Deaton - What Does the Empirical Evidence Tell us About the Injustice of Health Inequalities?

What does the empirical evidence tell us about the injustice of health inequalities?

Angus Deaton
Center for Health and Wellbeing
Princeton University
January 2011

ABSTRACT
Whether or not health inequalities are unjust, as well as how to address them, depends on how they are caused. I review a range of health inequalities, between men and women, between aristocrats and commoners, between blacks and whites, and between rich and poor within and between countries. I tentatively identify pathways of causality in each case, and make judgments about whether or not each inequality is unjust. Health inequalities that come from medical innovation are among the most benign. I emphasize the importance of early life inequalities, and of trying to moderate the link between parental and child circumstances. I argue that racial inequalities in health in the US are unjust and add to injustices in other domains. The vast inequalities in health between rich and poor countries are arguably neither just nor unjust, nor are they easily addressable. I argue that there are grounds to be concerned about the rapid expansion in inequality at the very top of the income distribution in the US; this is not only an injustice in itself, but it poses a risk of spawning other injustices, in education, in health, and in governance.