Much of the philosophical literature on health inequalities seeks to establish the superiority of one or another conception of luck egalitarianism. In recent years, however, an increasing number of self-avowed egalitarian philosophers have proposed replacing luck egalitarianism with alternatives that stress the moral relevance of distinct relationships, rather than the moral relevance of good or bad luck. After briefly explaining why I am not attracted to luck egalitarianism, I seek in this chapter to distinguish and clarify three views that have (...) been characterized in the philosophical literature as forms of relational egalitarianism. I call these three relational views equality of treatment, equality of concern, and social egalitarianism. I will explain why each claims to be a form of egalitarianism and why these three views should not be seen as competitors. I will argue that each brand of relational egalitarianism describes a plausible plank of distributive justice that bears on the evaluation of health inequalities and on the political institutions that create, sustain, or exacerbate them. To illustrate this pluralistic relational egalitarian approach, I will draw on a case study by Horton and Barker (this volume) to discuss how each of the three planks might be brought to bear on the evaluation of oral health disparities among the children of migrant Latino farmworkers in California. (shrink)

Political philosophers have become increasingly interested in questions of justice as applied to health. Much of this literature works from a distributive understanding of justice. In the recent debate, however, ‘relational’ egalitarians have proposed a different way of conceptualising equality, which focuses on the quality of social relations among citizens and/or how social institutions ‘treat’ citizens. This paper explores some implications of a relational approach to health, with particular focus on health care, health inequalities and health policy. While the relational (...) account can add interesting perspectives to current debates on justice and health, we also highlight some tensions and difficulties relational egalitarians might encounter and some discontinuities between the implications of a relational account and current discourse on health equity. (shrink)

Relational views of equality put forward a social and political ideal of equality that aims at being a better interpretation of what social justice requires than the prevailing distributive conceptions of equality, especially luck egalitarian views. Yet it is unclear what social justice as relational equality demands in distributive terms; Elizabeth Anderson's view seems to vacate a large part of the terrain of distributive justice in favor of a minimalist, sufficiency view. Against that, this paper argues that relational equality, properly (...) understood, requires setting stringent limits to distributive inequality, for both intrinsic and instrumental reasons. First, the relational egalitarian conception of society as a cooperative enterprise among equals gives rise to a presumption of equality in socially produced goods (and bads); inequalities in these goods have to be justified by justice-relevant reasons. Second, relational egalitarianism also delivers instrumental reasons to limit inequalities in income, wealth, and opportunities, because such inequalities may generate both opportunities for domination and inegalitarian status norms that threaten the social bases of self-respect of the worse off. (shrink)

Is equality a distributive value or does it rather point to the quality of social relationships? This article criticizes the distributive character of luck egalitarian theories of justice and fleshes out the central characteristics of an alternative, relational approach to equality. It examines a central objection to distributive theories: that such theories cannot account for the significance of how institutions treat people (as opposed to the outcomes they bring about). I discuss two variants of this objection: first, that distributive theories (...) fail to account for the importance of how institutions cause good shortfalls and, second, that they fail to account for the normative attitude of social and political institutions expressed in different ways of treating people. The article argues that the causal variant of the objection has only very limited reach, and endorses the expressive variant: the attitudes expressed by institutions in their treatment of persons, such as contempt or neglect, generate potentially unjust social relationships and hierarchies. This should be the focus of a relational egalitarian approach to social justice. The article proceeds to explain how it is possible that artificial agents such as institutions have attitudes and how these attitudes are not reducible to those of the individuals that sustain them, and argues that distributive theories cannot be so modified as to account for such attitudes. It concludes by indicating several directions for the development of more worked-out conceptions of relational equality on this basis. (shrink)

Many recent political philosophers have attempted to demonstrate that choice and responsibility can be incorporated into the framework of an egalitarian theory of distributive justice. This article argues, however, that the project of developing a responsibility-based conception of egalitarian justice is misconceived. The project represents an attempt to defuse conservative criticism of the welfare state and of egalitarian liberalism more generally. But by mimicking the conservative’s emphasis on choice and responsibility, advocates of responsibility-based egalitarianism unwittingly inherit the conservative’s unsustainable justificatory (...) ambitions, unattractive moralism, and questionable metaphysical commitments. More importantly, they misrepresent the nature of our concern with equality as a value. (shrink)

Pluralist egalitarians think that luck and relational egalitarianism each articulates a component in a pluralist account of egalitarian justice. However, this ecumenical view appears problematic in the light of Elizabeth Anderson's claim that the divide arises because two incompatible views of justification are in play, which in turn generates derivative disagreements – e.g. about the proper currency of egalitarian justice. In support of pluralist egalitarianism I argue that two of Anderson's derivative disagreements are not rooted in the disagreement over justification (...) she identifies, and that the disagreement over justification cuts across standard disagreements between luck and relational egalitarian justice. (shrink)

What kind of equality should we value and why? Current debate centres around whether distributive equality is valuable. However, it is not the only (potentially) morally significant form of equality. David Miller and T. M. Scanlon have emphasised the importance of social equality—a strongly egalitarian notion distinct from distributive equality, and which cannot be reduced to a concern for overall welfare or the welfare of the worst-off. However, as debate tends to focus on distribution, social equality has been neglected and (...) we do not have a clear understanding of what it is and why it might be valuable. This paper aims to address this gap. (shrink)

In his Tanner Lecture of 1979 called ‘Equality of What?’ Amartya Sen asked what metric egalitarians should use to establish the extent to which their ideal is realized in a given society. What aspect of a person’s condition should count in a fundamental way for egalitarians, and not merely as cause of or evidence of or proxy for what they regard as fundamental?

Much contemporary egalitarian theorizing is broadly divided between luck egalitarians, such as G. A. Cohen, Richard Arneson, and John Roemer, and relational egalitarians, such as John Rawls, Samuel Scheffler, Josh Cohen, and me. The two camps disagree about how to conceive of equality: as an equal distribution of non-relational goods among individuals, or as a kind of social relation between persons - an equality of authority, status, or standing.This disagreement generates a second, about when unequal distributions of non-relational goods are (...) unjust. Luck egalitarians claim that inequality is unjust when it is accidental: when it is caused by morally arbitrary factors such as circumstances of birth. Relational egalitarians claim that inequality is unjust when it disadvantages people: when it reflects, embodies, or causes inequality of authority, status, or standing. (shrink)