Health justice: Public views and values regarding inequalities in population health

Contemporary interest among researchers in the social gradient in health has brought with it important ethical questions. They include basic questions such as whether social class differences in health are morally problematic, which health inequalities matter most, and what the optimal distribution of health should look like. Although there exists a growing research basis on which to develop population health policies, little research has examined the public's values regarding health inequalities. This paper will describe the results of a descriptive study to identify the public's values regarding inequalities in U.S. population health. Specifically, this study was designed to learn what, if anything, the public finds ethically problematic about health inequalities, how they might allocate social resources to change the distribution of health, and whether variance in the causal explanation (individual, social, multifactoral) for health inequalities influences how they reason morally about the first two issues. Informed by normative and empirical literatures examining inequality in income and health care access, the focus group instrument was designed to elicit thought and discussion of three principles: efficiency, equality, and priority (to the least advantaged and to the sickest). The study also incorporates a facilitated discussion to further discuss these principles and to identify other values and concerns that might be operative in participants' reasoning and choices. This study is in its first phase and is being piloted during Winter 2008 with 60 focus group participants recruited from the jury pool of Manhattan, New York, with data analysis to follow during the Spring.