Overview

Health and Social Justice provides a theoretical framework for health ethics, public policy and law in which Dr Ruger introduces the health capability paradigm, an innovative and unique approach which considers the capability of health as a moral imperative. This book is the culmination of more than a decade and a half of work to develop the health capability paradigm, with a vision of a world where all have the capability to be healthy. This vision is grounded in the Aristotelian view of human flourishing and also Amartya Sen's capability approach. In this new paradigm, not just health care, or even just health alone, but the capability for health itself is a moral imperative, as is ensuring the conditions that allow all individuals the means to achieve central health capabilities. Key tenets of health capability include health agency, shared health governance, where individuals, providers and institutions work together to create a social system enabling all to be healthy, and the use of theorized agreements and shared reasoning to guide social choice and shape health policy and decision-making. This book provides philosophical justification for the direct moral importance of health and the capability for health and follows a norms-based approach to health promotion. It employs a joint scientific and deliberative approach to guide health system development and reform, and the allocation of scarce health resources. The health capability paradigm integrates both proceduralist and consequentialist approaches to justice, and both moral and political legitimacy are critical.

Full Product Details

Author:   Jennifer Prah Ruger (Associate Professor, Yale University)
Publisher:   Oxford University Press
Imprint:   Oxford University Press
Dimensions:   Width: 15.40cm , Height: 1.80cm , Length: 23.30cm
Weight:   0.488kg
ISBN:  

9780199653133

ISBN 10:   0199653135
Pages:   320
Publication Date:   29 March 2012
Audience:   Professional and scholarly ,  Professional & Vocational
Format:   Paperback
Publisher's Status:   Active
Availability:   To order  
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Table of Contents

Introduction The Current Set of Ethical Frameworks 1: Approaches to Medical and Public Ethics An Alternative Account- The Health Capability Paradigm 2: Health and Human Flourishing 3: Pluralism, Incompletely Theorized Agreements, and Public Policy 4: Justice, Capability, and Health Policy 5: Grounding the Right to Health Domestic Health Policy Applications 6: A Health Capability Account of Equal Access 7: A Health Capability Account of Equitable and Efficient Health Financing and Insurance 8: Allocating Resources: A Joint Scientific and Deliberative Approach Domestic Health Reform 9: Political and Moral Legitimacy: A Normative Theory of Health Policy Decision-making Conclusion

Reviews

Ruger enhances the reach of her powerful perspective by enlightening investigations of human flourishing ... By producing a book of such richness concerning a major area of human agency and policy, Jennifer Prah Ruger has substantially advanced the reach of public reasoning, not just about health care, but about social justice in general. from the foreword by Amartya K. Sen, Thomas W. Lamont University Professor and Professor of Economics and Philosophy, Harvard University and Nobel Laureate in Economics Jennifer Prah Ruger has produced a masterpiece - a beautifully written and strikingly bold 'health capability paradigm' for the analysis of problems of health and social justice ... This gem of a book is destined to push forward current debates about health care reform and its theoretical foundations. It will more than contribute to this field of investigation; it will be a defining moment. Tom L. Beauchamp, Professor of Philosophy and Senior Research Scholar at the Kennedy Institute of Ethics, Georgetown University I have no doubt that this book will become a beacon for the debates on health system reform in the United States and around the world. Julio Frenk, Dean and T & G Angelopoulos Professor of Public Health and International Development, Harvard School of Public Health [A]n original synthesis ... that illuminates a way forward toward a more rational health policy and health policy process. ... [A] must read for all serious students of health policy. Joseph P. Newhouse, John D. MacArthur Professor of Health Policy and Management and Director of the Division of Health Policy Research and Education, Harvard University [A]n attractive, concrete vision of a health society, strongly grounded in philosophy, economics and public health. Thomas Pogge, Leitner Professor of Philosophy and International Affairs, Yale University and Professorial Fellow at the Centre for Applied Philosophy and Public Ethics, Australian National University Ruger articulates a persuasive case ... for grounding reform in a commitment to human flourishing ... [and] presents us with practical tools for determining what to cover and how to allocate resources at a time when cost-containment must be a constraint on future policy. Health and Social Justice is an important book not just as a guide to current debates, but for understanding how to navigate future challenges in the rapidly evolving environment of health policy in the United States and other nations. Arthur Caplan, Director, Center for Bioethics and Sidney D. Caplan Chair of Bioethics, University of Pennsylvania [A] major contribution to an important, complex and continuing process that examines the theoretical and operational relationships between development, poverty reduction, health and human rights. ... [T]he health and human rights communities are enriched by Ruger's philosophical justification for the right to heath, as well as the health capability paradigm ... [W]e commend Ruger's excellent book Paul Hunt, Professor of Law, University of Essex and former United Nations Special Rapporteur on the right to the highest attainable standard of health, & Joo-Young Lee, School of Law, University of Essex, Symposium on Health and Social Justice in Journal of Human Development & Capabilities [A] complex, timely, ambitious reflection on moral and political legitimacy in healthcare. ... [A]n original theoretical framework ... [A] fresh, systematic, forward-looking paradigm ... Ruger has built 'brick by brick' a serious, provocative comprehensive defense of a progressive, social justice perspective on health and healthcare. Anita L. Allen, Henry R. Silverman Professor of Law and Professor of Philosophy, University of Pennsylvania and member of the Presidential Commission for the Study of Bioethical Issues, Symposium on Health and Social Justice in Journal of Human Development & Capabilities I view Ruger's book as the product of monumental scholarship that undoubtedly makes a significant contribution to future academic research on social ethics in healthcare and to academic courses focused on that subject. Uwe E. Reinhardt, James Madison Professor of Political Economy and Professor of Economics and Public Affairs, Princeton University, Symposium on Health and Social Justice in Journal of Human Development & Capabilities [Jennifer Prah Ruger's] most systematic and vital contribution. ... [S]eminal ... [D]emands attention and determined action Bulletin of the World Health Organization Health and Social Justice is clearly a scholarly work ... providing a different perspective on the meaning of health and the importance of true collaboration on the micro as well as macro levels. Journal of the American Medical Association In this important book, ... Ruger's 'health capability paradigm' builds upon Aristotle's theory of 'human flourishing' with ... insight from diverse fields such as law, politics, and economics. ... Those readers with an interest in law will find Professor Ruger's cogent analysis of and respectful counterargument to Professor Eugene Volokh's idea of a 'right to medical self-defense' particularly provocative. ... [R]eaders would be wise to heed [her model's] wisdom. Harvard Law Review [A] scientific and deliberative approach to guiding health system development and reform and allocating scarce health resources. Journal of Economic Literature Jennifer Prah Ruger invites the reader to envision a world where health policy allocated resources such that all persons could realize their maximum capabilities for health. ... This book ... offers an ethical framework for putting this ideal into practice Health and Human Rights Jennifer Prah Ruger provides a valuable contribution to the theoretical literature on the right to health care. ... Ruger's central health capabilities ... will resonate widely. ... Ruger presses the strengths of her approach, but wisely recognizes its limits. ... Readers will benefit from the impressive interdisciplinary nature of Ruger's analysis. The range of her work cuts easily across political philosophy, political science, economics, law, public health, and medical ethics. Inquiry Ruger combines sophisticated philosophy, concrete policy proposals, and astute observations ... With its theoretically sophisticated and realistic policy analysis, this work will be an important read for ethicists, students of health policy, and policy makers. CHOICE Understanding justice in health on the basis of health capabilities ... overcomes some theoretical divides, most importantly those between outcomes and procedures as well as freedom and welfare. Medicine, Health Care and Philosophy Jennifer Prah Ruger's book Health and Social Justice is a substantial contribution to the emerging scholarship at the intersection of health issues and the philosophy of social justice. ... Ruger proposes a bold and expansive theory ... [A]n innovative theory ... [T]he argument for refocusing health care policy onto health capabilities is compelling and substantively argued. ... Such a contribution is just what the emerging field of health and social justice scholarship needs. Public Health Ethics

Ruger enhances the reach of her powerful perspective by enlightening investigations of human flourishing and of the variety of influences that make substantial differences to the freedoms that human beings can actually have, and their ability to make well-informed and well-reasoned use of these freedoms. One of the central philosophical ideas on which Ruger has much to say is that of responsibility, and this applies both to individuals and to public institutions (through what Ruger calls 'shared health governance')... By producing a book of such richness concerning a major area of human agency and policy, Jennifer Prah Ruger has substantially advanced the reach of public reasoning, not just about health care, but about social justice in general. From the foreword by Amartya Sen, Thomas W. Lamont University Professor and Professor of Economics and Philosophy, Harvard University Jennifer Ruger has produced a well crafted and bold capabilities paradigm for the analysis of problems of health and social justice. Her vision of health and society is at once highly idealized and aimed at practical health policy, an impressive union of these objectives. This book will help push forward current debates about health care reform and its theoretical foundations. It will find a significant place in the literatures of both biomedical ethics and health policy. Tom L. Beauchamp, Professor of Philosophy and Senior Research Scholar at the Kennedy Institute of Ethics, Georgetown University Jennifer Prah Ruger has devoted almost two decades of her life to convince all kinds of audiences of the special moral importance of health. Her new book, Health and Social Justice, brings together the intellectual strength she has gathered in study and discussion of this topic. At the intersection of ethics, policy, and law, she proposes a 'health capability paradigm', which integrates ethical thinking and procedural mechanisms to guide health system reforms and improve the allocation of resources. I have no doubt that this book will become a beacon for the debates on health system reform in the United States and around the world. Julio Frenk, Dean and T & G Angelopoulos Professor of Public Health and International Development, Harvard School of Public Health Ruger presents the 'health capability paradigm', an original synthesis of philosophy, political science, and economics that illuminates a way forward toward a more rational health policy-and health policy process. A book that is a must read for all serious students of health policy. Joseph P. Newhouse, John D. MacArthur Professor of Health Policy and Management and Director of the Division of Health Policy Research and Education, Harvard University Health is special, and society ought to protect and promote the health of its members. For Ruger, society is not just officials with funds and influence. It's all of us taking responsibility, as individuals and politically, for the health of all. So what should we aim for? Developing a 'health capability paradigm', Ruger envisions a fair distribution of access to health, rather than health care. Must resources then be concentrated on the frailest? Ruger is committed to their reasonable accommodation, but utilizes notions of medical necessity, appropriateness, futility and cost-minimization to keep this commitment sensible and fair. The result is an attractive, concrete vision of a health society, strongly grounded in philosophy, economics and public health. Thomas Pogge, Leitner Professor of Philosophy and International Affairs, Yale University and Professorial Fellow, Centre for Applied Philosophy and Public Ethics, Australian National University The battle over health reform in the United States has made it clear that consensus about values is a prerequisite to both change and success. Jennifer Prah Ruger articulates a persuasive case in Health and Social Justice for grounding reform in a commitment to human flourishing... Ruger not only provides the normative basis for assuring health care for all, she also presents us with practical tools for determining what to cover and how to allocate resources at a time when cost-containment must be a constraint on future policy. Health and Social Justice is an important book not just as a guide to current debates, but for understanding how to navigate future challenges in the rapidly evolving environment of health policy in the United States and other nations. Arthur Caplan, Director, Center for Bioethics and Sidney D. Caplan Chair of Bioethics, University of Pennsylvania [A] seminal work...a book that demands attention and determined action Lawrence O Gostin, Bulletin of the World Health Association Health and Social Justice is clearly a scholarly work, written for individuals familiar with the areas of health policy, health reform, or philosophy...it is meant for those seriously immersed in these issues, providing a different perspective on the meaning of health and the importance of true collaboration on the micro as well as macro levels. Pat Fosarelli, Journal of the American Medical Association In this important book, Professor Jennifer Prah Ruger presents a model of universal health care that draws upon society's collective morality for its implementation and continued legitimacy. Professor Ruger's 'health capability paradigm' builds upon Aristotle's theory of 'human flourishing' with ... insight from diverse fields such as law, politics, and economics ... Those readers with an interest in law will find Professor Ruger's cogent analysis of and respectful counterargument to Professor Eugene Volokh's idea of a 'right to medical self-defense' particularly provocative. Equally fascinating is Professor Ruger's application of the theory of 'incompletely theorized agreements,' familiar to those interested in legal scholarship, to health care policy ... readers would be wise to heed [her model's] wisdom. Harvard Law Review ...a scientific and deliberative approach to guiding health system development and reform and allocating scarce health resources Journal of Economic Literature Jennifer Prah Ruger invites the reader to envision a world where health policy allocated resources such that all persons could realize their maximum capabilities for health ...This book...offers an ethical framework for putting this ideal into practice...a new theoretical model, the health capability paradigm, discussion on how this new approach and paradigm might be applied to domestic health policy, and a summary of its relevance for domestic health reform. Health and Human Rights Jennifer Prah Ruger provides a valuable contribution to the theoretical literature on the right to health care...Ruger develops a health capability paradigm...as a philosophical justification for a right to health...Ruger's central health capabilities of avoiding premature death and escaping morbidity...will resonate widely. Other implications of her paradigm also are appealing. Individual responsibility is a key element of her theory...and efficiency a core requirement...Ruger presses the strengths of her approach, but wisely recognizes its limits...Readers will benefit from the impressive interdisciplinary nature of Ruger's analysis. The range of her work cuts easily across political philosophy, political science, economics, law, public health, and medical ethics. David Orentlicher, Inquiry Ruger's project has some similarities with the work of Norman Daniels in Just Health, who employs a Rawlsian framework to develop an account of justice in health. However, Ruger builds her argument on a different theoretical basis... Understanding justice in health on the basis of health capabilities ... overcomes some theoretical divides, most importantly those between outcomes and procedures as well as freedom and welfare. Medicine, Health Care and Philosophy A substantial contribution to the emerging scholarship at the intersection of health issues and the philosophy of social justice...Prah Ruger proposes a bold and expansive theory of justice and health care policy...an innovative theory of health care policy that starts at the level of fundamental social values or ethical theory...[A]s a theory of health care and social justice, the argument for refocusing health care policy onto health capabilities is compelling and substantively argued...Such a contribution is just what the emerging field of health and social justice scholarship needs. Sridhar Venkatapuram, Public Health Ethics

Author Information

Jennifer Prah Ruger's previous appointments include Assistant Professor at Washington University in St. Louis, Schools of Medicine and Social Work, Speech Writer to the World Bank President, James D. Wolfensohn, Health Economist in the World Bank Health, Nutrition and Population Sector and Satellite Secretariat for the World Health Organization Transition Team, Health and Development Satellite. has authored numerous theoretical and empirical studies on the equity and efficiency of health system access, financing, resource allocation, policy reform and social determinants of health. These contributions are unified by an overarching interest in equity and disparities in health and health care, focusing on vulnerable and impoverished populations.

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