Health and Social Justice

Societies make decisions and take actions that profoundly impact the distribution of health. Why and how should collective choices be made, and policies implemented, to address health inequalities under conditions of resource scarcity? How should societies conceptualize and measure health disparities, and determine whether they've been adequately addressed? Who is responsible for various aspects of this important social problem? In Health and Social Justice, Jennifer Prah Ruger elucidates principles to guide these decisions, the evidence that should inform them, and the policies necessary to build equitable and efficient health systems world-wide. This book weaves together original insights and disparate constructs to produce a foundational new theory, the health capability paradigm. Ruger's theory takes the ongoing debates about the theoretical underpinnings of national health disparities and systems in striking new directions. It shows the limitations of existing approaches (utilitarian, libertarian, Rawlsian, communitarian), and effectively balances a consequentialist focus on health outcomes and costs with a proceduralist respect for individuals' health agency. Through what Ruger calls shared health governance, it emphasizes responsibility and choice. It allows broader assessment of injustices, including attributes and conditions affecting individuals' "human flourishing," as well as societal structures within which resource distribution occurs. Addressing complex issues at the intersection of philosophy, economics, and politics in health, this fresh perspective bridges the divide between the collective and the individual, between personal freedom and social welfare, equality and efficiency, and science and economics.

Introduction. The Current Set of Ethical Frameworks. 1. Approaches to Medical and Public Ethics. An Alternative Account- The Health Capability Paradigm. 2. Health and Human Flourishing. 3. Pluralism, Incompletely Theorized Agreements, and Public Policy. 4. Justice, Capability, and Health Policy. 5. Grounding the Right to Health. Domestic Health Policy Applications. 6. A Health Capability Account of Equal Access. 7. A Health Capability Account of Equitable and Efficient Health Financing and Insurance. 8. Allocating Resources: A Joint Scientific and Deliberative Approach. Domestic Health Reform. 9. Political and Moral Legitimacy: A Normative Theory of Health Policy Decision-making. Conclusion.

Jennifer Prah Ruger is Associate Professor at Yale University Schools of Medicine, Public Health, Law, and Graduate School of Arts and Sciences. Previous appointments include Assistant Professor at Washington University in St. Louis, Speechwriter to the World Bank President, James D. Wolfensohn, Health Economist in the World Bank Health, Nutrition and Population Sector and Satellite Secretariat for the World Health Organization Transition Team, Health and Development Satellite. Professor Ruger has authored numerous theoretical and empirical studies on the equity and efficiency of health system access, financing, resource allocation, policy reform, and social determinants of health. These contributions are unified by an overarching interest in equity and disparities in health and health care, focusing on vulnerable and impoverished populations nationally and globally.

Ruger presents the 'health capability paradigm', an original synthesis of philosophy, political science, and economics that illuminates a way forward toward a more rational health policy-and health policy process. A book that is a must read for all serious students of health policy. ro as well as macro levels.