Radical liberal theory

In radical liberal theory, freedom and private property rights are fundamental for the development of States; the market is essential, and individuals are responsible for their living conditions. Then the State will not assume responsibility for guaranteeing social and economic rights, mainly because doing so would imply intervening, and would undermine individual freedom and autonomy (^{Aguiar, 2003}).

This theory is based in the idea of natural equality granted from birth, as advocated by the French Revolution (^{Friedman & Friedman, 1980}), and proposes that all individuals are equal before the law with no consideration for their advantages or disadvantages; thus, such equality is merely an appearance built on conditions of inequality. This inequality is not to be intervened (^{Velez, 2011}), and it also deactivates the idea of common and relational assets (^{Rodríguez Palop, 2014-2015}). Autonomy is also essential for this theory, and altogether with inequality creates competition —even on disadvantageous grounds—, in which everyone is responsible for acquiring his resources and, certainly, defending them against the rest.

These theories propose the free market as an engine for improving health services, so that health cannot be seen as a right, and public spending is concentrated on those who comply with the moral and hygienic canons (^{Ugarte, 2005}). Different arguments are advocated to justify this concentration of public spending, such as stating that generalized access to public services would compromise the economic sustainability of the system (^{Solís, 2011}). This approach to health services makes itself evident, for example, and in the case of migrants, in health services that only provide them emergency care.

Liberal Equality: Rawls

Radical liberal theories are criticized because they are considered to maintain and justify inequities. As an example of this criticism, ^{Rawls’ (2006)} egalitarian liberal theory presents the egalitarian distribution of primary assets as a fair demand (of the exercise of freedom and autonomy); it also states that morally arbitrary inequalities should be alleviated, and that injustice is only tolerable if it prevents a greater injustice (^{Rawls, 2006 [1971]}).

According to ^{Rawls (2006 [1971])}, health is a natural asset, and as such is not under the control of the basic structure of the society that distributes the primary assets. Although, even if it is a natural asset, taking into account that health makes possible autonomy, the enjoyment of freedom, and the development of the life that one wants to live (^{Borrero, 2011}), and contributes to equal opportunity, it is the duty of society and the State to protect it, for example, by guaranteeing the regular functioning of health services (^{Daniels, 2001}).

Rawls’ stance (2006, [1971]) on social justice is concrete, for health justice, in ^{Daniels (2001)}, who proposes primary assets as determinant factors in medical assistance and healthcare, and states that disease restricts the opportunities of individuals, preventing them from fully participating in the economic, social, and political life of their societies.

Capability Approach

^{Amartya Sen (2003 [1992])} and ^{Martha Nussbaum (2007 [2006])} call into question Rawls’ theory (2006 [1971]). ^{Sen (2003 [1992])} states primary assets equality is not enough, as it does not guarantee the same possibilities and opportunities for people to employ them in the development of their life project. Likewise, ^{Martha Nussbaum (2007 [2006])} points out that primary assets leave out important elements such as life, health, and physical integrity.

From this criticism, ^{Sen (2003 [1992])} on the one hand, and ^{Nussbaum (2007 [2006])} on the other, propose another vision developed around the more equitable distribution of resources, focused on the capabilities —more on individuals than on assets—, on the way to achieve equality of opportunity (^{Friedman & Friedman, 1980}) as a means for individuals to develop their potential. And so, for Sen (2003 [1992]), equality of capabilities is essential for justice, as this equality refers to the general freedom of an individual to strive for his well-being. Then for ^{Nussbaum (2007 [2006])}, health is a condition for social justice, as disease positions individuals in a condition of asymmetrical dependence (^{Nussbaum, 2007 [2006]}). When it comes to the propositions by ^{Sen (2003 [1992])} and ^{Nussbaum (2007 [2006])}, it should be pointed out that their emphasis on capabilities implies progress, as they take into account human diversity within justice theories; the proposition by ^{Seyla Benhabib (2005 [2004]}, ^{2006 [1992]}, ^{2008 [2007]}) also follows this line, which is addressed below.

Acknowledgement and Redistribution: The Concrete Other in Social Justice

When it comes to including human diversity in social justice theories, it is important to point out that biopolitics, for the sake of homogeneity, normalizes societies, denies the differences in the demands, and the singularities in the individual (^{Fleury, 2004}). The stance of ^{Benhabib (2008 [2007]})⁵ can be assumed to question this homogenizing approach; according to this author, modernity’s view from moral and political universalism, as it strives for defining what is universal in the human being to establish a single justice for all humanity, has resulted in the exclusion of that which falls outside such universality.

From this critic to moral and political universalism, the abovementioned author proposes a post-enlightenment interactive universalism, a social justice theory that acknowledges the differences between human beings and aims at acknowledgment and redistribution from the concrete other, not forgetting the generalized other. This theory is based on the ethics of care and responsibility built from a moral dialog in which the reasoning is done from the other’s point of view (^{Benhabib, 2006 [1992]}).

As previously noted, in the development of her theory, Benhabib considers the perspective of the generalized other and the concrete other. The perspective of the generalized other implies the “abstraction of the concrete other’s individuality and identity” (^{Benhabib, 2008 [2007], p. 190}). Thus, making the particularities of the individual nonvisible, assuming him universal and ahistorical (^{Benhabib, 2006 [1992]}). Contrastingly, the perspective of the concrete other “requires that we perceive each and every being as an individual with an affective-emotional constitution, a concrete history, an identity that is both collective and individual” (^{Benhabib 2008 [2007], p. 191}), and so it highlights that the subject is unique, with a particular history, identity, context, capacities, needs, and limitations (^{Benhabib, 2006 [1992]}).

This approach by ^{Benhabib (2006 [1992])} calls into question the current social and economic system by including the concrete other in social justice theories; this current system, from the predominance of a radical liberal social justice theory, produces unequal but paradoxically homogenizing societies in which there is no space for mutual acknowledgment (^{Rodríguez Palop, 2014-2015}), and in which, in order to preserve identity, even the elimination of differences, and the domination, exclusion, and violence towards “the other” are accepted (^{Cordero, 2014}).

Precisely, ^{Benhabib (2006 [1992]}, ^{2008 [2007])} includes the concrete other into her approach to social justice, which is not always known in other social justice theories, that her propositions gain terrain against those other theories. This author goes beyond the question of resource distribution, which has already been central for other social justice theoreticians such as ^{Rawls (2006 [1971])}, who turn towards egalitarian redistributive claims. ^{Benhabib (2006 [1992]}, ^{2008 [2007])} provides space for demanding recognition, just as other authors such as ^{Nancy Fraser (2000}, ²⁰⁰⁸⁾, who in turn states that resource distribution cannot be separated from the acknowledgment of the other’s existence and their consequent right to resources. In the case of migrants, acknowledging them in relation to redistribution would imply recognizing their particularities as migrants and, on that base, allocate resources to them; for example, by being migrants they have unequal access to social, economic, and political resources, and so the redistribution policies that take them into account should have as one of their goals to mitigate such inequalities.

As for social justice theories to focus on either redistribution or recognition, it should be stated that even if both —redistribution and recognition— are different justice analysis paradigms, they cannot be separated nor reduced one to the other. As an example, ^{Fraser (2000)} points out that focusing only on recognition can create two problems: the first being the moving from redistribution to recognition, which presupposes that unequal distribution arises from the lack of recognition. Therefore, it is deemed unnecessary to design device- specific redistribution policies, thus risking the possibility of preserving and promoting economic inequality; the second being that the reification of identity can create separatism because if a member does not fit into the culture of a certain group, said member will be considered disloyal.

And so, ^{Fraser (2000}, ²⁰⁰⁸⁾ posits that in capitalist societies, separating them is a false antithesis, since the manifestations of socioeconomic inequality and the lack of cultural respect overlap and interact with each other, without being one a consequence of the other. Both redistribution and recognition are necessary, an economic transformation altogether with a cultural transformation. As an example of the necessary link between redistribution and recognition, within the context of migration, the statement by the same author can be mentioned, saying that the rights to citizenship and participation imply (either implicitly or explicitly) ideas about the different moral value of people (^{Fraser, 2000}, ²⁰⁰⁸⁾ .

Political View and Cosmopolitanism: Justice for a Global World

In order to continue with the ideas on social justice and migrants, it becomes necessary to take into account that migrants have surpassed national borders, and so considerations on social justice should be thought about from a global perspective. However, neither the political view nor cosmopolitanism (which are the main two propositions of global justice) addresses justice for migrants specifically. Consequently, to reflect on the living conditions and the health of migrants implies calling into question these theories, as well as the capacity of countries to face the challenge of plural coexistence that arises from the insertion of those who become part of their everyday life, even if they were not born in said countries.

The political view posits a State-centered global justice theory, applicable to relationships inside the nation-State and which cannot be extrapolated to individuals from different countries, as global justice strictly requires a unified sovereign power able to guarantee socio-economic justice. Concisely, for the relationships between countries it translates into a less demanding justice, substantive minimalism (a minimum of basic rights), in which humanitarian hardships are not a matter of justice, but welfare (^{Nagel 2008 [2005]}). Under this theory, migrants would not be protected by the justice of the receiving State, as they would not be seen as citizens, and they would also not be protected by their countries of origin, as they no longer reside there.

In its turn, for cosmopolitanism, global justice demands have their origin in a duty of equity towards everyone; to achieve so, institutions (not a global sovereign power) are required to implement equity or equal opportunity standards, a federal system able to expand the democratic and legitimate government (^{Nagel, 2008 [2005]}).

Generally, both positions advocate for a global justice arising from relationships between countries, not between individuals, and demand a global authority able to rule justice; they also set their scope to matters such as war and human rights violations. By such legal delimitation, certain rights such as economic and social are not taken into account (^{Nagel, 2008 [2005]}), since doing so would (most likely) require States to commit to ensuring the necessary socio-economic conditions (^{Lafont, 2009}).

Regarding these theories, Benhabib states that “global distributive justice for individuals fails to acknowledge the first principle of distribution, that is, the distribution of human beings as members of different communities” (^{Benhabib, 2005 [2004], p. 27}). Before the question of belonging to different communities, she points out in terms of the rights of foreigners, migrants, refugees, etc., that “the modern State went from being an instrument of rights to being a discretionary one without rights... thus creating millions of refugees, foreigners, deportees, and stateless peoples across borders” (^{Benhabib, 2005 [2004], p. 49}).

From these points made by ^{Benhabib (2005 [2004])} and coherently following her propositions about the concrete other, the author introduces a global justice theory termed cosmopolitan federalism, which takes into account the individual from the view of human rights, without disregarding the State. This theory advocates for porous yet not open borders, as it is not about everybody crossing them or the dissolution of the State, but instead about reflecting on the mechanism from which the rights of those who do cross the borders are to be defined, among other matters (^{Benhabib, 2005 [2004]}).

The propositions of the author’s cosmopolitan federalism can be found in her book The Rights of Others (^{Benhabib, 2005 [2004]}). In the development of her propositions, Benhabib picks up Immanuel Kant’s the right to hospitality, Hannah Arendt’s problem of the denationalization of minorities after World War II, and John Rawls’ law of peoples. Following the approaches of these three authors, Benhabib proposes the right to permanent residence from the view of a universal ethical law that takes into account non-discrimination, fair treatment, and the deliberation on the viability of legally integrating the foreigner into the State, based on political belonging; the latter understood as the “principles and practices for the integration of visitors, foreigners, immigrants, newcomers, refugees and asylees into previously existing political entities” (^{Benhabib, 2005 [2004], p. 24}).

This way, the integration of migrants into the State should take place on moral and egalitarian reciprocity grounds, and not be based on non-elective attributes such as ethnicity (^{Rivero Ojeda, 2010}; ^{Sánchez, 2009}), an issue addressed by the author when she states that, on a cosmopolitan level, it is not only about achieving fair distribution but also about implementing a vision of fair political belonging (^{Benhabib, 2005 [2004]}).

On the other hand, ^{Benhabib (2005 [2004])} states that it is necessary to rethink how citizenship and nationality correspond with each other (a matter fundamental in the development of the modern nation-State), and in the justice that generates tension between the universal acknowledgment of rights and the sovereign power of States (^{Benhabib, 2005 [2004]}). On this, the author also points out the fact that today, with a disaggregated citizenship in which collective identity and political and social rights do not necessarily coexist, there is an opportunity for including voices so far excluded from the public sphere, such as those of migrants.

Specifically, regarding citizenship and the rights of migrants, ^{Benhabib (2005 [2004])} proposes the right to have rights, originally set forth by ^{Arendt (1998 [1951])} to express the need for all human beings to have access to rights, even when outside the frame of nationality. According to this, the rights of foreigners would not be granted to them for belonging to a political community, a State, or a territory, but for being human, by integrating citizenship rights into a universal human rights regime. This integration would take place from political membership through the mechanism of democratic iterations, which constitute themselves into public deliberation processes wherein universalist claims and principles are addressed, in legal and political institutions, and civil society (^{Benhabib, 2005 [2004]}).

These public deliberation processes would open space for the voice of migrants and to freedom of communication in which both —citizens and immigrants— can dialogue on equal terms about the criteria that would favor their rights (^{Rivero Ojeda, 2010}). This way, and in line with ^{Rivero Ojeda (2010)}, Benhabib advocates for a fair democratic system in which diversity, migration, and universal rights are a moral and political priority.

The Health of Migrants, A Matter of Social Justice

According to ^{Héctor Abad Gómez (2012 [1987])} “a human society aspiring to be fair must provide the same physical, cultural and social environment opportunities to all of its components. If it does not, then it creates artificial inequalities” (^{Abad Gómez, 2012 [1987], p. 4}). These inequalities are a matter of public health, since, as pointed out by Latin American social medicine (^{Galeano, Trotta, & Spinelli, 2011}) and critical epidemiology (^{Breilh, 2013}), health cannot be thought only from the biological or individual perspective, as it is linked to the categorization of individuals, just as disease and death are.

In the same way, categorizations such as gender or ethnicity can derive into particular health-related impacts. For example, works such as those by Paula Braveman have shown how belonging to minority ethnicities impacts negatively on health (^{Braveman, 2012}; ^{Nuru-Jeter, Dominguez, Hammond, Leu, Skaff, Egerter, Jones, & Braveman, 2009}).

Just as in the case of ethnicity or gender, subject categorization impacts on migrants. In them, this manifests due to categorizations such as citizenship, migrants are granted unequal access to social, economic, political, and legal resources, and in turn, this unequal access results in migrants having poorer health conditions than nationals of the destination countries.

From this categorization of subjects, migrants are positioned hierarchically lower than nationals (^{Vargas Llovera, 2011}), and are accordingly excluded from social resources such as employment, housing, education, access to health services, etcetera.

Exclusion can worsen if migrants are perceived as pathogenic to the receiving societies, for example, when from pathologizing approaches they are considered a public health problem in the societies that receive them. For this reason, this paper has posited that migrants’ health should be approached from social justice reflections that acknowledges the relationship between their health conditions and their status as migrants.

Based on the above, the predominant social and global justice approaches were presented, highlighting Seyla Benhabib’s approaches (2006 [1992], 2005 [2004], 2008 [2007]) which particularly focus on justice for migrants. First, those social justice theories that limit resource redistribution without taking into account its underlying inequities are called into question, and so it proposes the need for recognizing the concrete other. Second, it posits a social justice theory centered around the right of every human being to have rights.

Regarding Benhabib’s first proposition (2006 [1992], 2008 [2007]), this paper highlights the acknowledgment of the concrete other, since this recognition allows to question the inequalities linked to categorization, which arise from the very constitution of populations and results in gaps in disease and death between them.

A social justice proposal that acknowledges the concrete other would also allow questioning biopower and its control over bodies, lives, and populations. Biopower, linked to negative biopolitics, homogenizes and excludes those who are different (^{Arendt, 2005 [1958]}); conversely, acknowledging the concrete other will precisely provide space for plurality, and by acknowledging plurality, those who are different would no longer have to be excluded or controlled.

When it comes to the second approach to the subject matter, it has been proposed that once migration is understood as a global phenomenon, social justice reflections in relation to migrants should also consider global justice theories. This paper specifically proposes a global justice based on Benhabib’s proposal (2005 [2004]): the right to have rights, that is, that the guarantee of rights should not be linked to nationality o citizenship, but is granted by belonging to humankind.

Benhabib’s advocacy (2005 [2004]) for the right to have rights also stands out due to its orientation and commitment to human rights; such orientation and commitment are shared by authors such as ^{Fraser (2008)}, who states that the various politics of acknowledgment that do not respect human rights are unacceptable, even if they promote social equality; there are also ^{Stolkiner (2010)} and ^{Santos de Sousa (1997)}, for whom human rights are essential for the vindication of oppressed groups. Even if it is noticeable that human rights share a legacy of liberal tradition, they should be recognized as valuable because of their link to the contextual scenarios that make them historical and situational (^{Varela & Sotelo, 2000}), and because in their time they came to be as a commitment to humanity, a “declaration” against the atrocities inflicted on fellow men.

On the other hand, it should be pointed out that the two approaches —social justice and global justice— have been brought together for the proposal of this paper: the acknowledgment of the concrete other (^{Benhabib, 2006 [1992]}, ^{2008 [2007]}) and the right to have rights (^{Benhabib, 2005 [2004]}); bringing these approaches together allows to link public health with human rights and with the issue of redistribution and recognition. This bringing together of approaches is essential for the development of an alternative to current health which, conditioned by the market, is increasingly limited to the privileged; that is, those who, as Bauman points out (2004), correspond to the ideals of a neoliberal system.

To think of public health that is linked to human rights, redistribution, and acknowledgment makes it possible to place health as a right that must be protected by the State and society. This matter is highly relevant, as public health commitments and their bets on health both show and mobilize the commitments of society itself (^{Varela & Sotelo, 2000}). And so, it becomes necessary to bring together public health and a commitment to social justice, as health is not merely a biological or individual matter, but a process, in which social, economic, ethical, and political conditions are also involved.

On the other hand, as it questions the pathologizing of the different, for example, its segregation, this proposal opens the door to reflections on what health, when understood as public, can do for what is considered public. As an example, the issue of migrant health invites public health to question its mechanisms and conditions when individuals such as migrants are excluded from the public sphere and the consequences of this exclusion on their health. This way, even if reflections on the public sphere are not exclusive to public health, they must indeed be essential to how it is developed as knowledge and practice.

All in all, this paper has posited how relevant it is for public health to approach the health of migrants reflecting from social justice; a view that takes into account the acknowledgment of the other and their right to have rights, allowing in the same measure to oppose the assessment of migrants as a threat. The proposed approach could concretize, for example, in: