Edited by Henriette Sinding Aasen, Siri Gloppen, Anne-Mette Magnussen and Even Nilssen
Chapter 8: Professionalism, discretion and juridification: social inequality in health and social citizenship
Does social inequality in health have an impact on people’s opportunities to exercise social citizenship? In this chapter we argue that there is reason to believe so. Furthermore, if social inequality in health influences social citizenship, what can the medical profession do to reduce this impact? Should physicians’ professional discretion be restricted to counteract this influence? These are the issues that we discuss in this chapter, and we base our discussion on analytical distinctions between various types of juridification processes. Social inequalities in health are large, persistent and well documented (Marmot 2005). Health inequalities show a marked social gradient in all countries, rich or poor. The more disadvantaged an individual is in a society, the worse are the prospects of good health outcomes. Although the main causes of social health inequalities are found outside the health care system – caused by factors such as economic or labor market inequalities – the health care system can contribute to maintaining, reducing or reinforcing social health inequalities by influencing social inequality in the distribution and health gain of health care (Bærøe and Bringedal 2011; Bringedal and Bærøe 2010; Bringedal and Tufte 2012). This may very well happen unintentionally. For instance, communication problems may adversely influence the type of care, and provision of standardized treatment may fail to be beneficial because of sociocultural barriers in individual cases. Even though a health care system cannot eradicate the social gradient in health disparities, it can at least avoid reinforcing social inequalities in health by ensuring adequate care.
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