Daniel Hausman

Many ethical theories, including in particular consequentialist moral the ories, require comparisons of the amount of good possessed or received by different people. In the case of some goods, such as monetary income, wealth, education, or health, such comparisons are relatively unproblematic. Even in the case of such goods there may be serious empirical measurement problems, but there appear to be no difficulties in principle. Thus Cooter and Rappoport maintained that there was no serious difficulty of making interpersonal utility comparisons for an earlier generation of economists who regarded utility as an index of “material welfare.”

This essay develops an account of health, the functional efficiency theory, which derives from Christopher Boorse's biostatistical theory. Like the BST, the functional efficiency theory is a nonevaluative view of health, but unlike the BST, it argues that the fundamental theoretical task is to distinguish levels of efficiency with which the parts and processes within organisms and within systems within organisms function. Which of these to label as healthy or pathological is of secondary importance. Because the statistical distributions that Boorse's account relies on are distributions of functional efficiency, the functional efficiency theory arguably complements rather than challenges the BST.

The health gradient among those who are by historical standards both remarkably healthy and well-off is of considerable moral importance with respect to benevolence, justice and the theory of welfare. Indeed it may help us to realize that for most people the good life lies in close and intricate social ties with others which can flourish only when inequalities are limited. The health gradient suggests that there is a story to be told in which egalitarian justice, solidarity, health and well-being go hand-in-hand

People condemn inequalities for many reasons. For example, many who have no concern with distribution per se criticize inequalities in health care, because these inequalities lessen the benefits provided by the resources that are devoted to health care. Others who place no intrinsic value on distribution believe that a just society must show a special concern for those who are worst off. Some people, on the other hand, do place an intrinsic value on equality of distribution, regardless of its contribution to other goals. Derek Parfit and Larry Temkin call these people "egalitarians." I shall always employ quotation marks when referring to "egalitarians" in this special sense, because, as I shall argue, this terminology is misleading. One of its unhappy implications is that almost all egalitarians are not "egalitarians."