Dossier: Equality, Health, and Health Policy


  • Kristin Voigt

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  • Kristin Voigt

The field of bioethics has secured a voice for philosophers when it comes to many of the ethical questions that arise in medical contexts, such as those about end-of-life care and consent to medical research. Philosophers have also begun to move beyond the medical context to consider broader questions about health policy and the distribution of health outcomes within populations, often using the lens of political philosophy to shed light on questions arising in this context. The label “population-level bioethics” (Wikler and Brock, 2007) that is sometimes applied to this area of inquiry explicitly makes the link between the field of bioethics and research concerned with issues around health arising at the level of populations. This growing literature addresses questions around health and health policy that are philosophically interesting and challenging but also high on political agendas across the world. Perhaps most prominently, Daniels’s (2008) seminal book Just Health explicitly engaged with the growing empirical literature on health inequalities and on the connection between social factors and health outcomes (the “social determinants of health”), opening up a rich and ongoing debate about justice and equality in health. The debate has also addressed possible justifications for universal healthcare and the conditions under which access to specific healthcare services may be denied; questions about whether there is a “right to health” and what this might entail; and questions about how to distribute resources between the young and the old, to those with different kinds of conditions, and to those facing different disadvantages. In addition to concerns arising within specific political communities, there has also been recognition of the importance of global justice for questions around health. For example, how should we respond to the migration of healthcare professionals from low-income to wealthier countries, which puts significant pressure on already strained healthcare systems? How should resources for global health be allocated, and how are we to assess the influence of private donors on such decisions? What is to be done about global threats to public health, such as highly contagious diseases that quickly spread across national borders? This special issue contributes to these ongoing debates by bringing together several papers that consider questions of justice, equality, and fairness as they arise in the context of healthcare, health policy, and population health. The papers in this special issue address a range of issues arising within healthcare systems, in relation to the arguments supporting individuals’ access to healthcare and with respect to how we think about health inequalities. The contributions by Ben Davies and Ben Saunders are concerned with the fair allocation of health-related goods. Three principles have emerged as the main contenders in the philosophical debate about distributive justice: egalitarian, prioritarian, and sufficientarian approaches. These approaches have also been considered for the distribution of healthcare resources. Davies’s paper defends a sufficientarian position. But his paper also considers a question that has received significantly less attention in the literature: the timescale over which concerns of justice in health apply. While it may seem natural to think that concerns of justice apply to people’s aggregate outcomes over their lifetimes, it is not clear that this leaves us with an adequate response to variations that may occur within a person’s life, leaving the person healthy and well off in some periods and suffering in others. Davies’s paper argues that lifetime views must be supplemented with what he calls “momentary sufficientarianism”: justice demands that we care about particular moments in people’s lives and about whether or not they have “enough” in each particular moment. In particular, on the kind of sufficientarian view Davies endorses, claims to benefits are …

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