Asada Yukiko
Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada.
Health Care Anal. 2006 Mar;14(1):25-36. doi: 10.1007/s10728-006-0008-6.
The history of the documentation of health inequality is long. The way in which health inequality has customarily been documented is by comparing differences in the average health across groups, for example, by sex or gender, income, education, occupation, or geographic region. In the controversial World Health Report 2000, researchers at the World Health Organization criticized this traditional practice and proposed to measure health inequality across individuals irrespective of individuals' group affiliation. They defended its proposal on the moral grounds without clear explanation. In this paper I ask: is health inequality across individuals of moral concern, and, if so, why? Clarification of these questions is crucial for meaningful interpretation of health inequality measured across individuals. Only if there was something morally problematic in health inequality across individuals, its reduction would be good news. Specifically, in this paper I provide three arguments for the moral significance of health inequality across individuals: (a) health is special, (b) health equity plays an important and unique role in the general pursuit of justice, and (c) health inequality is an indicator of general injustice in society. I then discuss three key questions to examine the validity of these arguments: (i) how special is health?, (ii) how good is health as an indicator?, and (iii) what do we mean by injustice? I conclude that health inequality across individuals is of moral interest with the arguments (b) and (c).
健康不平等的记录历史悠久。传统上记录健康不平等的方式是比较不同群体（例如按性别、收入、教育程度、职业或地理区域划分）的平均健康差异。在颇具争议的《2000年世界卫生报告》中，世界卫生组织的研究人员批评了这种传统做法，并提议衡量个体之间的健康不平等，而不考虑个体的群体归属。他们在没有明确解释的情况下从道德层面为其提议进行了辩护。在本文中，我提出以下问题：个体之间的健康不平等是否关乎道德，如果是，原因何在？澄清这些问题对于有意义地解读个体层面衡量的健康不平等至关重要。只有当个体之间的健康不平等存在道德问题时，减少这种不平等才是好消息。具体而言，在本文中，我为个体之间健康不平等的道德重要性提供了三个论据：（a）健康具有特殊性，（b）健康公平在总体的正义追求中发挥着重要且独特的作用，（c）健康不平等是社会普遍不公正的一个指标。然后我讨论了三个关键问题，以检验这些论据的有效性：（i）健康有多特殊？（ii）健康作为一个指标有多好？（iii）我们所说的不公正是什么意思？我的结论是，基于论据（b）和（c），个体之间的健康不平等具有道德意义。
