MORAL AND POLITICAL LEGITIMACY
Moral and political legitimacy in policy decision-making and implementation realms
WHAT IS IT?
The health capability paradigm emphasizes critical roles of moral and political legitimacy. To analyze and effectuate change in health policy and public health, we need substantive normative principles in deliberative government processes. Furthermore, we need to recognize the role of values in the political and policy realms of health care and public health. Internalizing core values form the basis for the policy and practices we develop in the fields of health care and public health. We must advance an understanding of health policy and public health reform that recognizes moral and political legitimacy in policy decision-making and implementation.
WHY IS IT IMPORTANT?
Many countries lack consensus about the core ethical principles concerning health care and public health. Moreover, irrelevant factors such as the pursuit of wealth, money, and power have unduly influenced domestic and global health. These factors compromise the moral and political legitimacy in domestic and global health. It is necessary to determine, in good faith, shared values and norms to achieve consensus for policy and practice. To address health problems, we need to determine, prioritize, and internalize shared values and norms. To ensure equity in health for all, we need morally and politically legitimate goals in policy-making and implementation.
Moral and political legitimacy in health policy and public health is crucial, because our shared values and norms determine how different policies and practices are formed and implemented. It enables us to institute change and impact based on what we respect, value, and prioritize.
WHAT DOES IT LOOK LIKE?
Values and norms must work together to form a coherent basis for health care and public health reform and implementation. Shared values and norms must support policy formation and implementation. Institutions and practitioners should make a consistent effort to build on, and adhere to, this consensus of values and norms.
For example, there is large consensus on the value and importance of children’s health. People widely believe that children have an intrinsic right to maintaining and building their health and well-being, and this drives current policies and practices about children’s health. Those who do not embrace these shared values and norms are often socially outcasted, particularly those who seek harm to children.
Similarly, valuing and developing certain driving habits has been central to building a healthy culture of driving. For example, most people have learned to believe that wearing a seat belt and not driving under the influence of drugs/alcohol are important. These values help drive current policies, practices, and campaigns about healthy driving behaviors.
HOW DO WE DO IT?
In order to improve the health capability of individuals and populations and ensure access to high quality health care and public health for all, we need to be scientific, honest, and transparent in health policy and public health decision-making and implementation. There needs to be widespread general agreement on values and adherent internalization to norms about health and equity. Policies and interventions need to appeal to public reason and be viewed as reasonable and rational. These ideas need to drive health policy and public health decision-making at the state, national and global level. Moreover, political structures, institutions, and decision-making must be legitimate and fair, excluding the undue influence of irrelevant factors such as the pursuit of wealth, money, and power.