Professor of Law, Faculty of Law, University of Technology Sydney, Sydney, Australia; School of Law, University of Leeds, Leeds, England.
Med Law Rev. 2022 Dec 8;30(4):610-634. doi: 10.1093/medlaw/fwac025.
Social determinants of health are the social and economic conditions that have a determining impact on health at an individual and population level. Working within this framework, in 2019 the O'Neill Institute for National and Global Health Law at Georgetown University and The Lancet published The legal determinants of health: Harnessing the power of law for global health and sustainable development. This report identifies and promotes four legal determinants: provision of universal health coverage under the Sustainable Development Goals; governance of national and global health institutions; implementation of evidence-based health interventions; and building legal capacity. These determinants are dominated by the role of law in founding and governing health institutions and regulating their interventions. Such work is essential. However, the relationship between law, health improvement, and health equity articulated through these four determinants risks marginalising questions of disadvantage and inequality that social determinants of health research-and the report itself-mandate we attend to. Addressing the UK experience of COVID-19, and how social inequalities profoundly impacted experiences and outcomes in the first year of the pandemic, this article builds on the Lancet-O'Neill Commission's important work to argue that any articulation of legal determinants of health must foreground law's role in improving fairness in social arrangements and the distribution of resources.
健康的社会决定因素是指在个人和人群层面上对健康具有决定性影响的社会和经济条件。在这一框架内，2019 年，乔治敦大学奥尼尔国家和全球卫生法律研究所与《柳叶刀》共同出版了《健康的法律决定因素：利用法律力量促进全球健康和可持续发展》。该报告确定并推动了四个法律决定因素：在可持续发展目标下提供全民健康覆盖；管理国家和全球卫生机构；实施循证卫生干预措施；以及建设法律能力。这些决定因素主要由法律在创立和管理卫生机构以及规范其干预措施方面的作用所决定。这类工作至关重要。然而，通过这四个决定因素所阐明的法律、健康改善和健康公平之间的关系，有可能使健康的社会决定因素研究——以及该报告本身——所要求我们关注的劣势和不平等问题边缘化。本文借鉴了《柳叶刀-奥尼尔委员会》的重要工作，以英国应对 COVID-19 的经验为基础，探讨了社会不平等如何深刻影响大流行第一年的经历和结果，认为任何对健康的法律决定因素的阐述都必须突出法律在改善社会安排公平性和资源分配方面的作用。
