social gradient in health; equality; justice in health; social status; population-level bioethics
Wallimann-Helmer Ivo, Schuppert Fabian, Fourie Carina (ed.) (2015), Social Equality: On What It Means to be Equals
, Oxford University Press, New York.
Fourie Carina, Schuppert Fabian, Wallimann-Helmer Ivo (2015), The Nature and Distinctiveness of Social Equality: An Introduction, in Fourie Carina, Wallimann-Helmer Ivo, Schuppert Fabian (ed.), Oxford University Press, New York, 1-19.
Fourie Carina (2015), To Praise and to Scorn: The Problem of Inequalities of Esteem for Social Egalitarianism, in Fourie Carina, Wallimann-Helmer Ivo, Schuppert, Fabian (ed.), Oxford University Press, New York, 87-106.
Fourie Carina, Sufficiency of Capabilities, Social Equality and Two-Tiered Health Care Systems, in Fourie Carina, Rid Annette (ed.), Oxford University Press, New York, 10..
Fourie Carina, The Sufficiency View: A Primer, in Rid Annette, Fourie Carina (ed.), Oxford University Press, New York, 1..
Rid Annette, Fourie Carina (ed.), What is Enough? Sufficiency, Justice, and Health
, Oxford University Press, New York.
Research strongly indicates that health follows a social gradient, e.g. the higher your class, or your rank in an occupational hierarchy, the higher your life expectancy. This is true even when individuals in different classes or ranks have access to the same free, public health care system and where none of the ranks can be considered to be impoverished. The social gradient in health indicates that there are inequalities in health beyond failures in access to health care and beyond material deprivation. Another way to put this is that the social gradient in health reflects a hierarchy of social status - where you are in the hierarchy of status is indicative of your mortality and morbidity. The fact that there seems to be a social gradient in health, however, does not indicate whether it is normatively significant. The empirical phenomenon - the social gradient in health - is the starting point for this normative research project. The normative question that this project aims to answer is, what, if anything, is morally objectionable about a social gradient in health? To answer this research question, we need to break it down into several normative questions. Are the actual inequalities in health between those at different levels of the gradient morally objectionable? Or are the potential injustices or inequalities underlying this gradient, such as hierarchies of social status, morally objectionable? Can equality be said to be morally significant at all when many political philosophers argue that what is really of significance is how healthy the worst off are, or whether individuals have ‘enough’ health? This project comprises two guiding research hypotheses, which aim to answer these questions. The first hypothesis is that socially imposed health inequalities, even above a threshold of health, can be unjust in themselves. The second is that certain kinds of hierarchies of social status underlying the social gradient of health are morally objectionable, even beyond their influence on other potential injustices, e.g. unfair health inequalities. The project will contribute to answering two broader research questions in normative ethics. The first question is, what is justice in health or its determinants? This is a primary question in the field of population-level bioethics (also known as public health ethics or political bioethics). The second question is, what, if anything, is wrong with hierarchies of social status? This question, when it is addressed at all, tends to be within the purview of political philosophy. Population-level bioethics has recently started looking to theories of social justice to help determine what fairness in health requires, but even these do not investigate the broader issues of inequality in social status underlying health inequality. In order to determine what is objectionable about the gradient in health, this project will investigate distributive justice as well as exploring the relatively under-theorized notion of social equality, which aims to establish what is morally objectionable about hierarchies of social status, and thus will widen the scope of population-level bioethics.