Children's Health Inequalities: Ethical and Political Challenges to Seeking Social Justice
Blacksher, Erika, The Hastings Center Report
Childhood obesity may have severe long-term consequences for health--indeed, for the overall course of a person's life. Do these harms amount to a problem of social justice? And if so, what should be done about it? Parents are usually granted considerable leeway to make decisions that affect their children's health. Social and moral theory has often overlooked the family, however, leaving us with an inadequate understanding of parental autonomy and of how social policy may influence it.
By and large, the richer you are, the healthier you will be and the longer you will live. This fact, often referred to as the social gradient in health, raises a host of important questions. Among the more basic is which, if any, social inequalities in population health are unjust. (1) My goal in this discussion is to investigate the disproportionate health problems that affect disadvantaged children, using U.S. childhood obesity as a case study. In the United States, childhood obesity afflicts as many as one in three socially disadvantaged children, with especially high rates among African American girls and Hispanic and Native American children of both genders. (2) For almost every childhood health indicator, moreover, minority and poor children do worse than their white and more affluent peers, respectively.
I will start by sketching the sources and nature of the harms to children and then try to draw out some important and neglected implications for seeking justice on their behalf. (3) I will argue that justice requires both broad structural reforms to improve the material and social conditions in which children are reared and specific programs targeted at the adults who have direct and special responsibility to care for them. In short, a social commitment to investing in children's health and futures requires a social commitment to investing in their families. The upshot for public policy is both to mitigate structural in equality among families and to promote parental capacity within them. (4)
This prescription for social policy faces considerable challenges. As the history of U.S. public policy shows, efforts to promote child welfare have tended to cycle between policies to fortify the material conditions in which children are reared and policies to improve parental behaviors and norms, and the latter have often been punitive and demeaning. (5) Rather than treating structural and behavioral changes as interrelated goals to be pursued in tandem, they have often been pursued in isolation or even pitted against each another. This history reflects, among other things, competing explanations for inequalities in children's outcomes, which may then be selectively employed in a political context polarized by a political left focused on structural reforms and a political right focused on personal (in this case, parental) responsibility.
In the second section of this paper, I argue that one source of these political and ethical challenges is a void in social and moral theory related to the family. Long neglected, recent analyses show the family to be both a site of private affiliation and a subject of justice. The theoretical and policy implications of this ambiguous status, however, are far from clear. I address one implication by clarifying the nature and extent of parental autonomy and specifying what it means to express respect for parents and families in a policy context that aims to promote children's health and development. In doing so, I hope to make a theoretical contribution to our understanding of the family as a subject of justice and a practical contribution to our collective capacity to secure the social, material, and familial resources that all children need to lead healthy, productive lives.
The Injustice of Children's Health Inequalities
Researchers who study children's health and development rarely say explicitly why they consider the topic worthy of public inquiry and response. …