Belancing responsibility for health: ethical dilemmas in policies aiming at promoting health in socioeconomically disadvantaged groups
Poorer and lower educated people have a clearly reduced (healthy) life expectancy compared to more affluent and higher educated groups, causing, among others, significant health disparities between neighbourhoods in cities. This is not a new phenomenon. Over the past 35 years, health policies to reduce socioeconomic health inequalities (whether national or local) have had very limited success. Recent coalition agreements of several larger cities in The Netherlands again show strong ambitions to reduce socioeconomic health inequalities, but public health professionals on the level of local governments struggle with the question of how to do so. The failure to reduce health inequalities is not merely a matter of ineffective health interventions, but also of a deep normative uncertainty. Although there is a broad political consensus on the ideal of ‘equal chances to health’ the question of how the governments should realize this ideal will inevitably face ethical dilemmas and trigger normative-political differences. This project will enable public health professionals on a local government level to articulate and resolve the ethical questions they face while developing and implementing ‘health equity policies’. By developing and applying a non-ideal account of health equity we aim to bypass the political dissensus that often paralyses health equity policy. Our research questions are: 1) what are the ethical dilemmas in local health equity practices, and how should local governments respond to them?; 2) how should we understand the relation between the governmental responsibility for health equity and the responsibility for non-health policy goals?; 3) what could and should citizen consultations mean in the context of health equity policies?