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Health inequities and social justice

The moral foundations of public health

Gesundheitliche Ungleichheit und soziale Gerechtigkeit. Die moralischen Grundlagen von Public Health

  • Leitthema: Public-Health-Ethik
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope


Recently we argued that social justice is concerned with human well-being, which is best understood as involving plural, irreducible dimensions, each of which represents something of independent moral significance. Health is one of these distinct dimensions of well-being, as is personal security, the development and exercise of cognitive capacities for reasoning, living under conditions of social respect, developing and sustaining deep personal attachments, and being able to lead self-determining lives. In this paper, we address why considerations of justice, and not utilitarian aims as applied narrowly to health outcomes, are most foundational to public health. In particular, we argue that the aspiration for improvement of the health of populations defines the positive aim of justice in public health, along with the negative aim of reducing or combating systematic disadvantage that affects adversely historically situated social groups and, more generally, children across the normal life span when their well-being is not assigned a special priority in the development of public health policies.


Vor kurzem haben wir ausführlich dargelegt, dass soziale Gerechtigkeit sich mit menschlichem Wohlergehen befasst. Wohlergehen umfasst einige, nicht reduzierbare Dimensionen, von denen jede etwas von unabhängiger moralischer Bedeutung darstellt. Gesundheit ist eine dieser verschiedenen Dimensionen des Wohlergehens, wie auch persönliche Sicherheit, die Entwicklung und das Training kognitiver Urteilsfähigkeiten, Leben unter den Bedingungen sozialer Beziehungen, Entwicklung und Erhalt persönlicher Bindungen und die Fähigkeit, ein selbstbestimmtes Leben zu führen. In dieser Arbeit befassen wir uns damit, warum Gerechtigkeitserwägungen und nicht utilitaristische Ziele, wie sie sehr eng gefasst auf die Ergebnisse gesundheitlicher Parameter angewandt werden können, grundlegend für Public Health und das öffentliche Gesundheitswesen sind. Insbesondere argumentieren wir, dass das Streben nach Verbesserung der Gesundheit der Bevölkerung das positive Ziel der Gerechtigkeit in Public Health definiert, komplementär zu dem negativen Ziel, eine systematische Benachteiligung zu vermindern oder zu bekämpfen, die schlecht gestellte soziale Gruppen betrifft. Dies schließt generell auch Kinder und ihre normale Lebensspanne mit ein, wenn ihrem Wohlergehen nicht besondere Priorität bei der Entwicklung politischer Strategien für das öffentliche Gesundheitswesen zugewiesen wird.

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Correspondence to R. R. Faden Ph.D., M.P.H..

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Faden, R.R., Powers, M. Health inequities and social justice. Bundesgesundheitsbl. 51, 151–157 (2008).

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