Chapter 35 Equity in health

Abstract

Abstract Equity in health has to be distinguished from equity in access to health care, or equity in the distribution of health care resources. We take as a working definition of health for our purposes the number of quality adjusted life years that a person may expect to enjoy over his or her lifetime. Although we mostly follow the economists' custom of regarding equity as synonymous with reducing inequalities in health, we also consider the much richer variety of concepts employed by philosophers when discussing distributive justice. Here however we have distinguished notions of justice which are essentially procedural from those which are substantive, concentrating mainly on the latter. What we have sought to do is to identify the implications of various philosophical theories of justice for the way in which a welfare economist might appraise a particular distribution of health within a community. To do this we distinguish theories which place constraints on admissible outcomes (the health opportunity set), from theories which require the social welfare function (or maximand) to have particular properties. This classification is summarised in the Table 1, which is the key exhibit around which the analysis and exposition is organised.