Marchand S, Wikler D, Landesman B
Program in Medical Ethics, Medical Sciences Center, University of Wisconsin Medical School, Madison 53706, USA.
Milbank Q. 1998;76(3):449-67, 305-6. doi: 10.1111/1468-0009.00098.
Class inequalities in health are intuitively unjust. Although the link between social class and health status has been fully documented, the precise nature of the injustice has not been made clear. Four alternative views are presented, corresponding to four goals: (1) maximizing the sum total of health; (2) equalizing the health status of higher and lower social classes; (3) maximizing the health status of the lowest social class; and (4) maximizing the health status of the sickest individuals in society. The nature of the injustice is further obscured by several theoretical and empirical questions, like the degree and significance of personal responsibility for illness and the relation of the degree of economic inequality to sum total of health.
健康方面的阶级不平等在直观上是不公平的。尽管社会阶层与健康状况之间的联系已有充分记录，但这种不公平的确切性质尚未明确。本文提出了四种不同观点，分别对应四个目标：（1）使健康总量最大化；（2）使社会阶层较高和较低群体的健康状况均等化；（3）使最低社会阶层的健康状况最大化；（4）使社会中病情最严重个体的健康状况最大化。一些理论和实证问题进一步模糊了不公平的性质，比如个人对疾病的责任程度和重要性，以及经济不平等程度与健康总量之间的关系。
