Is it unjust that elderly people suffer from poorer health than young people? Distributive and relational egalitarianism on age-based health inequalities

Abstract

In any normal population, health is unequally distributed across different age groups. Are such age-based health inequalities unjust? A divide has recently developed within egalitarian theories of justice between relational egalitarians focusing on the egalitarian nature of social relations and luck egalitarians focusing on the distribution of goods such as welfare or resources. I argue that the most plausible versions of these two theories – ‘whole lives’ luck egalitarianism and time-relative relational egalitarianism – imply conflicting answers to the opening question. Under realistic conditions, the former implies that, from the perspective of luck egalitarian justice, it is better that old people are disadvantaged by bad health than that they are not, whereas the latter theory implies that many age-based health inequalities involve unjust, non-egalitarian social relations and are therefore unjust. Hence, I contend that different egalitarian concerns must be balanced against one another, suggesting that the relational concern has greater weight in this particular case. Along the way, I propose a social model of old age analogous to the social model of disability and suggest that a whole lives version of relational egalitarianism might also be attractive.