Protecting The Health Consumer – Health Capabilities and Collective Voice Versus Patient Choice

‘Patients’ are increasingly seen through the lens of the ‘health consumer’. Non-communicable diseases and injuries are increasingly predominant, while a rejuvenated interest in the ‘social determinants of health’ and health inequalities re-locates individual biology and agency within a larger context of physical exposure and social conditions, highlighting longer chains of biomedical and social causal factors (Venkatapuram, 2011, 33, CDSH 2008). This contrasts against discussions which view patients as individual health consumers, leveraging self-efficacy to achieve societal health outcomes. The health capability paradigm offers an alternative perspective balancing individual health agency, scientific and professional judgement, and collectivist health norms (eg Ruger 2010, 141–142). This paper advances a health capability perspective on systemic health protection and argues for capability-oriented health system reforms (eg Thai Health 2013) which support and vindicate the principle of health protection. The discussion is illustrated with respect to well-known occupational and environmental health hazards such as asbestos that are beyond the health agency of individual ‘patients’ (Khoo and Kulsomboon, in progress). The goals are twofold – to prevent and decrease risk of exposure and to increase provision for those who have, or may in the future, become ill or disabled through exposure.  The discussion points to the importance of protection as a systemic attribute in health governance. It focuses particularly on collectivist and solidaristic consumer action and its role in participatory deliberation through organized civil society channels.

The theoretical discussion integrates reflexive health governance and the capabilities approach, linking normative, substantive and procedural claims for health justice and rights with theories of health governance. A ‘joint scientific and deliberative approach’ can provide a means to guide decisions and bring together normative substance, scientific evidence and procedural decision-making to achieve broader health system development and reform towards more legitimate and just forms of shared health governance  (Ruger 2010, 183).