Public Health, Ethics and Equity, page 63-92.docx

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Human Rights and Equity Studies
HREQ 1930
Saeed Hydaralli

Public Health, Ethics and Equity p. 63-92 - Life and Death patterned to social class - Middle Income groups in a more unequal society will have worse health than comparable or even poorer groups in a society with greater equality 4.2 Social Determinants of Health: Some Basic Findings - Five Central Findings o Income / Health Gradients – not result of fixed or determinate laws of economic development, however influenced by policy choices o Income / Health Gradients not result of deprivation of poor groups, but operates across whole socio-economic spectrum within societies o Steepness of income / health gradient affected by inequality in societies o Relative income or socioeconomic status more important than level of income o Social and psychosocial pathways Cross-National evidence on health inequalities - US richest nation, however poor health indicators - Costa Rica strong health indicators Individual SES and health - Determining factor in steepness of the gradient appears to be extent of income inequality in a society - High income inequality for middle income groups may have lower health status - Income inequality determines health status Relative Income and Health - Hypotheses: Income inequality has its effect on health inequalities only above some threshold level of inequality, a threshold cross in the US and more unequal countries, but not met in more egalitarian countries - Not resources, but degree of relative deprivation (Not the goods needed for survival, but lack of sources of self-respect that are deemed essential for full participation in society) - US – areas of high income inequality had an excess of death compared to areas of low inequality that was equivalent to all deaths due to heart disease - US – higher income inequality showed slower rates of life-expectancy improvement Pathways linking social inequalities to health inequalities - Differential investment in human capital is strong predictor of health across nations - Income inequality erodes social cohesion, which in turn reflected in significantly lower participation in political activity Health Inequalities and Inequities - Age, gender, race and ethnic differences in health status exist that are independent of socio- economic differences, raising distinct questions about equity or justice - Health inequalities persist even in societies that provide the poor with access to all of the determinants of health Justice as Fairness and Health Inequalities Justice when no one is ill - Rawl’s strategy was to show that a social contract that was designed to be fair to free and equal people would not only justify the choice of those equal basic liberties but would also justify the choice of principles guaranteeing equal opportunity and limiting inequalities to those that work to make the worst of groups fare as well o Assumed contractors fully functional over a normal life span Extending Rawl’s Theory - This extension of Rawls’s theory expands the notion of opportunity beyond just access to jobs and offices, since participation in other aspects of a plan of life also are affected by departures from normal functioning. Rawls endorses the overall approach in PL Justifying Inequality in Rawl’s Theory - It is irrational for contractors to insist on equality if doing so would make them worse off. Specifically, he argues that contractors would choose his Difference Principle, which permits inequalities provide that they work to make the worst off groups in society as well off as possible - Two points will help avoid misunderstanding of the Difference Principle and its justification o Requires maximal flow in the direction of helping worst off groups  Chain connectedness o Difference Principle: produce less health inequality than any proposed principles that allow inequalities  Flattening health gradient benefits all grou
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