Adina Preda

A growing body of empirical research examines the effects of the so-called “social determinants of health” on health and health inequalities. Several high-profile publications have issued policy recommendations to reduce health inequalities based on a specific interpretation of this empirical research as well as a set of normative assumptions. This article questions the framework defined by these assumptions by focusing on two issues: first, the normative judgments about the fairness of particular health inequalities; and second, the policy recommendations issued on this basis. We argue that the normative underpinnings of the approach are insufficiently supported and that the policy recommendations do not necessarily follow from the arguments provided. Furthermore, while many of the policies recommended—such as improving people's living conditions and reducing inequalities in wealth and power—are justified in their own right, the way these recommendations are tied to health is problematic

We thank the open peer commentators for their thoughtful responses to our article, "The Social Determinants of Health: Why Should We Care?" (Preda and Voigt 2015). Since space constraints prevent us from responding in detail to all the comments raised, we focus on two areas of concern that emerged from the commentaries. The first is our claim that avoidability is neither necessary nor sufficient for defining unjust or unfair health inequalities. The second area relates to the reasons we might give for treating health inequalities as morally problematic.

A recurring concern about luck egalitarianism is that its implementation would make some individuals, in particular those who lack marketable talents, experience shame. This, the objection goes, undermines individuals’ self-respect, which, in turn, may also lead to unequal respect between individuals. Loss of (self-)respect is a concern for any egalitarian, including distributive egalitarians, inasmuch as it is non-compensable. This paper responds to this concern by clarifying the relationship between shame and (self-)respect. We argue, first, a luck egalitarian society and ethos would be radically different from the current one and incompatible with shame over lack of talent, and, second, that while shame may still occur in a less than ideal luck egalitarian society, this kind of shame does not undermine egalitarian commitments.

Some theorists, especially egalitarians, seek to ‘apply’ theories of justice to a specific area or good, such as health, and assess the distribution of that good at the bar of justice. On the one hand, this is understandable, given that egalitarians are often interested in making policy recommendations and these would have to be area-specific. On the other hand, it is surprising in light of the fact that theories of justice normally envisage the ‘total package of goods’ or an overall good as the distribuendum. This article aims to show that this approach is problematic at least in the area of health.

This paper argues that a putative conflict between negative rights and positive rights is not a genuine conflict. The thought that they might conflict presupposes, I argue, that the two rights are valid. This is the first assumption of my argument. The second is that general rights impose duties on everyone, not just the party who faces a conflict of correlative duties. These two assumptions yield the conclusion that positive rights impose enforceable duties on the holder of the negative right; no right is thus infringed if this duty is enforced so no conflict occurs. If this is correct, it means that we can include welfare or socio-economic rights in a set of general rights without generating conflicts with negative rights to non-interference; this might clear some space for arguments that favour egalitarian redistribution although it does not show that general positive rights do exist

On some theories of rights, such as the Choice theory, only agents can have moral rights. The realm of right-holders thus excludes several potential candidates, among which are young children, mentally incapacitated persons, and groups since these are thought to lack the required degree of agency. This paper argues that groups can be right-holders. The argument comes in three steps: first, it is argued that full-blown or autonomous agency is not required for the possession of Choice theory rights, second, that groups can be seen as agents, albeit in a limited sense, and third, that groups can make irreducibly collective choices in spite of their limited agency. The upshot of this argument is that groups can have rights, provided that they are organized around a coherent decision-making procedure; furthermore, this account can be employed to argue that other creatures of limited agency are possible right-holders.

This paper asks whether (human) rights enforcement is permissible given that it may entail infringing on the rights of innocent bystanders. I consider two strategies that adopt a rights-sensitive consequentialist framework and offer a positive answer to this question, namely Amartya Sen’s and Hillel Steiner’s. Against Sen, I argue that trade-offs between rights are problematic since they contradict the purpose of rights, which is to provide a pluralist solution to disagreement about values, i.e. to allow agents to act in accordance with their values. I further argue that Steiner’s compensation strategy does not succeed in avoiding trade-offs so it falls prey to the same criticism. I propose a non-trade-off solution that is implicit in the accounts discussed and is more consistent with the meta-ethical framework advocated by Sen. This solution relies on an enforceable duty to share in the costs of rights enforcement hence it entails a degree of redistribution for enforcement purposes