as we discuss later in this section, the extraordinary disparities in life expectancy, child survival and health that distinguish those who live in rich and poor countries constitute a profound injustice that it is the duty of the global community to redress. One task of public health ethics is to identify which inequalities in health are the most egregious and thus which should be given high priority in public health policy and practice. That the life expectancy of some of world's poorest populations is over twenty-five years less than the life expectancy of those living in some affluent countries is a clear injustice of particular moral urgency. Not all inequalities are so obviously egregious, however, and different accounts of justice and of the relevance of individual responsibility for health may yield different conclusions. Different approaches to conceptualizing and measuring health inequalities have different ethical implications (Eyal, Hurst, Norheim & Wikler 2012). On the view that Powers and Faden defend (2006), social justice demands that, insofar as possible, all children achieve a sufficient level of health. Thus, inequalities in the health of children are a particular moral concern. The health of children is dependent on the decisions and actions of others and on features of the social structure over which children have no control. The value of health to children thus does not depend on what children can do for themselves, as it sometimes does for adults. Moreover, the level of well-being attainable in adulthood is in important respects conditioned by the level of health achieved in childhood. Compromised health in childhood has profound effects on health in adulthood, as well as on the development of the cognitive skills necessary for reasoning and self-determination. When inequalities in health exist between socially dominant and socially disadvantaged groups, they are all the more important because they occur in conjunction with other disparities in well-being and compound them (Wolff & de-Shalit 2007; Powers & Faden 2006). Reducing such inequalities are specific priorities in the public health goals of national and international institutions (Department of Health 2009; EuroHealthNet 2014 (Other Internet Resources); Healthy People 2020 (2014, in Other Internet Resources); Kettner & Ball 2004; WHO 2015). Whether through processes of oppression, domination, or subordination, patterns of systematic disadvantage associated with group membership are invidious and profoundly unjust. They affect
every dimension of well-being, including health. In many contexts, poverty co-travels with the systematic disadvantage associated with racism, sexism, and other forms of denigrated group membership. However, even when it does not, the dramatic differential in material resources, social influence and social status that is the hallmark of severe poverty brings with it systematic patterns of disadvantage that can be as difficult to escape as those experienced by the most oppressed minority groups. Even when these patterns are lessened,
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- Fall '19
- Public health ethics