On Equity & the SDOH

Stuart Rennie over at the always-fascinating Global Bioethics Blog notes some problems with the recently released Final Report of the WHO Commission on Social Determinants of Health:

That there are vast differences globally in infant and maternal mortality or life-expectancy has growing empirical support. And this situation is intuitively unjust. But it is hard to articulate precisely what makes it unjust, and what 'doing justice' might mean. The title of the WHO report would indicate that justice would be served by narrowing the differences, but the nature of this goal is unclear. Raising (say) the life-expectancy of Zimbabweans and lowering that of Swedes and Danes? That seems unfair to the latter. Raising all life-expectancies to that of Japan (82 years)? That would be a more positive way of doing justice, but the idea of doing so 'in a generation' seems wildly optimistic.

Though I'm less dubious than Rennie that it is difficult to articulate a conception of justice that captures the ethical and policy import of the Report, Rennie's point that equity is undertheorized in the Report is more concerning, IMO:

I have only looked over the report briefly so far, but as far as I can see, there is no ethical discussion about the meaning of 'equity' as a goal or ideal (the word 'ethics' or 'bioethics' only appear a couple of times). The concept is used throughout, but not defined or submitted to any serious analysis.

I also am only wading through the Report now, and as important as it is, I agree that the value of equity is seriously undertheorized.  Given that Amartya Sen is one of the commissioners, I am more than a little disappointed at this.  Readers of this blog know full well how important I deem the evidence on SDOH; but positive description of the effects of socioeconomic disparities are insufficient without an extensive normative analysis of how that evidence is to be incorporated into ethical public health policy.  Failure to do so runs the risk of the naturalistic fallacy, which, as I've noted on this blog, is all too common a flaw in discourse on public health policy. 

As Rennie puts it, "if you don't know where you want to go, it is hard to know where your analyses and interventions are supposed to be taking you." 

Comments

[Davis]

This is unjustice but knowledge coming to the people and this kind of event are slowly going down. I aspect that a day comes when it will be normal for this a revolutionary events want this time.
Davis Parker
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