Evaluating health inequalities: residual worries.

Adina Preda and Kristin Voigt should be commended for bridging the gap between moral philosophy and health policy. While I am convinced by much of their analysis of what they call the Health Equity as Social Change (HESC) model, I am not certain they are correct to claim that " in the HESC model, 'avoidability' appears as both a necessary and sufficient condition for health inequity " (Preda and Voigt, 8). I will explain my hesitation, and then explain some further qualms about Preda and Voigt's arguments concerning the evaluation of health inequalities. To start, I want to flag one claim that HESC proponents make that I think is mistaken but which Preda and Voigt seem to accept. This is the claim that whatever is unfair is unjust. Early in their paper, Preda and Voigt quote the Commission on the Social Determinants of Health as saying: " Where systematic differences in health are judged to be avoidable by reasonable action they are, quite simply, unfair. It is this that we label health inequity. Putting right these inequities…is a matter of social justice. " This in turn suggests that unfair health inequalities are perforce unjust. Preda and Voigt seem to accept this. For example, after asking whether " health inequalities are unfair when they result from a fair albeit unequal distribution of social goods, " they go on to restate this question as " Is there any theoretical framework that can support the claim that these inequalities are unjust? " By contrast, I would prefer a conceptual scheme on