NormanDaniels,Justice,Health,andHealthCare.PDFVIP

Justice, Health, and Health Care Norman Daniels, Tufts University Three Questions of Justice: A theory of justice for health and health care should help us answer three central questions. First, is health care special? Is it morally important in ways that justify (and explain) the fact that many societies distribute health care more equally than many other social goods? Second, when are health inequalities unjust? After all, many socially controllable factors besides access to health care affect the levels of population health and the degree of health inequalities in a population. Third, how can we meet competing health care needs fairly under reasonable resource constraints? General principles of justice that answer the first two questions do not, I argue, answer some important questions about rationing fairly. Is there instead a fair process for making rationing decisions? About twenty years ago, I answered the first question by claiming health care was special because of its impact on opportunity (Daniels 1981, 1985). Specifically, the central function of health care is to maintain normal functioning. Disease and disability, by impairing normal functioning, restrict the range of opportunities open to individuals. Health care thus makes a distinct but limited contribution to the protection of equality of opportunity. Though I construed health care broadly to include public health as well as individual preventive, acute and chronic care, I ignored other factors that have a profound effect on population health. Unfortunately, focusing on just health care adds to the popular misconception that our vastly improved health in the last century is primarily the result of health care. During the last twenty years, a major literature has emerged exploring the social determinants of health. We have long known that the richer people are, the longer and healthier