Journal Article

Answering the Empirical Challenge to Arguments for Universal Health Coverage Based in Health Equity

Lynette Reid

in Public Health Ethics

Volume 9, issue 3, pages 231-243
Published in print November 2016 | ISSN: 1754-9973
Published online December 2015 | e-ISSN: 1754-9981 | DOI: http://dx.doi.org/10.1093/phe/phv038
Answering the Empirical Challenge to Arguments for Universal Health Coverage Based in Health Equity

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Temkin asks how we should distribute resources between the social determinants of health (SDOH) and health care; Sreenivasan argues that if our goal is fair opportunity, funding universal health coverage (UHC) is the wrong policy. He argues that social equality in health has not improved under UHC and concludes that fair opportunity would be better served by using the resources to address the SDOH instead. His criticism applies more broadly than he claims: it applies to any argument for UHC based on health equity. However, neither his strong causal conclusion nor his stark policy proposal is justified. I review methodological challenges for establishing the relative causal contributions of health care and social policy, concluding that we may never have a robust causal account to support a consequentialist choice. Fortunately, we may not need to answer the allocation question as a dichotomy. Given what Sen calls the multidimensional nature of health equity and the role of UHC in cost containment, UHC may not be a threat to health equity. I also argue against Sreenivasan's claim that the data he discusses should not trouble sufficientists and prioritarians. The worst-off are not simply lagging in improvement; rather, their health status is stagnating or worsening.

Journal Article.  10025 words. 

Subjects: Philosophy of Science ; Philosophy of Biology ; Bioethics and Medical Ethics ; Medical Ethics ; Public Health

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