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)

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)

Social theory plays an important role in the nursing discipline and nursing inquiry as it helps conceptually embed nursing in the larger picture of the social world. For example, a broad category of critical theory provides a unique lens for uncovering social conditions of inequity and oppression. Among the sociological theories, actor‐network theory (ANT) is an approach to research and analysis that has recently gained interest among nurse philosophers and researchers. Studies guided by ANT seek to understand (...) phenomena of interest as constituted within the relationships between human and nonhuman actors to understand how care practices are co‐created/enacted and how they can be made more humane. In this paper, we describe the benefits of ANT for examining healthcare access for incarcerated individuals with life‐limiting illnesses accessing palliative care and for people using illicit drugs. We argue that attention to the materiality of care practices can contribute to efforts of advancing health equity for these groups. (shrink)

Health inequalities are embedded in a complex array of social, political, and economic inequalities. Responding to health inequalities will require systematic action targeting all the underlying (“upstream”) social determinants that powerfully affect health and well‐being. Systemic inequalities are a major reason for the rise of modern populism that has deeply divided polities and infected politics, perhaps nowhere more so than in the United States. Concerted action to mitigate shocking levels of inequality (...) could be a powerful antidote to nationalist populism. A basic yet critical start to addressing health inequalities is to recognize them, which demands improving data collection and analysis. Certainly, global indicators show vast progress in reducing poverty and extending life. Yet aggregate health data mask a deeper reality: health gains have disproportionately benefited the well‐off, leaving the poor and middle‐class behind. (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)

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)

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.

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)

In their article,1 Jecker et al highlight a widespread and hotly debated issue in the current application of artificial intelligence (AI) in medicine: whether we should develop more powerful AI. There are many perspectives on this question. I would like to address it from the perspective of the fundamental purpose of medicine. Since its inception, medicine has been dedicated to alleviating human suffering and ensuring health equity. For thousands of years, we have made great efforts and conducted many investigations (...) to eliminate human suffering and have achieved remarkable results. However, the reality of achieving health equity falls far short of expectations. The WHO considers health equity to be a fundamental human right, meaning that there should be no unjustified, avoidable or remediable differences among the population as a whole, whether those differences result from social, economic, demographic or geographic factors, or from other forms of inequality such as gender, race, disability or sexual orientation.2 Health equity means reducing and ultimately eliminating disparities in health outcomes between vulnerable groups and others, caused by health risk factors and difficulties in accessing quality health services. This means that we must strive to reduce structural social bias. It is well known that the traditional healthcare system is riddled with various health inequities. …. (shrink)

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 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)

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)

Abstract A number of recent studies suggest that income and social inequality (as opposed to poverty itself) have detrimental consequences on people's health. These studies argue that while the poor may suffer the most from inequality, the rich also suffer. On closer inspection, however, it emerges that the basic arguments and evidence that inequality has a causal effect on health are wanting in many respects.

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)

The unfairness of health inequalities depends on the more fundamental question of the relationship between justice in health and distributive justice more generally. In this article, I discuss some constraints on how health should be incorporated in a theory of justice and their implications for when health inequalities can be considered to be unfair. I argue against adopting separate distributive principles for health, and in favour of conceiving justice in health as interrelated (...) with, and contingent on, justice in the distribution of other important social goods and resources, in particular income. Accordingly, health inequalities are unfair when they are the result of an unfair distribution of resources. (shrink)

The strong correlation between people’s socioeconomic position and health within high income countries is a well-documented fact. A person’s occupation, income and education level tell us a lot about that person’s prospects on a long and healthy life, such that we can speak of a ‘social gradient in health’, or a ‘socioeconomic health gap’. This association is often perceived to be unjust. Therefore, it is generally thought that governments should aim to reduce socioeconomic health (...) class='Hi'>inequalities. However, this idea needs ethical justification, for it is not evident if and why exactly these inequalities are unjust. For instance, are inequalities in health unjust per se? Or because the underlying socioeconomic inequalities are unjust? And does justice require equal health levels, or a minimum level of health? What complicates the issue, is that the width of the health gap, or the steepness of the social gradient, depends on what health measures are used. Overall, the more subjective the measure, the greater the inequalities appear to be. But are all these measures equally morally relevant? This dissertation aims to give a better understanding of these philosophical questions. It does so by investigating the question of what we should understand by health in the first part, after which it addresses the question of how to evaluate socioeconomic health inequalities in the light of justice. The introduction begins with a description of the phenomenon of socioeconomic health inequalities, and how it has been addressed by politicians, epidemiologists and philosophers in the past and today. The chapter continues by formulating the central question of the dissertation – that of which health inequalities should be focused in the light of a concern with social justice. It explicates how this dissertation contributes to answering that question, by discussing the potential relation between the conceptualisation of health and justice evaluations, and by discussing which questions are addressed in each of the following chapters. The chapter 2 addresses the question of how health is conceptualised in the philosophical and public heath literature, and how theoretical concepts of health differ. It proposes to approach health concepts as a Wittgensteinian family of thick concepts and argues that while theories on health generally argue in favour of one specific concept, a comparison of concepts shows that we may need different concepts of health given the variety of health practices. By explicating the differences between five concepts of health, this chapter argues that each captures aspects of health that all seem relevant when we talk and think about health. Classifying these concepts based on their distinctions reveals them as members of a conceptual family: each of the discussed concepts differs from the others in at least one respect and resembles the others in several respects. Moreover, the discussion of the concepts shows that ‘health’ always both describes a condition and values that condition at the same time. Having both descriptive and evaluative dimensions, we can see health concepts as ‘thick concepts’. Given this evaluative dimension, it is important to reflect on the question of what understanding of health guides specific practices. Moreover, the distinctions revealed by the classification can serve as a conceptual toolbox for reflection on the assumptions and purposes of health practices. How such reflection could work is illustrated by a brief exploration of what health aspects are focused upon in three specific health practices. Chapter 3 presents a study into the question of how health is conceptualised by ordinary citizens and to what extent conceptualisations of health differ between socioeconomic groups. By making use of the method of concept mapping, this study analyses how different socioeconomic groups formulate their own answers regarding the question ‘what does health mean to you?’. It presents concept maps of health for three different socioeconomic groups living in the city of Utrecht that reveal that all groups have a multidimensional understanding of health. An interpretation of the concept maps reveals nuanced differences between groups. The multiple aspects of health were also ranked by importance. It appears that each group assigned most importance to mental health. All in all, the study shows that people in lower socioeconomic groups are more likely to show a conceptualisation of health that refers to 1) the absence of health threats, 2) a person within his/her circumstances, 3) the value of functional notions, and 4) an accepting attitude towards life. Chapter 4 addresses the question of what the theoretical and empirical study to concepts of health could imply for health equity practices. It does so by exploring further the suggestions made in chapters 2 and 3. Regarding the question of which health aspects should guide health equity policies, this chapter discusses the question of whether we should primarily look at subjective or objective health measures, and whether a universal or relative standard of health should be central. While justice-related concerns of impartiality and equal treatment may seem to favour an objective perspective and a universal health standard, it appears that we have good reason to account for the subjective perspective as well. It is also argued that a concern for recognition and participatory parity gives room for relative health standards. Th room for relative health standards confronts us with the question of how to deal with mechanisms like adaptive preferences that the concept maps reveal. It proposes a way out, by arguing for society-relative health standards. Chapter 5 examines the question of whether inequalities in health should be evaluated ‘directly’, thus independently of a distribution of their social determinants. It proposes a sufficientarian perspective, such that the central question of evaluation is that of whether everyone is – or can be – healthy enough. By discussing two sufficientarian approaches to health and social justice – by Powers & Faden and by Nussbaum – this chapter distinguishes two ways of setting a threshold level for health. Both approaches appear to provide an unsatisfactory basis for justice evaluations and lead us away from direct evaluation if we try to settle health minima that are less arbitrary. In anticipation to chapters 6 and 7, it is argued that the perspective of sufficient health for relational equality escapes this arbitrariness: compared to that of a decent human life, it better helps to answer both the question of what socioeconomic health inequalities a society is due to avoid, and the question of when socioeconomic health inequalities are unjust considering their consequences. Chapter 6 discusses to what extent Daniels’s theory of health justice provides a satisfactory answer to the question of what health inequalities a society is due to avoid. Daniels proposes an indirect evaluative approach by arguing that we should evaluate socioeconomic health inequalities in the light of Rawls’s principles of justice as fairness. That is, if socioeconomic inequalities are in accordance with fair equality of opportunity and with the difference principle, the corresponding health inequalities would be just. It is shown that the suggestion that Rawls’s principles regulate the social determinants of health neglects that not all social determinants of health belong to society’s basic structure as conceived of by Rawls and are thereby not subjected to the principles of justice. To acknowledge the social mechanisms leading to socioeconomic health inequalities in their full complexity, it is argued that we should broaden our understanding of society’s structure in accordance with Young’s notion of social structural processes. This renders the question of what health inequalities a society is due to avoid into a question of what we can expect from the side of the various actors that uphold the social structures that produce socioeconomic health inequalities. Lastly, it is discussed how a shift to Young’s theory completes the shift to non-ideal theorising that seem already initiated by Daniels, and that with this, the distinction between direct and indirect evaluation dissolves. Chapter 7 discusses to what extent equality in health is of instrumental value for a society of free and equals. It thus takes up the idea proposed in chapter 5, that an evaluation of the consequences of health inequalities is also due. Taking relational equality as an evaluative framework reveals three ways in which inequalities in life expectancy threaten this ideal. That is, via unequal risks to stigmatisation, unequal risks to unemployment and the risk of unequal pension enjoyments. It is thereby shown that these risks are especially great for those lower down the socioeconomic strata. It thus concludes that equality in health is of instrumental value to relational equality. The chapter continues to argue that our instrumental approach opens a new perspective: to mitigate the identified injustices by changing society, rather than by reducing inequalities in health. This is argued to be an advantage in the light of the realistic assumption that of the socioeconomic health inequalities will persist. The paper thus offers a complementary approach to both the evaluation and the mitigation of the injustice of socioeconomic inequalities in health. The discussion chapter summarises the central findings of the analyses of health concepts and discusses questions regarding the philosophical and practical merits of comparing theoretical health concepts, the need for developing new health measures or concepts and the importance or nonsense of studying citizen’s views on health. Repeating this for the dissertation’s second part, the central findings of the chapters on justice evaluation are summarised and followed by a discussion of questions and issues that have remained unaddressed so far. Here, central points of discussion are my take on rules of distribution, the distinction of direct and indirect evaluation, the role of ideal and non-ideal theory, the idea of relational equality, and personal responsibility for health. The chapter concludes by noting that also in the light of justice evaluations, all commonly used health measures are relevant for justice. Therefore, my recommendations for policy and further research entail that inequalities in each of these measures deserve attention by both policymakers and researchers. Specifically, policymakers and researchers should give attention to how exactly each of these health inequalities come about, in such a way that a discussion about the question of who can be assigned responsibility to alleviate them is well-informed; and both should give attention to the effects of health inequalities on the opportunities for people to live on equal standing, in such a way that when these opportunities are diminished, actions can be considered to aim to restore relational equality. (shrink)

Status anxiety, the constant concern about individuals’ position on the social ladder, negatively affects social cohesion, health, and wellbeing. Given previous findings showing that status anxiety is associated with economic inequality, we aimed in this research to test this association experimentally. A cross-sectional study was run in order to discard confounding effects of the relationship between perceived economic inequality and status anxiety, and to explore the mediating role of a competitive climate. Then we predicted that people assigned (...) to a condition of high inequality would perceive more status anxiety in their social context, and they would themselves report higher status anxiety. Thus, in an experimental study PEI was manipulated. In Study 1, PEI uniquely predicted status anxiety, and perceived competitiveness mediated the relationship. In Study 2 PEI increased perceived contextual status anxiety, a specific form of perceived competitiveness based on socioeconomic status. Moreover, preliminary evidence of an indirect effect was found from PEI to personal status anxiety, through perceived contextual status anxiety. These preliminary findings provide experimental evidence for the effects of economic inequality on status anxiety and the mechanism involved. Economic inequality makes people feel that they live in a society where they are constantly concerned and competing with each other for their SES. These results could have important implications as health and wellbeing could be promoted by reducing economic inequalities and the competitive and materialistic environments of our societies. (shrink)

This review essay looks at two important recent books on the empirical social science of inequality, Richard Wilkinson and Kate Pickett's The Spirit Level and John Hills et al .'s Towards a More Equal Society? , situating these books against the important work of Michael Marmot on epidemiology and health inequalities. I argue that political philosophy can gain a great deal from careful engagement with empirical research on the nature and consequences of inequality, especially in regard to (...) empirical work on the relationship between socioeconomic inequality, status, self-respect, domination, autonomy, the quality of social relations, and societal health outcomes. The essay also raises some methodological questions about the approach taken by Wilkinson and Pickett, as well as questioning the ways in which their argument is (or is not) best understood as being fundamentally egalitarian in character. It concludes with some reflections, prompted by Hills et al ., on the lessons that should be learned by egalitarians from the experience of the Blair and Brown governments in the UK. (shrink)

Social and structural inequities shape health and illness; they are an everyday presence within the doctor-patient encounter yet, there is limited ethical guidance on what individual physicians should do. This paper draws on a study that explored how doctors and their professional associations ought to respond to the issue of social health inequities.

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)

The COVID-19 pandemic has had a significant impact globally. Most affected, however, are those individuals and groups routinely disadvantaged by the social injustice created by the misdistribution of power, money, and resources. Simple measures that prevent the spread of COVID-19, such as frequent hand washing and social distancing, are unavailable to millions of people in the wealthiest of nations and in the poorest of nations. Disadvantaged groups are impacted more directly and in disproportionately higher numbers due to existing (...) poor health, and the disruption of services central to securing an income and an education will have lasting consequences for their futures. The unintended effect of exclusionary government policies is that privileged citizens and healthcare systems are also at greater risk. This paper seeks to highlight the impact of COVID-19 on those already suffering health inequities through consideration of some of the social determinants of health on groups in affluent and poorer nations. It also highlights some of the factors that may assist in tackling health inequities as we emerge from this pandemic. (shrink)

Cardiovascular disease exerts an enormous burden on women's health. The intake of a healthy diet may reduce this burden. However, social norms and economic constraints are often factors that restrain women from paying attention to their diet. Underpinned by critical realism, this study explores how gender/sex influences decision‐making regarding food consumption among women of low socioeconomic status (SES). The study was carried out at two cardiac facilities in Karachi, Pakistan, on 24 participants (male and female from different ethnic (...) backgrounds), who had received health education. Using an interpretive descriptive approach, the study identified major barriers to a healthy diet: proscribed gender roles and lack of women's autonomy, power, male domination, and abusive behaviours. Cardiovascular risk and disease outcomes for the Pakistani women of low SES are likely to further escalate if individual and structural barriers are not reduced using multifactorial approaches. (shrink)

In this article, I respond to ‘Fighting Status Inequalities’. I first note a niggle about the paper’s assumption that lowering socio-economic inequalities will lower the social gradient in health. I then suggest two further ways in which neorepublicanism may relate to social epidemiology: in terms of ‘moral physiology’ and through analysing which inequalities are unjust.

Inequality isn’t just for the young anymore. People over age sixty-five face large and growing inequalities in health, wealth, work, and family. The widening gap between better- and worse-off older Americans has begun to undermine legal institutions that once worked to correct inequality, including Social Security, Medicare, private pensions, and family law. In this Article, I briefly document the inequalities that have transformed old age in the last fifty years and then analyze three common justifications for (...) reform: budget solvency, inequality, and progressivity. I show that each of these falls short of the kind of principled justification that will be needed to justify cutting benefits, raising taxes, or both. (shrink)

The article addresses how societal inequalities shape market arrangements. While business scholars developed important work about the interplay of organizations and societal economic inequalities, less has been said about the embeddedness of markets in unequal social structures. We argue that this issue may be addressed by cross-fertilizing the sociological approach of Bourdieu and the Strategic Action Fields perspective. To demonstrate our view, we assessed the extreme case of polyethylene terephthalate (PET) recycling markets in Brazil, conducting a qualitative (...) study based on the precepts of abductive analysis and using data from different secondary sources, interviews, and participant observation. We verified the existence of correspondences between the power of strategic action fields and the positions the individuals controlling them occupy in what Bourdieu calls the social space and show how these differences enable inter field connections that tend to reproduce social hierarchies. (shrink)

In A Contribution to the Critique of Political Economy, Karl Marx outlined his idea of a material 'base' and politico-cultural 'superstructure'. According to this formula, a material reality - wealth, income, occupation - determined your politics, leisure habits, tastes, and how you made sense of the world. Today, the importance of material deprivation, in terms of threats to life, health and prosperity, are as acute as ever. Despite the continued importance of inequality and disadvantage, the identities apparently generated by (...) these realities are increasingly detached from material circumstances. In many casesthe identity has become a powerful signifier in its own right, and is now instrumentalised, idealised and imitated. People attempt to police the boundaries and determine the significance of the identity, so that the identity matters more than the lives of the individuals concerned. These powerful identities can be used for various purposes, from the commercial to the aesthetic to the political. This trend has accelerated in recent years, with increasing precarity and increasingly obvious inequality fuelling anger, and the internet acting as a perfect mechanism for identity theft. Identity Theft covers four different kinds of identity most susceptible to these trends - class, race, sex and age - considering how the boundaries of different identities are policed, and how different versions of the same identity can be deployed to different ends. Ultimately, the argument is not just that 'identities are more complex' than they appear, but rather that there are more important commonalities. Many totemic 'culture war' issues are not particularly contested, but have broad appeal, or little concern for most people. In the UK at least, what might be called a 'culture war' is waged largely on the periphery by crank politicians, social media groups and newspaper columnists. If there is one argument to be taken from this book, it is a call for conscientious objection in the culture wars.,. (shrink)

The problem of social equality and social inequality is investigated in the light of the concept of justice, the concept of just inequality and unfair equality. The author substantiates the interrelation of justice and equality as concepts and phenomena that are presented in an indissoluble unity and are actually a two-pronged problem. Justice is interpreted by the author as a measure of social equality and social inequality. The author explores the problem of social inequality from (...) the point of view of a materialistic understanding of history, the principle of development and an axiological approach. The concept of natural justice is investigated as the basis of justice established by people, that is, social justice. The legitimacy of the conditional use of the concept of natural justice as a natural right of an individual to use his natural gifts, which under certain conditions of social life activity can be decisive in human life, can give him fair advantages over other members of the society. The natural personal potential of an individual can cause significant differences in the intellectual and spiritual abilities of people, which, in the presence of diligence, determination and appropriate social norms, necessarily generate social inequality in society. Fair inequality does not contradict natural justice. Natural justice is contradicted by unfair inequality. A person by nature has the right to life, freedom and property in compliance with the mandatory norms established in this society. Justice established by people should not contradict natural justice. The validity of the use of the concept of legitimate elite as the most outstanding personalities in various respects, having high achievements and services to society in various spheres of human activity, is substantiated. (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)

Inequalities of social goods between gender, racial, or other groups call out for explanation. Such inequalities might be explained by socialization and discrimination. But historically some have attributed these inequalities to biological differences between social groups. Such explanations are highly controversial: on the one hand, they have a very troubling racist and sexist history, but on the other hand, they are empirical claims, and so it seems inappropriate to rule them out a priori. I propose (...) that the appropriate epistemic attitude toward biological explanations of social inequalities is a general but defeasible skepticism. I then turn to the appropriate moral attitude, arguing that when such explanations are inadequately supported, they are offensive. (shrink)

In this work, I have used many sources because this theme is very complex and it is very useful to follow tracks already well used by other authors who have ventured with these themes. The Gender report is a report on equality. No company will ever be expected to be right if it does not foresee includesive actions rather than excludents. The social constructions of the same company will have to contend with a reality of reference that embraces all (...) the universes and respects the personal values. Everything, therefore, aimed at the growth of Society as a non-arithmetic group of People who, with their history and their characteristics, increase the collective share capital. (shrink)

The Covid‐19 pandemic has revealed myriad social, economic, and health inequities that disproportionately burden populations that have been made medically or socially vulnerable. Inspired by state and local governments that declared racism a public health crisis or emergency, the Anti‐Racism in Public Health Act of 2020 reflects a shifting paradigm in which racism is considered a social determinant of health. Indeed, health inequities fundamentally rooted in structural racism have been exacerbated by the Covid‐19 (...) pandemic, which calls for the integration of antiracist praxis to promote ethical public health research processes. This commentary describes ways in which antiracist praxis—which emphasizes empowerment of traditionally marginalized populations—offers strategies to explicitly address power imbalance, stigmatization, and other consequences of structural racism in public health research. (shrink)

This article explores how structural failures in major federal environmental regulations —which set a foundation for environmental protections nationwide— have helped create many of the environmental injustices that people of color and low-income communities experience. It continues by examining how local governments have reinforced and compounded the failures in the federal environmental regulatory framework, particularly through local land use decisions. Although states play an important role in environmental policymaking, we propose that local governments are uniquely positioned to utilize a (...) class='Hi'>health justice approach to address environmental health inequities. This approach centers partnerships between frontline communities and local governments to develop just solutions that fill gaps within the federal environmental regulatory system and anticipate and mitigate the compounding effects of environmental health inequities. (shrink)

Social health disparities are increasing in most countries around the world. During the past two decades, a large amount of evidence has emerged about the health consequences of social inequalities. Despite such evidence, the concept of medical fairness, as traditionally defined by the World Medical Association, has remained unchallenged and even reinforced by some scholars who emphasize that doctors should remain neutral to the socioeconomic status of their patients when providing clinical care. The inconsistency between (...) public health and clinical care perspectives raises tension between a narrow interpretation of the ethics of justice, which stresses the importance of equality and impartiality, and the ethics of care, which highlights the importance of particularity and individuality in clinical practice. This article analyzes the concept of medical fairness using the emerging evidence that demonstrates the impact of social health disparities on clinical care. It proposes a new approach of medical fairness based on equity rather than on equality and provides a consistent ethical framework based on Paul Ricoeur’s three levels of medical judgments. This integrative framework provides a better balance between public health and clinical care in medical practice. (shrink)

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 2012, the international PISA survey reinforced the observation that the French educational system is one of the most unequal among OECD countries. The observation of serious inequalities in access to educational success for pupils from disadvantaged backgrounds could lead to a pessimistic vision suggesting that any possibility of transformation of the system is doomed to failure. Thus, the fight against inequalities in access to educational success is a form of runaway object which constitutes a challenge for research (...) which treats the social context as evolving and susceptible to significant and novel transformations. Developmental work research aims to support the work of professionals in the re-elaboration of their practices by seeking to go beyond the status quo of an unequal school. Drawing on this framework within an institutional network of schools, we seek to show how the intervention has highlighted power issues inscribed in the structures and how the actors, through their commitment in the research collaborative process, seek to go beyond the power issues inscribed in their work routines and enacted during the research process by different kinds of antagonism. We will argue that the fight against educational inequality involves overcoming systemic power relations crystallized in institution. This systemic power is expressed by a form of episodic power. Our results show restrictive and constructive effect on the expansive learning process and on the construction of a collective in the formative interventions. The restrictive side of epistemic power should be linked to systemic power which is historically inherited. We discuss the results in the light of the emergence of a fourth generation of activity theory. Our research makes it possible to make conceptual and methodological progress in the construction of a fourth generation of activity theory by showing the need for analysis and expansively learn about problematic power relations in heterogeneous collectives. (shrink)

Both gender and the law are significant determinants of health and well-being. Here, we put forward evidence to unpack the relationship between gender and outcomes in health and well-being, and explore how legal determinants interact and intersect with gender norms to amplify or reduce health inequities across populations. The paper explores the similarities between legal and health systems in their response to gender—both systems portray gender neutrality but would be better described as gender-blind. We conclude with (...) a set of recommendations to address both law and gender in implementing the work of the Lancet Commission on the legal determinants of health to improve health outcomes for all, irrespective of gender. (shrink)

Complexity of the changes taking place in modern societies makes it is necessary to deepen the analysis of the impact of social inequality on the activity of old people. Dissemination of new technologies and organizational forms allows solving many social problems and improving the quality of human life. At the same time broadens the range of areas in which old people are losing their authority and differ in expertise required for the achievement of socially valued goods. Article aims (...) to highlight the importance of inequality for the activity of the elderly and its relationship to social capital in conditions of shaping social dispersion space order. Study brings closer chosen results of empirical studies portraying the dimensions of internal diversity of seniors. ** Złożoność przemian zachodz¸a}cych we współczesnych społeczeństwach sprawia, iż niezbȩdne staje siȩ pogłȩbienie analiz oddziaływania nierówności społecznych na aktywność ludzi starych. Upowszechnianie siȩ nowych technologii i form organizacyjnych pozwala na rozwi¸a}zanie wielu problemów społecznych i podniesienie jakości życia ludzkiego. Jednocześnie poszerza siȩ zakres dziedzin, w których ludzie starzy trac¸a} swój autorytet oraz różni¸a} siȩ miȩdzy sob¸a} kompetencjami wymaganymi do osi¸a}gania społecznie cenionych dóbr. Celem artykułu jest zwrócenie uwagi na znaczenie nierówności dla aktywności ludzi starych oraz jej zwi¸azków z kapitałem społecznym w warunkach kształtowania siȩ w polskiej przestrzeni społecznej ładu rozproszonego. Opracowanie przybliża wybrane wyniki badań empirycznych, które ukazuj¸a wymiary zróżnicowania kategorii społecznej ludzi starych. (shrink)

This paper discusses three cultural narratives that threaten the health of people with intellectual/developmental disabilities (IDD) and which have become more evident during the COVID-19 pandemic. These meta-narratives are the medical model of health/disability; the population health approach to health inequalities; and policies premised on the assumption of the importance of national economic growth as an incentive for reducing health inequalities. Evidence exists that health research is more likely to become policy if (...) it fits within a medical model and addresses national economic growth. These two criteria are particularly problematic for people who have IDD. The paper also proposes a research model to facilitate the inclusion of IDD related issues in future policy regarding health inequalities. (shrink)

Hastings Center Report, Volume 52, Issue 2, Page inside_front_cover-inside_front_cover, March‐April 2022.

As social scientists with overlapping expertise in children and youth studies, inequalities, and medical sociology, we value the development of practical tools that medical professionals can utiliz...

The history of the documentation of health inequality is long. The way in which health inequality has customarily been documented is by comparing differences in the average health across groups, for example, by sex or gender, income, education, occupation, or geographic region. In the controversial World Health Report 2000, researchers at the World Health Organization criticized this traditional practice and proposed to measure health inequality across individuals irrespective of individuals’ group affiliation. They defended its (...) proposal on the moral grounds without clear explanation. In this paper I ask: is health inequality across individuals of moral concern, and, if so, why? Clarification of these questions is crucial for meaningful interpretation of health inequality measured across individuals. Only if there was something morally problematic in health inequality across individuals, its reduction would be good news. Specifically, in this paper I provide three arguments for the moral significance of health inequality across individuals: (a) health is special, (b) health equity plays an important and unique role in the general pursuit of justice, and (c) health inequality is an indicator of general injustice in society. I then discuss three key questions to examine the validity of these arguments: (i) how special is health?, (ii) how good is health as an indicator?, and (iii) what do we mean by injustice? I conclude that health inequality across individuals is of moral interest with the arguments (b) and (c). (shrink)

The concept of intersectionality is on its way to becoming a new paradigm in gender studies. In its current version, it denominates reciprocities between gender, race and class. However, it also allows for the integration of other socially defined categories, such as sexuality, nationality or age. On the other hand, it is widely left unclear as to which level these reciprocal effects apply: the level of social structures, the level of constructions of identity or the level of symbolic representations. (...) This article advocates an intersectional multi-level analysis which takes into account reciprocal effects between the various levels. This approach includes an analytical grasp of and methodical reflection on these reciprocal effects as well as making them empirically accessible. (shrink)