Health and Social Justice

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Societies make decisions and take actions that profoundly impact the distribution of health. Why and how should collective choices be made, and policies implemented, to address health inequalities under conditions of resource scarcity? How should societies conceptualize and measure health disparities, and determine whether they've been adequately addressed? Who is responsible for various aspects of this important social problem? In Health and Social Justice, Jennifer Prah Ruger elucidates principles to guide these decisions, the evidence that should inform them, and the policies necessary to build equitable and efficient health systems world-wide. This book weaves together original insights and disparate constructs to produce a foundational new theory, the health capability paradigm. Ruger's theory takes the ongoing debates about the theoretical underpinnings of national health disparities and systems in striking new directions. It shows the limitations of existing approaches (utilitarian, libertarian, Rawlsian, communitarian); and effectively balances a consequentialist focus on health outcomes and costs with a proceduralist respect for individuals' health agency. Through what Ruger calls shared health governance, it emphasizes responsibility and choice. It allows broader assessment of injustices, including attributes and conditions affecting individuals' "human flourishing," as well as societal structures within which resource distribution occurs. Addressing complex issues at the intersection of ethics, economics, and politics in health, this fresh perspective bridges the divide between the collective and the individual, between personal freedom and social welfare, equality and efficiency, and science and economics.

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Editorial Reviews

From the Publisher
"Ruger enhances the reach of her powerful perspective by enlightening investigations of human flourishing.... By producing a book of such richness concerning a major area of human agency and policy, Jennifer Prah Ruger has substantially advanced the reach of public reasoning, not just about health care, but about social justice in general."
—From the foreword by Amartya Sen, Thomas W. Lamont University Professor and Professor of Economics and Philosophy, Harvard University

"Jennifer Prah Ruger has produced a masterpiece—a beautifully written and strikingly bold 'health capability paradigm' for the analysis of problems of health and social justice.... This gem of a book is destined to push forward current debates about health care reform and its theoretical foundations. It will more than contribute to this field of investigation; it will be a defining moment."
—Tom L. Beauchamp, Professor of Philosophy and Senior Research Scholar at the Kennedy Institute of Ethics, Georgetown University

"I have no doubt that this book will become a beacon for the debates on health system reform in the United States and around the world."
—Julio Frenk, Dean and T & G Angelopoulos Professor of Public Health and International Development, Harvard School of Public Health

"[A]n original synthesis...that illuminates a way forward toward a more rational health policy and health policy process.... [A] must read for all serious students of health policy."
—Joseph P. Newhouse, John D. MacArthur Professor of Health Policy and Management and Director of the Division of Health Policy Research and Education, Harvard University

"[A]n attractive, concrete vision of a health society, strongly grounded in philosophy, economics and public health."
—Thomas Pogge, Leitner Professor of Philosophy and International Affairs, Yale University and Professorial Fellow, Centre for Applied Philosophy and Public Ethics, Australian National University

"Ruger articulates a persuasive case...for grounding reform in a commitment to human flourishing...[and] presents us with practical tools for determining what to cover and how to allocate resources at a time when cost-containment must be a constraint on future policy. Health and Social Justice is an important book not just as a guide to current debates, but for understanding how to navigate future challenges in the rapidly evolving environment of health policy in the United States and other nations."
—Arthur Caplan, Director, Center for Bioethics and Sidney D. Caplan Chair of Bioethics, University of Pennsylvania

"A major contribution to an important, complex and continuing process that examines the theoretical and operational relationships between development, poverty reduction, health and human rights.... [T]he health and human rights communities are enriched by Ruger's philosophical justification for the right to heath, as well as the health capability paradigm...We commend Ruger's excellent book."
—Paul Hunt, Professor of Law, University of Essex and former United Nations Special Rapporteur on the right to the highest attainable standard of health, & Joo-Young Lee, School of Law, University of Essex, Symposium on Health and Social Justice in Journal of Human Development & Capabilities

"A complex, timely, ambitious reflection on moral and political legitimacy in healthcare.... [A]n original theoretical framework...a fresh, systematic, forward-looking paradigm...Ruger has built 'brick by brick' a serious, provocative comprehensive defense of a progressive, social justice perspective on health and healthcare."
—Anita L. Allen, Henry R. Silverman Professor of Law and Professor of Philosophy, University of Pennsylvania and member of the Presidential Commission for the Study of Bioethical Issues, Symposium on Health and Social Justice in Journal of Human Development & Capabilities

"I view Ruger's book as the product of monumental scholarship that undoubtedly makes a significant contribution to future academic research on social ethics in healthcare and to academic courses focused on that subject."
—Uwe E. Reinhardt, James Madison Professor of Political Economy and Professor of Economics and Public Affairs, Princeton University, Symposium on Health and Social Justice in Journal of Human Development & Capabilities

"[Jennifer Prah Ruger's] most systematic and vital contribution.... [S]eminal ... demands attention and determined action."
—Bulletin of the World Health Organization

"Health and Social Justice is clearly a scholarly work...providing a different perspective on the meaning of health and the importance of true collaboration on the micro as well as macro levels."

"In this important book...Ruger's 'health capability paradigm' builds upon Aristotle's theory of 'human flourishing' with...insight from diverse fields such as law, politics, and economics.... Those readers with an interest in law will find Professor Ruger's cogent analysis of and respectful counterargument to Professor Eugene Volokh's idea of a 'right to medical self-defense' particularly provocative.... [R]eaders would be wise to heed [her model's] wisdom."
—Harvard Law Review

"A scientific and deliberative approach to guiding health system development and reform and allocating scarce health resources."
—Journal of Economic Literature

"Jennifer Prah Ruger invites the reader to envision a world where health policy allocated resources such that all persons could realize their maximum capabilities for health.... This book...offers an ethical framework for putting this ideal into practice."
—Health and Human Rights

"Jennifer Prah Ruger provides a valuable contribution to the theoretical literature on the right to health care.... Ruger's central health capabilities...will resonate widely.... Ruger presses the strengths of her approach, but wisely recognizes its limits.... Readers will benefit from the impressive interdisciplinary nature of Ruger's analysis. The range of her work cuts easily across political philosophy, political science, economics, law, public health, and medical ethics."

"Ruger combines sophisticated philosophy, concrete policy proposals, and astute observations... With its theoretically sophisticated and realistic policy analysis, this work will be an important read for ethicists, students of health policy, and policy makers."

"Understanding justice in health on the basis of health capabilities...overcomes some theoretical divides, most importantly those between outcomes and procedures as well as freedom and welfare."
—Medicine, Health Care and Philosophy

"Jennifer Prah Ruger's book Health and Social Justice is a substantial contribution to the emerging scholarship at the intersection of health issues and the philosophy of social justice.... Ruger proposes a bold and expansive theory... [A]n innovative theory... [T]he argument for refocusing health care policy onto health capabilities is compelling and substantively argued.... Such a contribution is just what the emerging field of health and social justice scholarship needs."
—Public Health Ethics

"Ruger demonstrates that she has...thought long and hard about multiple aspects of the ethical, legal, and political environments that impinge on public health and health care policy...and despite the interdisciplinary breadth of her research, I cannot think of a page of it that is extraneous.... Her HCP is constructed precisely in order to demonstrate what it would mean for policy and in practice to take capabilities earnestly in health policy debates....the clarity and forcefulness of her argument suggest that hers is a voice worth hearing on a related set of health policy topics not directly tackled in this impressive and wide-ranging volume."
—Journal of Health Politics, Policy and Law

"Editor's Choice"
—Journal of Ethics

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Product Details

  • ISBN-13: 9780199559978
  • Publisher: Oxford University Press
  • Publication date: 2/28/2010
  • Pages: 224
  • Product dimensions: 6.50 (w) x 9.30 (h) x 1.10 (d)

Meet the Author

Jennifer Prah Ruger is Associate Professor at Yale University Schools of Medicine, Public Health, Law, and Graduate School of Arts and Sciences. Previous appointments include Assistant Professor at Washington University in St. Louis, Speechwriter to the World Bank President, James D. Wolfensohn, Health Economist in the World Bank Health, Nutrition and Population Sector and Satellite Secretariat for the World Health Organization Transition Team, Health and Development Satellite. Professor Ruger has authored numerous theoretical and empirical studies on the equity and efficiency of health system access, financing, resource allocation, policy reform, and social determinants of health. These contributions are unified by an overarching interest in equity and disparities in health and health care, focusing on vulnerable and impoverished populations nationally and globally.

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Table of Contents

The Current Set of Ethical Frameworks
1. Approaches to Medical and Public Ethics
An Alternative Account- The Health Capability Paradigm
2. Health and Human Flourishing
3. Pluralism, Incompletely Theorized Agreements, and Public Policy
4. Justice, Capability, and Health Policy
5. Grounding the Right to Health
Domestic Health Policy Applications
6. A Health Capability Account of Equal Access
7. A Health Capability Account of Equitable and Efficient Health Financing and Insurance
8. Allocating Resources: A Joint Scientific and Deliberative Approach
Domestic Health Reform
9. Political and Moral Legitimacy: A Normative Theory of Health Policy Decision-making

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