Dear Adam and colleagues
As someone who long ago studied philosophy and
now works with epidemiologists, here is a
perhaps superficial response.
One spending less on elderly people in
order to spend more on younger people:
this is faced every day in the health
service and nowadays pressure groups
supporting older people are forcing a debate
on it. I have a wider problem with this,
which used to irritate Ken Judge when
we discussed these things (amicably
and fruitfully!). This is that I keep wanting
not just to trade off health expenditure on
one group v. another but health expenditure
versus military expenditure for example.
On Rawls' principal, I have already said I
find this a good approach to health inequality
issues, glad to find at least one person
agrees with me.
The idea of defining 'health' as a life-course
experience seems really excellent. In that
view, we are in even worse trouble over
increasing inequality because people in
less privileged social groups start to have
worse experiences right from the start (low
birth weight, infant deaths and congenital
handicaps are all strongly related to social
class). There seems to be a degree of
"equalisation in youth" during the school years.
Although middle class children are taller,
they are not much more likely to have major
or fatal diseases in later childhood (mind you
not many get these at that age in any case).
Accidental death and suicide, however, are
still class related at these ages. Then from
around age 40, working class people
begin to suffer more illness, and to be *far*
more 'limited' by whatever illnesses they do
have. You get a sort of vicious spiral by which
a working class person who gets mild
epilepsy, lets say, has to quit work, no
longer able to heat their house properly the
then acquire chronic bronchitis as well, and
so on.
Mel B
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