chapter  23
8 Pages

Why Health Equity?

In fact, equality, as an abstract idea, does not have much cutting power, and the real work begins with the specification of what is it that is to be equalized. The central step, then, is the specification of the space in which equality is to be sought, and the equitable accounting rules that may be followed in arriving at aggregative concerns as well as distributive ones. The content of the respective theories turns on the answers to such questions as 'equality of what?' and 'equity in what form?'(On this see [2].)

This is where health becomes a critical concern, making health equity central to the understanding of social justice. It is, however, important to appreciate that health enters the arena of social justice in several distinct ways, and they do not all yield exactly the same reading of particular social arrangements. As a result, health equity is inescapably multidimensional as a concern. If we insist on looking for a congruence of the different aspects of health equity before we make unequivocal judgements, then often enough health equity will yield an incomplete partitioning or a partial ordering. This does not do away with the discipline of rational assessment, or even of maximization (which can cope with incompleteness through reticent articulation), but it militates against the expectation, which some entertain, that in every comparison of social states there must be a full ranking that places all the alternative states in a simple ordering [3,4].a Indeed, even when two alternative states are ultimately ranked in a clear and decisive way, that ranking may be based on the relative weighing - and even perhaps a compromise - between divergent considerations, which retain their separate and disparate relevance even after their comparative weights have been assessed.