In this paper I argue that a narrow view of justice dominates the
bioethics literature. I urge a broader view. As bioethicists, we often
conceive of justice using a medical model. This model focuses attention
at a particular point in time, namely, when someone who is already sick
seeks access to scarce or expensive services. A medical model asks how
we can fairly distribute those services. The broader view I endorse
requires looking upstream, and asking how disease and suffering came
about. In contrast to a medical model, a social model of justice
considers how social determinants affect the health of a population.
For example, social factors such as access to clean drinking water,
education, safe workplaces, and police protection, profoundly affect
risk for disease and early death. I examine one important social
determinant of health, health care coverage, to show the limits of a
medical model and the merits of a broader view.
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