Understanding Health Inequalities and Justice: New Conversations across the Disciplines

Understanding Health Inequalities and Justice: New Conversations across the Disciplines

Understanding Health Inequalities and Justice: New Conversations across the Disciplines

Understanding Health Inequalities and Justice: New Conversations across the Disciplines

Synopsis

The need for informed analyses of health policy is now greater than ever. The twelve essays in this volume show that public debates routinely bypass complex ethical, sociocultural, historical, and political questions about how we should address ideals of justice and equality in health care. Integrating perspectives from the humanities, social sciences, medicine, and public health, this volume illuminates the relationships between justice and health inequalities to enrich debates.

Understanding Health Inequalities and Justice explores three questions: How do scholars approach relations between health inequalities and ideals of justice? When do justice considerations inform solutions to health inequalities, and how do specific health inequalities affect perceptions of injustice? And how can diverse scholarly approaches contribute to better health policy? From addressing patient agency in an inequitable health care environment to examining how scholars of social justice and health care amass evidence, this volume promotes a richer understanding of health and justice and how to achieve both.

The contributors are Judith C. Barker, Paula Braveman, Paul Brodwin, Jami Suki Chang, Debra DeBruin, Leslie A. Dubbin, Sarah Horton, Carla C. Keirns, J. Paul Kelleher, Nicholas B. King, Eva Feder Kittay, Joan Liaschenko, Anne Drapkin Lyerly, Mary Faith Marshall, Carolyn Moxley Rouse, Jennifer Prah Ruger, and Janet K. Shim.

Excerpt

Rebecca L. Walker, Michele Rivkin-Fish, and Mara Buchbinder

Across the globe and within local communities, people suffer from disease, disability, and early mortality at vastly different rates from one another. Some of these differences, such as those that stem from impoverished environmental conditions or a lack of access to health care, strike many observers as unjust; others, such as those that reflect choices to engage in potentially dangerous elite sports, may seem to have little to do with justice. How we understand the relationship between health inequalities and justice is influenced by many factors, including notions of deservingness, choice, vulnerability, luck, cultural and familial practices, and social group membership and status. Digging deeper, health “inequalities” themselves are constructed through choices about how to measure and reflect health differences, and concepts of justice reflect varying ideals of equality and fairness.

This book is about how we approach health inequalities and justice, and the relationship between them, and why that matters. Many of the conversations taking place in this volume are focused on issues of particular salience to the United States, but others reach beyond those borders. Consider an example to illustrate the significance of how we approach the interrelationship between health inequalities and justice. In 2012, average life expectancy at birth was almost seventy-three years for girls, while for boys it was just over sixty-eight years (WHO 2014). Is this gap of five years unjust? One relevant question is whether this “inequality” is simply a difference for health-care planners to work around, or whether it reflects an inequity that makes a moral demand on their attention and our shared resources. A related question is whether the statistic itself is as meaningful as it initially appears.

At first, it may seem that boys are at an unfair disadvantage merely in virtue of their sex, as long as we agree that one’s sex is not something that should determine one’s share of some significant good (here, life itself).

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