Inequalities in Health

Concepts, Measures, and Ethics

Edited by Nir Eyal, Samia A. Hurst, Ole F. Norheim, and Dan Wikler

Population-Level Bioethics

· Inequalities in health have become a central concern of health policy both within and between nations. This book offers the first searching, critical examination of many of the key concepts and ethical assumptions found in this scientific and health policy literature. These authors offer some of the first extended efforts to answer these questions - and in some cases to identify them.
· The contributors include global leaders in health economics, epidemiology, moral philosophy, and related academic fields such as Sir Tony Atkinson, Sir Michael Marmot, Angus Deaton, Frances Kamm, Erik Nord, Larry Temkin, Dan Hausman, and others.
· They also include some of the most promising young contributors to population-level bioethics.
· The range of disciplines represented here is unique in this field, as is the degree of integration across disciplinary boundaries.

Inequalities in Health

Concepts, Measures, and Ethics

Edited by Nir Eyal, Samia A. Hurst, Ole F. Norheim, and Dan Wikler

Description

Of every thousand children born in Iceland, two will die before their first birthday, but in Mozambique the death rate is sixty times higher. Even within countries - including some of the wealthiest - inequalities in longevity and health can be substantial. In recent years, epidemiologists have documented the extent of these inequalities both between and within countries, stimulating in turn research both on their sources and on possible means for their alleviation. These extensive and influential efforts in research and in policy development have raised health inequalities to a prominent position among the central concerns of both national and global health.

Less attention has been given to careful analysis and refinement of some key concepts and values that guide and motivate these studies of health inequalities. The essays in this book demonstrate the need to identify and debate alternative positions on the choice of measures of health inequality; the definitions of 'inequality' and 'inequity' in health, and their interrelationship; the ethical basis for attaching priority to narrowing gaps in longevity and health among individuals, groups, and societies; and the possible solutions to a series of puzzles involving uncertainty and variable population size.

The authors of these essays are philosophers, economists, epidemiologists, and physicians contributing to our understanding of ethical issues in population health. Their contributions will be of interest to anyone interested in inequalities in health, including specialists in health policy, public health, epidemiology, moral philosophy, demography, and health economics.

Inequalities in Health

Concepts, Measures, and Ethics

Edited by Nir Eyal, Samia A. Hurst, Ole F. Norheim, and Dan Wikler

Population-Level Bioethics

Nir Eyal, Samia Hurst, Sara Marchand, Ole F. Norheim, Dan Wikler — "Introduction: Inequalities in Health: Concepts, Measures, and Ethics"
Part I: Defining and measuring health inequality
1. Larry Temkin - "Inequality and Health"
2. Tony Atkinson - "Health Inequality, Health Inequity and Health Spending"
3. Yukiko Asada - "A Summary Measure of Health Inequalities: Incorporating Group and Individual Inequalities"
4. Kasper Lippert Rasmussen - "When Group Measures of Health Should Matter
5. Erik Nord - "Priority to the Worse Off: Severity of Current and Future Illness Versus Shortfall in Life Time Health"
6. Gustaf Arrhenius- "Egalitarian Concerns and Population Change"
Part II: Health Inequality and egalitarianism
7. Dan Hausman - "Egalitarian Critiques of Health Inequalities"
8. Alex Voorhoeve and Marc Fleurbaey - "Decide as You Would with Full Information! An Argument against ex ante Pareto"
9. Johann Frick - Uncertainty and Justifiability to Each Person
10. Shlomi Segall - "Equality of Opportunity For Health"
11. Wlodek Rabinowicz - "When in Doubt, Equalize"
12. Norman Daniels - "Reducing Health Disparities: No Simple Matter"
13. Nir Eyal - "Levelling Down Health"
14. Ole Norheim - "Atkinson's Measure of Inequality: Can Measures of Economic Inequality Help Us Understand Trade-Offs in Healthcare Priority Setting?"
15. Toby Ord And Nick Beckstead - "Rationing and Rationality: The Cost of Avoiding Discrimination"
16. Frances M. Kamm - Rationing and the Disabled: Several Proposals
Part III: Health Inequality and Public Policy
17. Angus Deaton - "What does the Empirical Evidence on SES and Health Tell Us About Inequity and About Policy?"
18. Michael Marmot-Fair Society Healthy Lives
19. Julian Le Grand - "Individual Responsibility, Health and Health Care"
20. Ritu Sadana - "WHO's Social Determinants Commission - Concepts and Measures of Health Inequalities"

Inequalities in Health

Concepts, Measures, and Ethics

Edited by Nir Eyal, Samia A. Hurst, Ole F. Norheim, and Dan Wikler

Population-Level Bioethics

Author Information

Edited by Nir Eyal, Samia A. Hurst, Ole F. Norheim, and Dan Wikler

Nir Eyal is Associate Professor of Global Health and Social Medicine (Medical Ethics) at the Harvard Medical School, with a joint appointment at Harvard's Program in Ethics and Health. He is writing, among other things, on egalitarianism, consequentialism, health resource rationing, and ethical issues in the delivery of care in resource-poor settings.

Samia A. Hurst is Swiss National Science Foundation professor of Bioethics at Geneva University's medical school in Switzerland, and member of several ethics committees including the research Ethics Review Committee at the World Health Organization. Her research focuses on fairness in clinical practice, and the protection of vulnerable persons.

Ole F. Norheim is a physician specializing in internal medicine and professor in medical ethics, University of Bergen. He is currently heading the research project Priority Setting in Global Health. His research interests include fair resource allocation for health in high- and low-income countries, with particular emphasis on how to measure population-level impacts of priority setting decisions.

Dan Wikler, a philosopher, is Mary B. Saltonstall Professor of Ethics and Population Health at the Harvard School of Public Health. He served as the first Staff Ethicist for the World Health Organization (1999-2001) and continues to work with World Health Organization on ethical issues in global health and health research. His principal research interests are ethical dimensions of population health research and policy.

Contributors:

Sir Tony Atkinson
Gustaf Arrhenius
Yukiko Asada
Nick Beckstead
Norman Daniels
Angus Deaton
Nir Eyal
Marc Fleurbaey
Johann Frick
Julian Le Grand
Daniel M. Hausman
Samia Hurst
F.M. Kamm
Kasper Lippert-Rasmussen
Sir Michael Marmot
Erik Nord
Ole Frithjof Norheim
Toby Ord
Wlodek Rabinowicz
Ritu Sadana
Shlomi Segall
Larry S. Temkin
Alex Voorhoeve
Dan Wikler