Social Justice
The Moral Foundations of Public Health and Health Policy
Issues in Biomedical Ethics Series

In bioethics, discussions of justice have tended to focus on questions of fairness in access to health care: is there a right to medical treatment, and how should priorities be set when medical resources are scarce. But health care is only one of many factors that determine the extent to which people live healthy lives, and fairness is not the only consideration in determining whether a health policy is just. In this pathbreaking book, senior bioethicists Powers and Faden confront foundational issues about health and justice. How much inequality in health can a just society tolerate. The audience for the book is scholars and students of bioethics and moral and political philosophy, as well as anyone interested in public health and health policy.

Chapter 1: The Job of Justice. 1.1 Which Inequalities Matter Most. 1.2 Justice and Well-Being. 1.3 Justice, Sufficiency, and Systematic Disadvantage. 1.4 Foundations of Public Health. 1.5 Medical Care and Insurance Markets. 1.6 Setting Priorities. 1.7 Justice, Democracy, and Social Values. Chapter 2. 2.1 Introduction. 2.2 Essential Dimensions of Well-Being. 2.3 A Moderate Essentialism. 2.4 Well-Being and Nonideal Theory. 2.5 The Main Alternatives. 2.6 Capabilities, Functioning, and Well-Being. 2.7 Relativism, Moral Imperialism, and Political Neutrality. 2.8 Justice and Basic Human Rights. Chapter 3: Justice, Sufficiency, and Systematic Disadvantage. 3.1 Varieties of Egalitarianism. 3.2 The Leveling-Down Objection. 3.3 The Strict Egalitarian's Pluralist Defense. 3.4 Is the Appeal to Equality Unavoidable. 3.5 A Sufficiency of Well-Being Approach. 3.6 Toward a Unified Theory of Social Determinants and Well-Being. 3.7 Densely Woven, Systematic Patterns of Disadvantage. 3.8 Conclusion. Chapter 4: Social Justice and Public Health. 4.1 Introduction. 4.2 Moral Justification for Public Health. 4.3 Public Health, the Negative Point of Justice, and Systematic Disadvantage. 4.4 Public Health, the Positive Point of Justice, and Health Inequalities. Chapter 5: Medical Care and Insurance Markets. 5.1 The Moral Foundations of Markets. 5.2 Sources of Market Failure. 5.3 Responses to Market Failure: Some Examples from the U.S. Experience. 5.4 Making Matters Worse: Employer-Based Insurance in the United States. 5.5 Private Markets and Public Safety Nets. Chapter 6: Setting Priorities. 6.1 Introduction. 6.2 Mimicking Markets. 6.3 Cost-Effectiveness and Cost-Utility Alternatives. 6.4 Systematic Disadvantage. 6.5 The Relevance of Childhood, Old Age, and Human Development. 6.6 Beyond Separate Spheres of Justice. 6.7 Trade-Offs within Health. 6.8 Conclusion. Chapter 7: Justice, Democracy, and Social Values. 7.1 Lost on the Oregon Trail. 7.2 From Substantive Justice. 7.3 Mimicking Majorities: Moralizing Preferences and Empiricizing Equity. 7.4 Theory, After All?. 7.5 DALYs, Deliberation, and Empirical Ethics. Chapter 8: Facts and Theory. References. Author Index. Subject Index.

Madison Powers is Director and Science Research Scholar, Kennedy Institute of Ethics, and Associate Professor of Philosophy, Georgetown University. Ruth Faden is Wagley Professor of Biomedical Ethics, and Director, Berman Bioethics Institute, Johns Hopkins University.