Justice, health, and status: moral theory and the new epidemiology of health disparities Public Deposited

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  • March 21, 2019
  • Courtwright, Andrew
    • Affiliation: College of Arts and Sciences, Department of Philosophy
  • Health is distributed unequally. Compared to whites in my home state of North Carolina, the infant mortality rate among blacks is 2.4 times greater, Native American children are hospitalized for asthma 2.8 times more frequently, and black adults are 40% more likely to die from strokes. Ethical and political discussions of these and other health disparities have focused on justice. The general strategy philosophers like Norman Daniels and Jennifer Ruger employ is to identify a certain state of affairs—equality of opportunity and equality of capabilities, respectively—and then to argue that health disparities limiting an individual’s or group’s access to that condition are unjust, demanding intervention. The most common corrective in this context is to improve access to health care. Recent work in epidemiology, however, has highlighted the importance of socioeconomic factors outside of access to care in creating health disparities. I explore the ways in which theories of justice have been expanded in light of this information, particularly data on the affects of social stigma on health. I suggest that further work in a broader moral territory—including the appropriateness of interpersonal attitudes like disesteem and contempt—is required if such theories are to provide an adequate framework for addressing health disparities. I conclude by considering an alternative approach, focused on a normative theory of socioeconomic status, for thinking about health disparities outside of the context of justice.
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  • In Copyright
  • Hill, Thomas E.
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  • University of North Carolina at Chapel Hill
  • Open access

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