Is it unjust that elderly people suffer from poorer health than young people? Distributive and relational egalitarianism on age-based health inequalities

Abstract

In any normal population, health is unequally distributed across different age groups. Are such age-based health inequalities unjust? A divide has recently developed within egalitarian theories of justice between relational egalitarians focusing on the egalitarian nature of social relations and luck egalitarians focusing on the distribution of goods such as welfare or resources. I argue that the most plausible versions of these two theories – ‘whole lives’ luck egalitarianism and time-relative relational egalitarianism – imply conflicting answers to the opening question. Under realistic conditions, the former implies that, from the perspective of luck egalitarian justice, it is better that old people are disadvantaged by bad health than that they are not, whereas the latter theory implies that many age-based health inequalities involve unjust, non-egalitarian social relations and are therefore unjust. Hence, I contend that different egalitarian concerns must be balanced against one another, suggesting that the relational concern has greater weight in this particular case. Along the way, I propose a social model of old age analogous to the social model of disability and suggest that a whole lives version of relational egalitarianism might also be attractive.

Affirmative Action in the Political Domain

“…To see that these views differ, suppose that X exploits 13 Y for 30 years after which Y exploits X for 30 years (cf. Lippert-Rasmussen, 2019: 155). In this case, X and Y relate as equals from the perspective of whole lives relational egalitarianism, but not according to time-relative relational egalitarianism since at no point in time in their lives do they relate as equals.…”

“…However, there is a further question as to when X and Y must enjoy non-discrimination in order to relate as equals. To see what I have in mind, we may, following Lippert-Rasmussen (2019), distinguish two specifications of relational egalitarianism: Whole lives relational egalitarianism : Justice requires that, from the perspective of their lives as a whole, people relate socially to one another as equals. Time-relative relational egalitarianism : Justice requires that, at any given moment, people relate socially to one another as equals (Lippert-Rasmussen, 2019: 154).…”

“…Time-relative relational egalitarianism : Justice requires that, at any given moment, people relate socially to one another as equals (Lippert-Rasmussen, 2019: 154).…”

Relational and Distributive Equality

“…The primary reasons, on Bidadanure's view (ch. 1), involve personal responsibility as well as a "common sense" notion of personal identity (for discussion, see Bou-Habib 2011;Lippert-Rasmussen 2019). Many theories of justice hold that differential exercises of responsibility can justify an unequal distribution of goods-if some work harder or make better choices, it is not unjust if they have more than others.…”

“…On the one hand, some relational egalitarians claim that those in the distributive camp have, as it were, "missed the point" of equality (Anderson 1999). On the other hand, some distributive egalitarians claim that relational egalitarian concerns can be incorporated within the distributive approach by including "relational" goods among those to be distributed equally (Cordelli 2015;Gheaus 2018;Lippert-Rasmussen 2018b). Others, including Bidadanure, advocate a hybrid approach: they accept that there is an important difference between the two approaches, and seek to incorporate both of them into a general theory of justice (Bidadanure 2021;Moles and Parr 2019).…”