Affirmative Action in Health

The ideal of equality of opportunity has long been considered central to health equity. Rawlsians, such as Norman Daniels, speak of health care as a means to (fair) equality of opportunity (Daniels 1985), whereas luck egalitarians have suggested the (diametrically opposed) ideal of equality of opportunity for health (LeGrande 1987, 1991, ch 7; Roemer 1998, ch 8; Segall 2010, ch 7). What unites both egalitarian camps, however, is the view that to achieve substantive (rather than merely formal) equality of opportunity we must often practice affirmative action. And yet, health equity and affirmative action have not (to my knowledge) been linked. My purpose in this paper, then, is to try and elucidate what ‘affirmative action in health’ might mean. I want to do so, in particular, by constructing and evaluating Rawlsian and luck egalitarian accounts of affirmative action. The former I glean from Daniels’s most recent work. He says there that we have a good reason to prioritize the medical needs of those whose ill health is the product of unjust social circumstances. The alternative account of affirmative action in health, with which I want to contrast Daniels’s, speaks of prioritizing the needs of members of groups who ex-ante face worse health prospects (African-Americans, say, and, somewhat more controversially, men).