Abstract

Much of the current work in the health development community is a direct response to social justice concerns related to the health threats embedded in contemporary social, economic, and political structures in various societies. In recent years, the issue of 'health inequity,' which generally describes an unfair distribution of health status within a population, has gained considerable international attention both as a political justification for increased resources and as a technical tool for fairly distributing the goods and resources that affect population health. However, interpretations of 'health inequity' typically do not capture the variety of concerns that abound, or provide guidance for developing and validating claims of health inequity. ;This dissertation uses a historical and conceptual analysis of the concept of health inequity to develop a framework that both captures the variety of meanings and social concerns generally intended, and also provides a strategy for developing claims that guide public policy. The first half of the work considers the changing meaning of 'health inequity' over time; the ways concepts of health and knowledge of disease affects assessments of justice; the implications of one popular interpretation of health inequity; and the cultural, conceptual, and practical limitations of that interpretation. ;These considerations lead to a framework that includes a reformed interpretation, a list of the components of a health inequity claim, and a tool for testing claims based on the three criteria essential to a claim of inequity: avoidability, choice, and responsible agency. The second half of the dissertation delves more deeply into the rationale for, meaning of, and use of each criterion in testing the validity of claims. 'Avoidability' requires that harms cited in an inequity claim be avoidable in terms of scientific knowledge, human and financial resources, and on moral grounds. The role of individual 'choice' in creating health risks and patterns of health is also relevant to judgments of equity, as self-determination and opportunities for health are widely considered central to justice. Finally, a claim must demonstrate that an agent either is culpable in a creating a particular health risk/outcome, or is accountable for remedying the situation. The dissertation ends by offering specific recommendations for identifying health inequities and discusses implications for future work