The infant mortality rate in Liberia is 50 times higher than it is in Sweden, whilst a child born in Japan has a life expectancy at birth of more than double that of one born in Zambia. 1 And within countries, we see differences which are nearly as great. For example, if you were in the USA and travelled the short journey from the poorer parts of Washington to Montgomery County Maryland, you would find that ‘for each mile travelled life expectancy rises about a year and a half. There is a twenty-year gap between poor blacks at one end of the journey and rich whites at the other’. (Marmot, 2004, p.2). There are two types of questions which it is important to ask about inequalities in health such as these. The first are social scientific questions about the extent of inequalities in health and the factors which are causally responsible for these inequalities. Examples of social scientific questions to ask might be: how do infant mortality rates in the UK differ according to social class? What is the difference in life expectancy between Japanese who emigrate to the US and those who remain in Japan? Why do civil servants in higher ranked jobs tend to live longer than civil servants in lower ranked jobs? The second type are normative questions about the reasons we have to care about inequalities in health. Important normative questions to answer are: which inequalities in health should we care about (all inequalities or merely some of them)? When is an inequality in health unjust? How should we weigh our concern for equality in health against other factors such as maximising the..
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