Health and Social Justice
Price:
$74.00 (06)Description
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 philosophy, 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.
Features
- Contains applications to policy issues and resource allocation decisions at both the macro and micro levels
- Clear and in-depth introduction of the analytical components of the health capability paradigm
- Challenges the current scope of public opinion research
- Argues that shared values are needed to achieve social agreement for political and legal decision-making and has pragmatic advantages in forging consensus and coalitions.
Reviews
"Ruger enhances the reach of her powerful perspective by enlightening investigations of human flourishing and of the variety of influences that make substantial differences to the freedoms that human beings can actually have, and their ability to make well-informed and well-reasoned use of these freedoms. One of the central philosophical ideas on which Ruger has much to say is that of responsibility, and this applies both to individuals and to public institutions (through what Ruger calls 'shared health governance')... 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. Her vision of health and society is at once highly idealized and suited for practical health policy-an impressive and rare union of theory and practice. 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
"Jennifer Prah Ruger has devoted almost two decades of her life to convince all kinds of audiences of the special moral importance of health. Her new book, Health and Social Justice
, brings together the intellectual strength she has gathered in study and discussion of this topic. At the intersection of ethics, policy, and law, she proposes a 'health capability paradigm', which integrates ethical thinking and procedural mechanisms to guide health system reforms and improve the allocation of resources. 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
"Ruger presents the 'health capability paradigm', an original synthesis of philosophy, political science, and economics that illuminates a way forward toward a more rational health policy-and health policy process. A book that is 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
"Health is special, and society ought to protect and promote the health of its members. For Ruger, society is not just officials with funds and influence. It's all of us taking responsibility, as individuals and politically, for the health of all. So what should we aim for? Developing a 'health capability paradigm', Ruger envisions a fair distribution of access to health, rather than health care. Must resources then be concentrated on the frailest? Ruger is committed to their reasonable accommodation, but utilizes notions of medical necessity, appropriateness, futility and cost-minimization to keep this commitment sensible and fair. The result is an 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
"The battle over health reform in the United States has made it clear that consensus about values is a prerequisite to both change and success. Jennifer Prah Ruger articulates a persuasive case in Health and Social Justice
for grounding reform in a commitment to human flourishing.... Ruger not only provides the normative basis for assuring health care for all, she also 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
About the Author(s)
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.
