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Oxford University Press
01 September 2009
Development economics; Health economics; Welfare economics; Medical ethics & professional conduct; Public health & preventive medicine; Health systems & services
Societies make decisions and take actions that profoundly impact the distribution of health. Why and how should collective choices be made, and policies implemented, to address health inequalities under conditions of resource scarcity? How should societies conceptualize and measure health disparities, and determine whether they've been adequately addressed? Who is responsible for various aspects of this important social problem? In Health and Social Justice, Jennifer Prah Ruger elucidates principles to guide these decisions, the evidence that should inform them, and the policies necessary to build equitable and efficient health systems world-wide. This book weaves together original insights and disparate constructs to produce a foundational new theory, the health capability paradigm. Ruger's theory takes the ongoing debates about the theoretical underpinnings of national health disparities and systems in striking new directions. It shows the limitations of existing approaches (utilitarian, libertarian, Rawlsian, communitarian), and effectively balances a consequentialist focus on health outcomes and costs with a proceduralist respect for individuals' health agency. Through what Ruger calls shared health governance, it emphasizes responsibility and choice. It allows broader assessment of injustices, including attributes and conditions affecting individuals' human flourishing, as well as societal structures within which resource distribution occurs. Addressing complex issues at the intersection of philosophy, economics, and politics in health, this fresh perspective bridges the divide between the collective and the individual, between personal freedom and social welfare, equality and efficiency, and science and economics.
By:   Jennifer Prah Ruger (Associate Professor Yale University)
Imprint:   Oxford University Press
Country of Publication:   United Kingdom
Dimensions:   Height: 241mm,  Width: 163mm,  Spine: 23mm
Weight:   629g
ISBN:   9780199559978
ISBN 10:   019955997X
Pages:   316
Publication Date:   01 September 2009
Audience:   Professional and scholarly ,  Undergraduate
Format:   Hardback
Publisher's Status:   Active
Introduction The Current Set of Ethical Frameworks 1: Approaches to Medical and Public Ethics An Alternative Account- The Health Capability Paradigm 2: Health and Human Flourishing 3: Pluralism, Incompletely Theorized Agreements, and Public Policy 4: Justice, Capability, and Health Policy 5: Grounding the Right to Health Domestic Health Policy Applications 6: A Health Capability Account of Equal Access 7: A Health Capability Account of Equitable and Efficient Health Financing and Insurance 8: Allocating Resources: A Joint Scientific and Deliberative Approach Domestic Health Reform 9: Political and Moral Legitimacy: A Normative Theory of Health Policy Decision-making Conclusion

Jennifer Prah Ruger is Associate Professor at Yale University Schools of Medicine, Public Health, Law, and Graduate School of Arts and Sciences. Previous appointments include Assistant Professor at Washington University in St. Louis, Speechwriter to the World Bank President, James D. Wolfensohn, Health Economist in the World Bank Health, Nutrition and Population Sector and Satellite Secretariat for the World Health Organization Transition Team, Health and Development Satellite. Professor Ruger has authored numerous theoretical and empirical studies on the equity and efficiency of health system access, financing, resource allocation, policy reform, and social determinants of health. These contributions are unified by an overarching interest in equity and disparities in health and health care, focusing on vulnerable and impoverished populations nationally and globally.

Reviews for Health and Social Justice

Ruger enhances the reach of her powerful perspective by enlightening investigations of human flourishing and of the variety of influences that make substantial differences to the freedoms that human beings can actually have, and their ability to make well-informed and well-reasoned use of these freedoms. One of the central philosophical ideas on which Ruger has much to say is that of responsibility, and this applies both to individuals and to public institutions (through what Ruger calls 'shared health governance')... By producing a book of such richness concerning a major area of human agency and policy, Jennifer Prah Ruger has substantially advanced the reach of public reasoning, not just about health care, but about social justice in general. From the foreword by Amartya Sen, Thomas W. Lamont University Professor and Professor of Economics and Philosophy, Harvard University Jennifer Ruger has produced a well crafted and bold capabilities paradigm for the analysis of problems of health and social justice. Her vision of health and society is at once highly idealized and aimed at practical health policy, an impressive union of these objectives. This book will help push forward current debates about health care reform and its theoretical foundations. It will find a significant place in the literatures of both biomedical ethics and health policy. Tom L. Beauchamp, Professor of Philosophy and Senior Research Scholar at the Kennedy Institute of Ethics, Georgetown University Jennifer Prah Ruger has devoted almost two decades of her life to convince all kinds of audiences of the special moral importance of health. Her new book, Health and Social Justice , brings together the intellectual strength she has gathered in study and discussion of this topic. At the intersection of ethics, policy, and law, she proposes a 'health capability paradigm', which integrates ethical thinking and procedural mechanisms to guide health system reforms and improve the allocation of resources. I have no doubt that this book will become a beacon for the debates on health system reform in the United States and around the world. Julio Frenk, Dean and T & G Angelopoulos Professor of Public Health and International Development, Harvard School of Public Health Ruger presents the 'health capability paradigm', an original synthesis of philosophy, political science, and economics that illuminates a way forward toward a more rational health policy-and health policy process. A book that is a must read for all serious students of health policy. Joseph P. Newhouse, John D. MacArthur Professor of Health Policy and Management and Director of the Division of Health Policy Research and Education, Harvard University Health is special, and society ought to protect and promote the health of its members. For Ruger, society is not just officials with funds and influence. It's all of us taking responsibility, as individuals and politically, for the health of all. So what should we aim for? Developing a 'health capability paradigm', Ruger envisions a fair distribution of access to health, rather than health care. Must resources then be concentrated on the frailest? Ruger is committed to their reasonable accommodation, but utilizes notions of medical necessity, appropriateness, futility and cost-minimization to keep this commitment sensible and fair. The result is an attractive, concrete vision of a health society, strongly grounded in philosophy, economics and public health. Thomas Pogge, Leitner Professor of Philosophy and International Affairs, Yale University and Professorial Fellow, Centre for Applied Philosophy and Public Ethics, Australian National University The battle over health reform in the United States has made it clear that consensus about values is a prerequisite to both change and success. Jennifer Prah Ruger articulates a persuasive case in Health and Social Justice for grounding reform in a commitment to human flourishing... Ruger not only provides the normative basis for assuring health care for all, she also presents us with practical tools for determining what to cover and how to allocate resources at a time when cost-containment must be a constraint on future policy. Health and Social Justice is an important book not just as a guide to current debates, but for understanding how to navigate future challenges in the rapidly evolving environment of health policy in the United States and other nations. Arthur Caplan, Director, Center for Bioethics and Sidney D. Caplan Chair of Bioethics, University of Pennsylvania [A] seminal work...a book that demands attention and determined action Lawrence O Gostin, Bulletin of the World Health Association Health and Social Justice is clearly a scholarly work, written for individuals familiar with the areas of health policy, health reform, or is meant for those seriously immersed in these issues, providing a different perspective on the meaning of health and the importance of true collaboration on the micro as well as macro levels. Pat Fosarelli, Journal of the American Medical Association Ruger's project has some similarities with the work of Norman Daniels in Just Health, who employs a Rawlsian framework to develop an account of justice in health. However, Ruger builds her argument on a different theoretical basis... Understanding justice in health on the basis of health capabilities ... overcomes some theoretical divides, most importantly those between outcomes and procedures as well as freedom and welfare. Medicine, Health Care and Philosophy ...a scientific and deliberative approach to guiding health system development and reform and allocating scarce health resources Journal of Economic Literature A substantial contribution to the emerging scholarship at the intersection of health issues and the philosophy of social justice...Prah Ruger proposes a bold and expansive theory of justice and health care innovative theory of health care policy that starts at the level of fundamental social values or ethical theory...[A]s a theory of health care and social justice, the argument for refocusing health care policy onto health capabilities is compelling and substantively argued...Such a contribution is just what the emerging field of health and social justice scholarship needs. Sridhar Venkatapuram, Public Health Ethics Jennifer Prah Ruger invites the reader to envision a world where health policy allocated resources such that all persons could realize their maximum capabilities for health ...This book...offers an ethical framework for putting this ideal into practice...a new theoretical model, the health capability paradigm, discussion on how this new approach and paradigm might be applied to domestic health policy, and a summary of its relevance for domestic health reform. Health and Human Rights In this important book, Professor Jennifer Prah Ruger presents a model of universal health care that draws upon society's collective morality for its implementation and continued legitimacy. Professor Ruger's 'health capability paradigm' builds upon Aristotle's theory of 'human flourishing' with ... insight from diverse fields such as law, politics, and economics ... Those readers with an interest in law will find Professor Ruger's cogent analysis of and respectful counterargument to Professor Eugene Volokh's idea of a 'right to medical self-defense' particularly provocative. Equally fascinating is Professor Ruger's application of the theory of 'incompletely theorized agreements,' familiar to those interested in legal scholarship, to health care policy ... readers would be wise to heed [her model's] wisdom. Harvard Law Review

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