Conceptualising, Engaging and Acting on the Social Gradient. The Right of Everyone to the Highest Attainable Standard of Health.

Despite decades of action on global health inequalities by public health and human rights health inequalities have persisted and deepened, with the Covid-19 pandemic highlighting the intractable nature of social, ethnic, gender, socio-economic and cultural inequalities with consequent poorer health outcomes. The social gradient, drawn from social epidemiology, is a correlation of social factors with health outcomes. It articulates a notion of health inequalities for which action has been less well developed. It depicts a graduated relationship between social determinants and health outcomes which suggests that wherever you are placed in the gradient you experience less good health than the persons immediately above you, and slightly better health than the persons immediately below. The research problem explored is whether and to what extent the right to health has conceptualised, engaged with, and acted upon social gradient health inequalities. This thesis is transdisciplinary in scope by considering the social gradient’s relevance to the right to the enjoyment of everyone to the highest attainable standard of physical and mental health. It addresses the need to explore the implications of the social gradient for the right to health and contributes to an interdisciplinary debate about the right to health and health inequalities. It establishes the integral place of the social gradient in the right to health as a social determinant of health and identifies the benefits and limitations of doing so. The thesis concludes with a proposal for Amartya Sen’s capability approach to enable collaboration between public health and human rights on conceptualisations of and action on the social gradient.