In this book by the award-winning author of Just Healthcare, Norman Daniels develops a comprehensive theory of justice for health that answers three key questions: what is the special moral importance of health? When are health inequalities unjust? How can we meet health needs fairly when we cannot meet them all? Daniels' theory has implications for national and global health policy: can we meet health needs fairly in ageing societies? Or protect health in the workplace while respecting individual liberty? Or (...) meet professional obligations and obligations of justice without conflict? When is an effort to reduce health disparities, or to set priorities in realising a human right to health, fair? What do richer, healthier societies owe poorer, sicker societies? Just Health: Meeting Health Needs Fairly explores the many ways that social justice is good for the health of populations in developed and developing countries. (shrink)

In recent years, there has been a growing groundswell of support for the idea that universal health coverage should be provided even in the developing world. While I wholeheartedly agree with the eventual goal of attaining universal health coverage globally, and the sooner the better, I have worries as to whether the world's rich countries, or institutions like the World Health Organization, should be pushing the world's poorest countries to take whatever steps are necessary to achieve that goal. My fear (...) is that universal health coverage in the developing world is an intoxicating, but potentially dangerous, idea whose time may not yet have come. This article's aim is not to settle the question of whether the developing world should be urged, or pushed, to adopt policies of universal health coverage. It is merely to explore some worries about the wisdom of such a tack. The article is divided into eight sections. In Section 1, I give a brief introduction. In Section 2, I provide some background for my topic. In Section 3, I discuss the notion of universal health coverage, and what the push for such a goal in the developing world seemingly involves. In Section 4, I raise some general worries I have about the push for universal health coverage in the developing world. In Section 5, I present a wide range of possible justifications for universal health coverage in the developing world. In Section 6, I discuss whether any of the purported justifications of universal health coverage in the developing world actually do so. In Section 7, I consider some comments, objections, and responses. Finally, in Section 8, I offer a brief conclusion. (shrink)

I distinguish four different interpretations of ‘equality of opportunity.’ We get four interpretations because a neglected ambiguity in ‘opportunity’ intersects a well-known ambiguity in ‘equality.’ The neglected ambiguity holds between substantive and non-substantive conceptions of ‘opportunity’ and the well-known ambiguity holds between comparative and non-comparative conceptions of ‘equality.’ Among other things, distinguishing these four interpretations reveals how misleading ‘equal opportunity for advantage’ formulations of luck egalitarianism can be. These formulations are misleading in so far as they obscure the difference between (...) two separate claims about which inequalities are consistent with true equality. Luck egalitarianism claims that inequalities that have been chosen in some suitable sense are consistent with true equality, while the traditional ideal of equality of opportunity only claims that inevitable inequalities that have been determined through fair competitions are consistent with true equality. Obscuring the difference between these two claims therefore serves both to arrogate the rhetorical advantages of the traditional ideal to luck egalitarianism and to cover over a limitation to luck egalitarianism’s ambition to provide a comprehensive principle of distributive justice. (shrink)

One widely accepted way of justifying universal access to health care is to argue that access to health care is necessary to ensure health, which is necessary to provide equality of opportunity. But the evidence on the social determinants of health undermines this argument.

In Capital in the Twenty-First Century, Thomas Piketty argues that markets, absent political intervention, tend toward economic divergence and that this has deleterious consequences for democratic ideals of equal voice and meritocracy. His goal is to foster a public conversation about what a society dominated by wealth—which we already beginning to experience as the twenty-first century begins—would look like if we wish to maintain an egalitarian ethos. His work will contribute to and further motivate several discussions in feminist bioethics, namely, (...) on the funding and organization of care labor, reproductive rights, global health, and commodification. (shrink)

In Capital in the Twenty-First Century, Thomas Piketty argues that markets, absent political intervention, tend toward economic divergence and that this has deleterious consequences for democratic ideals of equal voice and meritocracy. His goal is to foster a public conversation about what a society dominated by wealth—which we already beginning to experience as the twenty-first century begins—would look like if we wish to maintain an egalitarian ethos. His work will contribute to and further motivate several discussions in feminist bioethics, namely, (...) on the funding and organization of care labor, reproductive rights, global health, and commodification. (shrink)

Political theorists generally defend the moral importance of health care by appealing to its purported importance in promoting good health and saving lives. Recent research on the social determinants of health demonstrates, however, that health care actually does relatively little to promote good health or save lives in comparison with other social and environmental factors. This article assesses the implications of the social determinants of health literature for existing theories of health care justice, and outlines a new approach that can (...) justify publicly subsidized comprehensive health care despite its limited contribution to good health. Even if health care plays a relatively limited role in promoting good health, it remains morally important because of the care it provides to individuals. As such, it can be justified in terms of care ethics. When health care is justified primarily in terms of care rather than health, however, the goals of a just health-care system shift. The measure of a just health-care system is no longer strictly its ability to generate good health outcomes but also its ability to provide individuals with accessible, good quality daily care. This different focus has important consequences for the way we think about the institutions of a just health-care system as well as for the delivery and allocation of medical goods and services. (shrink)

This report by the WHO Consultative Group on Equity and Universal Health Coverage addresses how countries can make fair progress towards the goal of universal coverage. It explains the relevant tradeoffs between different desirable ends and offers guidance on how to make these tradeoffs.

Bioethical Prescriptions collects F.M. Kamm's articles on bioethics -- revised for publication in book form -- which have appeared over the last 25 years and which have made her among the most widely-respected philosophers working in this field.