Health disparities in the US and China

Health disparities across a population are among the most profound indicators of social inequalities that we can find.  And the fact of significant disparities across groups is a devastating statement about the circumstances of justice under which a society functions.  These disparities translate into shorter lives and lower quality of life for whole groups of people, relative to other groups.

Both the United States and China appear to display significant health disparities across their populations. Here are a couple of studies that draw attention to these facts.

United States

Here is an important new study on the question of health disparities in the United States by public health researchers at Harvard and UCSF.  The study is "Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States". And the answer the researchers provide to the question above is that the US possesses very significant health disparities across segments of its population. The study is worth reading in detail.

The authors analyze mortality statistics by county, and they break the data down by incorporating racial and demographic characteristics. The data groups fairly well around the eight Americas mentioned in the title:


Here is how they describe their findings:

The gap between the highest and lowest life expectancies for race-county combinations in the United States is over 35 y. We divided the race-county combinations of the US population into eight distinct groups, referred to as the “eight Americas,” to explore the causes of the disparities that can inform specific public health intervention policies and programs.

And here is their conclusion:

Disparities in mortality across the eight Americas, each consisting of millions or tens of millions of Americans, are enormous by all international standards. The observed disparities in life expectancy cannot be explained by race, income, or basic health-care access and utilization alone. Because policies aimed at reducing fundamental socioeconomic inequalities are currently practically absent in the US, health disparities will have to be at least partly addressed through public health strategies that reduce risk factors for chronic diseases and injuries.

For example, their data show that "the life expectancy gap between the 3.4 million high-risk urban black males and the 5.6 million Asian females was 20.7 y in 2001." This is an enormous difference in longevity for the two groups; and it is a difference that tags fundamental social structures that influence health and risk across these two populations.

Here is a time-series graph of the behavior of longevity for the eight Americas:
So what are the factors that appear to create these extreme differences in mortality across socioeconomic and racial groups in America? They consider health care access and utilization; homicide; accidents; and HIV as primary potential causes of variations in mortality for a group. Most important of all of these factors for the large populations appear to be the health disparities that derive from access and utilization.  And here they offer an important set of recommendations:

Opportunities and interventions to reduce health inequalities include (1) reducing socioeconomic inequalities, which are the distal causes of health inequalities, (2) increasing financial access to health care by decreasing the number of Americans without health plan coverage, (3) removing physical, behavioral, and cultural barriers to health care, (4) reducing disparities in the quality of care, (5) designing public health strategies and interventions to reduce health risks at the level of communities (e.g., changes in urban/neighborhood design to facilitate physical activity and reduce obesity), and (6) designing public health strategies to reduce health risks that target individuals or population subgroups that are not necessarily in the same community (e.g., tobacco taxation or pharmacological interventions for blood pressure and cholesterol).

These findings are squarely relevant to assessing the justice of our society. The country needs to recognize the severity of the "health/mortality equity" issue, and we need to make appropriate policy reforms so that these disparities begin to lessen.

China

Several research papers address these issues for the case of China.  One is a World Bank working paper by David Dollar called "Poverty, Inequality, and Social Disparities During China's Economic Reform" (link).  Dollar notes that China has dramatically reduced its poverty rate over the past 25 years, whereas its income inequality measures have increased sharply during the same period. (Albert Park and Sangui Wang review the poverty statistics for this period in China Economic Review; link.)  They conclude that these inequalities between rural and urban populations, and between well educated urban professionals and the urban working class, have also resulted in significant inequalities in health status and outcomes for the various sub-populations.

Shenglan Tank, Qingyue Meng, Lincoln Chen, Henk Bekedam, Tim Evans, and Margaret Whitehead review the current evidence available on health equity in China in "Tackling the challenges to health equity in China" (link).  "Although health gains have continued, concern for the equitable distribution of social benefits of economic progress has grown" (25).  Further:

Disparities in income and wealth between the urban and rural areas, between the eastern and western regions, and between households have widened substantially. In 1990, the richest province had a GDP per person more than seven times larger than the poorest province, but by 2002, the same ratio had grown to 13 times greater.41The Gini coefficient, a measure of income inequality,42increased for China as a whole from 0·31 in 1978–79 to 0·45 in 2004. The level of income inequality in China is now similar to that in the USA, roughly comparable to that in the most inequitable Asian countries—Philippines and Thailand—and approaching the notoriously inequitable levels in Brazil and Mexico. (29-30)

The authors quote Amartya Sen on health equity (Amartya Sen, Why health equity"; link):

Health equity cannot be concerned only with health in isolation. Rather it must come to grips with the larger issue of fairness and justice in social arrangements, including economic allocations, paying attention to the role of health in human life and freedom.  Health equity is most certainly not just about the distribution of health, not to mention the even narrower focus on the distribution of health care. Indeed, health equity has an enormously wide reach and relevance.

And inequalities in personal income in different provinces lead to highly different levels of ability to fund public amenities in these provinces, with large effects on public health in poor provinces:

Living conditions differ greatly between areas of different affluence. Safe drinking water is available to 96% of the population of large cities but to less than 30% in poor rural areas. Differences in access to effective sanitation are even larger, 90% of residents in large cities have adequate sanitation, compared with less than 10% in poor rural areas (figure 6).

Two graphs capture the big picture:

In figure 1 the data demonstrate a strong correlation between life expectancy and average income for China's provinces and municipalities, from just about 65 years for the poorest regions to 78 years in Shanghai region.  Figure 2 demonstrates major inequalities in child health between rural and urban locations.  The authors further report that infant mortality also varies dramatically across regions: "Rural infant mortality rates are nearly five times higher in the poorest rural counties than in the wealthiest countries -- 123 versus 26 per 1000 live births, respectively" (26). One important source of data on these issues that these researchers use is the Chinese National Health Service survey of 1998; link.

The most detailed analysis of health disparities in China I've been able to find is a paper published in 2010 by Feinian Chen, Yang Yang, and Guangya Liu, "Social Change and Socioeconomic Disparities in Health over the Life Course in China: A Cohort Analysis" (link).  They make use of the China Health and Nutrition Survey to allow for a longitudinal study of health in several segments of China's population. (Here is a description of the CHNS.) Their conclusion:

Using data from the China Health and Nutrition Survey, we find significant socioeconomic status (SES) differences in the mean level of health and that these SES differentials generally diverge over the life course. We also find strong cohort variations in SES disparities in the mean levels of health and health trajectories. (126)

It would appear that studies of health status in China disaggregated by population segments are not yet as fully developed as one would wish.  The CHNS appears to have limited data coverage (much more limited than the national census, for example), and none of the studies mentioned in these articles appear to disaggregate down to levels lower than the province.  But the summary findings of all three of these articles point in the same direction: it is probable that there are significant inter-regional and inter-sectoral inequalities in health outcomes for the sub-populations corresponding to these segments.

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Posted in: CAT_policy,health,justice

How can justice be causal?

Is social justice an empirical characteristic of a set of social arrangements? And can social justice be a causal factor in processes of social change or social stability?

Before justice could be considered an empirical feature of a set of social arrangements, we would need to have a more specific understanding of what we mean by the term. And we would need to be able to "operationalize" this complex concept in order to be able to apply it to different social arrangements. But neither of these tasks is insurmountable; certainly not more so than defining and applying the ideas of fascism, liberal democracy, or welfare state to specific societies.

So let's begin with a simple, applicable definition of justice. Let's focus on just three dimensions of a society's functioning: distribution of access to society's wealth; the degree of abuse of power and its contrary, reliable legal protections of the person; and the extent of individual freedoms. Injustice involves --

• exploitation and inequality
• unwarranted coercion by the state or private organizations
• the abuse of people's freedoms.

A society is more just when it involves less of any of these features. And each of these dimensions seems measurable.

But immediately a problem arises. Each of these features requires a key normative judgement. Exploitation is the unfair division of the fruits of productive activity among the participants. The qualifier "unwarranted" requires that we supply a normative theory of the state. And "abuse" of freedom isn't simply restriction on freedom; it is the unjustified or unequal restriction on freedom. So in order to measure any of these characteristics in a particular social context it isn't enough to know who gets what or who does what to whom; we need a background set of normative ideas that allow us to judge which kinds of treatment and inequality count as exploitation, coercion, or the abuse of freedom.

This is where Amartya Sen's ideas about capabilities, realizations, and freedoms are practical and useful. We might substitute "capabilities realization deficit" for exploitation. Here we might argue that a society that leaves a significant portion of its population in material conditions where they cannot fulfill most of their basic human capabilities is for that reason unjust. We might measure the gap in human development between the top quintile and the bottom quintile as an estimate of the degree of exploitation that is prevalent in a given society. We may not know in detail how the system of distribution works, but the severity of the gap gives reason to believe that a portion of the society is being treated unfairly.  The Human Development Index provides a basis for beginning to assess different countries along these lines (link).

Second, we might measure coercion and legality by the estimating the degree to which a society has effectively implemented a working system of law that is applied equally. The World Bank has made some efforts in this direction through its Worldwide Governance Indicators (link; working paper here).  This gives us an empirical measure of the degree of lawlessness and unchecked state power that exists in various societies.

We might measure freedoms by aggregating observable features of democratic participation in various societies.  The Economist has constructed a Democracy Index that was first implemented in 2006 (link). This gives us an empirical way of assessing the rough degree of involvement citizens can have in public decision-making; or in other words, it is a measure of the degree to which it is possible for citizens to exercise their freedoms in a public space.

So we might imagine a "justice index" for a society that aggregates measures like these into an overall assessment of the degree of justice the society currently demonstrates.  It would then be interesting to see how societies differ in this measure, and how other important social characteristics may be correlated with this measure.  I haven't done this experiment, but here's what we might expect: higher injustice ratings correspond to greater likelihood of social conflict, lower productivity, and lower community and civic engagement.

What mechanisms might be hypothesized that would originate in these core aspects of a society's justice profile and its various outcomes?  Here we can identify a couple of factors that would support a causal interpretation.  For example, absolute or relative deprivation can cause people to rebel as they struggle to create social changes that protect their interests.  Further, as Barrington Moore demonstrated in Injustice, the conviction that basic social arrangements are unfair can also move people to activism and resistance -- as we seem to be seeing in the Occupy Wall Street movement.  These factors derive from the distributive arrangements of a society: injustice can provoke resistance.  Similar statements can be made about state violence and lawlessness. We have seen in Libya, Syria, and Morocco that state violence against protesters can actually have the effect of strengthening and broadening resistance.

So these aspects of injustice can have effects on mobilization and resistance by a population. Are there other effects that injustice can have?  As noted earlier (link), Pickett and Wilkinson argue in The Spirit Level: Why Greater Equality Makes Societies Stronger that inequalities of income have surprisingly strong associations with a variety of social ills.  This could be developed into an argument that social justice and injustice lead to behaviors that either promote or undermine social welfare.

Finally, it seems plausible to imagine that the intangibles that accompany a harmonious society -- a population of people who generally feel that they are fairly treated by their basic institutions and their fellow citizens -- will lead to a variety of other social goods, including cooperation, civic engagement, and economic productivity.  Conversely, it is plausible to suppose that a dis-harmonious society would give rise to the negatives of these qualities: less cooperation, less civic involvement, and less economic productivity.

So two things seem true.  First, it does seem possible to "measure" injustice (supported, of course, by a normative theory of why various kinds of inequality are illegitimate).  And second, it does seem plausible that the features of a society that constitute its injustice may also have causal consequences for social unrest, social wellbeing, and social cooperation.  And these are certainly significant social consequences.

(Perhaps there is an analogous set of questions at the individual level: Is "virtue" a specific empirical characteristic of a person's character? And can virtue be a causal factor in the individual's life outcomes and level of happiness?)

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Posted in: CAT_moraltheory,inequality,justice

Rawls's framework for global justice

Rawls's A Theory of Justice was immediately received as a major and progressive contribution to the theory of justice within existing societies. His Law of Peoples (1999) was intended to carry his basic ideas about justice to the international realm.  (Here is a PDF of a preliminary version of the title essay of the book as published in Critical Inquiry in 1993.) Here is how he defined the goal of a law of peoples in 1993:

The law of peoples ... is a family of political concepts along with principles of right justice, and the common good that specify the content of a liberal conception of justice worked up to extend to and apply to international law. It provides the concepts and principles by reference to which that law is to be judged. (43)

In contrast to the reception A Theory of Justice received, his work on the international part of the theory has not had much influence, and was roundly criticized for being too accepting of international inequalities.   Philip Pettit put the point this way in his contribution to Rex Martin and David Reidy's Rawls's Law of Peoples: A Realistic Utopia:

John Rawls's work on the law of peoples is notorious for its anti-cosmopolitan stance: roughly, its insistence that those of us in well-ordered societies do not owe to the members of other societies the sort of justice we owe to one another. (38)

This is exactly the critique that Philippe van Parijs offered to Rawls prior to publication of the book (link).

Given that Rawls's intuitions seem to have been solidly progressive in other spheres, it is worth considering why he took this very limited view of the obligations of justice in the global context. Why did he begin with the perspective of peoples rather than persons?  (Here I'll make use of the 1993 statements of the view.)

A number of the critics put their cases in terms of Rawls's anti-cosmopolitanism.  "Cosmopolitanism" is the view that we are all citizens of the world, and we have positive moral relationships with each other no matter what nation issues our passports.  No one would deny that everyone has some kinds of moral relationships to everyone else -- for example, the obligation not to impose harm on innocent people.  But cosmopolitanism extends to the idea of positive obligations -- the obligation to render assistance as well as the obligation to refrain from gratuitous harm.  The contrary to cosmopolitanism might be called "nationalism", but this implies assumptions that Rawls would presumably not have accepted.  So let's call it "bounded people-ism": the claims of justice that a person has against other persons extend only to other members of his/her people and government.

One deep reason for the direction that Rawls took was the assumption he made about how to make use of the original position and the veil of ignorance in arriving at principles of international justice.  If this framework involved all human beings, then the results would have been very similar to the argument made in the case of a well-ordered society: inequalities need to be the least system possible consistent with maximizing the position of the least-well-off stratum of society.  However, Rawls chose instead to include "peoples" rather than "persons" in the argument from the original position in the case of international justice. What is a people?

By peoples I mean persons and their dependents seen as a corporate body and as organized by their political institutions, which establish the powers of government. In democratic societies persons will be citizens; in hierarchical and other societies they will be members. (41)

And he directly addresses the question of why it should be peoples rather than persons whose perspectives are represented in the original position for international justice:

Wouldn't it be better to start with the world as a whole, with a global original position, so to speak, and discuss the question whether, and in what form, there should be states, or peoples, at all? ... I think there is no clear initial answer to this question. We should try various alternatives and weigh their pluses and minuses. Since in working out justice as fairness I begin with domestic society, I shall continue from there as if what has been done so far is more or less sound. So I simply build on the steps taken until now, as this seems to provide a suitable starting point for the extension to the law of peoples. A further reason for proceeding thus is that peoples as corporate bodies organized by their governments now exist in some form all over the world. (42-43)

So his reasons for beginning with this premise are, first, we have to start somewhere and there isn't a philosophically compelling reason to favor persons over peoples in this setting; and second, peoples (and states) exist as actors in the world, so it is feasible to begin the analysis at this level. This way of formulating the original position is designed to establish fair terms of interaction between societies -- or in other words,

... fair conditions under which the parties, this time as representatives of societies well ordered by liberal conceptions of justice, are to specify the laws of peoples and the fair terms of their cooperation. (45)

This formulation, of course, immediately precludes certain questions, including all questions of difference in outcomes for the least-well-off in the various societies.  The fact that the LWO in country X are worse off than the LWO in country Y cannot be a factor in this deliberation, and therefore there cannot emerge a positive obligation to transfer resources from society Y to X to ameliorate this difference.

Here are the principles that Rawls arrives at through this construction:

1. Peoples (as organized by their governments) are free and independent, and their freedom and independence is to be respected by other peoples.
2. Peoples are equal and parties to their own agreements.
3. Peoples have the right of self-defense but no right to war.
4. Peoples are to observe a duty of nonintervention.
5. Peoples are to observe treaties and undertakings.
6. Peoples are to observe certain specified restrictions on the conduct of war (assumed to be in self-defense).
7. Peoples are to honor human rights. (46)

In the final version of the argument in 1997 he adds a final principle:

8. Peoples have a duty to assist other peoples living under unfavorable conditions that prevent their having a just or decent political and social regime.

Later in 1993 he comments on the idea of a human right:

Human rights have, then, these three roles:
1. Their being fulfilled is a necessary condition of a regime's legitimacy and of the decency of its legal order.
2. Their fulfillment is also sufficient to exclude justified and forceful intervention by other peoples, say by economic sanctions or, in grave cases, by military force.
3. "They set a moral limit to pluralism" among peoples. (59)

Several things are evident from these lists.  First, the obligations represented here are indeed minimalist; basically, they are limitations on the use of coercive means by peoples (states) to achieve their ends.  Even the 8th principle added in the 1997 version creates an obligation only to assist other peoples in achieving a just political regime.  Second, there are no requirements of distributive justice in this list of principles.  Each society has internal requirements of distributive justice; but there is no inter-society requirement of distributive justice.  The fact that there are large inequalities of resources between countries is not a basis for a claim of injustice, according to these principles.

This framework has been strongly criticized by philosophers and others who found that it was far too accepting of global inequalities.  Alan Buchanan focuses on the global inequality part of the story in his 2000 contribution in Ethics. Buchanan holds that even representatives of peoples would not have overlooked the significant inequalities imposed on peoples by the global economic system.  He maintains that the original position concerned with international justice would have to take into account two important facts:

There is a global basic structure, which, like the domestic basic structure, is an important subject of justice because it has profound and enduring effects on the prospects of individuals and groups, including peoples in Rawls's sense.

The populations of states are not "peoples" in Rawls's sense and are not likely to become so without massive, unjustifiable coercion, but rather are often conflicting collections of "peoples" and other groups. (700-1) 

The first fact, if recognized, would ensure that the international original position would necessarily take into account the inequalities created by this system for different peoples.  He also believes that the second fact raises salient issues for the international original position.  Essentially the issue here is this: what happens when the multiple peoples of a single state come into conflict? By making the assumptions that "peoples within unified states" are the agents within the international original position, Rawls makes it impossible to arrive at principles of international justice that would specify just behavior in the face of civil war or secessionist movements. This approach makes it impossible to address intrastate conflict.

Tom Pogge extends his own critique of Rawls's position on international distributive justice in a Fordham Law Review article (link) (also included in Martin and Reidy's Rawls's Law of Peoples: A Realistic Utopia).  Fundamentally, Pogge is highly critical of Rawls's failure to arrive at an international theory of justice that provides a basis for critique of global inequalities. In this piece he argues that Rawls's two theories are in fact inconsistent with each other.

As indicated above, much of this body of criticism has to do with the view that Rawls's Law of Peoples creates only the most limited obligations across peoples.  His view is not "cosmopolitan".  But a more fundamental criticism, which Buchanan hints at, is that there is a major strand of injustice embedded within the world system that is wholly invisible within Rawls's formulation of the law of peoples.  This is the fact that global institutions may create systematically imbalanced economic relations among states, with the result that some states are in a position to take unfair advantage of other states. This is a form of injustice that would not be accepted within the terms of a domestic society. But there is no basis within the framework of the law of peoples to identify and criticize these types of injustices.

These criticisms are surely correct.  As a theory of global justice, the Law of Peoples doesn't begin to provide enough of a normative basis to arrive at sound judgments about international arrangements.  I began by asking how it came to pass that Rawls presented such a limited theory of international justice. The best answer I can offer is that he was focusing on the wrong issues.  He focused on issues of war and interstate violence, and he did not sufficiently bring into his view the empirical realities associated with a highly unequal world economic structure.  And this is puzzling, since questions of global inequalities -- of resources, of power, and of self-determination -- were certainly widely debated at Harvard in the 1970s and 1980s while Rawls's thinking on this subject was developing.

(In addition to critics, Rawls has some defenders in this area.  Samuel Freeman provides an extensive and reasoned response to many of these criticisms of Rawls's theory of international justice here (link).)

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Posted in: CAT_moraltheory,globalization,justice,Rawls

The Racial Equity dividend

Racial justice organizations around the United States are struggling to find the resources from the corporate and foundation worlds needed to support their continuing work. One part of the problem seems to be that business leaders simply aren't convinced that racial inequalities are a fundamental and debilitating problem in the United States that presents a concrete threat to their own business activities. The issue has fallen off the first page of the priority list. This suggest that we need to revisit some of the costs that the structures of racial inequity are imposing on regions and cities.

The social costs of persistent racial inequity come in many dimensions. But particularly persuasive is the issue of the actual economic costs that these inequities impose on a region. We might put the point this way: racial inequities are an economic drag on a region, blocking the production of wealth and income and slowing down economic growth. Is it possible to estimate the magnitude of these hidden economic costs of continuing racial inequity?

Let's think about this problem in the context of southeast Michigan and its major city, Detroit. What would southeast Michigan look like if the racial gaps of the region were erased? The gaps that exist between white and black citizens in the region are well documented. Residential segregation is extreme. Unemployment levels are dramatically higher for African-American youth and adults. Health disparities are large and debilitating. Educational outcomes are significantly worse for African-American young people, including high school graduation rates and college attendance. And, of course, family and individual incomes and wealth levels are substantially different.

So imagine a different scenario: a region in which residential segregation has ended. Schooling outcomes are equal for white and black students. Health disparities have disappeared. Employment rates have equalized. And average incomes, wealth holdings, and employment rates have converged across races. Plainly this would be socially desirable outcome; it would be a great improvement in social justice. But what would the economic effects be? How much new income and wealth would this scenario represent over the present situation?

We might approach this question directly, by estimating the aggregate income created by bringing 40% of the population up to the per capita income of the majority population. Likewise we could estimate the aggregate wealth that would be needed in order to equalize the wealth gap. Nationally black households in 2010 earned only 58% of the income of white households (link). I don't have full data for Wayne County at hand, but if the ratio is roughly similar, this implies roughly a $20,000 gap in Wayne County household income between white and black households, which aggregates to almost $6 billion in lost income as a result of racial inequity. If the social factors leading to this inequity were eliminated, this would add $6 billion to the county's income, consumption, and savings. (These are back-of-the envelope estimates, of course, and should be taken only as illustrative of the magnitude of the problem. Here are some basic demographic and income data for Wayne County based on census results; link.)

This scenario presupposes economic growth and jobs growth, but this assumption is supported by the large increase in the talent and education level of the population. We would also need to estimate the economic benefits associated with improved health status for the African-American population -- likewise a large number that public health researchers have probably already estimated. It is well understood in the field of global public health that improving a population's health status also improves its productivity. (Here is a study sponsored by the Kellogg Foundation that tries to estimate these costs and benefits. Nationally the costs associated with racial disparities in health are estimated in the trillions.)

Another approach to this issue would be to follow the lead of CEOs for Cities in attempting to estimate the "talent dividend" (link): do an econometric study of cities measuring degree of racial difference and per capita income. This would be the "racial equity dividend." I don't know if there is a recognized metric that already exists for measuring racial gaps in metropolitan regions, but it shouldn't be hard to construct. It should include components reflecting segregation, income, schooling, and health -- kind of a Human Development Index for Regional Racial Equity. We could then plot racial inequity against per capita income to see whether there is a relationship between these variables. I don't know the answer, but I'd bet there is such a relationship. This would be a genuinely interesting piece of social research. And it might help communities realize the core importance of attacking their regional issues when it comes to racial equity. (I would love to know from Richard Florida whether there is any work available on this question in his research on cities.)

This whole line of thought depends on a hidden premise: that the racial gaps that exist in the metro regions of our country derive ultimately from racialized social and economic institutions that systematically produce and reproduce these racialized outcomes. This is what we once referred to as "institutionalized racism", though the term now sounds dated. It represents the systemic ways in which African-American people are tracked into lower social outcomes in health, education, employment, and income and wealth. Justice requires that we at long last dissolve those institutional tracks. But the economic health of the country demands no less as well. And it is in the best interest of corporations and foundations to support these efforts in their home cities and regions.

(Here is a series in the Detroit News on the costs of segregation; link.)

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Posted in: CAT_policy,justice,race

Is justice a security issue?

Most people would probably say they would prefer to live in a more just world to a less just one. There is a strong moral basis for preferring justice. But is this a consideration that states and large international organizations need to take into account as they design their strategies and plans for serving their present and future interests? Do national governments have good practical reasons to think about the consequences their policies and actions may have on the circumstances of justice in the world? What about policies and actions through which states attempt to secure their future economic wellbeing -- do policy makers need to pay attention to the social justice consequences of these actions?

There is a strong empirical and historical case for thinking that the answer to this question is "yes." Injustice is a source of resentment, indignation, and conflict. In the long run, the victims of injustice will not be ignored. Justice is a security issue for states and supra-national organizations, and simple prudence demands that policy makers take it into account. To put a simple label on this idea, justice is a security issue.

Here is a European Union statement about its longterm interests that makes this point fairly explicitly (link):

In the context of ever-increasing globalisation, the internal and external aspects of security are inextricably linked. Flows of trade and investment, the development of technology and the spread of democracy have brought prosperity and freedom to many people, while others have perceived globalisation as a cause of frustration and injustice. In much of the developing world, poverty and diseases such as AIDS give rise to security concerns, and in many cases economic failure is linked to political problems and violent conflict. Security is a precondition for development. Competition for natural resources is likely to create further turbulence. Energy dependence is a special concern for Europe.

What are the theoretical and historical arguments for this conclusion? Here are several.

On the side of theory, several points are well established. Chronic and unrelieved poverty leaves people with low attachment to their own societies and less for the global community. The frustration of very basic human needs is bound to fuel indignation and resistance. So poverty and deprivation are causes of resistance. But there is also evidence that inequality itself has negative consequences for a society's health; this is the central finding of The Spirit Level: Why Greater Equality Makes Societies Stronger (link). Finally, the social psychology created by a system that is perceived to be unfair and exploitative is likely to breed resistance and lawless action. Barrington Moore, Jr. was right when in Injustice he wrote:

Without strong moral feelings and indignation human beings will not act against the social order. In this sense moral convictions become an equally necessary element for changing the social order, along with alterations in the economic structure. 469

Gareth Stedman-Jones summarizes Barrington Moore's conclusion in these terms: "His argument is that human beings in stratified societies accept hierarchies of authority, so long as these hierarchies are not merely imposed by force, but based upon an 'unwritten' social contract, which binds together dominant and subordinate groups in a set of mutual obligations" (link).

So there are good empirical reasons, based in social psychology and the study of contentious politics, for expecting that injustice breeds conflict.

Are there historical demonstrations of the consequences of injustice for disorder? There are. We have the examples of slave revolts throughout the Americas in the 18th and 19th centuries; anti-colonial movements in Africa and Asia following World War II; the sustained resistance of the Burmese and East Timor peoples to dictatorship; and the sustained struggle for equal rights in the United States by African Americans, sometimes punctuated by major urban riots. In each case a set of social institutions had been created that were profoundly unjust for a sizable population, and this population gathered resolve and courage in opposing those arrangements.

So the conclusion seems clear. If we want to have a world in which there is a sustainable level of the rule of law and a low level of social conflict, we need to invest in justice. We need to work to create a system in which all peoples can satisfy their most basic human needs; where everyone can feel that he/she is respected in her humanity; and where no one judges that the basic structure of social life is exploitative.

In other words, states are well advised to actively include the basic requirements of justice in their plans for the future. Otherwise they are simply creating the tinder for future conflict.

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Posted in: CAT_globalization,globalization,justice,labor rights,poverty

Rawls on the EU

During the final preparation of The Law of Peoples: with "The Idea of Public Reason Revisited" John Rawls had extensive interaction with Philippe van Parijs. Van Parijs was particularly interested in the political and legal circumstances surrounding the establishment of the legal structure of the European Union and the obligations states and their citizens would have to each other within the EU. A key question is whether a political body -- a state or confederation -- needs to encompass a single unified "people" (whether by language, traditions, or culture); or if, on the contrary, such a body can consist of multiple peoples who nonetheless have duties of justice to each other.

What turns on this from a moral point of view is the level of moral concern that members of this kind of union owe each other. Are their obligations limited to the domain of "concern" that gives rise to some obligations of charity? Or are they closely enough interconnected that they are subject to the demands of justice towards each other? If the latter then the difference principle applies to them when inequalities of life circumstances are apparent. If the former then only weaker principles of assistance apply.

For van Parijs this question is particularly acute in the case of Belgium, which was even then subject to fissional pressures along linguistic-cultural lines between Flemings and Walloons.

Van Parijs and Rawls exchanged several careful and thoughtful letters on these issues in 1998, and these letters were published in their entirety in Revue de philosophie économique in 2003 (link).

The disagreements between van Parijs and Rawls are very interesting to follow in detail. There is one aspect of the exchange that is particularly intriguing on the subject of Rawls's own assessment of modern capitalism. The passage is worth quoting. Here is an excerpt from Rawls's letter:

One question the Europeans should ask themselves, if I may hazard a suggestion, is how far–reaching they want their union to be. It seems to me that much would be lost if the European union became a federal union like the United States. Here there is a common language of political discourse and a ready willingness to move from one state to another. Isn't there a conflict between a large free and open market comprising all of Europe and the individual nation-states, each with its separate political and social institutions, historical memories, and forms and traditions of social policy. Surely these are great value to the citizens of these countries and give meaning to their life. The large open market including all of Europe is aim of the large banks and the capitalist business class whose main goal is simply larger profit. The idea of economic growth, onwards and upwards, with no specific end in sight, fits this class perfectly. If they speak about distribution, it is [al]most always in terms of trickle down. The long–term result of this — which we already have in the United States — is a civil society awash in a meaningless consumerism of some kind. I can't believe that that is what you want.

So you see that I am not happy about globalization as the banks and business class are pushing it. I accept Mill's idea of the stationary state as described by him in Bk. IV, Ch. 6 of his Principles of Political Economy (1848). (I am adding a footnote in §15 to say this, in case the reader hadn't noticed it). I am under no illusion that its time will ever come – certainly not soon – but it is possible, and hence it has a place in what I call the idea of realistic utopia.

Several aspects of this passage are noteworthy. The first is a tentative skepticism about the goal of creating a European community in a strong sense -- a polity in which individuals have strong obligations to all other citizens within the full scope of the expanded boundaries. Rawls seems to equate this goal with the idea of creating a somewhat homogeneous and pervasive European culture, replacing German, French, or Italian national cultures. And he offers the idea that the traditions, affinities, and loyalties associated with national identities are important aspects of an individual's pride and satisfaction with his/her life.

What is surprising about these views is that Rawls seems to overlook the polyglot, poly-cultural character of the United States and Canada themselves. Both North American countries seem to have created some remarkable solutions to the problem of "unity with difference." It is possible to be a committed United States citizen but also a Chicago Polish patriot, a Los Angeles Muslim, or a Mississippi African American. Each of these is a separate community with its own traditions and values. But each can also embody an overlay of civic culture that makes them all Americans. It certainly doesn't seem impossible to imagine that Spaniards will develop a more complex identity, as both Spaniard and European. So Rawls's apparent concerns about homogenization and loss of collective meaning seem ill founded.

Even more interesting, though, are his several comments about globalization and capitalism. As we observed in a post about the property-owning democracy (link), Rawls has already expressed the idea that capitalism has a hard time living up to the principles of justice. Here he goes a step further and reveals a significant mistrust of the value system created by capitalism. He refers to the world the "bankers and capitalists" want to create -- one based on acquisitiveness and the pursuit of profit -- and he clearly expresses his opinion that this is incompatible with a truly human life.

The goal of perpetual growth expresses this ideology, and Rawls reveals his skepticism about this idea as well. He offers the opinion that the pursuit of growth by this class is no more than the pursuit of greater wealth and more meaningless consumption. And he clearly believes this is a dead-end. Instead, he endorses J. S. Mill's idea of a steady-state (link). (Interestingly, this position lines up well with current thinking of environmentalists; for example, James Gustave Speth and The Bridge at the Edge of the World: Capitalism, the Environment, and Crossing from Crisis to Sustainability (link).)

Here Rawls seems to express a cultural critique of capitalism: the idea that the driving values of a market society induce a social psychology of consumerism that overrides the individual's ability to construct a thoughtful life plan of his/her own.

Finally, Rawls criticizes the neo-liberal dogmas about distribution of income that had dominated public discourse in the U.S. almost since the publication of A Theory of Justice: the theory of trickle-down economics. That theory holds that everyone will gain when businesses make more profits. And, of course, the data on income distribution in the U.S. since 1980 has flatly refuted that theory (link).

(Van Parijs' most recent book, Linguistic Justice for Europe and for the World (Oxford Political Theory), will be published in October. It is highly relevant to this debate with Rawls.)

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Posted in: CAT_moraltheory,justice,Rawls

The moral basis for an extensive state

A recent post focused on the conception of society involved in seventeenth and eighteenth English political thinking, the theory of possessive individualism.  The post suggested that this conception has a lot of resonance with the ideas and rhetoric of the Tea Party today.  I've also posted a number of discussions of the social ideals of John Rawls (link, link), expressing a liberal democratic view of the good society.  These posts remind me how important it is to have some fairly specific ideas about how we would want society to be organized in the future, so we can also have some ideas about current reforms that might take us in that direction.  And today we don't seem to have a lot of clarity about this kind of vision, especially on the progressive side of the political spectrum.

The ideal that seems to lie behind the conservative Tea Party political philosophy is simple but alarming:

1. Citizens should have maximum possible liberties of activity and use of property.


2. Citizens have no positive obligations to other citizens, beyond those associated with respecting liberties and property rights.


3. The state exists only to secure the liberties and security of citizens; this means the state needs to have funds to provide for national defense, enforcement of property rights, and maintenance of public order.


4. The state has no legitimate basis for creating more extensive regulations on the exercise of liberty and property (FDA, EPA, regulation of banks, …).  Such regulations represent an unjustified interference with the exercise of private property rights.


5. The state has no legitimate basis for using tax moneys to provide a social safety net (unemployment payments, welfare payments, food and housing subsidies, …).  Such transfer programs represent an unjustified system of redistribution of wealth and income that violates the property rights of anyone who is taxed more extensively than a fair share of the costs of providing for national defense and maintenance of public order.

This political philosophy is familiar from Robert Nozick's Anarchy, State, and Utopia (1974).  At the time Nozick's vision was considered extreme from a philosophical point of view; it took to a logical limit the very limited assumptions about individual rights that were a part of the Lockean tradition of political philosophy, and arrived at what was then a very startling set of conclusions about the limits on legitimate state action.  Nozick referred to this conception as the "minimal state".  Nozick's philosophy expressed a form of libertarian conservativism, with no inclination towards the "social values" of more recent conservatism.

If this political philosophy were to be enacted through legislation, it would imply a number of things: abolition of mandatory social security, abolition of regulatory agencies like EPA and FDA, abolition of unemployment benefits and poverty-based welfare programs, and dramatic reduction of taxes on the affluent.  This is a vision of the minimal state with a vengeance; and it seems rather familiar from much of the rhetoric offered by Tea Party activists and Republican presidential candidates alike.

We could spend time thinking about the deficiencies of this political philosophy from a number of points of view.  Here my interest is different; I'd like to consider what components might go into a political philosophy that expresses a moral justification for the more extensive state that a great many Americans would want to have. First, what are the institutional arrangements that might be considered?

A strong alternative to the minimal state is the Nordic model -- essentially the political and economic system associated with Scandinavian democracies in the 1960s through the 1980s.  Here is an interesting monograph on the economic and social characteristics of the Nordic model: The Nordic Model: Embracing globalization and sharing risks (Torben M. Andersen, Bengt Holmström, Seppo Honkapohja, Sixten Korkman, Hans Tson Söderström, Juhana Vartiainen; published by the Research Institute of the Finnish Economy); link.  The authors describe the key economic and social commitments of the Nordic model in these terms:

• a comprehensive welfare state with an emphasis on transfers to households and publicly provided social services financed by taxes, which are high notably for wage income and consumption;


• a lot of public and/or private spending on investment in human capital, including child care and education as well as research and development (R&D);


• and a set of labour market institutions that include strong labour unions and employer associations, significant elements of wage coordination, relatively generous unemployment benefits and a prominent role for active labour market policies. (13)

A key goal of the study is to assess the economic performance of the Nordic model over the past fifty years.  The study's summary conclusion is very favorable: contrary to anti-tax, anti-government ideology, the Nordic economies have performed very well.

The Nordic countries have, according to many indicators, succeeded relatively well in fulfilling their social ambitions. Recently, this has been combined with a satisfactory economic performance in terms of employment and productivity levels as well as growth of GDP per capita. Also, the macroeconomic balance is good and public finances are strong. There is indeed a Nordic success story in the sense of a favourable combination of economic efficiency and social equality. 

True, the Nordics went through a period of low productivity growth in the 1970s (like most other OECD countries) as well as a major financial and macroeconomic crisis with very high unemployment rates and large fiscal imbalances in the early 1990s (somewhat earlier and less dramatically in the case of Denmark). But even so, the Nordics have more or less managed to keep up with the US in terms of PPP-adjusted GDP over the last 25–30 years, which is more than can be said of most other EU15 countries. The longterm performance is mainly recorded as a high rate of total factor productivity growth. This indicates that technical progress, notably in the area of information and communication technology (IT), has played in important role in growth. More importantly, it also shows that the Nordics – contrary to popular belief – demonstrate a high degree of economic flexibility and capacity of structural change. The macroeconomic crises have helped the process by inducing growth-enhancing changes in structural policies (and, for a while, through the improvements of competitiveness caused by large depreciations in the early 1990s). (15)

These are social and economic arrangements that establish an active state, a state with broad responsibilities to the welfare of its citizens, and a state that calls upon a significant fraction of the wealth of society to do its work.  What are the moral principles that might underly such a conception of a good society?  Here are a few axioms that seem to be worth considering within such a political philosophy.

1. Society is a system of interdependency and mutual benefit for all citizens. Everyone benefits from being part of a just society.


2. The moral situation of individuals in society includes several important components:


1. Individuals within society have rights, liberties, and needs for personal security.


2. Individuals have obligations to each other to help prevent hardship and to facilitate full human development. These obligations derive from at least two sources: (a) the benefits we all enjoy as a result of social cooperation in a functioning society; and (b) the moral recognition we have of the equal human worth and dignity of fellow citizens.


3. Individuals within society have universal needs to facilitate their full human development and functioning, including education, health care, housing, and adequate nutrition.


3. Certain core functions for the state follow from these moral ideas:


1. The state is obligated to create a system of law that protects the rights, liberties, and security needs of all citizens.


2. The state is obligated to serve as one of the important vehicles through which our positive obligations to other citizens are honored. 


1. The state needs to ensure that all citizens have access to education, healthcare, and the essentials of life.


2. The state needs to provide a safety net for citizens whose earnings within the market economy leave them unable to provide for a decent standard of living.


3. The state is obligated to protect the public from the harmful effects of private activities, including regulations concerning health and safety, conditions of labor, and environmental harms.


4. A handful of moral constraints surround the policies and laws the state may adopt:


1. The state is authorized to collect taxes to efficiently perform its functions of protecting rights, securing welfare, and regulating harmful activities.


2. The state is obligated to be procedurally just and economically efficient in its administration of public programs.


3. The policies and laws of the state need to be adopted through a democratic process in which all citizens have equal voice.

This formulation highlights a cluster of values that can potentially gain wide support within a democracy: the equal worth of all individuals, the importance of liberty, the importance of a range of social obligations all citizens have to each other, and the idea that the state needs to be articulated in such a way as to embody these moral ideas.

If the theory of the minimal state owes much of its content to John Locke, the more extensive state described here owes much of its moral rationale to Jean-Jacques Rousseau.  Rousseau brought the moral perspective of the "individual within community" into the foundations of political philosophy.  Josh Cohen's Rousseau: A Free Community of Equals provides an excellent discussion of Rousseau's political theory; link.

(Gosta Esping-Andersen has studied the politics and policies of social democracies through a lifetime of writing. Especially important are The Three Worlds of Welfare Capitalism and Politics Against Markets: The Social Democratic Road to Power.)

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Posted in: CAT_policy,inequality,justice

Possessive individualism

C. B. Macpherson was a political philosopher who placed a genuinely novel interpretation on the history of political thought in The Political Theory of Possessive Individualism: Hobbes to Locke when the book appeared in 1962. Macpherson was a Canadian philosopher who influenced quite a few young scholars in the 1970s in North America and Great Britain. Macpherson offered the basis of a strong critique of a certain kind of liberalism -- the liberalism that places essentially the whole normative weight on the value of the individual and his/her liberties, and essentially no emphasis on the social obligations we all have towards each other. A first wave of criticism of narrow liberalism took this form:

The repair that was needed [to liberal theory] was one that would bring back a sense of the moral worth of the individual, and combine it again with a sense of the moral value of community, which had been present in some measure in the Puritan and Lockean theory. (2)

But Macpherson feels the need to go further:

The present study … suggests that the difficulties of modern liberal-democratic theory lie deeper than had been thought, that the original seventeenth-century individualism contained the central difficulty, which lay in its possessive quality. Its possessive quality is found in its conception of the individual as essentially the proprietor of his own person or capacities, owing nothing to society for them. The individual was seen neither as a moral whole, nor as part of larger social whole, but as an owner of himself. The relation of ownership, having become for more and more men the critically important relation determining their actual freedom and actual prospect of realizing their full potentialities, was read back into the nature of the individual. the individual, it was thought, is free inasmuch as he is proprietor of his person and capacities. The human essence is freedom from dependence on the wills of others, and freedom is a function of possession. Society becomes a lot of free equal individuals related to each other as proprietors of their own capacities and of what they have acquired by their exercise. Society consists of exchange between proprietors. (3)

The individualism that Macpherson identifies is of a specific sort; it is "possessive" individualism. What does Macpherson mean by this? Here we have the heart of the theory of possessive individualism: the individual as solely an owner of himself. Here is his formulation late in the book:

1. What makes a man human is freedom from dependence on the wills of others.
2. Freedom from dependence on others means freedom from any relations with others except those relations which the individual enters voluntarily with a view to his own interest.
3. The individual is essentially the proprietor of his own person and capacities, for which he owes nothing to society.
4. Although the individual cannot alienate the whole o fhis property in his own person, he may alienate his capacity to labour.
5. Human society consists of a series of market relations.
6. Since freedom from the wills of others is what makes a man human, each individual's freedom can rightfully be limited only by such obligations and rules as are necessary to secure the same freedoms for others.
7. Political society is a human contrivance for the protection of the individual's property in his person and goods, and (therefore) for the maintenance of orderly relations of exchange between individuals regarded as proprietors of themselves. (263-4)

The core of the book is a set of interpretive chapters on Hobbes, Locke, the Levellers, and Harrington. These chapters are careful, detailed, and closely textual and contextual. The book puts forward a fairly simple theory: the British tradition of political philosophy expresses a rather particular ideology that is pre-philosophical. The ideology (possessive individualism) is a very specific conception of the individual and his/her roles in the social world. The philosophical theories that are built on that ideology give shape to that set of assumptions, but they are ill suited to recognizing or critiquing those assumptions. Macpherson highlights the interpretive challenge of discovering these underlying assumptions: "Where a writer can take it for granted that his readers will share some of his assumptions, he will see no need to set these out at the points in his argument where we, who do not share those assumptions automatically, think they should have been stated to make the argument complete" (5).

What is the social context of this ideology? It is the reality of market society:

These assumptions do correspond substantially to the actual relations of a market society. (4)

One of Macpherson's more indirect goals in his philosophy is to provide an intellectually sound foundation for the liberal democratic state -- a state that recognizes the worth of the individual while also recognizing the social obligations that we all have towards each other and that need to be expressed through the social programs of the state. Fundamentally, Macpherson is interested in helping formulate a political theory that lays a powerful normative base for social democracy.

Macpherson's interpretation of Hobbes's philosophy provides an interesting discussion of "models of society" that is worth drawing attention to. He suggests that Hobbes formulates three models of society: customary or status society; simple market society; and possessive market society (47-48).

The concept of possessive market society is neither a novel nor an arbitrary construction. It is clearly similar to the concepts of bourgeois or capitalist society used by Marx, Weber, Sombart, and others, who have made the existence of a market in labour a criterion of capitalism, and like their concepts it is intended to be a model or ideal type to which modern (i.e. post-feudal) European societies have approximated. (48)

What Macpherson means by a model here needs some careful interpretation. He refers to it as an "ideal type" in this passage. More specifically, a model is a specification of several key structural features of a social order. Here is the model of a customary or status society:

1. The productive and regulative work of the society is authoritatively allocated to groups, ranks, classes, or persons.
2. Each group, rank, class, or person is confined to a way of working, and is given and permitted only to have a scale of reward...
3. There is no unconditional individual property in land.
4. The whole labour force is tied to the land, or to the performance of allotted functions, or (in the case of slaves) to masters. (49)

Macpherson thinks that these four characteristics create a specific form of system behavior for societies that embody them: "From these properties of a status society certain characteristics follow" (49).

The most complex model is the possessive market society, with postulates defining allocation of work, rewards for work, enforcement of contract, individual rational maximizing, individual's property in his labour, individual ownership of land, individuals want more utility or power, individuals have differential energy, skill, or possessions. With these postulates (including institutions and actors), we get a certain kind of social functioning. This is an "aggregation dynamics" argument. In other terms, it is a micro-to-macro argument up the struts of Coleman's boat.

It is worthwhile drawing out the connections between possessive individualism and conservative libertarian political groups in the present. The Tea Party seems to be a contemporary descendant of this ideology. Taxation is theft; the state has no legitimate role beyond protecting individual security and property; government regulation of private business activity is an immoral intrusion on liberty and property; individuals possess liberties and property that the state cannot limit; individuals deserve what they own and owe nothing to society or other citizens. Justice is served by simply protecting the possessions of individual citizens. Robert Nozick seems to have represented many of these values in Anarchy, State, and Utopia.

Those who favor a more expansive vision of a democratic society have several core values that conflict with these: Individuals have obligations to other members of society; government has the responsibility of protecting the wellbeing of the least advantaged in society; government has the responsibility of protecting the public good against harmful effects of private activities; decisions about public policies can and should be made through effective institutions of democratic self-determination; inequalities of wealth and power need to be restrained to ensure the political voice of the whole of society. Taxation is legitimate for at least three different reasons: it is a legitimate policy tool for limiting wealth inequalities to levels consistent with democratic equality; it is a legitimate vehicle for redistributing income to satisfy the requirement of providing a social minimum; and it is legitimate as a source of revenue needed to accomplish the public functions of the state, including provision of public goods and regulation of environment, labor, air safety, food safety, and the like. Justice is served by creating a system of legislation and policy that ensures the dignity and democratic rights of all members of society. John Rawls expresses most of these value in Justice as Fairness: A Restatement.

Our political sphere could still use a powerful and unifying theory providing a justification for these social democratic ideas. So Macpherson's voice is still relevant, almost fifty years later.

Here is a review of the book by the great English Marxist historian, Christopher Hill.

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Posted in: CAT_moraltheory,justice

Global justice

There is a clear and reasonably uncontroversial basis for a simple theory of justice that all nations/cultures can accept. This is grounded a few core values about human development and is expressed in the Universal Declaration of Human Rights, the Millenium Development Goals, and other founding documents of the United Nations. This conception emphasizes several key values:

• equal worth of all persons


• value of freedom


• value of democracy and self-determination


• the injustice of hunger, lack of education, lack of healthcare


• the injustice of capricious arrest and state violence (illegality)

These values provide a basis for steering our core institutions and practices in the direction of greater justice: whenever it is possible to reform institutions and practices in ways that enhance one or more of these factors, we should do so.  Policy makers and legislators can ask the question, how will this or that change to a set of institutions affect the well-being of individuals and populations affected; how will the change affect the freedoms and opportunities for self-determination of the people affected; how will it work to increase the effective scope of law within various societies?

John Rawls drew a strong distinction between ideal justice and imperfect justice, and noted that his contributions were directed to the formulation of a theory of ideal justice (Justice as Fairness: A Restatement, 13).  He did not believe that the ideal theory of justice would suffice to provide a road map for creating a more just society.  When we consider the complexity and difficulty of improving the justice of fundamental international institutions and relations, the program of arriving at an ideal theory seems unappealing.  Instead, we need to have some plausible and action-supporting principles that allow for practical improvement in the overall justice of the global system. We need to have some concrete ideas about how to get from here to there.

This approach -- the idea that we can improve justice in a piecemeal way -- spares us the heroic pretense of offering a general, universal theory of justice that we hope or expect all people can be persuaded to accept. It works from the point of view that injustice is more specific and more widely agreed upon. We don't need to engage in irresolvable debates about whether there are universal human rights in order to agree that the world will be more just if fewer people are forced into famine conditions.

This is the approach taken by Madison Powers and Ruth Faden in their study of the ethics of global public health in Social Justice: The Moral Foundations of Public Health and Health Policy (link), and it has the clear advantage of pragmatism.  It is pragmatic on the side of moral agreement, in the sense that it makes no strong claims about abstract moral theories that may be controversial across perspectives.  And it is pragmatic on the side of policy, in the sense that it provides an incremental strategy for improving the conditions of justice in the world.  And in fact, the premises mentioned above conform fairly closely to the six dimensions of personal well-being that Powers and Faden highlight: health, personal security, reasoning, respect, attachment, and self-determination.

One of the greatest advocates for justice in global development is Amartya Sen (Development as Freedom).  Sen's major contribution is the idea of the importance of creating conditions in which people can fulfill and actualize their human capabilities.  Sen's most recent work on global justice topics is his The Idea of Justice, in which he offers an alternative to Rawls's approach to the problem.  Here he gives primacy to the value of full human development as a benchmark for global justice.

I turn now to the second part of the departure, to wit the need for a theory that is not confined to the choice of institutions, nor to the identification of ideal social arrangements. The need for an accomplishment-based understanding of justice is linked with the argument that justice cannot be indifferent to the lives that people can actually live. The importance of human lives, experiences and realizations cannot be supplanted by information about institutions that exist and the rules that operate. (17)

Tom Pogge's work on global justice provides a good bridge between abstract moral theory and practical, real-world issues of justice in a developing world.  Pogge has sought to engage these issues in ways that have real, substantive engagement with the issues of poverty, hunger, and maltreatment that continue to set the stage for the majority of the earth's population today.  In an important recent volume, World Poverty and Human Rights: Cosmopolitan Responsibilities and Reforms, Andreas Follesdal and Thomas Pogge have pulled together an extended working group of scholars and activists concerned with global justice.  The volume took its origin at a conference in Oslo in 2003.  (Here is an article by Pogge on global justice and poverty (link), and here is a video interview with Pogge on the consequences of the global economic crisis on poverty; link.)  Pogge and his colleagues focus closely on the actual workings of international institutions to attempt to measure the degree to which they disadvantage the people of the less-developed world.

Consider for example a long-term contract concerning the exportation of natural resources which the government of some African country concludes with a rich Western state or one of its corporations.  Within the traditional philosophical framework, it is self-evident that such an agreement must be honored: "People are to observe treaties and undertakings" says Rawls's second principle of state conduct, and the third one adds: "Peoples are equal and are parties to the agreements that bind them" (Rawls 1999). But here is the reality. The African government is corrupt and oppressive, and its continuation in power depends largely on the military.  The sales it conducts impose environmental harms and hazards on the indigenous population. Yet, most of these people do not benefit, because the revenues are partly siphoned off by the small political elite and partly spent on arms needed for military repression. (These arms are suppled by other rich Western states in accordance with other contracts executed, without coercion, between them and the African government.) (5)

Why should gimlet-eyed policy makers take these arguments about global justice seriously?  What does justice have to do with the nuts and bolts of international economic policy reform?  Why should self-interested nations and their leaders adjust their policies to the demands of justice? The humanitarian and moral reasons are self-evident.  But it is also true that there is a powerful reason to care about justice that is based in self-interest.  This is because systemic injustice is itself a threat to national security.  Governments are destabilized, insurgencies are supported, cities experience riots, and anti-liberal violent movements flourish in conditions where masses of people are enmeshed in circumstances of injustice.  Barrington Moore, Jr. made these arguments in Injustice: The Social Bases of Obedience and Revolt (1978), and his conclusions seem even more compelling in the world today.

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Posted in: CAT_policy,globalization,justice

Ethical thinking for global public health

Here is a fine recent book that brings together recent thinking about development ethics with some of the specific issues faced in the field of global public health. Madison Powers and Ruth Faden published Social Justice: The Moral Foundations of Public Health and Health Policy in 2008, and it represents a genuinely interesting extended essay on the topic of justice in global health policy.  Here is an early statement of their governing perspective:

Our central focus, only vividly appreciated in hindsight, was in a notion of social justice that went beyond issues of distributive justice, micro-allocational questions of priority setting in medical care, or any number of questions centered on how one individual fares relative to some other individual. Beginning, as we did, with moral questions in public health and health policy, it is perhaps not surprising that our focus in social justice is largely directed at the well-being of people in social communities or groups. (ix)

 What is evident here is that Powers and Faden are bringing the perspective of public health into the discussion of issues that have been raised in other contexts (development ethics, bio-medical ethics) without the population-based starting point.

A second important difference in approach taken by Powers and Faden is to take seriously the finding within public health studies that inequalities come into populations' health outcomes in ways other than inequalities of access.

We contend that it is impossible to make progress in our understanding of the demands of justice within medical care without looking outside of medical care to public health and to the other determinants of inequalities in health and indeed without situating an analysis of justice and health policy in the wider social and political context. (x)

This perspective brings Powers and Faden into a degree of connection to Kate Pickett and Richard Wilkinson in The Spirit Level: Why Greater Equality Makes Societies Stronger (link).

A third distinctive feature of the project is the authors' rejection of the goal of arriving at a simple, unified theory of health justice.

In place of some single theory of justice drawn from one of the leading contenders for being the "right" account of justice, we argue instead that most of these other contenders have it wrong.  Indeed, we use the term 'theory' somewhat  cautiously. ... We choose to steer a middle course on the question, and we agree with Thomas Nagel's conclusion that whatever we are likely to attach the label of 'theory' to in the realm of normative inquiry will reflect an aspiration to develop some systematic but noncomprehensive account of some part of the moral landscape. (x)

The job of justice, as we see it, is to specify those background social and economic conditions that determine whether certain inequalities, that may themselves result from the promotion of other indispensable moral aims, should be seen as unfair. Ours is an account of justice that denies that there are separate spheres of justice, within health policy or within social policy more generally. (x)

Ours is a nonideal theory of justice, intended to offer practical guidance on questions of which inequalities matter most when just background conditions are not in place. (30)

Their central concern is with justice in health; and this comes down to a theory about inequalities.

The central question we pose in this book is, Which inequalities matter most? The aim of this book is to develop a theory of social justice suitable for answering questions of this kind in a variety of concrete circumstances.  (3)

But they insist on the point that theirs is not an "ideal" theory of justice; rather, it is intended to provide the basis for reasoned decisions about the practical, real problems we face in a world of substantial inequalities in life prospects.  Moreover, their account does not begin with a principle of distributive justice, but rather with a conception of the human good.  They offer Amartya Sen and Martha Nussbaum as exemplars rather than John Rawls (4).

As Sen correctly notes, a theory of justice of this sort begins with some underlying account of what persons "can do and be" (Sen 1993). Theories in this tradition start with ideals, to be sure, but they are ideals of a very different kind from those that form the starting points of Rawlsian ideal theory. (4)

So their theory is one that begins with a rich conception of human well-being and flourishing, not with a contractual deliberation between hypothetical individuals behind a veil of ignorance.  Here is a general statement of their view:

Social justice is concerned with human well-being. In our view, well-being is best understood as involving plural, irreducible dimensions, each of which represents something of independent moral significance. Although an exhaustive, mutually exclusive list of the discrete elements of well-being is not our aim (and may not be possible), we build our account around six distinct dimensions of well-being, each of which merits separate attention within a theory of justice. These different dimensions offer different lenses through which the justice of political structures, social practices, and institutions can be assessed. Without attention to each dimension, something of salience goes unnoticed. (15) 

The six dimensions of well-being that they identify include health, personal security, reasoning, respect, attachment, and self-determination (16).

This approach has a lot in common with Amartya Sen's most recent thinking in The Idea of Justice (as well as Sen's earlier work and that of Martha Nussbaum).  Here is Sen's description of his work in The Idea of Justice:

What is presented here is a theory of justice in a very broad sense.  Its aim is to clarify how we can proceed to address questions of enhancing justice and removing injustice, rather than to offer resolutions of questions about the nature of perfect justice. (kl 183)

Here the emphasis is on "enhancing" justice rather than providing a conception of ideal justice.  Sen's work here is intended to be practical: it should assist policy makers in their deliberations as reforms are considered.  Sen refers to this approach as "comparative justice".

We are engaged in making comparisons in terms of the advancement of justice whether we fight oppression (like slavery, or the subjugation of women), or protest against systematic medical neglect (through the absence of medical facilities in parts of Africa or Asia, or a lack of universal health coverage in most countries in the world, including the United States), or repudiate the permissibility of torture ..., or reject the quiet tolerance of chronic hunger. (kl 225)

In terms of the analysis offered by Powers and Faden, we improve justice by moving a population forward in any one of the six (or more) dimensions of human well-being that were noted.

Inherent in the idea of comparing the justice of several different scenarios, is the idea of reasoning across different perspectives on justice.  Sen is committed to the notion that it is possible to engage in reasoned dialogue with people with whom you have deep disagreements about starting points.  And this theory of comparative justice is intended to help facilitate those reasoned discussions.

Sen contrasts his approach to justice with that of John Rawls in these terms:

In the approach to justice presented in this work, it is argued that there are some crucial inadequacies in [Rawls's] overpowering concentration on institutions (where behaviour is assumed to be appropriately compliant), rather than on the lives that people are able to lead. (kl 203)

Several things seem important to me in both books mentioned here.  First, each is an innovative contribution to issues that are core to what we might refer to as "global justice" -- hunger, health, abusive states, educational deprivation.  Second, each is aiming to create a philosophical framework within which practical, real-world issues can be handled in a reasoned way.  Third, each seeks to broaden the moral perspective of contractualism that has set the terms for discussions of justice for the past forty years.  And, finally, each shuns the goal of formulating a general system or a unified theory on the basis of which to judge all possible social arrangements in terms of justice.

These features make the moral ideas of Powers, Faden, and Sen particularly helpful when we turn our attention to trying to influence international practices and institutions in the direction of greater justice for the people of the world.  The arguments are pragmatic, modest in scope, and potentially less bound to a particular tradition of moral thinking.  (Sen makes this latter point quite explicitly: "Some of the reasoning of, for example, Gautama Buddha (the agnostic champion of the 'path of knowledge'), or of the writers in the Lokayata school (committed to relentless scrutiny of every traditional belief) in India in sixth-century BC, may sound closely aligned, rather than adversarial, to many of the critical writings o the leading authors of the European Enlightenment" (kl 268).)

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Posted in: CAT_policy,globalization,justice