Thoughts on Health Inequality
By Thuwein Y. Makamba
Improving health inequality doesn’t necessarily increase health equity; Sen argued that distribution of wealth in a fashion that will make overall society unhealthy is not the right way to pursue health equity. In many low income countries, the pie is too small to be distributed to everybody, and it is suggested to let economies grow first before implementation of egalitarian social policies. However, in societies like United States where the pie is already big, it is imperative to implement social policies that will improve social determinants of health and provide everybody capabilities to achieve good health. However, policy makers must understand that providing capability for citizens to achieve health doesn’t mean they will achieve good health. This is explained by the idea of “subculture of poverty” brought by anthropologist Oscar Lewis who argued that poor people have sense of dependence, of not belonging, and are marginalized in their own country. These people (poor) are convinced that existing institutions do not serve their interest or needs. In response to this, it is imperative that when improving social determinants of these populations’ health, the behavioral change component should also implemented in parallel with improving education status.
Providing healthcare for all and implementing policies that will improve social conditions for the poor is a moral decision, and decisions in morality are non-uniform amongst politicians and policy makers. United States political ideology (premises of Washington Consensus) is highly influenced by early political thinkers like John Locke who argued that “every man has a property in his own person. This nobody has any right to but himself. The labor of his body, and the work of his hands, we may say are properly his.” This thinking has shaped a society in a way that it is not accepted to distribute one’s income, because the labor is the unquestioned property of the laborer. This explain why more egalitarian social policies are not acceptable in United States, despite the evidence of immense sufferings to those disadvantageous social groups. And the fact that the idea of ‘unquestioned property of the laborer” is only valid when there was the same level of equality to begin with. The critics of equal social policies are negating the notion of accident of birth, which it was not in poor people choosing to be born in conditions with poor determinants of health.
Those who disputes ideas of equality often say that “it is better that some should be unhappy than that none should be happy”. Although this thinking is flawed because equality can also means that everyone should be happy. Also, it also known that wherever health inequalities are greatest the overall health status of the population is lower. Therefore it is in everybody interest to adopt the policies that would improve health equity of the society. The only inequality that should be allowed is that if it would benefit those who are least well-off, argued by John Rawls in his Difference Principle. But this Rawls’ accepted inequality would only be tolerated if it will improve equity rather than bringing everybody down.
The marker for moral excellence in our society should be based on how we can avoid premature deaths, and needless illness. We have signed a social contract with our governing institutions to pursue equal justice for all and this include giving everybody the chance to pursuit of healthiness regardless of their social status or income.