Abstract

Children born in low-income countries (LICs) can on average expect to live 20.1 life years less and are 16 times more likely to die before their fifth birthday than children born in high-income countries (see Table 7.1). Is this inequality in life prospects acceptable? Many people live in poverty; 74 percent of the people in LICs live on less than U.S.$2 per day. Low-income populations are growing due to high fertility rates and there is a high burden of disease; in addition, the majority of people in LICs live in rural regions and are hard to reach with health care services. Health care expenditures in LICs are on average 1/180th of high-income country expenditures. This scarcity of resources raises the justice issue: Whom should governments and charity organizations favor in allocating these limited resources? And what can theories of justice tell us about the moral grounds for making fair decisions? Policy decisions on access, availability, and quality of medical and public health services influence both the overall level of health in a population and the distribution of health between individuals. But access and quality of medical services do not solve the whole problem. Improving the position of the worst off in other, non-health domains of justice, such as liberty, income, education or capabilities, will have a substantial impact on population health. It is thus urgent to establish legitimate and practical procedures for making fair priority decisions and involving key stakeholders in an impartial and reasonable way. What should such legitimate priority setting procedures look like?