From Publishers Weekly
"We have long known that more affluent and better-educated members of a society tend to live longer and healthier," state the authors at the outset of the essay at the heart of this slim volume. They aim to recast the debate about health care in America. Instead of just worrying about cost and access, Daniels, Kennedy and Kawachi argue that in order to deal with health inequalities, we need to remedy the problem of income inequality." In making this argument, the three academics (Daniels is a philosopher; Kennedy and Kawachi are public health scholars) draw both on broad-brush statistics (showing, for instance, that states with fairer income distributions boast better health) and on philosopher John Rawls's influential theory of justice. Along the way, they recommend four policy proposals: early childhood interventions; nutritional supplements for poor women and children; changes in the workplace environment; and income redistribution. In a series of responses to this essay, several scholarsAsuch as Marcia Angell, the editor-in-chief of the New England Journal of MedicineAtake issue with aspects of the authors' proposal, arguing, for example, that the social causes of poor health (wealth? occupation?) remain unclear; that their argument ignores differentials based on gender or race; and perhaps most potently, that their "utopian" plan nudges aside the "doable but difficult task of making medical care more fairly distributed." Still, the basic point proposed by Daniels, Kennedy and KawachiAthat good health depends mainly on factors outside the health care sectorAshould prompt a more textured debate on health policy. (Sept.)
Copyright 2000 Reed Business Information, Inc.
With the national debate on health-care issues largely limited to politicians' sound bites and expensive corporate-sponsored ads, concerned readers will welcome this challenging exchange on root causes. The authors, specialists in philosophy, public health, and public policy at Tufts and Harvard, extend John Rawls' concept of justice in assessing statistical evidence that justice is good for health, and inequality (both within a society and between societies) is unhealthy. The point, they urge, goes beyond the health effects of poverty itself: in relatively unequal societies, the middle class, too, is less healthy than are middle-class people in more equal societies. Instead of focusing entirely on broadening access to health care, the authors suggest, a society that aims to improve its citizens' health also needs to address early childhood interventions, nutrition, work environment, and income distribution. Brief, thoughtful responses from economists, philosophers, bioethicists, and physicians (including the New England Journal of Medi
cine's editor in chief) crystallize objections from several competing viewpoints. A valuable addition to Beacon's New Democracy Forum series. Mary CarrollCopyright © American Library Association. All rights reserved