to live a healthy life in dignity. Yet four billion people still lack any kind of social protection. When health emergencies occur, many people – often the poorest of the poor – risk falling further into poverty because of unanticipated health spending. Even essential everyday health expenses can push families and vulnerable populations over the edge financially, particularly in rural areas. High health costs, combined with inadequate income security often lead them to forgo vital health care, reinforcing a vicious cycle of poverty and ill health.
In his 2021 report, Our Common Agenda, United Nations secretary-general António Guterres committed the UN system to promote and sustain universal social protection floors, including universal health coverage. The objectives, functions and principles of social protection systems are grounded in a series of ILO international labour standards. The ILO is also proud to lead work on social protection through the Global Accelerator on Jobs and Social Protection for Just Transitions, launched in September 2021 by the secretary-general.
Every year, around 2.9 million workers die due to occupational accidents and diseases, and at least 402 million people suffer from non-fatal occupational injuries. Estimates by the ILO and the World Health Organization indicate that work-related diseases are responsible for 81% of all work-related deaths. Occupational safety and health policies developed through social dialogue and backed by well-resourced labour institutions are essential for the protection of life and health at work. An important step forward was the decision by the International Labour Conference in 2022 to include a safe and healthy working environment in the ILO’s framework of fundamental principles and rights at work.
Health services cannot be delivered without enough adequately trained, supported and protected health and care workers. Yet there is an unequal distribution of health workers globally and within countries. In low-income countries, health workforce shortages are as high as 84%, while the shortage in upper-middle-income countries is around 23%. In some Asian and African countries, almost 90% of the population does not have access to health care. Labour force survey data from 56 countries has shown that the majority of health and social care workers live in urban areas, and almost half of the world’s population lives in rural areas.
Many countries face severe challenges in the recruitment, deployment and retention of health and care workers. Dissatisfaction with working conditions due to low wages, insufficient resourcing, work overload, long hours, unsafe working environments, exposure to violence and harassment, stress, burn-out, limited access to social protection and weak career prospects have led to high turnover and attrition rates of health workers in many countries. The health sector has been significantly disrupted by the Covid-19 pandemic. This has demonstrated the need for increased sustainable investments in health systems, including in decent working conditions for health and care workers.
A vital contribution
In 2016, the UN High-Level Commission on Health Employment and Economic Growth recognised the vital contribution of the health sector to economies, investments and job creation, especially for youth and women. The ILO, WHO and the Organisation for Economic Co-operation and Development are working together on the Working for Health programme and its Multi-Partner Trust Fund, to provide assistance to countries, social partners and key stakeholders, so they can develop strategies to scale up health workforce investments based on improved health labour market data, multi-stakeholder involvement and social dialogue.
Policymakers need to make health a political priority by taking a social justice approach to investments in health and care. This includes investments in social protection, occupational safety and health, and decent work for health and care workers. They need to promote policies that ensure access to affordable and high-quality care for all. It is not only for the ILO to advocate such policies and to take action within the scope of its own mandate – it is a shared responsibility across the UN system and its constituents. For this reason, the ILO is developing a Global Coalition for Social Justice, which will bring together a wide range of multilateral bodies and stakeholders to position social justice as a global policy imperative, through strengthened cooperation and policy coherence. I firmly believe that such a coalition can enable the international system to better help countries tackle policy areas where social justice is lacking, so we can make good health and well-being a reality for all.
