The article looks into the problem of determining health equity. There is a conception in society that public health service should be based on the fundamental principle of justice. However, there is no unity of views how it should be realized either in the scientific community or among men in the street. In scientific discourse there are coexisting ideas about the validity of the definition that is focused on the three groups of interpretations: the liberal, distributive paradigm and the paradigm of possibilities. The first is characterized by the emphasis on the individual’s personal responsibility, the second – by attention to the social determinants of health, the third highlights the ideal of creating equality of not health services and health benefits, but the opportunities to maintain the health. In recent years, the policy in the sphere of the health of Russia has been reoriented toward a liberal model. Using a semi-formalized interview in two subjects of the Russian Federation, the representatives of various socio-demographic groups were interviewed for the purpose of obtaining social ideas of the fairness of Russian health protection. It was possible to obtain information on social ideas regarding the justice of ensuring availability of health service in connection with the place of residence, age, gender, dependencies and others. The interpretations concerning the rendering medical services to the able-bodied unemployed were also analyzed, the conclusions about the attitudes toward equality in rendering medical services were made, which runs counter to the current discourse of power.
The situation in the sphere of health of Russians can be called unfavorable: in comparison with the developed countries, the indicators that characterize this area of the social sphere, such as life interval, sickness rate, mortality, show ill-being. One of the topics raised in this regard is the organization of health protection, health policy on the distribution of benefits for the optimal work of this subsystem of the Russian society. Under the conditions of transition to the market and modernization of public health, scientific and political discussions continue on the justice of health care and the availability of medical services for citizens. However, social ideas about the principles of its implementation, the need for availability of medical services for different categories of citizens vary both within the community of experts and among the population.
Social theory has developed several approaches to social justice. Among the various classifications, the most significant in the context of the recent transformation of the socio-political and economic system is the selection of liberal (or liberal-democratic) justice and social (distributive) model, for example, by Will Kymlicka . In the Soviet period, social policy was built on the basis of the second approach to justice – more pronounced at the early stage, evolving on subsequent into the ideas about equality of opportunities . Under the existing situations of Russia, the discourses of the authorities on fair health migrate towards the liberal model: an information and political agenda is being formed, which states that health resources are more equitably distributed in favor of those who are more responsible for their health and do not risk it, have done a great service before society, have made a contribution to it, are more important (for example, they do not have shadow incomes, make transfers to the fund of compulsory health insurance) .The issues about priority models is in keeping with the discussion taking place in other countries with a market economy. Some researchers problematize the situation concerning the injustice of the equal distribution of medical services between those whose health suffers as a result of individual actions and irresponsible behavior, whether it is alcohol consumption , risky hobbies and sports, etc. . Another part of the scientists points to the determining importance of social conditions, to the ability of being responsible , the influence of social factors on the choice of lifestyle, habits .The expansion of a new health paradigm is associated with the interests of political actors to reduce the price of health care . The critics of the paradigm argue that healthism becomes an ersatz-religion and veils the problem of inequality .
One can identify an approach or a paradigm of equality of opportunity among the extreme forms of the distributive and liberal models of health equity. Justice as the ensuring of the choice does not preclude the actualization of such ideas as equality, consideration of personal success in the distribution of benefits, but at the same time, the real effective opportunities that people have for the choice in life, including choosing a way of life in the context of health[10,11].
Thus, scientific models of equitable health care receive different interpretations – liberal, distributive, the approach of equal opportunities. However, any models of social policy cannot be realized without taking into account the normative-value system of social groups and social ideas of the population about justice. Ordinary conceptualization of justice and availability of health service became the object of sociological research.
The modernization of public health services and power discourse, conducted in recent years in Russia, are oriented towards the liberal model and the economic logic of efficiency, which runs counter to the social ideas of the citizens – consumers of medical services – about the principles of fairness of Russian healthcare, which escalates the situation of dissatisfaction with the organization of the system of health care. The results of these interviews make it possible to identify the repertoire of possible interpretations of justice and become the basis for a formalized mass survey by questionnaire.
The work is performed according to the Russian Government Program of Competitive Growth of Kazan Federal University.
The article was prepared with the financial support of the Russian Foundation for Basic Research (Grant №16-03-00579а“Social justice and equity in a health care: experts’ views, mass-media discourse and people’s attitudes”).
- Kimlika U. Modern Political Philosophy. Introduction. М.: Economic Higher School Publishing, 2010.
- Chernysh М.F. Social Justice and Its Mirages// The World of Russia. 2012. № P. 111.
- To reach police. The unemployed can be offered to pay the rest of medical treatment instateclinics// Russian Newspaper. 2014. July 15.
- Albertsen A. Drinking in the last chance saloon: luck egalitarianism, alcohol consumption, and the organ transplant waiting list // Medicine, Health Care and Philosophy. 2016. 19(2) P. 325-338.
- Walker T. Who do we treat first when resources are scarce? // Journal of applied philosophy. 2010. 27(2). P. 200-211.
- Brown R.C.H. Moral responsibility for (un)healthy behavior // Journal of Medical Ethics. 2013. doi:1136/medethics-2012-100774
- Buyx A., Prainsack B. Lifestyle-related diseases and individual responsibility through the prism of solidarity // Clinical Ethics.2012. 7(2). P.79-85.
- Crawford R. Cultural influences on prevention and the emergence of a new health consciousness. // Taking Care: Understanding and Encouraging Self- Protective Behavior. Cambridge: Cambridge University Press, 1987. P. 95–113.
- Gvozdev М.G. Health is min the Context of Criticism of Social Medicine // Society: Philosophy, History, Culture. 2016. №9. P.80-81.
- Sen A. The idea of justice. L.: Penguin books, 2010.
- Ruger J.P. The health capability paradigm and the right to health care in the United States // Theoretical Medicine and Bioethics. –37(4). Pp.275-292.
- “Confrontation of Logics”: Doctor, Patient and Power under Conditions of Reforming the System of Health Service/ Free Analytical Return of Levada-Center URL: http://www.levada.ru/cp/wp-content/uploads/2016/05/299_1-15_Svodnyj-analiticheskij-otchet.pdf (accessdate 30.06.2017).
- KArayeva О. Ideas of Justice and Effectiveness in the Systems of Health Protection in Different Countries (According to data of ISSP) // Herald of Public Opinion. 2014. № 1/2 (JanuaryJune). URL: http://www.levada.ru/sites/default/files/vom_1-2_2014.pdf (access
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