The Many Faces of Health Justice

Key Question Being Explored in This Insight:

How does a pluralistic concept of health justice, incorporating distinctions like active vs. passive injustice and principles like equality, priority, sufficiency, and efficiency, address multifaceted health inequities?

View the page of: Sudhir Anand

Institution: University of Oxford

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Economic Inequalities Economics Social Sciences

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Image courtesy of interviewee. February 27, 2025

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1. Definition of Justice: The video explores the concept of justice, specifically focusing on the definition found in an early Roman law video by Justinian, which defines justice as the constant and perpetual will to render to each person his or her due.

2. Plague of Justinian: The video links the historical convideo of the Plague of Justinian, which occurred around 541 AD, to the concept of justice, discussing how the response to the plague and its impact on society raised questions of fairness and justice.

3. Health Justice: The video delves into the idea of health justice, discussing how different theories and approaches to justice intersect with the realm of healthcare, emphasizing the importance of ensuring fair and equitable access to healthcare and addressing health injustices.

4. Types of Justice: The video outlines key distinctions between different types of justice, such as corrective justice, comparative justice, and substantive justice, highlighting the nuances in assessing fairness and addressing wrongs or harms in society, including in the healthcare sector.

5. Health Inequality, Inequity, and Injustice: The video discusses the relationships between health inequality, inequity, and injustice, emphasizing that not all health inequalities are injustices or inequities, and providing a nuanced perspective on the various aspects of health justice that need to be considered for a comprehensive understanding and approach to addressing health disparities.

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Here are some key quotes from the video:

1. "Justice is the constant and perpetual will to render to each person his due." (Defining justice as summum jus summa iniquitas)
2. "Human experiences are observations and responses by individuals and groups of individuals in that, a group of people, individuals, or whole communities or indeed, regions are not getting their due."
3. "Misfortune versus an injustice."
4. "Health justice is justice in the health sphere."
5. "Equality in some form is universally seen as a central component of justice."
6. "Sufficiency permits inequalities but aims for a minimum threshold for everyone."
7. "Corrective justice is concerned with compensating individuals for health harms or wrongs that have been inflicted on them."
8. "Not all health inequalities are health inequities or health injustices."
9. "All health inequities are indeed health injustices."
10. "Health justice is a broad and inclusive concept with many faces or facets."

Feel free to let me know if you need more information or assistance with anything else.

X-TIMESTAMP-MAP=LOCAL:00:00:00.000,MPEGTS:90000

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When I started, working on this paper, it was the,

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f*g end of the, global pandemic.

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And I, wanted to do research on,

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the idea of justice, a definition of justice.

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And, I looked for it

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and found it in an early

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Roman law text, which was, the work

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of Justinian and his, legal advisors.

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It's called The Institutes of Justinian.

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But it just so happened that,

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the first recorded plague called the Plague of Justinian.

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And,

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because Justinian himself contracted that plague,

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was around the same time,

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1500 years ago in 5 41 80,

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around then, and his, institutes of Justinian,

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which is a,

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a Roman law text codifies the definition

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of justice as soon quicker

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tributary, which is the key

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concept of justice, which is used in

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all the various theories of justice in philosophy,

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and by philosophers to,

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recognize the, their approach to justice,

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if you like, and sum quicker.

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Tributary literally means justice

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is the constant

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and perpetual will to render

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to each person is due, is sort of heard you.

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Okay? So the operative word is due

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and it's due, which actually, if you like, I mean,

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I haven't put it this way in the paper,

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but if you like, the way

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that de is interpreted in different approaches to justice

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is, what creates

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or constitutes these many phases of justice.

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Okay? Now going back, I, I do want to go back

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to Justinian, who is well recognized for his,

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brilliant contributions to the codification of Roman law

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through, not just the institutes of Justinian,

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but the, improvements

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and, codification of

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existing law, texts, if you like.

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So this was the first attempt at codifying that,

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and that was all brilliant.

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However, just Justinian,

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in dealing with the plague,

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the first plague, Justinian's plague,

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he survived the plague,

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but many, many of his, subjects

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from whom he raised taxes perished, they didn't survive.

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But what Justinian did is he increased the levy

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of taxes on those who survived in order

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to have the same total, tax revenue, if you like,

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from which instead of helping

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and supporting those that were sick

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and were perishing, he used these revenues

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for great public works,

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and he built the Hagia Sophia in,

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Constantinople, which is, a great,

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which was a great cathedral of the, Byzantine Empire,

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but which, has now,

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been converted into a mosque.

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But after, the first Turkish,

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the, the, Kamal at tur, the founder

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of Modern Turkey had converted it into a museum,

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but now Elgan has converted it into a mosque

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where people pray

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and practice, Islam, which is

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a pity, but that's what it is.

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Okay? But then Justinian, what the point I was making is

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that Justinian himself, was criticized

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by his court historian called Pro Copious

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when he wrote the history of the War's Book two.

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And also when, he wrote his Secret history,

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a book called Secret History,

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about the way Justinian responded to

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the plague and how it affected his people.

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Well, that is also a pandemic, okay? It's a global pandemic.

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And, there is a question of, was there,

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an injustice?

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I mean, in a sense, in the paper also, I discussed the idea

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of a misfortune versus an injustice.

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Um, in a sense, since it was

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not likely called the virus was not likely caused

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by humans,

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although some people suggest it might have been caused in a

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laboratory in Wuhan in China,

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but, it was, you know, it was a virus which,

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jumped from, an animal to the humans.

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Um, so it was a misfortune,

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but the way that it's been dealt with is what is

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if, which creates the sense of injustice.

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And of course, lots

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and lots of people have commented during the pandemic of,

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governments not dealing adequately with,

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protecting people, with providing PPE,

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with, getting people vaccinated with,

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sending in developing countries, sending people back

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to their villages,

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or,

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where there wasn't adequate, means to,

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deal with, covid

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if it was contracted by members of, the village.

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Um, and oxygen,

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if you remember, there was, the

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outside a Delhi Hospital, there were

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cremations going on because people were dying

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before they could be admitted to the hospital while waiting

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to be admitted to the hospital and so on.

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Okay? So that's in, in a sense, that was,

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this was a global pa, by the way, in the plague of Justinian

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lasted a long time and it spread through the Mediterranean.

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And something like, historians estimate, somewhere

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between 30 and 50 million people died.

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Okay? Um, but that was over 200 years.

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In the case of, COVID-19,

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there have been millions of deaths.

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I mean, you know, the variable estimates,

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but at least 5 million plus over the world.

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So it was a global pandemic, which,

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killed a lot of people.

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Human experiences are, observations,

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and responses by

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individuals and groups of individuals in,

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recognizing

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that, a group of people,

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individuals, or whole communities

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or indeed, regions

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are not getting their due.

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They're not getting their due.

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So there are calls for, rectifying the situation

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and, that's what sometimes

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can bring about change, bring about, remediation

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of the situation,

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or at least some remediation of the situation.

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I mean, we've seen that in the case of,

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recently in a different context,

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the post office horizon scandal.

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We've seen that in the infected blood scandal, where,

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there was a health injustice as opposed to the,

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post office, scandal, which, concerned the,

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subpostmasters being convicted of,

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crimes they did not commit.

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But in the case of the infected blood scandal,

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there was health harms

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because people were,

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had transfusions of blood that hadn't been screened for

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hepatitis C and HIV

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and the recipients of these,

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blood transfusions got HIV

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and or hepatitis C, which led to

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health harms and losses and deaths.

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Many, many people died too.

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Then there was secondary health harms by, you know,

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the spread of HIV through,

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sexual contacts and so on.

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So, that is exactly a,

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an aspect of justice, which is

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that people should get their due.

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That, you know, one sentence definition could be,

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that health justice is justice in the health sphere,

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but that doesn't get us very far, okay?

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Because we need to understand what aspect of,

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justice is involved in,

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this facet of health justice.

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And that depends on how the idea of what is due

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in different contexts is,

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interpreted or is approached

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and in different context.

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What is due is, sometimes

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perhaps, recognized

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through, what we were speaking about earlier,

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namely, people

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Have identified, a health injustice through anger

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or calls for remediation or rectification of the situation.

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So, then the task becomes how do you,

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conceptualize this

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and characterize the different types of health justice?

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And that is something that I've tried to do in this paper.

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Roles is not really a theory of health justice.

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It is a theory of justice

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and the preeminent, philosophical theory of justice

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in the last, certainly in the last century,

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sin, I'll get to the contrast between what sins took.

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The idea of justice, which came out in 2009 compared

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to roles is, a theory of justice classic

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roles came out in 1970.

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Now, the, the pro,

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the difference is there are important differences

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between these two approaches in how they could

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deal with health justice roles.

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Doesn't explicitly deal with health justice,

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but, there are five differences.

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And, the rolls in project is

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the characterization of a perfectly just society

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where a sense approach is on the lives

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that people actually lead.

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In other words, what he calls realizations, which enables

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binary comparisons between

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less than perfect justice.

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So it enables a comparison of a situation, which

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in his words can, can,

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state that one

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situation is more just than another,

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even though it is not perfectly just

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So it enables comparisons of justice

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between less than ideal situations

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to less than ideal situations.

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Roles cannot do that, okay?

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Secondly, as I said, roles is theory is about institutions

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that are needed for a perfectly just society,

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what he calls the basic structure of society

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and sends approach, what I just said on the lives

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that people actually lead realizations as he calls them,

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including the processes that bring about the outcomes.

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Okay? Roles is,

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focuses on primary goods, which are goods like income,

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wealth, and so on,

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that people enjoy versus sense reliance on capabilities,

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what people can do

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and be, how, whether they can function.

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These, he calls them functionings doings

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and beings of people.

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So, then there is a difference between the nature

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of impartiality involved in the assessment of justice.

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In the case of roles, it's closed in the case

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of his original position, the veil of ignorance.

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I'll go into that now,

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but it's open in senses case in the case

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of his smithian, Adam Smithian, impartial observer,

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in, we who

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has a, in courts of view from everywhere,

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so it's not closed.

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Finally, roles is, consideration

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of justice is confined to the sovereign

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or nation state in a fair system of cooperation

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in determining the basic structure of that society.

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Whereas sins approaches universalist in

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that it permits a assessment of global justice through,

242
00:16:16.345 --> 00:16:18.845
for example, the impartial,

243
00:16:18.845 --> 00:16:22.325
through the impartial spectator or observer.

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So those are the differences, and of course I could go into,

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00:16:27.985 --> 00:16:32.605
but we may not have time to, distinguish between them,

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00:16:32.605 --> 00:16:36.885
between the idea of using primary goods as the currency

247
00:16:37.345 --> 00:16:42.085
of justice versus capabilities as the currency of justice.

248
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Currency, meaning that which,

249
00:16:47.545 --> 00:16:51.205
the variable through which, advantage

250
00:16:51.585 --> 00:16:54.005
or deprivation is assessed.

251
00:16:54.545 --> 00:16:56.365
And the currency of justice in

252
00:16:56.965 --> 00:16:59.765
economic justice could be money, income, or wealth.

253
00:17:00.105 --> 00:17:03.165
The currency of justice in health could be health status.

254
00:17:03.985 --> 00:17:08.525
The currency of justice may be capabilities, functionings

255
00:17:08.545 --> 00:17:10.565
of people can they do and be,

256
00:17:10.705 --> 00:17:14.165
and this is quite important incidentally, in one context,

257
00:17:14.375 --> 00:17:15.405
which I can mention.

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00:17:16.065 --> 00:17:18.805
Um, the idea, you know,

259
00:17:19.695 --> 00:17:22.885
about seven plus mil billion people in the world,

260
00:17:23.015 --> 00:17:27.005
7.4 billion people, at least 50, not at least

261
00:17:28.215 --> 00:17:31.825
approximately 50, 15% are

262
00:17:33.155 --> 00:17:37.105
disabled physically

263
00:17:37.245 --> 00:17:39.695
or through ill health, and

264
00:17:39.695 --> 00:17:43.455
that's about 800 plus million people in developing

265
00:17:43.895 --> 00:17:48.815
countries, 400 plus million people in, in,

266
00:17:49.145 --> 00:17:50.565
developed countries.

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Let's consider the difference in assessing, people's,

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00:17:56.385 --> 00:17:59.405
situation, either in terms

269
00:17:59.465 --> 00:18:02.565
of the primary goods they hold in commonwealth

270
00:18:02.785 --> 00:18:04.285
or in terms of capabilities.

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The disabled have two handicaps.

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One, by virtue of their disability, they have an earning

273
00:18:16.105 --> 00:18:19.755
handicap, but their need for income is greater than that

274
00:18:19.775 --> 00:18:24.405
of a able-bodied person, in order

275
00:18:24.405 --> 00:18:28.615
to try to live normal lives

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00:18:28.835 --> 00:18:30.575
and alleviate their handicap.

277
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For example, a disabled person might require a wheelchair,

278
00:18:34.305 --> 00:18:38.255
might require assistance with, you know,

279
00:18:39.515 --> 00:18:44.465
in living in, dressing

280
00:18:45.005 --> 00:18:46.505
in, et cetera.

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00:18:46.505 --> 00:18:50.265
Yeah. And, being able to lead

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00:18:50.285 --> 00:18:51.825
as normal a life as possible.

283
00:18:52.285 --> 00:18:57.035
So there is a, both an earning handicap by virtue

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00:18:57.175 --> 00:18:58.195
of their disability

285
00:18:58.815 --> 00:19:02.595
and a conversion handicap of converting income

286
00:19:02.775 --> 00:19:05.955
or primary goods or into good living

287
00:19:06.535 --> 00:19:08.615
and functioning.

288
00:19:09.035 --> 00:19:10.575
That's a conversion handicap.

289
00:19:11.155 --> 00:19:13.655
So, which greatly reinforces

290
00:19:13.835 --> 00:19:17.375
and magnifies the earning handicap.

291
00:19:18.015 --> 00:19:22.435
So that deprivation resulting from

292
00:19:22.605 --> 00:19:27.545
disability, which is a health status, matter,

293
00:19:28.205 --> 00:19:32.465
is captured directly through the capability perspective

294
00:19:33.205 --> 00:19:35.545
in contrast to assessing

295
00:19:36.245 --> 00:19:40.025
the disadvantage based on income of primary goods,

296
00:19:40.435 --> 00:19:44.905
which ignores the plight of, doesn't take account of,

297
00:19:45.445 --> 00:19:49.185
the plight of disabled people as such, just

298
00:19:50.355 --> 00:19:52.365
what is their holdings of income

299
00:19:52.365 --> 00:19:54.605
or primary goods is how it's assessed.

300
00:19:55.585 --> 00:20:00.445
I'd like to start, by the way, by, you know,

301
00:20:00.815 --> 00:20:04.885
faces of injustice can be to do with the

302
00:20:06.215 --> 00:20:08.925
inequality, inequity

303
00:20:09.905 --> 00:20:11.365
and many other features.

304
00:20:11.825 --> 00:20:16.365
So I'd like to start with an illustration of a

305
00:20:17.005 --> 00:20:19.325
possible health injustice, okay?

306
00:20:20.795 --> 00:20:22.595
A possible health injustice.

307
00:20:24.505 --> 00:20:28.165
So let me look at the inequality in

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00:20:28.755 --> 00:20:29.885
life expectancy

309
00:20:30.185 --> 00:20:34.325
or longevity between males and females.

310
00:20:36.605 --> 00:20:38.945
It is the case that in all developed

311
00:20:39.005 --> 00:20:42.505
and developing countries, and I provided a chart for that.

312
00:20:42.685 --> 00:20:47.205
By the way, women live longer than men

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00:20:48.055 --> 00:20:50.265
sometimes by as much as 10 years.

314
00:20:52.905 --> 00:20:57.005
We know that the death rates for females are lure than those

315
00:20:57.185 --> 00:20:59.405
for males at all ages,

316
00:21:01.265 --> 00:21:02.525
indeed, even before birth.

317
00:21:05.805 --> 00:21:09.545
In this sense, although about 115

318
00:21:10.635 --> 00:21:13.105
males are conceived for

319
00:21:15.805 --> 00:21:20.035
every hundred females, their number, their numbers

320
00:21:21.075 --> 00:21:26.015
are whittled down thereafter, just 105

321
00:21:26.645 --> 00:21:31.015
boys are born for every 100 girls born

322
00:21:31.565 --> 00:21:35.255
because of the disproportionate rate of

323
00:21:35.775 --> 00:21:38.725
spontaneous abortions, stillbirths

324
00:21:39.875 --> 00:21:42.815
and miscarriages of male fetuses,

325
00:21:44.145 --> 00:21:47.635
more boys than girls also die in infancy and childhood.

326
00:21:48.955 --> 00:21:52.155
Okay? It's well known that women

327
00:21:52.785 --> 00:21:54.115
have a biological

328
00:21:54.815 --> 00:21:59.795
and genetic advantage compared to men in longevity.

329
00:22:01.015 --> 00:22:04.995
The reasons are to do with differences, both in biology

330
00:22:05.615 --> 00:22:09.985
and in genes, sex hormones and chromosomes.

331
00:22:11.345 --> 00:22:16.145
For example, testosterone increases

332
00:22:16.165 --> 00:22:19.085
levels of LDL

333
00:22:19.235 --> 00:22:21.565
that is low density lipoprotein,

334
00:22:22.575 --> 00:22:24.165
which is the bad cholesterol,

335
00:22:25.275 --> 00:22:28.455
and testosterone decreases HDL

336
00:22:28.455 --> 00:22:32.575
or high density lipoprotein, which is the good cholesterol.

337
00:22:34.765 --> 00:22:38.505
On the other hand, estrogen has beneficial effects

338
00:22:39.165 --> 00:22:43.745
on cardiovascular health by lowering LDL

339
00:22:45.965 --> 00:22:47.865
and increasing HDL.

340
00:22:50.385 --> 00:22:54.115
There are also other detrimental effects that,

341
00:22:54.825 --> 00:22:58.755
wellknown of testosterone, for example,

342
00:23:00.355 --> 00:23:02.925
association with risky behaviors.

343
00:23:05.485 --> 00:23:07.945
And there are beneficial effects of estrogen,

344
00:23:10.135 --> 00:23:12.955
for example, as an antioxidant,

345
00:23:15.155 --> 00:23:19.535
and there are chromosomal differences, xx for women

346
00:23:19.795 --> 00:23:21.375
and XY for men.

347
00:23:22.135 --> 00:23:25.205
These may also affect relative mortality rates

348
00:23:25.475 --> 00:23:30.085
because an abnormal gene on one X chromosome

349
00:23:30.425 --> 00:23:33.245
for women can use the normal gene

350
00:23:34.025 --> 00:23:35.725
on the other X chromosome,

351
00:23:36.935 --> 00:23:41.675
but men cannot rely on an alternative chromosome if a

352
00:23:41.705 --> 00:23:44.715
gene on one of the chromosomes is defective.

353
00:23:46.545 --> 00:23:50.045
And of course, currently modern medicine

354
00:23:50.675 --> 00:23:54.085
does not have the technology

355
00:23:54.905 --> 00:23:58.285
to compensate for men's biological

356
00:23:58.665 --> 00:24:00.005
and genetic disadvantage.

357
00:24:01.805 --> 00:24:04.565
So given the biological

358
00:24:04.825 --> 00:24:07.565
and genetic differences between women

359
00:24:07.745 --> 00:24:11.395
and men, if we attempted

360
00:24:11.395 --> 00:24:15.275
to equalize life expectancy between the sexes,

361
00:24:15.985 --> 00:24:17.635
that will not be achievable

362
00:24:18.335 --> 00:24:22.625
unless we discriminate against women,

363
00:24:23.085 --> 00:24:25.265
for example, in healthcare

364
00:24:26.645 --> 00:24:29.305
or in nutrition at an earlier stage of life,

365
00:24:29.365 --> 00:24:31.625
or even at a later stage of life and so on.

366
00:24:33.365 --> 00:24:38.165
But such discrimination violates what is known

367
00:24:38.185 --> 00:24:42.725
as process fairness, which is seen as a fundamental

368
00:24:43.435 --> 00:24:47.485
requirement of justice, including health justice.

369
00:24:48.805 --> 00:24:50.305
Are men

370
00:24:50.305 --> 00:24:53.225
and women treated equally in terms of healthcare

371
00:24:53.405 --> 00:24:57.625
for the same disease that they, for the same

372
00:24:58.495 --> 00:25:01.265
illness that they, have?

373
00:25:02.675 --> 00:25:03.975
You could treat them unequally,

374
00:25:04.115 --> 00:25:06.695
but that would go against process fairness.

375
00:25:07.325 --> 00:25:09.655
Okay? So,

376
00:25:10.765 --> 00:25:14.775
process fairness in this case would override the health

377
00:25:15.175 --> 00:25:19.185
egalitarian demand for equality in longevity

378
00:25:19.375 --> 00:25:20.985
between women and men.

379
00:25:22.575 --> 00:25:26.175
But then incidentally, if you happen to observe,

380
00:25:26.755 --> 00:25:31.575
and indeed it has been observed, equality of female

381
00:25:31.795 --> 00:25:35.015
and male life expectancy in a country,

382
00:25:36.525 --> 00:25:41.425
as has happened in some countries in not

383
00:25:41.455 --> 00:25:43.745
that distant the past in the sixties,

384
00:25:43.895 --> 00:25:45.625
even the 1970s equality,

385
00:25:45.845 --> 00:25:48.545
or even worse,

386
00:25:48.885 --> 00:25:51.505
men outliving women in some countries

387
00:25:52.095 --> 00:25:54.305
that has been observed in some Middle Eastern

388
00:25:54.485 --> 00:25:57.255
and other countries,

389
00:25:57.965 --> 00:26:01.175
that would be strong evidence of a health injustice

390
00:26:01.765 --> 00:26:05.465
because, we expect women

391
00:26:06.005 --> 00:26:08.945
to live longer than men given equal treatment.

392
00:26:09.965 --> 00:26:14.625
Yeah. So there are many different aspects

393
00:26:14.645 --> 00:26:19.205
of health justice, which are based on some important

394
00:26:19.635 --> 00:26:22.005
definitions and distinctions.

395
00:26:22.945 --> 00:26:24.725
So the standard definition of justice,

396
00:26:24.895 --> 00:26:27.725
which I mentioned earlier in a different context,

397
00:26:28.745 --> 00:26:32.685
is assume quicker tributary IE to render

398
00:26:32.865 --> 00:26:34.925
to each person his or her due.

399
00:26:35.675 --> 00:26:38.975
And although that's quite abstract in this form, what is

400
00:26:39.715 --> 00:26:44.485
due is specified differently in different

401
00:26:45.765 --> 00:26:49.995
faces of health justice and in different practical contexts.

402
00:26:52.245 --> 00:26:55.425
The, a distinction that is

403
00:26:56.975 --> 00:27:00.065
I've just started, just had started making was that

404
00:27:00.065 --> 00:27:05.025
between process fairness and, substantive justice.

405
00:27:05.845 --> 00:27:09.305
So process fairness refers to justice

406
00:27:10.355 --> 00:27:11.655
of the processes

407
00:27:12.315 --> 00:27:13.535
or procedures

408
00:27:14.285 --> 00:27:17.655
that are used in arriving at the final outcomes.

409
00:27:19.405 --> 00:27:23.835
Final outcomes mean final health outcomes, end states

410
00:27:24.055 --> 00:27:27.875
and so on, where a substantive justice refers

411
00:27:28.095 --> 00:27:30.515
to the fairness of the end state itself.

412
00:27:31.135 --> 00:27:36.075
For example, the distribution of the final outcomes in terms

413
00:27:36.075 --> 00:27:40.115
of health, longevity, many, many,

414
00:27:40.145 --> 00:27:43.515
many other measures of health, infant mortality,

415
00:27:43.995 --> 00:27:48.555
maternal mortality, prevalence of diseases, and so on.

416
00:27:49.025 --> 00:27:53.085
Okay, so how do you get to the final outcomes?

417
00:27:53.705 --> 00:27:56.845
The processes or procedures themselves have to be

418
00:27:57.715 --> 00:27:59.475
fair, okay?

419
00:27:59.975 --> 00:28:02.635
That's an important aspect of

420
00:28:05.025 --> 00:28:09.475
justice, which is not substantive justice as it's called,

421
00:28:09.645 --> 00:28:13.395
which is to do only with the outcomes themselves,

422
00:28:13.745 --> 00:28:14.835
with the end state

423
00:28:15.255 --> 00:28:18.875
or culminations of whatever processes are used

424
00:28:18.875 --> 00:28:20.275
to get to the end state.

425
00:28:22.335 --> 00:28:25.555
The next distinction extremely important also, is that

426
00:28:25.555 --> 00:28:26.955
between comparative

427
00:28:27.655 --> 00:28:32.415
and non-comp comparative justice, the distinction

428
00:28:32.415 --> 00:28:33.855
between comparative

429
00:28:34.115 --> 00:28:37.855
and non-comp justice contrasts

430
00:28:38.795 --> 00:28:40.535
two concepts as follows.

431
00:28:42.575 --> 00:28:47.185
Justice takes a comparative form when the determination

432
00:28:47.365 --> 00:28:51.625
of what is due to a person depends

433
00:28:52.795 --> 00:28:57.635
on what might also be due to other people, other people.

434
00:28:58.375 --> 00:29:01.315
It takes a non-comp comparative form

435
00:29:01.985 --> 00:29:05.955
when we can determine what is due to a person

436
00:29:06.815 --> 00:29:10.675
simply by knowing the relevant facts about

437
00:29:11.025 --> 00:29:14.915
that particular person without reference to anyone else.

438
00:29:17.065 --> 00:29:20.055
Now, principles of equality are

439
00:29:21.185 --> 00:29:25.555
obviously comparative in form since what is due

440
00:29:25.575 --> 00:29:29.755
to each person is the same as what others are getting.

441
00:29:31.085 --> 00:29:35.415
Similarly, the widely, very widely used concept of health

442
00:29:36.095 --> 00:29:38.695
inequity is also comparative

443
00:29:39.235 --> 00:29:42.565
because it requires a judgment on

444
00:29:42.745 --> 00:29:47.085
how one group is doing relative to another,

445
00:29:47.435 --> 00:29:51.685
whether the health differences between people

446
00:29:52.545 --> 00:29:55.205
are unfair or unjust.

447
00:29:56.235 --> 00:29:59.645
Okay? So health equity is also

448
00:30:00.405 --> 00:30:03.725
a comparative justice concept.

449
00:30:07.165 --> 00:30:10.975
Another distinction I want to make is that between equality

450
00:30:11.315 --> 00:30:15.225
and sufficiency, now equality

451
00:30:15.965 --> 00:30:19.215
in some form is universally seen

452
00:30:19.475 --> 00:30:21.655
as a central component of justice.

453
00:30:24.025 --> 00:30:27.525
Egalitarianism has strong intuitive appeal

454
00:30:28.345 --> 00:30:30.845
in the space of health and wellbeing

455
00:30:31.435 --> 00:30:35.345
because being worse off than others

456
00:30:36.095 --> 00:30:39.745
through no fault of one's own seems unjust.

457
00:30:42.835 --> 00:30:47.565
However, the idea of sufficiency as contrasted

458
00:30:47.565 --> 00:30:52.285
with equality is that each person should have enough,

459
00:30:53.835 --> 00:30:56.215
not that everyone should have the same

460
00:30:58.075 --> 00:31:02.615
as a principle of justice, I may call it

461
00:31:03.495 --> 00:31:07.035
arianism determines what is due

462
00:31:07.915 --> 00:31:11.135
to a person on the basis of a given

463
00:31:12.215 --> 00:31:15.915
absolute standard, and not on the basis of

464
00:31:15.945 --> 00:31:17.355
what other people have.

465
00:31:18.555 --> 00:31:21.215
So, sufficiency permits, inequalities,

466
00:31:21.835 --> 00:31:26.695
but aims for a minimum threshold for everyone, for example,

467
00:31:27.435 --> 00:31:29.775
in terms of healthcare or health.

468
00:31:30.895 --> 00:31:34.235
And this is a, a distinction similar to the economic,

469
00:31:34.525 --> 00:31:38.875
inequality distinction between income inequality

470
00:31:39.295 --> 00:31:40.555
and income poverty.

471
00:31:41.105 --> 00:31:44.995
Yeah. Next, perhaps finally,

472
00:31:45.395 --> 00:31:48.475
'cause you're getting on, I want to get a corrective

473
00:31:48.735 --> 00:31:50.115
and compensatory justice.

474
00:31:51.385 --> 00:31:54.215
Corrective justice is concerned

475
00:31:54.605 --> 00:31:58.575
with compensating individuals for health harms

476
00:31:58.755 --> 00:32:01.985
or wrongs that have been inflicted on them,

477
00:32:02.565 --> 00:32:06.465
as we mentioned earlier about the blood scan,

478
00:32:06.825 --> 00:32:09.145
infected blood scandal and so on.

479
00:32:09.805 --> 00:32:13.965
And for example, there are many, many, health harms

480
00:32:15.135 --> 00:32:19.395
that come about from actions by,

481
00:32:20.455 --> 00:32:23.515
either individuals, corporations,

482
00:32:24.485 --> 00:32:25.995
industries, and so on.

483
00:32:26.925 --> 00:32:30.705
For example, failure to ensure occupational

484
00:32:31.805 --> 00:32:35.775
workplace safety has sometimes resulted in industrial

485
00:32:36.215 --> 00:32:37.255
accidents and loss of life.

486
00:32:39.210 --> 00:32:42.935
Industrial discharges have polluted drinking water

487
00:32:44.035 --> 00:32:47.735
and resulted in illnesses and deaths.

488
00:32:49.195 --> 00:32:53.995
Occupational hazards such as, exposure

489
00:32:54.655 --> 00:32:59.355
to asbestos has caused mesothelioma,

490
00:33:01.095 --> 00:33:05.105
lack of adequate testing of drugs, for example, thalidomide

491
00:33:06.145 --> 00:33:09.905
resulted in reform

492
00:33:10.005 --> 00:33:12.225
babies and so on.

493
00:33:12.565 --> 00:33:17.505
So, there's lots of,

494
00:33:18.155 --> 00:33:22.085
harms that need compensation

495
00:33:22.495 --> 00:33:24.905
correction, rectification.

496
00:33:26.055 --> 00:33:28.785
And these are, again,

497
00:33:30.885 --> 00:33:34.495
not comparative or generally not comparative.

498
00:33:35.285 --> 00:33:38.385
So it's not a question of comparative justice here,

499
00:33:38.845 --> 00:33:41.265
but again, of non-comp comparative

500
00:33:41.605 --> 00:33:43.985
or if you like, absolute justice.

501
00:33:45.075 --> 00:33:47.455
So the, the last distinction,

502
00:33:47.465 --> 00:33:51.015
which is a very important distinction that I want to make is

503
00:33:51.015 --> 00:33:55.335
that between health inequality, health inequity,

504
00:33:55.755 --> 00:33:57.295
and health injustice.

505
00:33:59.325 --> 00:34:02.825
So using the distinctions that I've just discussed, yeah,

506
00:34:03.685 --> 00:34:06.545
the definition and distinctions that I've just discussed,

507
00:34:07.005 --> 00:34:08.985
we can understand the relationship

508
00:34:09.655 --> 00:34:13.105
between health inequality, health inequity,

509
00:34:13.325 --> 00:34:14.385
and health injustice.

510
00:34:15.125 --> 00:34:17.345
In a Venn diagram that I've constructed,

511
00:34:19.855 --> 00:34:24.025
that health inequality simply refers to differences

512
00:34:25.125 --> 00:34:27.905
in an elementary mathematical sense,

513
00:34:29.475 --> 00:34:33.725
whereas health inequity refers to health

514
00:34:34.445 --> 00:34:39.255
inequalities that are unfair or unjust.

515
00:34:41.295 --> 00:34:44.395
By contrast, as I'm trying to suggest,

516
00:34:45.875 --> 00:34:50.405
health injustice is a much broader concept,

517
00:34:51.175 --> 00:34:54.605
which include, which includes all assessments

518
00:34:55.065 --> 00:34:59.925
of procedural, substantive, and corrective justice.

519
00:35:00.555 --> 00:35:02.845
Whether these are comparative

520
00:35:04.175 --> 00:35:07.795
or non-comp, comparative health equity

521
00:35:10.085 --> 00:35:13.185
or health inequity forms a proper

522
00:35:15.045 --> 00:35:19.945
and likely quite small subset of all health injustices

523
00:35:20.495 --> 00:35:24.345
because health inequity is restricted

524
00:35:24.965 --> 00:35:28.985
to comparative assessments, not absolute assessments

525
00:35:29.325 --> 00:35:34.185
to comparative assessments of substantive justice, only

526
00:35:34.605 --> 00:35:38.925
of, final outcomes in health only.

527
00:35:39.475 --> 00:35:44.215
Okay? Whether there are final outcomes in terms of,

528
00:35:45.715 --> 00:35:47.725
socioeconomic gradients of health

529
00:35:48.505 --> 00:35:52.685
or, health gradients across groups of people

530
00:35:54.045 --> 00:35:57.225
identified, in other ways,

531
00:35:58.095 --> 00:35:59.235
but only final outcomes.

532
00:36:00.145 --> 00:36:03.965
So this diagram shows that the sets that correspond

533
00:36:04.025 --> 00:36:07.305
to the three concepts have

534
00:36:07.785 --> 00:36:09.065
respective overlaps.

535
00:36:11.345 --> 00:36:14.085
And I'd like to note the following points about the

536
00:36:14.085 --> 00:36:15.365
membership of these sets.

537
00:36:15.855 --> 00:36:20.395
First of all, not all health inequalities are health

538
00:36:20.525 --> 00:36:23.035
inequities or health injustices.

539
00:36:23.715 --> 00:36:26.835
I just mentioned female life expectancy

540
00:36:27.005 --> 00:36:28.315
being greater than male.

541
00:36:28.345 --> 00:36:31.475
Life expectancy is certainly a health inequality,

542
00:36:32.095 --> 00:36:36.475
but it is not a health inequity or a health injustice

543
00:36:37.115 --> 00:36:39.365
because the inequality is not unfair.

544
00:36:42.045 --> 00:36:45.225
Second, not all health inequities

545
00:36:46.405 --> 00:36:49.865
or health injustices are health inequalities,

546
00:36:50.835 --> 00:36:55.615
for example, as I'd mentioned, female life expectancy being

547
00:36:56.185 --> 00:36:59.335
equal to male life expectancy in a country

548
00:37:00.155 --> 00:37:03.295
is a health inequity and a health injustice,

549
00:37:03.875 --> 00:37:05.935
but not a health inequality.

550
00:37:06.765 --> 00:37:11.255
It's a health equality. All health inequities

551
00:37:11.635 --> 00:37:13.375
are indeed health injustices

552
00:37:13.375 --> 00:37:17.295
because they form a proper, subset

553
00:37:17.715 --> 00:37:19.295
of the health injustices.

554
00:37:20.115 --> 00:37:21.335
As I have mentioned earlier,

555
00:37:23.925 --> 00:37:26.625
not all health injustices or health inequities.

556
00:37:27.845 --> 00:37:29.825
For example, a person

557
00:37:30.165 --> 00:37:33.825
who has less than the threshold level of healthcare

558
00:37:35.165 --> 00:37:37.785
suffer a health injustice

559
00:37:38.635 --> 00:37:41.065
under the sufficiency principle,

560
00:37:41.535 --> 00:37:44.145
does not have the minimum threshold level of healthcare,

561
00:37:45.195 --> 00:37:47.255
but it's not a health inequity

562
00:37:47.405 --> 00:37:50.855
because no comparison with other persons is involved.

563
00:37:53.315 --> 00:37:57.905
This person falls below the threshold, whatever el

564
00:37:58.505 --> 00:38:02.465
whatever else is happening to health, equality

565
00:38:02.765 --> 00:38:04.305
or inequity and so on.

566
00:38:04.575 --> 00:38:08.905
This is a health injustice, which is non-comp comparative.

567
00:38:10.095 --> 00:38:14.275
Of course, as I mentioned earlier, all process unfairnesses,

568
00:38:14.465 --> 00:38:18.595
whether they're comparative or not, are health injustices,

569
00:38:19.295 --> 00:38:23.515
but not a health inequity, which is concerned only with

570
00:38:24.385 --> 00:38:28.125
substantive or health

571
00:38:28.355 --> 00:38:30.165
outcome, states.

572
00:38:32.025 --> 00:38:34.845
And indeed corrective or compensatory or,

573
00:38:35.025 --> 00:38:38.445
or reparative justice is a health injustice,

574
00:38:38.745 --> 00:38:40.365
but it's not a health inequity.

575
00:38:41.045 --> 00:38:44.945
So there's a large group of health injustices, which are,

576
00:38:45.285 --> 00:38:47.785
nothing to do with health inequity

577
00:38:47.925 --> 00:38:49.185
or health inequalities.

578
00:38:49.645 --> 00:38:52.455
So I've tried to show here, that

579
00:38:53.075 --> 00:38:55.295
health justice is a broad

580
00:38:55.835 --> 00:39:00.495
and inclusive concept with many faces or facets.

581
00:39:02.505 --> 00:39:04.035
It's evident that a single

582
00:39:04.535 --> 00:39:08.595
or unidimensional view of health justice

583
00:39:09.345 --> 00:39:13.245
will be inadequate to the task.

584
00:39:14.835 --> 00:39:19.495
So we do have to turn to different aspects of faces

585
00:39:19.755 --> 00:39:24.015
of health justice to address the varieties of injustice

586
00:39:25.045 --> 00:39:27.495
that are observed in the world.

587
00:39:28.295 --> 00:39:31.615
Remedial action will be required,

588
00:39:32.315 --> 00:39:34.535
in many fronts,

589
00:39:35.365 --> 00:39:39.215
from reducing health inequities across socioeconomic groups

590
00:39:40.185 --> 00:39:41.725
and racial groups in a country,

591
00:39:42.385 --> 00:39:46.525
but tackling also the stark injustice where billions

592
00:39:46.625 --> 00:39:51.045
and billions of people in the world do not have sufficient

593
00:39:51.895 --> 00:39:52.965
basic healthcare.

Quick Answers

Exploring Justice in the Shadows of a Pandemic

00:00:00 - When I started, working on this paper, it was the, f*g end of the, global pandemic. And I, wanted to do research on, the idea of justice, a definition of justice. And, I looked for it and found it in an early Roman law text, which was, the work of Justinian and his, legal advisors.

00:00:38 - But it just so happened that, the first recorded plague called the Plague of Justinian. And, because Justinian himself contracted that plague, was around the same time, 1500 years ago in 5 41 80, around then, and his, institutes of Justinian,

00:01:13 - a Roman law text codifies the definition of justice as soon quicker tributary, which is the key concept of justice, which is used in all the various theories of justice in philosophy, and by philosophers to,

The Essence of Justice through Justinian's Legacy

00:01:48 - if you like, and sum quicker. Tributary literally means justice is the constant and perpetual will to render to each person is due, is sort of heard you. Okay? So the operative word is due and it's due, which actually, if you like, I mean,

00:02:19 - but if you like, the way that de is interpreted in different approaches to justice is, what creates or constitutes these many phases of justice. Okay? Now going back, I, I do want to go back to Justinian, who is well recognized for his, brilliant contributions to the codification of Roman law

00:02:54 - but the, improvements and, codification of existing law, texts, if you like. So this was the first attempt at codifying that, and that was all brilliant. However, just Justinian, in dealing with the plague,

Justinian's Tax Levy and the Transformation of Hagia Sophia

00:03:25 - he survived the plague, but many, many of his, subjects from whom he raised taxes perished, they didn't survive. But what Justinian did is he increased the levy of taxes on those who survived in order to have the same total, tax revenue, if you like, from which instead of helping

00:03:58 - and were perishing, he used these revenues for great public works, and he built the Hagia Sophia in, Constantinople, which is, a great, which was a great cathedral of the, Byzantine Empire, but which, has now, been converted into a mosque.

00:04:31 - the, the, Kamal at tur, the founder of Modern Turkey had converted it into a museum, but now Elgan has converted it into a mosque where people pray and practice, Islam, which is a pity, but that's what it is. Okay? But then Justinian, what the point I was making is that Justinian himself, was criticized

The Impact of Global Pandemics: Misfortune or Injustice?

00:05:03 - when he wrote the history of the War's Book two. And also when, he wrote his Secret history, a book called Secret History, about the way Justinian responded to the plague and how it affected his people. Well, that is also a pandemic, okay? It's a global pandemic.

00:05:34 - an injustice? I mean, in a sense, in the paper also, I discussed the idea of a misfortune versus an injustice. in a sense, since it was not likely called the virus was not likely caused by humans, although some people suggest it might have been caused in a laboratory in Wuhan in China,

00:06:05 - jumped from, an animal to the humans. so it was a misfortune, but the way that it's been dealt with is what is if, which creates the sense of injustice. And of course, lots and lots of people have commented during the pandemic of, governments not dealing adequately with,

Challenges in Global Health Response

00:06:38 - with, getting people vaccinated with, sending in developing countries, sending people back to their villages, or, where there wasn't adequate, means to,

00:07:08 - if it was contracted by members of, the village. and oxygen, if you remember, there was, the outside a Delhi Hospital, there were cremations going on because people were dying before they could be admitted to the hospital while waiting

00:07:36 - Okay? So that's in, in a sense, that was, this was a global pa, by the way, in the plague of Justinian lasted a long time and it spread through the Mediterranean. And something like, historians estimate, somewhere between 30 and 50 million people died. Okay? but that was over 200 years. In the case of, COVID-19,

Global Pandemic Impact: Calls for Rectification

00:08:08 - I mean, you know, the variable estimates, but at least 5 million plus over the world. So it was a global pandemic, which, killed a lot of people. Human experiences are, observations, and responses by individuals and groups of individuals in,

00:08:41 - that, a group of people, individuals, or whole communities or indeed, regions are not getting their due. They're not getting their due. So there are calls for, rectifying the situation and, that's what sometimes

00:09:12 - of the situation, or at least some remediation of the situation. I mean, we've seen that in the case of, recently in a different context, the post office horizon scandal. We've seen that in the infected blood scandal, where, there was a health injustice as opposed to the, post office, scandal, which, concerned the,

Injustice in Healthcare: Infected Blood Scandal

00:09:45 - crimes they did not commit. But in the case of the infected blood scandal, there was health harms because people were, had transfusions of blood that hadn't been screened for hepatitis C and HIV and the recipients of these,

00:10:15 - and or hepatitis C, which led to health harms and losses and deaths. Many, many people died too. Then there was secondary health harms by, you know, the spread of HIV through, sexual contacts and so on. So, that is exactly a,

00:10:48 - that people should get their due. That, you know, one sentence definition could be, that health justice is justice in the health sphere, but that doesn't get us very far, okay? Because we need to understand what aspect of, justice is involved in, this facet of health justice.

Exploring Health Justice in Different Contexts

00:11:24 - in different contexts is, interpreted or is approached and in different context. What is due is, sometimes perhaps, recognized through, what we were speaking about earlier,

00:11:53 - Have identified, a health injustice through anger or calls for remediation or rectification of the situation. So, then the task becomes how do you, conceptualize this and characterize the different types of health justice? And that is something that I've tried to do in this paper.

00:12:25 - It is a theory of justice and the preeminent, philosophical theory of justice in the last, certainly in the last century, sin, I'll get to the contrast between what sins took. The idea of justice, which came out in 2009 compared to roles is, a theory of justice classic

Comparing Approaches to Health Justice

00:12:57 - Now, the, the pro, the difference is there are important differences between these two approaches in how they could deal with health justice roles. Doesn't explicitly deal with health justice, but, there are five differences. And, the rolls in project is the characterization of a perfectly just society

00:13:31 - that people actually lead. In other words, what he calls realizations, which enables binary comparisons between less than perfect justice. So it enables a comparison of a situation, which in his words can, can,

00:14:00 - situation is more just than another, even though it is not perfectly just So it enables comparisons of justice between less than ideal situations to less than ideal situations. Roles cannot do that, okay? Secondly, as I said, roles is theory is about institutions that are needed for a perfectly just society, what he calls the basic structure of society

Roles and Justice: A Comparative Analysis

00:14:35 - that people actually lead realizations as he calls them, including the processes that bring about the outcomes. Okay? Roles is, focuses on primary goods, which are goods like income, wealth, and so on, that people enjoy versus sense reliance on capabilities, what people can do

00:15:06 - These, he calls them functionings doings and beings of people. So, then there is a difference between the nature of impartiality involved in the assessment of justice. In the case of roles, it's closed in the case of his original position, the veil of ignorance. I'll go into that now, but it's open in senses case in the case

00:15:40 - in, we who has a, in courts of view from everywhere, so it's not closed. Finally, roles is, consideration of justice is confined to the sovereign or nation state in a fair system of cooperation in determining the basic structure of that society.

Currency of Justice: Assessing Global Justice

00:16:11 - that it permits a assessment of global justice through, for example, the impartial, through the impartial spectator or observer. So those are the differences, and of course I could go into, but we may not have time to, distinguish between them, between the idea of using primary goods as the currency

00:16:43 - Currency, meaning that which, the variable through which, advantage or deprivation is assessed. And the currency of justice in economic justice could be money, income, or wealth. The currency of justice in health could be health status. The currency of justice may be capabilities, functionings

00:17:10 - and this is quite important incidentally, in one context, which I can mention. the idea, you know, about seven plus mil billion people in the world, 7.4 billion people, at least 50, not at least approximately 50, 15% are disabled physically or through ill health, and

Disability and Income Inequality

00:17:43 - countries, 400 plus million people in, in, developed countries. Let's consider the difference in assessing, people's, situation, either in terms of the primary goods they hold in commonwealth or in terms of capabilities. The disabled have two handicaps.

00:18:16 - handicap, but their need for income is greater than that of a able-bodied person, in order to try to live normal lives and alleviate their handicap. For example, a disabled person might require a wheelchair, might require assistance with, you know, in living in, dressing

00:18:46 - Yeah. And, being able to lead as normal a life as possible. So there is a, both an earning handicap by virtue of their disability and a conversion handicap of converting income or primary goods or into good living and functioning. That's a conversion handicap. So, which greatly reinforces and magnifies the earning handicap.

Health Injustice and Disability: A Capability Perspective

00:19:22 - disability, which is a health status, matter, is captured directly through the capability perspective in contrast to assessing the disadvantage based on income of primary goods, which ignores the plight of, doesn't take account of, the plight of disabled people as such, just

00:19:52 - or primary goods is how it's assessed. I'd like to start, by the way, by, you know, faces of injustice can be to do with the inequality, inequity and many other features. So I'd like to start with an illustration of a possible health injustice, okay?

00:20:24 - So let me look at the inequality in life expectancy or longevity between males and females. It is the case that in all developed and developing countries, and I provided a chart for that. By the way, women live longer than men sometimes by as much as 10 years.

Gender Disparities in Longevity and Biological Advantage

00:20:57 - for males at all ages, indeed, even before birth. In this sense, although about 115 males are conceived for every hundred females, their number, their numbers are whittled down thereafter, just 105

00:21:31 - because of the disproportionate rate of spontaneous abortions, stillbirths and miscarriages of male fetuses, more boys than girls also die in infancy and childhood. Okay? It's well known that women have a biological and genetic advantage compared to men in longevity.

00:22:05 - and in genes, sex hormones and chromosomes. For example, testosterone increases levels of LDL that is low density lipoprotein, which is the bad cholesterol, and testosterone decreases HDL or high density lipoprotein, which is the good cholesterol.

Gender Disparities in Cardiovascular Health

00:22:39 - on cardiovascular health by lowering LDL and increasing HDL. There are also other detrimental effects that, wellknown of testosterone, for example, association with risky behaviors.

00:23:10 - for example, as an antioxidant, and there are chromosomal differences, xx for women and XY for men. These may also affect relative mortality rates because an abnormal gene on one X chromosome for women can use the normal gene on the other X chromosome,

00:23:41 - gene on one of the chromosomes is defective. And of course, currently modern medicine does not have the technology to compensate for men's biological and genetic disadvantage. So given the biological and genetic differences between women

Title: Gender Disparities in Healthcare and Life Expectancy

00:24:11 - to equalize life expectancy between the sexes, that will not be achievable unless we discriminate against women, for example, in healthcare or in nutrition at an earlier stage of life, or even at a later stage of life and so on. But such discrimination violates what is known

00:24:43 - requirement of justice, including health justice. Are men and women treated equally in terms of healthcare for the same disease that they, for the same illness that they, have? You could treat them unequally, but that would go against process fairness. Okay? So,

00:25:15 - egalitarian demand for equality in longevity between women and men. But then incidentally, if you happen to observe, and indeed it has been observed, equality of female and male life expectancy in a country, as has happened in some countries in not

Inequalities in Lifespan and Health Justice

00:25:43 - even the 1970s equality, or even worse, men outliving women in some countries that has been observed in some Middle Eastern and other countries, that would be strong evidence of a health injustice because, we expect women to live longer than men given equal treatment. Yeah. So there are many different aspects

00:26:19 - definitions and distinctions. So the standard definition of justice, which I mentioned earlier in a different context, is assume quicker tributary IE to render to each person his or her due. And although that's quite abstract in this form, what is due is specified differently in different

00:26:52 - The, a distinction that is I've just started, just had started making was that between process fairness and, substantive justice. So process fairness refers to justice of the processes or procedures that are used in arriving at the final outcomes.

Substantive Justice and Comparative Analysis

00:27:24 - and so on, where a substantive justice refers to the fairness of the end state itself. For example, the distribution of the final outcomes in terms of health, longevity, many, many, many other measures of health, infant mortality, maternal mortality, prevalence of diseases, and so on. Okay, so how do you get to the final outcomes?

00:27:57 - fair, okay? That's an important aspect of justice, which is not substantive justice as it's called, which is to do only with the outcomes themselves, with the end state or culminations of whatever processes are used to get to the end state. The next distinction extremely important also, is that

00:28:27 - and non-comp comparative justice, the distinction between comparative and non-comp justice contrasts two concepts as follows. Justice takes a comparative form when the determination of what is due to a person depends on what might also be due to other people, other people.

Comparative Justice and Health Equality

00:29:01 - when we can determine what is due to a person simply by knowing the relevant facts about that particular person without reference to anyone else. Now, principles of equality are obviously comparative in form since what is due to each person is the same as what others are getting.

00:29:36 - inequity is also comparative because it requires a judgment on how one group is doing relative to another, whether the health differences between people are unfair or unjust. Okay? So health equity is also a comparative justice concept.

00:30:11 - and sufficiency, now equality in some form is universally seen as a central component of justice. Egalitarianism has strong intuitive appeal in the space of health and wellbeing because being worse off than others through no fault of one's own seems unjust.

Sufficiency and Corrective Justice in Healthcare

00:30:47 - with equality is that each person should have enough, not that everyone should have the same as a principle of justice, I may call it arianism determines what is due to a person on the basis of a given absolute standard, and not on the basis of

00:31:18 - So, sufficiency permits, inequalities, but aims for a minimum threshold for everyone, for example, in terms of healthcare or health. And this is a, a distinction similar to the economic, inequality distinction between income inequality and income poverty. Yeah. Next, perhaps finally, 'cause you're getting on, I want to get a corrective

00:31:51 - Corrective justice is concerned with compensating individuals for health harms or wrongs that have been inflicted on them, as we mentioned earlier about the blood scan, infected blood scandal and so on. And for example, there are many, many, health harms that come about from actions by,

Health Injustice and Corrective Measures in Industries

00:32:24 - industries, and so on. For example, failure to ensure occupational workplace safety has sometimes resulted in industrial accidents and loss of life. Industrial discharges have polluted drinking water and resulted in illnesses and deaths. Occupational hazards such as, exposure

00:33:01 - lack of adequate testing of drugs, for example, thalidomide resulted in reform babies and so on. So, there's lots of, harms that need compensation correction, rectification.

00:33:30 - not comparative or generally not comparative. So it's not a question of comparative justice here, but again, of non-comp comparative or if you like, absolute justice. So the, the last distinction, which is a very important distinction that I want to make is that between health inequality, health inequity, and health injustice.

Understanding Health Inequality, Inequity, and Injustice

00:34:03 - the definition and distinctions that I've just discussed, we can understand the relationship between health inequality, health inequity, and health injustice. In a Venn diagram that I've constructed, that health inequality simply refers to differences in an elementary mathematical sense,

00:34:34 - inequalities that are unfair or unjust. By contrast, as I'm trying to suggest, health injustice is a much broader concept, which include, which includes all assessments of procedural, substantive, and corrective justice.

00:35:04 - or non-comp, comparative health equity or health inequity forms a proper and likely quite small subset of all health injustices because health inequity is restricted to comparative assessments, not absolute assessments to comparative assessments of substantive justice, only

Understanding Health Inequalities, Inequities, and Injustices

00:35:39 - Okay? Whether there are final outcomes in terms of, socioeconomic gradients of health or, health gradients across groups of people identified, in other ways, but only final outcomes. So this diagram shows that the sets that correspond to the three concepts have

00:36:11 - And I'd like to note the following points about the membership of these sets. First of all, not all health inequalities are health inequities or health injustices. I just mentioned female life expectancy being greater than male. Life expectancy is certainly a health inequality, but it is not a health inequity or a health injustice because the inequality is not unfair.

00:36:46 - or health injustices are health inequalities, for example, as I'd mentioned, female life expectancy being equal to male life expectancy in a country is a health inequity and a health injustice, but not a health inequality. It's a health equality. All health inequities are indeed health injustices

Inclusive Perspectives on Health Injustice

00:37:17 - of the health injustices. As I have mentioned earlier, not all health injustices or health inequities. For example, a person who has less than the threshold level of healthcare suffer a health injustice under the sufficiency principle, does not have the minimum threshold level of healthcare,

00:37:47 - because no comparison with other persons is involved. This person falls below the threshold, whatever el whatever else is happening to health, equality or inequity and so on. This is a health injustice, which is non-comp comparative. Of course, as I mentioned earlier, all process unfairnesses, whether they're comparative or not, are health injustices,

00:38:24 - substantive or health outcome, states. And indeed corrective or compensatory or, or reparative justice is a health injustice, but it's not a health inequity. So there's a large group of health injustices, which are, nothing to do with health inequity or health inequalities.

Complexity of Health Justice

00:38:53 - health justice is a broad and inclusive concept with many faces or facets. It's evident that a single or unidimensional view of health justice will be inadequate to the task. So we do have to turn to different aspects of faces

00:39:25 - that are observed in the world. Remedial action will be required, in many fronts, from reducing health inequities across socioeconomic groups and racial groups in a country, but tackling also the stark injustice where billions and billions of people in the world do not have sufficient

00:39:51 -

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