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Equality in health, equality for health: Justice, status and the social gradient in health

Applicant Schaber Peter
Number 146668
Funding scheme Project funding (Div. I-III)
Research institution Ethik-Zentrum Universität Zürich
Institution of higher education University of Zurich - ZH
Main discipline Philosophy
Start/End 01.01.2014 - 30.04.2016
Approved amount 234'075.00
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Keywords (5)

social gradient in health; equality; justice in health; social status; population-level bioethics

Lay Summary (German)

Lead
Es gibt soziale Gradienten von Gesundheit. Das bedeutet, dass es für jeden Schritt auf einer sozialen Leiter einen entsprechenden Gesundheitszustand gibt. Je besser (schlechter) der soziale Status, desto besser (schlechter) der Gesundheitszustand. Sind diese Ungleichheiten fair? Und weshalb schon beziehungsweise weshalb nicht?
Lay summary

Inhalt und Ziel des Forschungsprojekts

Das Ziel dieses Projektes ist es, den moralischen Status von sozialen Gradienten von Gesundheit zu untersuchen. Genauer bedeutet dies zu bestimmen, ob solche sozialen Gradienten ethisch erlaubt oder verboten sind. Um diese ethische Frage beantworten zu können, müssen wir: (1) die möglichen Determinanten der sozialen Gradienten von Gesundheit, untersuchen (2) den moralischen Status von Ungleichheiten analysieren, und durch die Kombination der ersten beiden Schritte, (3) festzustellen, ob die möglichen Determinanten eine wichtige Rolle dabei spielen, ob die resultierenden Ungleichheiten ungerecht sind. Ein Beispiel dafür sind die folgenden Fragen: Falls Ungleichheiten im Einkommen oder in der Bildung einen Einfluss auf Gesundheitsungleichheiten haben, folgt dann daraus, dass die  Gesundheitsungleichheiten an sich unfair sind? Oder aber sind diese Gesundheitsungleichheiten an sich unfair, unabhängig davon was die Determinanten sind? Oder sind Ungleichheiten im Einkommen oder in der Bildung unfair, unabhängig davon ob sie zu Gesundheitsungleichheiten führen?

 

Wissenschaftlicher und gesellschaftlicher Kontext

Das Projekt verbindet politische Philosophie mit Ethik des Gesundheitswesens, um eine Antwort auf das folgende ethische Problem zu finden: Wann, wenn überhaupt, sind soziale Gradienten von Gesundheit unfair? Antworten zu dieser Frage sind von grosser Wichtigkeit, um die Prioritäten einer sozial gerechten Regierung verstehen zu können sowie um bestimmen zu können, ob und wenn ja welche Massnahmen in Kraft gesetzt werden müssen, um sozialen Gradienten von Gesundheit sowie andere Arten von sozialen Ungleichheiten entgegenwirken zu können.

 

Direct link to Lay Summary Last update: 24.10.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
Social Equality: On What It Means to be Equals
Wallimann-Helmer Ivo, Schuppert Fabian, Fourie Carina (ed.) (2015), Social Equality: On What It Means to be Equals, Oxford University Press, New York.
The Nature and Distinctiveness of Social Equality: An Introduction
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.
To Praise and to Scorn: The Problem of Inequalities of Esteem for Social Egalitarianism
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.
Sufficiency of Capabilities, Social Equality and Two-Tiered Health Care Systems
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..
The Sufficiency View: A Primer
Fourie Carina, The Sufficiency View: A Primer, in Rid Annette, Fourie Carina (ed.), Oxford University Press, New York, 1..
What is Enough? Sufficiency, Justice, and Health
Rid Annette, Fourie Carina (ed.), What is Enough? Sufficiency, Justice, and Health, Oxford University Press, New York.

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Einzelvortrag auf Einladung der University of Washington in Seattle Individual talk Sufficiency of Capabilities, Social Equality and Two-Tiered Health Care Systems 26.01.2016 Seattle, United States of America Fourie Carina;
Vortrag im Rahmen eines Visiting Scholarships an der LMU München Individual talk To Praise and to Scorn: The Problem of Inequalities of Esteem for Social Egalitarianism 15.01.2016 München, Germany Fourie Carina;
Tagung für Praktische Philosophie Talk given at a conference Das gute Leben und das würdevolle Leben 01.10.2015 Salzburg, Austria Muders Sebastian;
Internationale Wissenschaftliche Klausurwoche zum Thema "Pluripotente Stammzellen" Talk given at a conference Which Value for Embryos? 28.09.2015 Wessobrunn, Germany Muders Sebastian;
Tagung der Gesellschaft für Analytische Philosophie (GAP) Talk given at a conference Menschenwürde: Intrinsisch, inhärent, absolut? 14.09.2015 Osnabrück, Germany Muders Sebastian;
Jahrestagung der Society for Applied Philosophy Talk given at a conference Inflationary Dignity? 04.06.2015 Edinburgh, Great Britain and Northern Ireland Muders Sebastian;
La théorie de l’estime sociale, une confrontation de modèles Talk given at a conference The Problem of Inequalities of Esteem for Social Egalitarianism 16.04.2015 Paris, France Fourie Carina;
Einzelvortrag auf Einladung der New York State University at Albany Individual talk To Praise and to Scorn: The Problem of Inequalities of Esteem for Social Egalitarianism 23.01.2015 Albany (NY), United States of America Fourie Carina;
The Idea of Social Equality Talk given at a conference To Praise and to Scorn: The Problem of Inequalities of Esteem for Social Egalitarianism 17.09.2014 York, Great Britain and Northern Ireland Fourie Carina;
MANCEPT Workshop in Political Theory Individual talk The Subjects of Social Equality 08.09.2014 Manchester, Great Britain and Northern Ireland Fourie Carina;
Jahrestagung der Society for Applied Philosophy Talk given at a conference The Problem of Inequalities of Esteem for Social Egalitarianism 27.06.2014 Oxford, Great Britain and Northern Ireland Fourie Carina;


Associated projects

Number Title Start Funding scheme
160631 Respect, Recognition and Relational Equality 01.05.2015 Scientific Conferences
120200 Towards an Integrative Model of Allocative Health Care Justice: Egalitarianism, Prioritarianism, Sufficientarianism 01.09.2008 Project funding (Div. I-III)

Abstract

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.
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