Personal vis-a-vis social responsibility for disparities in health status: An issue of justice

摘要

Health inequities are disparities which can be avoided through rational actions on the part of policymakers. Such inequalities are unnecessary andunjust and may exist between and within nations, societies, and population groups. Social determinants such as wealth, income, occupation,education, gender, and racial/ethnic groups are the principal drivers of this inequality since they determine the health risks and preventive behaviors,access to, and affordability of health care. Within this framework, there is a debate on assigning a personal responsibility factor over and abovesocietal responsibility to issues of ill health. One school of philosophy argues that when individuals are worse-off than others for no fault of theirown, it is unjust, as opposed to health disparities that arise due to avoidable personal choices such as smoking and drug addiction for which thereshould (can) be a personal responsibility. Opposing thoughts have pointed out that the relative socioeconomic position of an individual dictates howhis/her life may progress from education to working conditions and aging, susceptibility to diseases and infirmity, and the consequences thereof.The existence of a social gradient in health outcomes across populations throughout the world is a testimony to this truth. It has been emphasizedthat assuming personal responsibility for health in public policy-making can only have a peripheral place. Instead, the concept of individualresponsibility should be promoted as a positive concept of enabling people to gain control over the determinants of health through conscious,informed, and healthy choices.