Shared health governance: the potential danger of oppressive "healthism"

We share an interest in public health and in the capabilities approach developed by Amartya Sen, Martha Nussbaum, and others (Comim, Qizilbash, and Alkire 2008; Sen 2009; Nussbaum 1999), so were curious to see how Jennifer Prah Ruger would apply her "health capability paradigm" to health governance. The resulting model-shared health governance (SHG)-has real potential to promote justice in health in some contexts. However, based on the description provided in this issue (Ruger 2011), aspects of SHG seem at odds with important features of the capabilities approach. We suggest that SHG will better safeguard the freedoms of individuals-including their health capabilities-if modified in two ways: (1) if the scope of application is reduced, and (2) if a focus on capabilities for health rather than achievements of health is more consistently maintained.