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Health care system is one of the most important institutions that have to be controlled by the government of each country. This system should be organized in such a way so that every citizen can receive necessary medical treatment. Unfortunately, this can happen only in ideal conditions which are obviously beyond attainment, and there is no doubt that in reality people coming from different social and economic backgrounds still have unequal access to health care services. Also, health inequality is sometimes confused with inequity; that is why some ethical theories on this matter should be observed.
What Makes Health Inequality and Inequity Different?
Health inequality and inequity may seem identical notions due to their formal resemblance. In fact, these collocations denote different concepts, but the borderline between them is subtle. According to the study conducted by Arcaya, Arcaya, and Subramanian (2015), health inequality implies differences in the health of people while health inequity (also referred to as health disparity) is a sub-type of health inequality, it conveys a concept of an unjust difference in health. As follows from abovementioned definitions, making the distinction between them is a crucial question since they are closely associated with one another.
Firstly, it should be mentioned that scholars divide all theories into two broad groups: consequential and non-consequential (Holland, 2015). The essence of consequential ethics is connected to the defining consequences of actions as right or wrong (Holland, 2015). Non-consequential ethics, in its turn, is not related to the consequences, this theory deals with rightness or wrongness of actions (Holland, 2015). Among these groups, scholars single out subtheories, such as utilitarianism, deontology, Kantianism, principlism, virtue ethics, liberal objection, and so on (Holland, 2015).
Utilitarianism is an impartial theory considered a version of consequentialism; according to it, consequences of an action are positive when they make the level of so-called utility (meaning well-being, welfare or benefit) as high as possible (Holland, 2015). This theory is also applied to public health: “any health policy that will produce maximal health gain is morally justified” (Holland, 2015, p. 44). Jones (2010) writes about utilitarianism the following: “the good of the many can outweigh the good of an individual if the balance of happiness gained by the many easily outweighs the comparable unhappiness of the single individual” (p. 48). Moreover, the scholar claims that the harm of health inequalities and inequities cannot be outweighed by any benefit (Jones, 2010).
In the framework of utilitarianism, scholars talk about distributive justice, most conceptions of which include the notion of equity and equal access; however, equity is violated by health disparities (Jones, 2010). Nowadays is a problem of unequal distribution among the poor and the rich or, in other words, inequity (injustice) in access to health care. Inequities, in their turn, tend to lead to inequalities that can be replaced by the word imbalance. It can be concluded that these notions are not the same in the context of this theory.
Even though according to various ethical theories the level health inequalities and inequities should be reduced, the problem of disparities in the health care system still exists. It can be illustrated by data collected by researches who devoted their studies to the use of electronic health records in US hospitals. Jha et al. (2009) found out that the level of electronic-records system adoption appeared to be higher among hospitals that may have more significant financial support. Gans, Kralewski, Hammons Dowd (2005) concluded that the lack of sponsoring is the most common reason for not transitioning to such a system. From these data, the principle of distributive justice is not correctly applied; that is why there are inequalities in access to health.
All things considered, it can be concluded that the issue of health inequalities and inequities is crucial in modern society. There is a fine line between these concepts since inequity is a sub-type of inequality. Scholars have suggested a variety of ethical theories which are nowadays applied in the field of health, some of them deal with distinguishing between notions of inequality and inequity.
Arcaya, M. C., Arcaya, A. L., & Subramanian, S. V. (2015). Inequalities in health: Definitions, concepts, and theories. Global Health Action, 8(1), 1-12.
Gans, D., Kralewski, J., Hammons, T., & Dowd, B. (2005). Medical groups’ adoption of electronic health records and information systems. Health Affairs, 24(5), 1323-1333.
Holland, S. (2015). Public health ethics. Cambridge, England: Polity Press.
Jha, A. K., DesRoches, C. M., Campbell, E. G., Donelan, K., Rao, S. R., Ferris, T. G.,…, Blumenthal, D. (2009). Use of electronic health records in US hospitals. New England Journal of Medicine, 360(16), 1628-1638.
Jones, C. M. (2010). The moral problem of health disparities. American journal of public health, 100(1), 47-51.