With  Social Justice: The Moral Foundations of Public Health and Health Policy  the multidisciplinary writers' team of Madison Powers and Ruth Faden have delivered an interesting and compelling answer to the questions of how much inequality in health a just society can tolerate and which inequalities matter most.  They arrive at the answers to these questions through the development of their own theory of social justice. As in John Rawls' theory of justice, the authors are primarily concerned with the basic structure of society. However, unlike his, Powers & Faden's is not an ideal theory. Rather, their interest is in what justice requires of social institutions and practices in the here and now, and in the way multiple social determinants systematically compromise the wellbeing of socially situated groups.

 

In Chapter Two, the authors explain that the job of justice is to satisfy six intersecting but distinct dimensions of wellbeing: health, personal security, reasoning, respect, attachment, and self-determination. This entails a rejection of any "separate spheres" account of health (like the one Michael Walzer gives, for example). It also means that in promoting health, other dimensions should be taken into account, while health, in turn, cannot be left out of any consideration of social justice, including those made by non-health segments of government. Powers & Faden admit that this functional account of wellbeing draws heavily upon Sen (and Nussbaum)'s capabilities approach to justice. They argue for their theory in discussion with authors like Rawls, Dworkin, Sen and some other of the most important theories in the field and although their arguments are thoughtful, some might ask whether yet another new account of justice with yet another list of elements of wellbeing can add anything substantive to the debate. The authors claim that their theory does add something new, as the important differences between the capabilities approach and theirs is that this dimensions of wellbeing approach focuses on the actual satisfaction of each dimension to a certain basic level. An important reason for this requirement, is that in the early stages of life, actual fulfillment, rather than the capability of it, is to be ensured -- otherwise health as well as other dimensions of wellbeing could be compromised throughout the lifecourse. Children play an important role in Powers & Faden's account of justice for another reason: in their view, society is morally responsible for the health and wellbeing of its children, as they are not self-determining and cannot ensure the satisfaction of all dimensions of their wellbeing themselves. In any case, the requirement of sufficiency determines which levels of inequalities cannot be tolerated in a just society: certainly not those that allow parts of the population to fall below the sufficiency level in any dimension. In addition, these dimensions can function as a justificatory basis for basic human rights, the authors explain.