socialhealthjustice (1)

socialhealthjustice (1) - Society, Health, and Justice We...

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Society, Health, and Justice We have long known that the more affluent and better-educated members of a society tend to live longer and healthier lives: René Louis Villermé made this point as early as 1840, and it has been shown to hold for just about every human society. Recent research suggests that the correlations between income and health do not end there. We now know, for example, that countries with a greater degree of socioeconomic inequality show greater inequality in health status; also, that middle-income groups in relatively unequal societies have worse health than comparable, or even poorer, groups in more equal societies. Inequality, in short, seems to be bad for our health. Moreover, and perhaps more surprisingly, universal access to health care does not necessarily break the link between social status and health. Our health is affected not simply by the ease with which we can see a doctor--though that surely matters--but also by our social position and the underlying inequality of our society. We cannot, of course, infer causation from these correlations between social inequality and health inequality (though we will explore some ideas about how the one might lead to the other). Suffice to say that, while the exact processes are not fully understood, the evidence suggests that there are social determinants of health. These social determinants offer a distinctive angle on how to think about justice, public health, and reform of the health care system. If social factors play a large role in determining our health, then efforts to ensure greater justice in health care should not focus simply on the traditional health sector. Health is produced not merely by having access to medical prevention and treatment, but also, to a measurably greater extent, by the cumulative experience of social conditions over the course of one’s life. By the time a sixty-year-old heart attack victim arrives at the emergency room, bodily insults have accumulated over a lifetime. For such a person, medical care is, figuratively speaking, "the ambulance waiting at the bottom of the cliff." Much contemporary discussion about reducing health inequalities by increasing access to medical care misses this point. We should be looking as well to improve social conditions--such as access to basic education,
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levels of material deprivation, a healthy workplace environment, and equality of political participation--that help to determine the health of societies. These conditions have unfortunately been virtually ignored within the academic field of bioethics, and in public discussions about health care reform. Academic bioethics is quick to focus on exotic new technologies and the vexing questions they raise for doctors and health administrators, who must make decisions about patient care and the allocation of scarce medical resources. And we all worry about the doctor-patient relationship under managed care, as insurance companies have taken a newly aggressive role in making
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This note was uploaded on 04/29/2010 for the course PHL 453 taught by Professor Gifford during the Spring '10 term at Michigan State University.

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socialhealthjustice (1) - Society, Health, and Justice We...

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