Michael,
The short answer to your last question ("How do economists, engineers or
social scientists deal with efficiently generated entities (like wealth,
health or heat) which are inefficiently distributed (like wealth, health
and heat)?") is, as far as economists are concerned, "Not very well".
The first problem would be that we would not recognise the term
"inefficiently distributed" in the sense you mean, preferring the term
"non-optimal distribution" which leaves the "efficiency" issue (as you
mean it) rather opaque. But even when we had grasped your meaning, I
think that most economists would take the view that "efficiency" (i.e
maximising something subject to resource constraints) is where our
expertise lies, and all this distributive justice stuff is for someone
else to worry about. The economists who are associated with HEN are
the exceptions, who think that distributive justice is also important.
Indeed there will be some who even think it is more important than
simply maximising population health (always subject to resource
constraints of course). But then we have to break loose from the
conventional language of our subject and attempt to "invent" a
non-welfarist paradigm!
I do not want to burden the members of this email network further with
all this, important though it is, but those whose appetite has been
whetted but not satisfied might try two of my recent publications in
which these issues are explored in greater depth. One of them emerged
from HEN itself, namely:
"Equity and Cost-effectiveness: A Short Note" pp50-53 in Oliver A,
Cookson R and McDaid D (editors) THE ISSUES PANEL FOR EQUITY IN HEALTH,
London, The Nuffield Trust, 2001.
The other piece is a bit more demanding, and was jointly authored with a
colleague of mine at Sheffield University, and is
Tsuchiya A and Williams A "Welfare Economics and Economic Evaluation" pp
22-45 of Drummond M and McGuire A (editors) ECONOMIC EVALUATION IN
HEALTH CARE, Oxford University Press 2001.
So we are doing our best to meet you halfway!
Alan
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