Justification
Health is an outcome of biological, mental and social determinants. At present, no formal, overarching theory or process allows the social determinants and social dimensions of health to form part of the debates, processes and theories of health care delivery. In so far as the social parameters of health are addressed at all, they are placed within the orbit of public health and play little part in other health care sectors.
As socialists, we in the Socialist Health Association, recognise that we share a social responsibility to all. In fact, we believe the social aspects of human being to be formative of humanity and the human condition. Consequently, we argue that the social principle should inform and influence health care delivery alongside those principles of respect for the individual autonomy, the aspiration towards quality care and responsible financial accounting.
It is proposed that this principle of social responsibility become recognised as social governance, and that the Socialist Health Association campaign for social governance to become integrated within the governance systems of health care, as a third system of health care governance, alongside those existing systems of financial and clinical governance.
Social governance would allow our insights into health and health care delivery to form part of the framing debates on health and would provide all health carers with a role and responsibility for promoting a just, equitable and health-promoting wider economy.
Social governance – a definition
Social governance is a theory, process and ethic that makes explicit the social dimensions of health, emphasises the principle that as humans we share one humanity and one earth, and encourages a collective and involved responsibility of all for a healthy society and healthy world.
The theory of social governance – a healthy economy, a healthy society
As a theory, social governance recognises that health emerges not just from clinical practices but also from the ways we live, run our economy and relate to each other.
A healthy society is recognised by the health and well-being of its members, the quality of its social relationships, the goals to which it aspires and the heritage that it leaves to future generations.
A healthy society is founded upon a healthy economy, since it is the economy that determines our social relationships with each other, helps satisfy our needs and produces the goods that we aspire towards.
A theory of social governance for health would allow health care to become more deeply involved in the critique and reform of the present economic order. It would do this both by monitoring the consequences of economic activities on health and well-being and by developing the theory and practice of an economy whose goal is health and well-being.
The process of social governance – democracy, participation, debate and social audit
The health of a democratic society can be judged by the degree to which its members feel valued, supported and listened to. Through processes of democracy, participation and debate, social governance would give to health care a pioneering role in developing a healthy, informed, inclusive and responsible democracy. The democratic and horizontal processes of social governance would complement the often autocratic, bureaucratic and vertical processes associated with much of financial and clinical governance.
Social audit would monitor the contribution of health care institutions to the development of social capital under headings that might include human capital, natural capital, physical capital and cultural capital. In so doing, social governance would contribute to the development of social conscience and awaken a sociological and ecological imagination in health care.
Looking out into the general economy, social governance would see extreme poverty, malnutrition, violence, destruction of human habitat and degradation of the human condition as symptoms and signs of a disordered, pathogenic economic system and seek to align health care alongside the many movements and theories seeking to correct the pathologies of the current economic order
Social governance would be distinguished from corporate social responsibility. Corporate Social Responsibility is hierarchical, a response to externally driven norms, often formal and legal. Social governance would promote the values and processes that provide governance over Corporate Social Responsibility.
The ethic of social governance – an ethic of human kinship
As socialists, we recognise that humanity is one. The ethic of social governance would allow this ethic of human kinship to become a guiding principle within health care practice.
With an ethic of kinship, the principles of solidarity, fairness and responsibility would be repeatedly strengthened and re-affirmed.
The benefit of a platform of Social Governance for the Socialist Health Association
Through social governance, the values, visions and organisational theories of a socially informed theory of health would find a platform within health care. Through social governance, health care could become the pioneer for a different way of doing economics, a way that would serve as model for all those who believe in a fair, equitable and sustainable society that recognises no boundaries for human kinship.
