In the popular folklore three-score-years-and-ten is treated as a fair innings for people, and thereby serves as an informal reference point for judgements about distributive justice within a community. But length of life alone is an insufficient basis for such judgements - a person's health-related quality-of-life also needs to be taken into account. If one of the objectives of public policy is to reduce inequalities in lifetime health, it will be demonstrated that this is very likely to (...) require systematic discrimination against the older members of a community. The notion of community solidatity will also be tested, because a decision will need to be made as to whether the same fair innings applies to all members of the community, or whether some are entitled to more than others. The strength of the fair innings principle is that it brings these issues to the fore in a systematic way which should ais their resolition in a practical context. (shrink)

In this article, we argue that apart from evaluating the causes and the social determinants of health inequalities, an evaluation of the effects of health inequalities is due. For this, we propose the ideal of relational equality as an evaluative framework, and test to what extent health inequalities threaten this ideal of a society of equals. We identify three ways in which they do and argue that these risks are especially great for those (...) lower down the socio-economic strata. We thus conclude that equality in health is instrumental to social justice, and that socio-economic inequalities in health are not only unjust due to their causes but also due to their consequences. We continue to argue that our instrumental approach opens a perspective to mitigate the identified injustices by changing society, rather than reducing inequalities in health, and argue that this is an advantage in the light of the realistic assumption that of the socio-economic health inequalities will persist. The article thus offers a complementary approach to both the evaluation and the mitigation of the injustice of socio-economic inequalities in health. (shrink)

This article argues that because racial inequalities are embedded in American society, as well as in medicine, more evidence-based investigation of the effects and implications of affirmative action is needed. Residency training programs should also seek ways to recruit medical students from underrepresented groups and to create effective mentorship programs.

Social inequalities in health in the UK persist despite attempts to reduce them. We argue that work and pensions constitutes an area of intervention where there is potential to make change happen. We propose that workers who are exposed to significant health risks through their occupation should be allowed to draw their state pension earlier, based on a minimum number of years in the workforce. We model this proposal on similar policies in other European countries. In (...) our modification, the pension age and the retirement age would be separated, such that workers can receive a state pension whether or not they choose to continue working. This arrangement may encourage workers either to reduce their working hours or to change to less demanding or harmful work. The health of these workers would thereby benefit from reduced exposure to a harmful work environment, reduced stress and more opportunities for rest and relaxation. However, it has also been suggested that retirement is bad for mental health. In response, our proposal enables workers to phase in full retirement over a period of part-time work, and we believe that this would counter any potential negative effects on health caused by retirement. (shrink)

In most countries in the global north, social differences in health status and disease prevalence and outcomes are persistent and growing. This is also the case in the welfare states of Scandinavia. In Denmark, the empirical point of departure for this article, income inequality is relatively low and social mobility is generally considered to be high. One of the ideals of the Danish welfare state is that all citizens have free and open access to the tax-funded (...) class='Hi'>health-care system. All Danish citizens can register at a general practice, which serves as the gatekeeper for more specialized health-care... (shrink)

Can epistemologies anchor processes of social inequality? In this paper, we consider how epistemological dominance in science, engineering, and health fields perpetuates disadvantages for students who enter higher education with alternative epistemologies. Drawing on in-depth interviews with Native American students enrolled at two US research universities who adhere to or revere indigenous epistemologies, we find that epistemological dominance in SE&H degree programs disadvantages students through three processes. First, it delegitimizes Native epistemologies and marginalizes and silences students who value (...) them. Second, in the process of imparting these dominant scientific epistemologies, SE&H courses sometimes require students to participate in pedagogical practices that challenge indigenous ways of knowing. Third, students encounter epistemological imperialism: most students in the sample are working to earn SE&H degrees in order to return to tribal communities to “give back,” yet, because the US laws regulating the practice of SE&H extend onto tribal lands, students must earn credentials in epistemologies that devalue, delegitimate, and threaten indigenous knowledge ways to practice on tribal lands. We examine how students navigate these experiences, discuss the implications of these findings for SE&H education, and describe how epistemological dominance may serve as a mechanism of inequality reproduction more broadly. (shrink)

Background: Social inequities in health systems are threats to global health. Considering the important role of nurses in establishing social justice, identification of factors affecting nurses’ participation in this area can contribute to the development of social justice. Objective: This study aimed to identify factors affecting nurses’ participation in establishing social justice in the health system. Research design and methods: The study was conducted using conventional qualitative content analysis approach. Purposive sampling was used (...) to select 14 participants in 2019. The data were collected through semi-structured interviews and analyzed concurrently with data gathering. Participants and research context: In total, six faculty members, five nursing managers, and three clinical nurses from three different universities were interviewed. Ethical considerations: The research was approved by the Ethics Committee of Urmia University of Medical Sciences in Iran. Findings: Four main themes were found, including inadequate professional authority, insufficient attention to social justice in the area of education, clinical concerns as barriers to professional presence in society, and reflection of personality traits in the profession. These are the main factors affecting nurses’ participation in establishing social justice in the health system. Discussion: Authorities need to take effective steps to establish social justice through reforming the health system’s policy-making and power-acquisition domains, promoting nurses’ involvement in social factors in health issues, and adding professional values as a part of nursing curriculum. The clinical practice environment can also be helpful through providing quality, safe, and cost-effective services. In addition, fair and efficient recruitment process for new nurses can contribute to the establishment of social justice in the health system. Conclusion: Macro-level managerial factors such as policy, education, and clinical environment, along with personal factors, play a significant role in the participation of nursing profession in establishing social justice. (shrink)

Inequities shape the everyday experiences and life chances of individuals at the margins of societies and are often associated with lower health and particular challenges in accessing quality treatment and support. This fact is even more dramatic for those individuals who live at the nexus of different marginalized groups and thus may face multiple discrimination, stigma, and oppression. To address these multiple social and structural disadvantages, intersectional approaches have recently gained a foothold, especially in the public health (...) field. This study makes an empirically informed argument for the merits of increasing the use of intersectional frameworks in the mental health field. In the mental health field, the potential for greater attention to multiple unjustified disadvantages appears to be of particular importance, as many mental health service users already face stigma and discrimination because of their mental health issues and thus may benefit particularly frequently and far-reachingly from effective problem awareness about multiple disadvantages. Intersectional approaches may help address the complexity, interdependence, and mutual constitution of social inequalities better than previous approaches that examined only one category of sociostructural stratification. By helping to identify the needs of those at the greatest risk of poor health, intersectional frameworks and tools can contribute not only to better address the needs of multiple disadvantaged individuals with mental health issues but also to the promotion of equity in the field of mental health, contributing to the reduction of health disparities. (shrink)

Empirical evidence confirms the existence of health inequalities between women and men in developing countries, with women experiencing poorer health status than men, as well as less access to vital health services. These disparities have different sources and take different forms, some of which result from cultural factors, others from discriminatory laws and practices, and still others from the biological fact that only women undergo pregnancy and childbirth, a major cause of maternal mortality. The injustice lies (...) in the fact that many of these disparities result from socially controllable factors, while others could be remedied, especially in cases of violations of human rights. Past and recent policies and practices of the United States Government can be faulted for both actions and omissions that have contributed to such inequalities. Different conceptions of global justice are explored, with implications for who owes what to whom regarding these disparities. (shrink)

Many social gradients in health appear steeper for men than for women. I refer to this as the “Steepness Puzzle.” This paper explores the ethical implications of this Puzzle. First, it identifies potential explanations for the Steepness Puzzle, including methodological problems. Second, it highlights two harms associated with the methodological explanation: the consequences of biased epistemic practices and the marginalization of women. It also demonstrates how attempts to flatten the gradients in health could disproportionately favor men or (...) reinforce troubling gendered norms. Finally, I suggest ways to address the methodological problems underlying the Puzzle. (shrink)

Many classical approaches in the area of phenomenological pscyhopathology focus on structures of lived experience of mental illness and overlook the role social context plays in the formation of lived experiences. The paper addresses this issue and contributes to recent research which has pointed out that there is a need for an approach to mental health which investigates the role of context in shaping lived experiences. We propose a conception of contextuality (or situatedness) which we develop in terms (...) of two main characteristics: intersectionality and social relationality of the human condition. We take context to be shaped by social interdependence and by the intersection of multiple factors including gender, race, ethnicity, class, socio-economic status and power relations. We develop this analysis in relation to substance misuse, refer to, and compare, certain case studies and perspectives from Brazil to illustrate our approach which can, however, be applied to other areas of mental health. We suggest that the proposed contextual approach is crucial for an in-depth understanding of psychopathology from a phenomenological perspective and in relation to contemporary ethico-political issues concerning social differences and inequalities in mental health. (shrink)

The federal government is funding a sea change in health care by investing in interventions targeting social determinants of health, which are significant contributors to illness and health inequity. This funding power has encouraged states, professional and accreditation organizations, health care entities, and providers to focus heavily on social determinants. We examine how this shift in focus affects clinical practice in the fields of oncology and emergency medicine, and highlight potential areas of reform.

This paper offers a realist critique of socialresearch on health inequalities. A conspectus of thefield of health inequalities research identifies twomain research approaches: the positivist quantitativesurvey and the interpretivist qualitative `casestudy'. We argue that both approaches suffer fromserious philosophical limitations. We suggest that aturn to realism offers a productive `third way' bothfor the development of health inequality research inparticular and for the social scientific understandingof the complexities of the social world in general.

Values are numerous, interrelated and hard to discern in professional practice. This article reports on key findings from research into locating professional values within health social work practice in Aotearoa New Zealand. The research explores how 15 health social workers experience and negotiate value demands when working with newborn infants. A staged methodology underpinned by constructivist grounded theory was utilised to generate theoretical knowledge through two phases of semi-structured individual interviews. The research firmly located health (...) social workers practice in the middle ground of a complex, tension-ridden practice environment with health social workers courageously striving to balance competing requirements. Within a health model influenced by neoliberal policy, key tensions related to challenges faced due to professionals oversimplifying social circumstances in risk-laden situations. This resulted in issues of judgements, bias and racism being a central concern for the participants’ social work practice. Despite these tensions, the place of social justice as a primary organising value was affirmed by the research. A stronger focus on the profession’s values would strengthen the collective voice of health social workers and their identity, in order to better address the systemic drivers of health inequities. (shrink)

In the literature on responsibility and health care, many associate responsibility-sensitive health policies with a form of luck egalitarianism. On this view, if some health inequality is due to the choices, or responsible agency, of one of the patients involved, then it is not unjust, and we have no responsibility to compensate for it. If the inequality’s origins cannot be traced back to the patients’ choices, then it is not their responsibility, and thus it becomes society’s responsibility (...) to compensate for it. This division of responsibilities between the individual and society applies not only to the past, but also to our responsibilities concerning the future. For instance, some luck egalitarians think that inequalities in life expectancy between men and women are unjust (Segall 2010) and should be compensated. Alex Voorhoeve has recently raised a new frontier in this debate concerning ‘prospective’ lives: the lives of those who will be born in the future. Against Voorhoeve, I argue that prospective inequalities are not a concern for egalitarians. This qualifies the claim that all inequalities not traceable to personal responsibility are unjust and suggests that there is no responsibility to structure society or our social institutions to avoid such prospective inequalities. (shrink)

Scientific advances in health care have been disproportionately distributed across social strata. Disease burden is also disproportionately distributed, with marginalized groups having the highest risk of poor health outcomes. Social determinants are thought to influence health care delivery and the management of chronic diseases among marginalized groups, but the current conceptualization of social determinants lacks a critical focus on the experiences of people within their environment. The purpose of this article was to integrate the (...) literature on marginalization and situate the concept in the framework of social determinants of health. We demonstrate that social position links marginalization and social determinants of health. This perspective provides a critical lens to assess the societal power dynamics that influence the construction of the socio‐environmental factors affecting health. Linking marginalization with social determinants of health can improve our understanding of the inequities in health care delivery and the disparities in chronic disease burden among vulnerable groups. (shrink)

How should we think, from the point of view of distributive justice, about inequalities in health and longevity? Norman Daniels’s influential account derives a social duty to reduce health inequalities from Rawls’s principle of fair equality of opportunity. This paper criticises Daniels’s approach and offers an alternative. To the extent that the basic structure of society shapes people’s opportunities to be healthy, we ought to think of ‘the social bases of health’ directly as (...) a Rawlsian primary social good. The paper attempts to clarify the correct principle for its distribution, and its relationship to other goods that give rise to considerations of justice. (shrink)

Empirical research shows the significant negative effects inequality has on aspects such as public health, vulnerability to violence, and social trust. While the majority of researchers agree that there exist specific social determinants of health as well as a distinct social gradient in health , there is wide disagreement both over what the exact causal relationship between social inequalities and health is, and what the adequate policy responses especially to the SGH (...) are. For policy-oriented theorists, the question arises which normative implications these empirical findings offer for philosophers working on equality.This paper argues that the first lesson philosophers should take away from the empirical literature is that the issue that needs to be addressed is harmful social inequality, rather than unequal material distributions, or unequal opportunities and starting gates as such. That is to say, inequality with respect to a specific feature X is not—in itself—the problem, but the problem are the negative effects of certain harmful forms of complex social inequalities. For our normative analysis this entails that we should focus on the conceptualization of the ideal of social equality, and the kinds of relationships and institutional arrangements compatible with it. (shrink)

ABSTRACT In spite of vast global improvements in living standards, health, and well‐being, the persistence of absolute poverty and its attendant maladies remains an unsettling fact of life for billions around the world and constitutes the primary cause for the failure of developing states to improve the health of their peoples. While economic development in developing countries is necessary to provide for underlying determinants of health – most prominently, poverty reduction and the building of comprehensive primary (...) class='Hi'>health systems – inequalities in power within the international economic order and the spread of neoliberal development policy limit the ability of developing states to develop economically and realize public goods for health. With neoliberal development policies impacting entire societies, the collective right to development, as compared with an individual rights‐based approach to development, offers a framework by which to restructure this system to realize social determinants of health. The right to development, working through a vector of rights, can address social determinants of health, obligating states and the international community to support public health systems while reducing inequities in health through poverty‐reducing economic growth. At an international level, where the ability of states to develop economically and to realize public goods through public health systems is constrained by international financial institutions, the implementation of the right to development enables a restructuring of international institutions and foreign‐aid programs, allowing states to enter development debates with a right to cooperation from other states, not simply a cry for charity. (shrink)

Bridging Social Inequality Gaps - Concepts, Theories, Methods, and Tools focuses on contemporary discussions around multifaceted causes, explanations, and responses to social disparities. The contributors provide studies related to social and cultural dimensions of inequality, economic and technological dimensions of inequality, environmental dimensions of inequality, and political, ethical, and legal dimensions of inequality, as well as a variety of other perspectives on disparities. The volume also covers crucial issues and challenges for the global, national, regional, and local (...) implementation of public policies to reduce inequalities, including innovative actions, projects, and programs focused on achieving the United Nations Sustainable Development Goals (SDGs). The collection includes chapters encompassing research and practical recommendations from various disciplines such as sociology, economics, management, political science, administrative science, development studies, public health, peace and conflict studies, cultural studies, educational studies, communication studies, and social work. This book is an asset to academic and expert communities interested in theories of social inequality as well as effective measurement tools, public services, and strategies. Moreover, the volume helps students, practitioners, and people working in government, business, and nonprofit organizations to build more equitable social relationships. (shrink)

This study investigates how social franchises extend health care in rural areas, thus addressing vast and persistent disparities in health care access. We conducted an inductive study of Unjani, a South African organization that extended primary health services to disadvantaged rural communities through a network of 135 health clinics. Our analysis focused on the process of impact intermediation—the propagation of impact across multiple layers of the franchise network, including franchisees and downstream beneficiaries. To facilitate impact (...) intermediation, the franchisor harmonized the mission of the franchisees with its own mission and integrated community impact among franchisees. Such coordination and monitoring activity exposed franchisees to intermediation problems in the form of mission conflict and impact divergence. Our analysis reveals how Unjani nurtured network stewardship that afforded the franchisee nurses with greater support, autonomy, and ownership, thus overcoming intermediation problems in their pursuit of shared communal responsibilities to extend health care to rural communities. (shrink)

Extant sociological theories of gendered power within marriage focus on how social forces—such as gender inequality—shape women’s power within already established partnerships and subsequently affect their risk of intimate partner violence. Yet, inequitable social forces similarly shape women’s life conditions prior to and during the marital transition, with implications for women’s power in marriage. In Myanmar, gender relations between women and men historically have been touted as equitable and advantageous to women. Rare qualitative data find that structural gender (...) inequalities permeate Myanmar society, and intersect with other social forces, to constrain women’s marital power. In particular, we argue that women’s transition into marriage is a critical period to assess how gendered social inequalities determine the future distribution of power within marital relationships. These premarital social processes result in a “preconditioning” of relationship dynamics from the onset of marriage, with long-term effects on women’s power within the relationship, and subsequent exposure to intimate partner violence. We encourage sociological work on gendered power in the family to systematically consider women’s premarital social conditions as predictors of women’s relative power in marriage, with implications for their health and well-being. (shrink)

Inequities in health and health care are one of the greatest challenges facing the international community today. This problem raises serious questions for health care planners, politicians and ethicists alike. The major world religions can play an important role in this discussion. Therefore, interreligious dialogue on this topic between ethicists and health care professionals is of increasing relevance and urgency. This article gives an overview on the positions of Islam and Christianity on equity and the distribution (...) of resources in health care. It has been written in close collaboration and constant dialogue between the two authors coming from the two religions. Although there is no specific concept for the modern term equity in either of the two religions, several areas of agreement have been identified: All human beings share the same values and status, which constitutes the basis for an equitable distribution of rights and benefits. Special provisions need to be made for the most needy and disadvantaged. The obligation to provide equitable health services extends beyond national and religious boundaries. Several areas require intensified research and further dialogue: the relationship between the individual and the community interms of rights and responsibilities, how to operationalize the moral duty to decrease global inequalities in health, and the understanding and interpretation of human rights in regard to social services. (shrink)

Societies vary in their levels of social inequality and in the degree of popular support for policies that reduce disparities within them. Survey research in Texas, where levels of disparity in health and medical care are relatively high, studied how psychological mechanisms of moral disengagement relate to public support for expanding access to government-subsidized health care. Telephone interviews ( N = 1,063) measured agreement with statements expressing tendencies to minimize the effects of inequality, blame its victims and (...) morally justify limits on government help. The interviews also assessed support for general and specific policies to reduce inequality, e.g., through state-subsidized health care for lower income groups, as well as political party affiliation, ideological orientation, gender, age, education and income. Agreement with beliefs expressing moral disengagement was associated with opposition to governmental policies to reduce inequality in children’s health care. Beliefs that justify the withholding of government assistance, blame the victims of societal inequality, and minimize perceptions of their suffering were strongly related to variation between and within groups in support for governmental action to reduce inequality. (shrink)

This theoretical exploration is an attempt to conceptualize the link between gender and urban environmental health. The proposed ecofeminist framework enables an understanding of the link between the urban physical and social environments and health inequities mediated by gender and socioeconomic status. This framework is proposed as a theoretical magnifying glass to reveal the underlying logic that connects environmental exploitation on the one hand, and gendered health inequities on the other. Ecofeminism has the potential to reveal (...) an inherent, normative conceptual analysis and argumentative justification of western society that permits the oppression of women and the exploitation of the environment. This insight will contribute to a better understanding of the mechanisms underlying gendered environmental health inequities and inform healthy public policy that is supportive of urban environmental health, particularly for low‐income mothers. (shrink)

In this article, I draw on my fieldwork creating protein models of hepatitis B at a biotech laboratory to think through how to approach the body and disease from ontological and phenomenological perspectives. I subsequently draw on Mariella Pandolfi’s work on how bodies can be made to suffer history and Paul Farmer’s work on global tuberculosis disparities to explore ways of analysing embodied activity as a means of identifying and clinically addressing enactments of social inequality and disease. I also (...) introduce Merleau-Ponty’s phenomenological concept of ‘flesh’ as a conceptual heuristic that allows us to understand the meaningful structuring of ontological worlds beyond our own. As I argue, bringing these perspectives together not only allows us to re-envision what an effective disease treatment should be in diverse medical contexts, but also how to better understand health disparities and the nature of disease itself. (shrink)

The recent “turn to matter” evident in material feminist theories of the more‐than‐human world offers distinct posthuman understandings of the world as continuously relationally entangled, emergent or materializing. In this paper, I consider how these premises both trouble conventional understandings of matter and/or materials, but likewise potentially revise and revitalize understandings of the political for health and inequalities, and for nursing. This is both timely and much needed given contemporary contexts of austerity‐driven neoliberalism in health care and (...) the unprecedented growth in disparities of wealth and well‐being. I wish to explore whether material feminisms allow us to retheorize connections between abstract theory and material concerns like health and inequalities, differently. This is not theory in opposition to practice or activism, but theory conceptualized as sets of entangled emergent practices, but also what constitutes the political, as more fully relational to and in praxis with health‐related activism. I will argue these theories further justify how practitioners can visibly care for and care more about social and health inequalities. Drawing mainly on the work of material feminist, Karen Barad, and her bringing together of queer and feminist theory, as well as feminist new materialisms and understandings of posthumanism, I discuss how this turn to matter together with meaning might transform understandings of health and inequalities. (shrink)

In political philosophy and in economics, unfair inequality is usually assessed between individuals, nowadays often on luck-egalitarian grounds. You have more than I do and that's unfair. By contrast, in epidemiology and sociology, unfair inequality is traditionally assessed between groups. More is concentrated among people of your class or race than among people of mine, and that's unfair. I shall call this difference the egalitarian ‘divorce’. Epidemiologists, and their ‘divorce lawyers’ Paula Braveman, Norman Daniels, and Iris Marion Young, explain that (...) not every inequality between individuals is an inequity. Only inequality between social status groups is unfair. Only such inequality stems from problems like partiality, discrimination, oppression, inequality-related population health problems, and unfair distribution of prospects. And it alone is actionable. By contrast, inequality between individuals, e.g. in longevity, is natural, inevitable, less important, or otherwise less informative — not unjust. In ‘divorce trial’ mode, I respond to epidemiologists that group inequalities lack the intrinsic disvalue that they ascribe them. They may be instrumentally or contingently bad or wrong, not essentially so. I then shift to ‘remarriage’: although group inequalities lack intrinsic badness or wrongness, for multiple reasons they remain useful to measure. (shrink)

Discourse on communities and aging traditionally has focused on the availability, accessibility, and quality of local services to support older adults in need of assistance. More recently, however, a growing worldwide “age‐friendly” movement has pushed the conceptualization of community supports for an aging society beyond service provision. The term “age friendly” is used in considering how various aspects of a community facilitate or impede the health and well‐being of individuals as they experience long lives.Frameworks on age friendliness include attention (...) to health and community services for older adults but also encompass other aspects of communities, such as the physical design of outdoor spaces and buildings, the diversity of mobility options for drivers and nondrivers alike, and the availability of safe, affordable, and various types of housing. Age‐friendly frameworks also highlight how the very social fabric of a community can influence older residents’ quality of life. Over the past decade, a growing number of cities and communities have launched age‐friendly initiatives as organized and comprehensive efforts to make localities better for residents as they age. This essay begins to explore how AFIs can address social inequalities in health and aging. It concludes by describing how embedding a spatial justice lens within age‐friendly efforts could help AFIs realize more fully the changes that they seek to create at the local, national, and global levels. (shrink)

Many ethical issues are posed by public health interventions. Although abstract theorizing about these issues can be useful, it is the application of ethical theory to real cases which will ultimately be of benefit in decision-making. To this end, this paper will analyse the ethical issues involved in Childsmile, a national oral health demonstration programme in Scotland that aims to improve the oral health of the nation's children and reduce dental inequalities through a combination of targeted (...) and universal interventions. With Scotland's level of dental caries among the worst in Europe, Childsmile represents one of the largest programmes of work aimed at combating oral health inequalities in the UK. The areas of ethical interest include several contrasting themes: reducing health inequalities and improving health; universal and targeted interventions; political values and evidence base; prevention and treatment; and underlying all of these, justice and utility. (shrink)

Advances in molecular technologies have the potential to help remedy health inequities through earlier detection and prevention; if, however, their delivery and uptake are not more carefully considered, there is a very real risk that existing inequities in access and use will be further exacerbated. We argue this risk relates to the way that information and knowledge about the technology is both acquired and shared, or not, between health practitioners and their patients.A healthcare system can be viewed as (...) a complex social network comprising individuals with different worldviews, hierarchies, professional cultures and subcultures and personal beliefs, both for those giving and receiving care. When healthcare practitioners are not perceived as knowledge equals, they would experience informational prejudices, and the result is that knowledge dissemination across and between them would be impeded. The uptake and delivery of a new technology may be inequitable as a result. Patients would also experience informational prejudice when they are viewed as not being able to understand the information that is presented to them, and information may be withheld.Informational prejudices driven by social relations and structures have thus far been underexplored in considering equitable implementation and uptake of new molecular technologies. Every healthcare interaction represents an opportunity for experiencing informational prejudice, and with it the risk of being inappropriately informed for undertaking such screening or testing. Making knowledge acquisition and information dissemination, and experiences of informational prejudice, explicit through sociologically framed investigations would extend our understandings of equity, and offer ways to affect network relationships and structures that support equity in delivery and uptake. (shrink)

There is consistent and strong empirical evidence for social inequalities in health, as a vast and fast growing literature shows. In recent years, these findings have helped to move health equity high on international research and policy agendas. This paper examines how the empirical identification of social inequalities in health relates to a normative judgment about health inequities and puts forward an approach which embeds the pursuit of health equity within the (...) general pursuit of social justice. It defends an indirect approach to health equity, which views social inequalities in health as unjust in so far as they are the result of an unjust basic structure of society in Rawls’ sense. (shrink)

ABSTRACTDeveloping strategies to reduce inequities in health requires an understanding of how inequities occur, determining the salient factors in their production, and deciding which ones are most amenable to change. The recognition of several principles regarding the manifestations and genesis of inequities can help to decide on strategies. In making decisions, it is important to consider whether the aim is to reduce disparities in the occurrence of ill health or to reduce disparities in the severity of ill (...) class='Hi'>health. Evidence shows that the major impact on equity of health services, particularly regarding their potential to reduce severity, is attributable to the strength of primary care resources and services in communities and countries. Virtually every influence on the genesis of inequities is determined by the political context in which policy is made. The issue of health services is not different in this regard from other types of strategies.There is no longer any doubt about the pervasive influence of social factors on health. Almost two centuries of descriptive research provides convincing evidence of associations between social structures and relationships and health status in all countries and in all societies; if there is anything new from more recent research, it is that the association is not limited to differences between the lowest social strata and other social strata. Rather, the association is noted throughout the social spectrum. That is, there is a social gradient in health such that, for many if not most manifestations of ill health, the lower the social stratum, the worse the health.The challenge for the future is to understand why this is the case, to create a consensus that these inequalities are unnecessary and unacceptable, and to devise strategies that are both effective and possible. This paper will focus on the first of these aims, in a context that facilitates attention to the second and third aims. (shrink)

Social justice is widely advanced as a central nursing value, and yet conceptual understandings of social justice remain inconsistent and vague. Further, despite persistently articulated commitments to upholding social justice, the profession of nursing has been implicated in perpetuating inequities in health and health care. In this context, it is essential to establish both conceptual clarity and tangible guidance for nurses in enacting practices to advance social justice—particularly through regulatory, education and accreditation documents that (...) shape the nursing profession. This Foucauldian discourse analysis examines how social justice is discursively positioned within nursing professional documents in Canada, and illustrates that social justice was largely discursively excluded from these texts. Where social justice discourses were invoked, we identified that four central discursive patterns obscured and de‐centred this nursing value: (i) Vague language undermined professional commitments to social justice; (ii) Constructions of knowledge and awareness de‐emphasized practice; (iii) Individualism discourses minimized institutional/professional responsibility; and (iv) Aspirational language obscured present action. Extending from this analysis, we contend that the nursing profession must re‐examine how social justice is understood and articulated, and call for a re‐conceptualization of social justice grounded in nursing practice toward remediating inequities in health and health care. (shrink)

We thank the open peer commentators for their thoughtful responses to our article, "The Social Determinants of Health: Why Should We Care?" (Preda and Voigt 2015). Since space constraints prevent us from responding in detail to all the comments raised, we focus on two areas of concern that emerged from the commentaries. The first is our claim that avoidability is neither necessary nor sufficient for defining unjust or unfair health inequalities. The second area relates to the (...) reasons we might give for treating health inequalities as morally problematic. (shrink)

There is growing international interest in the choice of socioeconomic indicators for health research. This study used a combination of standard and novel methods to compare three occupation-based measures of social position in terms of their ability to explain variation and measure inequality in self-assessed health. The recently developed National Statistics Socioeconomic Classification (NS-SEC) is compared with its predecessor, the Registrar General64 living in private households in Scotland, logistic regression models are used to compare the classifications' ability (...) to predict self-assessed health. Concentration indices are estimated to compare how well they capture inequality in self-assessed health. The study shows that all three classifications are strongly associated with self-assessed health, though the associations are heavily attenuated by adjustment for one another and for other measures of social position. Despite their differing theoretical bases, the three are closely related. No evidence is found that any of them systematically under- or overstate the extent of inequality in self-assessed health in either men or women, and the extent to which they measure independent dimensions of social inequality is questioned. It is concluded that the availability of the new classifications is unlikely to transform our understanding of the extent or the causes of socioeconomic inequality in health, but provides useful opportunities for sensitivity analysis. (shrink)

In this paper we examine some issues of distributive justice in relation to the distribution of health in a population. Our focus is on socioeconomic inequalities in health within a society. Research suggests that socioeconomic status and level of education are strongly correlated with level of health such that those with lower status in a society are relatively sicker than their counterparts who have higher status. Importantly, the correlation we are concerned with is not the obvious (...) correlation between poor health and absolute material deprivation, or poor health and bad health habits. In nearly all countries, those at the bottom of the socioeconomic scale suffer anywhere from 2–4 times the mortality and morbidity rates of those at the top. This startling statistic apparently holds true regardless of differences in the material position of the worst-off. Moreover, even in the wealthiest countries the groups who have the highest status enjoy better health and longer life than those who have the next-highest status, and so on down the socioeconomic scale. Our question is whether these social inequalities in health are unjust in and of themselves. -/- . (shrink)

Roma communities across Europe still remain a neglected population group by way of the social and economic disadvantage that largely characterizes their lives. Roma communities continue to experience structural socioeconomic health inequalities on the grounds of their ethnic origin, alarmingly unveiling a pattern of systematic discrimination and ethnic marginalization. Without any doubt, such a highly worrying situation calls for States to incorporate Roma health rights within their law and policy agendas in a manner consistent with right (...) to health requirements. Against this background, this paper seeks to identify an operational human rights framework for States as a driver for better informed policies and implementation as well as for Roma engagement in the deliberations about their life prospects. The paper argues that continuing, concerted, and proactive State engagement is required for effectively addressing the structural obstacles impeding Roma socioeconomic health rights realization and maximizing Roma opportunities for well-being. (shrink)

Pesticides remain an integral part of development efforts to renew economic growth in Central America and lift the region out of a severe economic crisis. This paper analyzes the implications of the continued reliance on pesticides for heightening economic and ecological problems in the agrarian sector.Relying on a case study of export melon production in Choluteca, Honduras, the author argues that current development strategies, which rely heavily on pesticides, are generating ecological disruption that creates conditions biased against small producers. Lack (...) of knowledge of the hazards inherent in the technology and the resulting emergence of pesticide resistant pests, crop losses, environmental contamination, and public health problems, pose serious obstacles to the survival of small-scale producers. Meanwhile transnational and other flexible, large scale operations often adapt to such conditions, and on occasion may even turn such problems to their benefit. The author concludes that economic growth may only be sustainable when questions of social equity and ecological viability are brought to the forefront of U.S. development strategies. (shrink)

Disturbing international inequalities in health abound. Life expectancy in Swaziland is half that in Japan. A child unfortunate enough to be born in Angola has 73 times as great a chance of dying before age 5 as a child born in Norway. A mother giving birth in southern sub-Saharan Africa has 100 times as great a chance of dying from her labor as one birthing in an industrialized country. For every mile one travels outward toward the Maryland suburbs (...) from downtown Washington, DC on its underground rail system, life expectancy rises by a year – reflecting the race and class inequities in American health. Are the glaring, even larger, international health inequalities also unjust? -/- All of us no doubt think they are grossly unfortunate. Many of us think they are unfair or unjust. Why should some people be at such a health disadvantage through no fault of their own, losers in a natural and social lottery assigning them birth in an unhealthy place? Others of us are troubled by the absence of the kinds of human relationships that ordinarily give rise to the claims of egalitarian justice that we make on each other – for example, being fellow citizens or even interacting in a cooperative scheme. Who has obligations of justice to reduce these international inequalities? And do those obligations hold regardless of how the inequalities came about? What institutions are accountable for addressing them? (shrink)

Deindustrialization is a major burden on workers’ health in many countries, calling for theoretically informed sociological analysis. Here, we present a novel neoclassical sociological synthesis of the lived experience of deindustrialization. We conceptualize industry as a social institution whose disintegration has widespread implications for the social fabric. Combining Durkheimian and Marxian categories, we show that deindustrialization generates ruptures in economic production, which entail job and income loss, increased exploitation, social inequality, and the disruption of services. These (...) ruptures spill over to the field of social reproduction, generating material deprivation, job strain, fatalism, increased domestic workload, anomie, community disintegration, and alienation. These ruptures in social reproduction are sources of psychosocial stress, through which deindustrialization gets embodied as ill health and dysfunctional health behavior. We substantiate this framework through the extensive qualitative thematic analysis of 82 life history interviews in Hungary’s rust belt. (shrink)

A growing body of empirical research examines the effects of the so-called “social determinants of health” on health and health inequalities. Several high-profile publications have issued policy recommendations to reduce health inequalities based on a specific interpretation of this empirical research as well as a set of normative assumptions. This article questions the framework defined by these assumptions by focusing on two issues: first, the normative judgments about the fairness of particular health (...) inequalities; and second, the policy recommendations issued on this basis. We argue that the normative underpinnings of the approach are insufficiently supported and that the policy recommendations do not necessarily follow from the arguments provided. Furthermore, while many of the policies recommended—such as improving people's living conditions and reducing inequalities in wealth and power—are justified in their own right, the way these recommendations are tied to health is problematic. (shrink)

The WHO Commission on the Social Determinants of Health revealed that there is a 28-year disparity between the life expectancy in the poorest postcode and the richest postcode of Glasgow (CSDH, 2008). There are two sets of questions that it is important to ask about health inequalities like these: first, epidemiological questions about the mechanisms that cause inequalities in health and the measures that are effective in reducing them. Second, normative questions about which (...) class='Hi'>inequalities in health are wrong and why they are wrong. The papers in this symposium result from the inaugural conference of UCL's Centre for Philosophy, Justice and Health (CPJH) and focus on the relationship between these epidemiological and normative questions. (shrink)

This article asserts that traditionally dominant models of health promotion in the US are fairly characterized by methodological individualism. This schema produces a focus on the individual as the node of intervention. Such emphasis results in a number of scientific and ethical problems. I identify three principal ethical deficiencies: first, the health promotions used are generally ineffective, which violates canons of distributive justice because scarce health resources are expended on interventions that are unlikely to produce health (...) benefits. Second, the health promotions used tend to expand health inequalities between the affluent and the least well-off. Third, the health promotions used are likely to intensify stigma against the least well-off, a deficiency that itself may exacerbate the ‘densely-woven patterns of disadvantage’ that characterize life on the tail of the social gradient. Because Powers and Faden’s health sufficiency model of social justice argues that the amelioration of such clusters of disadvantage should be the primary ethical goal of public health policy, methodologically individualist models of health promotion are ethically deficient and should not stand as primary approaches for health promotion in a just social order. (shrink)

This paper examines the arguments presented by the Roman Catholic Bishops in their 1993 Pastoral Resolution, Comprehensive Health Care Reform: Protecting Human Life, Promoting Human Dignity, Pursuing the Common Good, concerning health care reform. Focusing on the meaning of equality in health care and traditional Roman Catholic doctrine, it is argued that the Bishops fail to grasp the force of the differences among persons, the value of the market, and traditional scholastic arguments concerning obligatory and extraordinary (...) class='Hi'>health care. To attempt to equalize the distribution of health care would be ruinous. A more traditional understanding of Christian thought reveals an acceptance of inequality in health care distribution and a bias against using the secular state to coerce a solution to such concerns for social justice. (shrink)

The infant mortality rate in Liberia is 50 times higher than it is in Sweden, whilst a child born in Japan has a life expectancy at birth of more than double that of one born in Zambia. 1 And within countries, we see differences which are nearly as great. For example, if you were in the USA and travelled the short journey from the poorer parts of Washington to Montgomery County Maryland, you would find that ‘for each mile travelled life (...) expectancy rises about a year and a half. There is a twenty-year gap between poor blacks at one end of the journey and rich whites at the other’. (Marmot, 2004, p.2). There are two types of questions which it is important to ask about inequalities in health such as these. The first are social scientific questions about the extent of inequalities in health and the factors which are causally responsible for these inequalities. Examples of social scientific questions to ask might be: how do infant mortality rates in the UK differ according to social class? What is the difference in life expectancy between Japanese who emigrate to the US and those who remain in Japan? Why do civil servants in higher ranked jobs tend to live longer than civil servants in lower ranked jobs? The second type are normative questions about the reasons we have to care about inequalities in health. Important normative questions to answer are: which inequalities in health should we care about (all inequalities or merely some of them)? When is an inequality in health unjust? How should we weigh our concern for equality in health against other factors such as maximising the.. (shrink)