Responsibilities for Poverty-Related Ill Health (Special Section‪)‬

My view on justice in regard to health is distinctive in two ways. First, I hold that the strength of our moral reasons to prevent or to mitigate particular medical conditions does not depend only on what one might call distributional factors, such as how badly off the people affected by these conditions are in absolute and relative terms, how costly prevention or treatment would be, and how much patients would benefit from a given treatment. Rather, it depends also on relational factors, that is, on how we are related to the medical conditions they suffer. This point is widely accepted in regard to conduct. You have, for instance, stronger moral reason to make sure that people are not harmed through your negligence than you have to ensure that they are not harmed through causes outside your control (others' negligence or their own, say, or bad weather). And your moral reason to help an accident victim is stronger if you were materially involved in causing her accident. I assert an analogous point also in regard to any social institutions that agents are materially involved in upholding: in shaping an institutional order, we should be more concerned, morally, that it not contribute substantially to the incidence of medical conditions than we should be that it prevent medical conditions caused by other factors. Thus, we should design any institutional order so that it prioritizes the alleviation of those medical conditions to which it substantially contributes. In institutional con texts as well, what is important to moral assessment is not merely the distribution of health outcomes as such, but also whether and how social factors contribute to their incidence. The latter consideration is needed to distinguish different degrees of responsibility for medical conditions and for their prevention and mitigation.