Class, health and justice

Milbank Q. 1998;76(3):449-67, 305-6. doi: 10.1111/1468-0009.00098.


Class inequalities in health are intuitively unjust. Although the link between social class and health status has been fully documented, the precise nature of the injustice has not been made clear. Four alternative views are presented, corresponding to four goals: (1) maximizing the sum total of health; (2) equalizing the health status of higher and lower social classes; (3) maximizing the health status of the lowest social class; and (4) maximizing the health status of the sickest individuals in society. The nature of the injustice is further obscured by several theoretical and empirical questions, like the degree and significance of personal responsibility for illness and the relation of the degree of economic inequality to sum total of health.

MeSH terms

  • Health Care Rationing*
  • Health Services Accessibility
  • Health Services Needs and Demand
  • Health Status Indicators*
  • Humans
  • Income
  • Internationality
  • Resource Allocation*
  • Social Class*
  • Social Justice*
  • United States / epidemiology