Table Of ContentPUBLIC HEALTH, ETHICS, AND EQUITY
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Public Health, Ethics,
and Equity
Edited by
SUDHIR ANAND
FABIENNE PETER
AMARTYA SEN
1
1
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Preface
This book originated in a set of workshops and seminars that we organised at
Harvard University in 1998 and 1999. Our objective in launching this series
of meetings was to initiate a wide investigation of the ethical issues underlying
inequalities in health. We were moved by the recognition that the extensive
empirical and policy literature on health inequalities had not been matched by
an adequate appreciation of the normative underpinnings of health equity. We
assembled, therefore, authors and commentators interested in these issues,
from a variety of disciplines, and invited them to contribute to this important
subject area. We were most encouraged by the wide interest generated by the
workshops and the lively discussions at the meetings. We are also deeply grate-
ful to the authors for their willingness to revise and restructure their papers,
taking note of the discussions, comments and written exchanges. Moreover, the
continuing involvement of many of the participants in the enquiry we initiated
has been extremely gratifying. The respective contributions made in different
chapters in this volume are briefly discussed in a separate Introduction.
The workshops and seminars were organised as part of the Global Health
Equity Initiative, and funded by a grant from the Rockefeller Foundation to
Harvard University. The later stages of the work in preparing, editing and pro-
ducing the volume for publication were supported by a grant from the
Rockefeller Foundation to St Catherine’s College, Oxford. We are very grateful
to the Foundation for its generous backing of this project.
SA, FP, AS
August 2004
Acknowledgements
Thanks are due to the following journals and publishers for giving us permission
to reprint:
“The Concern for Equity in Health” by Sudhir Anand, which originally
appeared in the Journal of Epidemiology and Community Health56(7) 2002:
485–7; copyright BMJ publishing group
“Why Health Equity?” by Amartya Sen, which originally appeared in Health
Economics 11(8) 2002: 659–66; copyright John Wiley & Sons
“Health Equity and Social Justice” by Fabienne Peter, which originally
appeared in theJournal of Applied Philosophy18(2) 2001: 159–70; copyright
Blackwell Publishers
“Disability-Adjusted Life Years: A Critical Review” by Sudhir Anand and
Kara Hanson, which originally appeared in the Journal of Health Economics
16(6) 1997: 685–702; copyright Elsevier
“Ethical Issues in the Use of Cost Effectiveness Analysis for the Prioritization
of Health Care Resources” by Dan Brock, which originally appeared in
Handbook of Bioethics: Taking Stock of the Field from a Philosophical
Perspective, edited by George Khushf. Dordrecht: Kluwer, 2004; copyright
Kluwer Academic Publishers.
Contents
List of Figures ix
List of Tables x
List of Abbreviations xi
List of Contributors xii
Introduction 1
Sudhir Anand and Fabienne Peter
Part I. Health Equity 13
1. The Concern for Equity in Health 15
Sudhir Anand
2. Why Health Equity? 21
Amartya Sen
Part II. Health, Society, and Justice 35
3. Social Causes of Social Inequalities in Health 37
Michael Marmot
4. Health and Inequality, or, Why Justice is Good for Our Health 63
Norman Daniels, Bruce Kennedy, and Ichiro Kawachi
5. Health Equity and Social Justice 93
Fabienne Peter
Part III. Responsibility for Health and Health Care 107
6. Personal and Social Responsibility for Health 109
Daniel Wikler
7. Relational Conceptions of Justice: Responsibilities for
Health Outcomes 135
Thomas W. Pogge
8. Just Health Care in a Pluri-National Country 163
Philippe Van Parijs
viii Contents
Part IV. Ethical and Measurement Problems in
Health Evaluation 181
9. Disability-Adjusted Life Years: A Critical Review 183
Sudhir Anand and Kara Hanson
10. Ethical Issues in the Use of Cost Effectiveness Analysis for
the Prioritisation of Health Care Resources 201
Dan W. Brock
11. Deciding Whom to Help, Health-Adjusted Life Years
and Disabilities 225
Frances M. Kamm
12. The Value of Living Longer 243
John Broome
Part V. Equity and Conflicting Perspectives on Health Evaluation 261
13. Health Achievement and Equity: External and
Internal Perspectives 263
Amartya Sen
14. Ethics and Experience: An Anthropological Approach
to Health Equity 269
Arthur Kleinman
15. Equity of the Ineffable: Cultural and Political Constraints on
Ethnomedicine as a Health Problem in Contemporary Tibet 283
Vincanne Adams
Index 307
List of Figures
3.1. All cause mortality by grade of employment Whitehall,
men 25-year follow-up 39
3.2. (a) IHD and (b) Suicide by social class in England
and Wales, males 1970–93 40
3.3. Life expectancy at age fifteen in Europe, (a) men and
(b) women 47
3.4. Model of pathways of social influences on health 49
3.5. Cigarette smoking by deprivation in Great Britain: GHS 1973
and 1996 50
3.6. Odds ratio for new CHD in Whitehall II by employment
grade—men 53
3.7. Odds ratio for new CHD in Whitehall II by employment
grade—men. Fully adjusted: adjusted for height,
coronary risk factors, low control at work 53
3.8. Standardised mortality from CHD, 0–64 years 54
4.1. Relationship between country wealth and life expectancy 66
4.2. Relationship between country wealth and life expectancy
among advanced industrial economies 67
4.3. Self-rated health and individual household income 69
12.1. A distribution of well-being 244
12.2. Two alternative distributions of well-being 245
12.3. A stylised demographic transition 247
12.4. Another example 252
Description:The chapters by Sen, Anand, and Marmot are inspiring and enlightening. Everyone interested in health ethics, development, inequality, or justice should read this book. It clearly shows how targeted interventions can influence complex webs of social and biological events to bring marked improvements
