Justice in Health

Within and across all societies, some people live longer and healthier lives than others. Although many of us intuitively think of health as a very important good, general theories of justice have hitherto paid little attention to its distribution. This is a thesis about what we owe to one another, as a matter of justice, in view of our unequal levels of health. The first part of the thesis addresses the problem of social justice in health. I argue that the basic institutional framework of society must be arranged so as to ensure an egalitarian distribution of the âsocial bases of health,â that is, the socioeconomic conditions that shape our opportunities for a healthy life. Inequalities in health, including those caused by differences in individual lifestyles, are only fair when people have been given fair opportunities. This egalitarian approach to the social bases of health must be complemented by a sufficientarian concern for meeting all basic health needs, regardless of whether these originate in unfair social arrangements. The second part of the thesis takes up the problem of global justice in health. Although I argue against the idea that domestic principles of justice can be simply replicated on a global scale, I emphasise the fact that there are a number of international institutions and practices that shape peopleâs opportunities for health. One of these is the state systemâthe division of the world into sovereign statesâwhich I argue grounds the idea of the human right to health. I also examine two more specific examples of global practices that contribute to global inequalities in health, namely global trade in tobacco and the global labour market for healthcare workers. Both of these, I suggest, must be restricted in light of their impact on health levels worldwide.