Short literature notices

So far, issues of health equity have been discussed predominantly in terms of access to health care. These approaches, however, fail to take into account that health is influenced by a wide range of social circumstances and public policies. For example, poverty is still one of the main factors behind health inequalities within and between countries. Any comprehensive approach to health equity therefore must take into consideration the socio-economic determinants of health, including the empirical literature on social inequalities in health. The volume, edited by Sudhir Anand, Fabienne Peter and Amartya Sen, tries to examine these issues from a variety of different perspectives, including contributions from philosophers, anthropologists, economists and public-health specialists. In the first section, Sudhir Anand and Amartya Sen discuss the concept of health equity. Anand argues that inequalities in health status are of special ethical concern because of the denial of opportunities. Socio-economic inequalities in health matter more than inter-individual inequalities in health because they derive from social rather than natural factors. Amartya Sen then provides a multidimensional framework for examining health equity. In the second section ‘‘Health, Society, and Justice’’, Michael Marmot demonstrates – based on the famous ‘‘Whitehall’’ studies – that health is positively correlated with socio-economic status. Norman Daniels, Bruce Kennedy and Ichiro Kawachi provide further empirical evidence from cross-national research that there is a rather steep socio-economic gradient of health inequality. Reform efforts therefore should focus on the social living conditions. Along the lines of these arguments, Fabienne Peter outlines an approach to health equity that proceeds indirectly and embeds health equity within a broader concept of social justice. Section three is devoted to the responsibility for health and health care. According to Daniel Wikler, personal responsibility for health should only play a limited role in health policies by empowering people to improve their health-related behaviour. Based on a relational conception of justice, ThomasW. Pogge argues that responsibility for health outcomes transcends national boarders. Philippe van Parijs discusses the case of Belgium where the two main linguistic groups, the Flemish and the Walloon, disagree on the allocation of the national health-care budget. Section four is concerned with ethical and measurement problems in health evaluations. Sudhir Anand and Kara Hanson first provide a critical review of the DALY concept as a measure of the burden of disease. Dan Brock discusses ethical issues in the use of cost effectiveness analysis for the allocation of scarce health care resources, Frances Kamm discusses different principles and arguments that determine whom we should help. John Broome finally investigates how longevity can be included in the valuation of people’s health. The final section provides an overview of different perspectives on the evaluation of health and health equity with contributions by Amartya Sen (external and internal perspectives), Arthur Kleinman (anthropological perspective) and an ethnomedical case study by Vincenne Adams (Tibet). Altogether, this volume presents a wide spectrum of different perspectives on health equity. Hopefully, this will be a starting point for further investigations of these important ethical issues.