Justice, Health, and Normal Function: A Political Foundation for Just Health Distribution

Health is a particularly important social good, not least because it protects equality of opportunity: whatever goals we have, we need health to pursue them. Justice requires that we protect equality of opportunity, and so a just society must protect the health of its citizens. However, health resources are scarce; hence, theories of justice must consider how to distribute them fairly. Such distributional schemes must meet two requirements: first, they must fix what counts as a health need, and second, they must determine how to prioritize health needs. Existing discussions often focus on the second requirement alone, but this risks producing an arbitrary and illegitimate distribution. Those who do try to meet the first requirement typically offer naturalistic accounts of the distinction between health needs and non-health needs. However, I argue that this distinction cannot be read off of the natural world without taking a controversial stand with respect to metaphysical and normative assumptions about which reasonable people disagree. In response to these views, I contend that agreement among reasonable people can itself serve as an objective standard for a distinction between health needs and non-health needs. Using a Rawls-inspired reasoning game, I argue that reasonable people would agree to a conception of health that marries a statistically derived goal-directed notion of function to a set of inputs and goals to which rational, reasonable, and impartial contractors could unanimously consent.