Keywords: health and fairness; Right to health; Health responsibility; Health reform and development
China Library Classification Number: R 19 Document Identification Number: A Document Number:1004-1494 (2012) 04-0069-04.
In March 2009, the Central Committee and the State Council adopted the Opinions on Deepening the Reform of the Medical and Health System. The opinion puts forward that the reform of medical and health system should adhere to the unity of fairness and efficiency, strengthen the government's responsibility in the basic medical and health system, strengthen the government's responsibility in system, planning, financing, service and supervision, safeguard the public welfare of public medical and health, and promote fairness and justice. It can be said that health equity has become the goal of health reform and development of our government. So, what is health equity? What is the meaning of health equity? What is the specific boundary of health equity? Solving these problems is undoubtedly of great significance for promoting health equity and safeguarding citizens' health rights.
First, the connotation of health and fairness
What is health equity? The starting point is fair. Health equity means that all members of society have the opportunity to obtain the highest possible health level, which is the basic right of human beings. ? [1] Results What do the fairies think? Health equity means that people with different income, race and gender should have the same or similar health level, and the distribution of health indicators such as prevalence rate, infant mortality rate, maternal mortality rate and life expectancy should not be significantly different among different people, and the distribution of health status should not be related to the socio-economic attributes of individuals or groups. ? [2] The eclectics think? Health equity is the combination of opportunity equity and result equity. ? [3] The author believes that the above three views are one-sided to some extent, and they only see the fair distribution of health rights, while ignoring the reasonable sharing of health responsibilities.
? The concept of justice is determined by the role of its principles in distributing rights and obligations and determining the appropriate division of social interests. The concept of justice is an explanation of this role. ? [4] In Rawls' view, the connotation of justice is determined by the distribution principle of rights and obligations, and different distribution principles have formed different views on justice. Fairness is the principle of distribution of rights and obligations. Justice is fairness, which is a view of justice with fairness and equality as its value pursuit. First, fairness means that no matter what decision is made, every citizen, regardless of gender, age, occupation, social status and wealth, should be treated equally to ensure a fair starting point. Second, fairness is equality with differences. Due to the objective existence of subject differences, absolute equivalence of results is impossible. Absolute equalitarianism will dampen the enthusiasm of the capable and damage social efficiency. ? If a society insists on giving equal respect and hospitality to all its members, regardless of its behavioral characteristics, it will be unreasonable, not sad, and will be very short-lived. ? [5] Third, fairness refers to paying attention to the disadvantaged groups in society and striving to improve their disadvantaged position in order to ensure the value and dignity of people as human beings.
The so-called health equity is the rational distribution of health rights and health responsibilities. The fair distribution of health right includes the fair distribution of health resources, the fair provision of health services, the fair health status and so on. The fair distribution of health responsibility is the reasonable sharing of government responsibility and individual responsibility. Some people may say that health is their own, and their health is their own responsibility, which has nothing to do with others. However, this is not the case. 1946, the world health organization put forward in its constitution, what is health? The perfect state of personal physical and mental health and social harmony is not only the absence of disease or weakness. ? [6] The continuous expansion of health connotation makes the determinants of health extensive and complex. Specifically, there are four determinants of health: the first is genetic factors, including body shape, resistance and susceptibility to diseases, genetic diseases and so on; Second, personal lifestyle, including diet, sleep, exercise, etc. Third, environmental factors, in which the social environment includes religion, race, gender, socio-economic status, education, occupation, etc., and the natural environment includes air, water, residence, workplace, etc. The fourth is health care services, including accessibility, quality and fairness. The former two are personal determinants of health, while the latter two are social determinants of health. 1978 The Almaty Declaration issued by the International Conference on Primary Health Care pointed out that health is a basic human right and reaching the highest possible health level is an important social goal in the world. Therefore, it is the unshirkable responsibility of the government to eliminate the adverse effects of social factors on health and safeguard public health. Although health is personal, health responsibility involves the sharing of responsibilities between the government and individuals. Whether the responsibility sharing is reasonable is also an important aspect of health equity.
Due to genetic factors, the differences in health outcomes are randomly distributed in the whole social group, and most of them are inevitable. We believe that the health difference caused by genetic factors is a misfortune, not an unfair health. ? The boundary between injustice and misfortune is inevitable, because it is impossible to turn all needs into rights and the right to ask for other people's resources with common secular moral language. ? [7] The health inequality caused by individual's free choice should also be borne by himself. For example, bad behavior and lifestyle are important factors affecting public health. ? The World Health Organization (WHO) estimated in 1992 that 60% of the deaths in the world are mainly due to bad behaviors and lifestyles. ? [8] Bad behaviors and lifestyles include smoking, excessive drinking, excessive entertainment, laziness in sports, overeating and so on. Some people know that bad behaviors and lifestyles are harmful to health, but they still go their own way, resulting in a gap with the health of others. This kind of behavior is obviously irresponsible, and this unfair consequence can only be borne by yourself. ? It is obviously unfair to hold me responsible for other people's irresponsible behavior. ? [9] Health inequality caused by social factors should be borne by the government. ? Many health inequalities are caused by social factors, such as poverty, nutrition, early living conditions, gender and racial discrimination, drinking water, education, housing and control over one's own destiny. ? [10] Health inequality caused by social factors is not only unfortunate, but also unfair. John? JohnKrebs thinks: The government has the responsibility to provide conditions to ensure that people live a healthy life. In addition to protecting its citizens from harm, the butler government? Reducing health inequality and protecting the health of vulnerable groups is also a special responsibility. ? [ 1 1]
Second, the significance of health equity
Health equity is a social and political issue. Unfair health will widen the health gap between different social classes, cause public dissatisfaction and lead to the legitimacy crisis of the government. Maintaining health and fairness is of great significance.
First of all, health equity is conducive to narrowing the health gap and promoting social harmony. Health equity is the basic condition for citizens to participate in social competition on an equal footing. The measures taken by the government, such as fair distribution of health resources, fair provision of health services, establishment of a fair medical security system, and appropriate assistance to the health vulnerable groups, will certainly help to narrow the health gap between different social classes, improve the health level of the whole people, and create conditions for citizens to participate in social competition on an equal footing. On the contrary, health unfairness will lead to more and greater unfairness. An unhealthy person will lose many development opportunities and make his living conditions worse. The deterioration of living conditions, poverty and disease are likely to breed social dissatisfaction and even hatred. Such as AIDS patients. When their diseases are not effectively treated or treated unfairly, they are likely to have dissatisfaction, hatred and even revenge on society, leading to the spread of AIDS, thus seriously endangering public health. For another example, which social class should public health resources meet first? If it leans to the lower level, then public health resources should first cover the basic medical services of the lower level, and the urban middle class will be dissatisfied with the low level of medical services; On the other hand, if public health resources are first used for high-quality medical services in cities, the lower classes will be dissatisfied. Comparing the two, meeting the needs of the lower class is more in line with health and fairness. Otherwise, the health gap will be even greater. It can be said that unfair health will intensify social contradictions and affect social harmony. Social harmony includes not only the harmony between subject and external object, but also the harmony within subject. The former covers the relationship between people and others, social and natural, and reflects people's good social adaptability; The latter only refers to the relationship between man and himself, and its goal is physical and mental health. From the connotation of social harmony, health is also an internal part of social harmony, and health equity is an important condition for achieving social harmony.