Choice, Equality and Cost
Chapter 14: Equalising medical care
There is more to good health than formal care. Marked inequalities in health statusare caused by the unequal distribution of power, income, goods, and services, globally and nationally, the consequent unfairness in the immediate, visible circumstances of peoples’ lives – their access to health care, schools, and education, their conditions of work and leisure, their homes, communities, towns, or cities – and their chances of leading a flourishing life. (World Health Organization, 2008: 1) The social gradient is always multidimensional. It is often unjust. The structural conditions of daily life and not the formal care inputs alone must all be thrown into the melting pot if a more equal society is to be forged. A holistic approach is required that does not economise on the homes and the jobs. There is more to good health than uncaring economics, biased politics and medical solutions that are not enough to equalise the life-chances in illness and death. The health divide ‘appears to have little to do with differences in health care systems. For example, the mortality differentials for the United States, which favors market-based health care (at least for the non-elderly), and Austria, where the government provides universal health care, are virtually identical’ (Cutler et al., 2011b: 124).
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