By Lasse Nielsen.
Mildred and Meagan lead different lives. Mildred resides in an affluent and socially privileged neighbourhood, comes from a higher-middle-income household and is out of a well-educated family. Meagan, on the other hand, is from a non-educated, working-class background, out of a low-income family and lives in a much less salubrious area.
What we know today, with reference to the influential work of Michael Marmot and others on the social gradient of health, is that Mildred and Meagan face very different health prospects, and that this inequality between them is largely a social fact explained by social determinants of health.
Social inequality in health, such as displayed in the case with Mildred and Meagan, is still a central problem in many welfare state societies, and it is a major social injustice. The question in my recent JME paper is: what theory of health justice is best able to capture and explain that injustice?
The thesis defended is that health sufficientarianism better than egalitarian alternatives explains the relevant injustice involved in social inequality in health. Health sufficientarianism says that it is unjust when someone is below the threshold level of good enough health.
The sufficientarian view has an advantage because it ties the injustice in health inequality to structural risk of actual health deficiency. This better captures the injustice because the social gradient of health does not, in fact, represent a necessary distributive relation of inequality in health between Mildred and Meagan as individuals, but a structural pattern in the prevalence and risk of actualized health deficiencies based on their social group affiliation.
As such, health sufficientarianism offers a promising explanation for our concern with social health inequality. This is an important contribution to a future in which we need to uphold social justice in health while facing still more demanding requirements for health care priority-setting.
Paper title: Health sufficientarianism and health inequality
Author: Lasse Nielsen
Affiliations: University of Southern Denmark
Competing interests: None