Public Health Ethics Advance Access originally published online on March 3, 2009
Public Health Ethics 2009 2(1):53-58; doi:10.1093/phe/php006
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Implementing the Marmot Commission's Recommendations: Social Justice Requires a Solution to the Equity–Efficiency Trade-Off
Haukeland University Hospital and University of Bergen, Norway
* Corresponding author: Research Group in Global Health: Ethics, Culture and Economics, Department of Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018
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The WHO Commission on Social Determinants of Health has documented pervasive inequalities in health in many countries. These are clearly associated with unfair distribution of the social determinants of health. Policies directed at reducing this unfair distribution should be promoted across all sectors and institutions responsible for securing equal opportunities and freedom for all citizens. This article argues that such policies will need to balance the competing goals of reducing social group inequalities in health and improving average health. We need a public debate about how to make such difficult choices. This paper outlines a framework that can help us structure our thinking about this dilemma.