Equity and population health: Toward a broader bioethics agenda

Hastings Center Report

Volumn 36, Issue 4, 2006, Pages 22-35

  Daniels, Norman ^a  

^a NONE

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EID: 33748497830     PISSN: 00930334     EISSN: None     Source Type: Journal    
DOI: 10.1353/hcr.2006.0058     Document Type: Short Survey

References (69)

1. This characterization is neutral between a value-free, stochastic account of normal functioning, such as Boorse's, and a modestly normative, etiological (or evolutionary) account, such as Wakefield's account of mental disorders as harmful dysfunctions. Neither account views pathology simply as an "unwanted condition" without providing a clear, objectively ascribable view of what makes it a dysfunction at some level within the organism. See C. Boorse, "On the Distinction between Disease and Illness," Philosophy and Public Affairs 5, no. 1 (1975): 49-68;
2. C. Boorse, "A Rebuttal on Health," in What is Disease?, ed. J.M. Humber and R.F. Almeder (Totowa, N.J.: Humana Press), 1-134;
3. J.C. Wakefield, "The Concept of Mental Disorder: On the Boundary between Biological Facts and Social Values," American Psychologist 47 (1992): 373-88.
4. Preamble to Constitution of WHO, adopted by International Health Conference, New York, June 19-22, 1946; entered into force April 7, 1948, never amended.
5. I sidestep a debate about whether to measure all individual variation in health, later factoring in infotmation about demographic subgroups (compare this to E. E. Gakidou, C.J.L. Murray, and J. Frenk, "Defining and Measuring Health Inequality," Bulletin of the World Health Organization 78 [2000]: 42-54),
6. or to focus on health inequalities across important subgroups, such as by class or race or ethnicity (P. Braveman, B. Starfield, and H.J. Geiger, "World Health Report 2000: How It Removes Equity from the Agenda for Public Health Monitoring and Policy," British Medical Journal 323 [2002]: 678-81).
7. Rawls's social contract situation involves a simplifying assumption that all people are fully functional over a normal lifespan. We might take this to be an egalitarian default position. See J. Rawls, A Theory of Justice (Cambridge, Mass.: Harvard University Press, 1971).
8. My health egalitarian behaves like Parfit's "prioritarian": one would not level down the better health of some to make them more equal with those in worse health (blind the sighted to equalize health states with the blind) if there were no reasonable offsetting gain to those who are in worse health. Doing so would frustrate the ultimate egalitarian goal of making all fully normal over a normal lifespan. D. Parfit, "Equality or Priority?" University of Kansas, Lindley Lecture, 1995.
9. I set aside ethical and conceptual problems that arise in the construction of summary measures of population health, which allow us to aggregate across various health conditions of different seriousness and length.
10. D. Brock, "Ethical Issues in Recipient Selection for Organ Transplantation," in Organ Substitution Technology: Ethical Legal and Public Policy Issues, ed. D. Mathieu (Boulder, Col.: Westview Press, 1988), 86-99;
11. F. Kamm, "The Choice between People, Commonsense Morality, and Doctors," Bioethics 1 (1987): 255-71;
12. N. Daniels, "Rationing Fairly: Programmatic Considerations," Bioethics 7, nos. 2-3 (1993): 224-33;
13. F. Kamm, Morality, Mortality: Death and Whom to Save From It, volume 1 (Oxford, U.K.: Oxford University Press, 1993);
14. N. Daniels, "Four Unsolved Rationing Problems," Hasting Center Report 24, no. 4 (1994): 27-29;
15. P. Dolan et al., "QALY Maximization and Peoples Preferences: A Methodological Review of the Literature, Health Economics 14 (2005): 197-208.
16. D.R. Gwatkin, "Who Would Gain most from Efforts to Reach the Millennium Development Goals for Health? An Inquiry into the Possibility of Progress that Fails to Reach the Poor," Health, Nutrition and Population Discussion Paper, The World Bank, December 2002; available at http://poverty.worldbank.org/files/13920_g watkin1202.pdf.
17. M. Marmot and R.G. Wilkinson, Social Determinants of Health (Oxford, U.K.: Oxford University Press, 1999).
18. Because these additional social factors so crucially affect population health and its distribution, the distinction that labels health as a natural rather than as a social good, as in Rawls or Nagel, is less clear. See Rawls, A Theory of Justice;
19. T. Nagel, "Justice and Nature," Oxford Journal of Legal Studies 17, no. 2 (1997): 303-21.
20. N. Daniels, B. Kennedy, and I. Kawachi, "Why Justice Is Good for Your Health: Social Determinants ol Health Inequalities," Daedalus 128, no. 4 (1999): 215-51;
21. N. Daniels, B. Kennedy, and I. Kawachi, Is Inequality Bad for Our Health? (Boston, Mass.: Beacon Press, 2000).
22. Daniels, Kennedy, and Kawachi, "Why Justice Is Good for Your Health."
23. Ibid.
24. Suppose we flatten SES gradients of health as much as the principles of justice would seem to require us to, but socioeconomic inequalities remain that induce some health inequalities. Are these residual health inequalities just? Or must we eliminate all social and economic inequalities that contribute to health inequalities? Some might interpret the priority Rawls gives to opportunity as requiring this response. Then, Rawls's theory becomes more egalitarian than was supposed. Alternatively, we might come to understand the mechanisms through which health inequalities are produced by other inequalities and intervene to reduce them without having to reduce otherwise justifiable inequalities. On another reading, Rawls's theory may not specifically answer this question about residual health inequalities. See Daniels, Kennedy, Kawachi, "Why Justice Is Good for Your Health."
25. D. Mechanic, "Disadvantage, Inequality, and Social Policy," Health Affairs 21, no. 2 (2002): 48-59.
26. L. Temkin, Inequality (New York: Oxford University Press, 1993).
27. N. Daniels and J.E. Sabin, Setting Limits Fairly: Can We Learn to Share Medical Resources? (New York: Oxford University Press, 2002).
28. N. Daniels, "Fair Process in Patient Selection for Antiretroviral Treatment for HIV/AIDS in WHO's 3 by 5 program," The Lancet 366 (2005): 169-71.
29. W. Miller, L.S. Robinson, and R.S. Lawrence, eds., Valuing Health for Regulatory Cost-Effectiveness Analysis, a report issued by the Institute of Medicine (Washington, D.C.: National Academies Press, 2006).
30. L.J. Kotlikoff and S. Burns, The Coming Generational Storm (Cambridge, Mass.: MIT Press, 2004);
31. P Peterson, Gray Dawn: How The Coming Age Wave Will Transform America-And The World (New York: Three Rivers Press, 1999);
32. R Wallace, Agequake: Riding the Demographic Rollercoaster Shaking Business, Finance and Our World (London, U.K.: Nicolas Brealey Publishing, 2001).
33. Kotlikoff and Burns, The Coming Generational Storm.
34. Peterson, Gray Dawn, citing 1996 census figures.
35. Center for Strategic and International Studies, Meeting the Challenge of Global Aging (Washington, D.C.: Center for Strategic and International Studies, 2002), available at http://www.csis.org/gai.
36. R. Jackson and N. Howe, Global Aging: The Challenge of the New Millennium (Washington, D.C.: Center for Strategic and International Studies and Watson Wyatt Worldwide, 1999), at http://www. csis.org/component/option,com_csis_pubs/ task,view/id,892/type,1/.
37. Ibid.
38. "Aging on the World Stage," International Center for Longevity, May 2006 at http://www.ilcusa.org/_lib/pdf/madrid2002.pdf.
39. Center for Strategic and International Studies, Meeting the Challenge of Global Aging, chapter 3.
40. B.L. Neugarten, Age or Need? Public Policies for Older People (Beverly Hills, Calif.: Sage Publications, 1982).
41. M. Gillick, "Medicare Coverage for Technological Innovations: Time for New Criteria?" New England Journal of Medicine 350 (2004): 2199-2203.
42. N. Daniels, Am I My Parents Keeper? An Essay on Justice between the Young and the Old (New York: Oxford University Press, 1988).
43. Ibid.
44. A. Williams, "Intergenerational Equity: An Exploration of the Fair Innings Argument," Health Economics 6 (1997): 117-32.
45. F. Kamm, Morality Mortality.
46. K. Shepsle and E. Dickson, "Working and Shirking: Equilibrium in Public Goods Games with Overlapping Generations of Players," Journal of Law, Economics, and Organization 17 (2001): 285-318.
47. Privatization strategies do not solve the problem; they just represent one conclusion about what such equity requires, and they do so without allowing us to use a scheme that addresses the age group problem at the same time. In addition, privatization is not even a starter for lifespan health systems the way it is for income support.
48. The UN Commission on Human Rights "urges States to take steps, individually and through international assistance and cooperation, especially economic and technical, to the maximum of their available resources, with a view to achieving progressively the full realization of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health by all appropriate means, including particularly the adoption of legislative measures." UN Commission on Human Rights, "The Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health," Commission on Human Rights Resolution 2003/28.
49. T. Nagel, "The Problem of Global Justice," Philosophy and Public Affairs 33, no. 2(2005): 113-47.
50. J. Rawls, The Law of Peoples (Cambridge, Mass.: Harvard University Press, 1999).
51. Forty years versus more than eighty years; "People Facts and Figures," at http://www.os-connect.com/pop/pl.asp? whichpage= 10&pagesize=20&sort=Country, accessed May 5, 2006.
52. UNICEF, "The State of the World's Children," at http://www.unicef.org/sowc00/stat2.htm, accessed August 23, 2005.
53. WHO/UNICEF/UNFPA, "Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF, and UNFPA," at http://childinfo.org/areas/ maternalmortality/, accessed May 5, 2006.
54. C. Beitz, "Rawls's Law of Peoples," Ethics 110 (2000): 669-96.
55. T.W. Pogge, World Poverty and Human Rights: Cosmopolitan Responsibilities and Reforms (Cambridge, U.K.: Blackwell Publishers, 2002);
56. T.W. Pogge, "Human Rights and Global Health: A Research Program," Metaphilosophy 36, nos. 1-2 (2005): 182-209.
57. J. Cohen and C. Sabel, "Extra Rempublicam Nulla Justifia," Philosophy & Public Affairs 34, no. 2 (2006): 147-75.
58. T. Pogge, "Severe Poverty as a Violation of Negative Duties," Ethics and International Affairs 19, no. 1 (2005): 55-83.
59. World Health Organization, International Migration, Health, and Human Rights (Geneva, Switzerland: World Health Organization, 2003), 13.
60. S. Alkire and L. Chen Alkire, "'Medical Exceptionalism' in International Migration: Should Doctors and Nurses Be Treated Differently?" JLI Working Paper 7-3 (2004): 1-10.
61. L. Chen and P. Hanvoravonchai, "HIV/AIDS and Human Resources," Bulletin of the World Health Organization 83 (2005): 143-44.
62. B. Liese, N. Blanchet, and G. Dussault, "The Human Resource Crisis in Health Services in Sub-Saharan Africa," background paper prepared for the World Development Report 2004, Making Services Work for Poor People (Washington, D.C.: The World Bank, 2004).
63. C. Deeming, "Policy Targets and Ethical Tensions: UK Nurse Recruitment," Social Policy and Administration 38, no. 7 (2004): 227-92.
64. Pogge, "Human Rights and Global Health: A Research Program."
65. Ibid.
66. Cohen and Sabel, "Extra Rempublicam Nulla Justita."
67. Daniels and Sabin, Setting Limits Fairly.
68. Cohen and Sabel, "Extra Rempublicam Nulla Justita."
69. Nagel, "Global Justice," 130.