Health & social care policy

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SH4003 WEEK 2 The Idea of Equality in Health and Social Care
The idea of equality is very important in health & social care policy & practice. It’s a familiar idea & an everyday concept.
BUT what exactly do we mean by “equality”?
Equality is a ‘contested concept’.
This means that there are different theoretical ways to understand it & there is disagreement about which understanding should be accepted.
Example: two people could be of the same weight, but of different height. We can call them equals.
The terms ‘equality’, ‘equal’, and ‘equally’ signify a qualitative relationship between different objects.
That is, we use these terms when we want to say that different objects have the same qualities in at least one respect – but not in all respects, i.e. regarding one specific feature, with differences in other features. (Same weight; different height)
SO, ‘equality’ is not the same as ‘identity’. When different objects share the same ‘identity’, their qualities are the same in ALL respects. The objects are the sam
Equality implies similarity rather than sameness.
To say that people are equal is NOT to say that they are identical.
In fact, for people to be equal, they cannot be identical. They must be different, in at least one respect.
The concept of equality can be used to both DESCRIBE something & to PRESCRIBE something:
For example:
“These two people are of equal height” – DESCRIBES
“These two people should be treated equally before the law” – PRESCRIBES
In order to apply prescriptive rules about the equality of people (i.e. to treat them as equals), we need to be able to identify which people the rules apply to (i.e. to know who is counted as an equal).
Also, we need to be able to explain what exactly is meant by ‘treating people equally’,
& to think about whether & when any amount of inequality might be OK.
There are big and important questions when trying to understand the idea of equality:
What kind of equality, if any, should be offered, and to whom, and when?
Equal in what respect?
People have answered these questions in different ways – that is why we say that ‘equality’ is a ‘contested concept’. It does not have a unified meaning.
For example, Kate Pickett & Richard Wilkinson, in their book ‘The Spirit Level: Why Equality is Better for Everyone’ (2010), claim that wealth inequality causes ‘status anxiety’ at all income levels, which leads to health and social problems
Therefore, they say, society ought to be arranged to minimise wealth inequality, if we wish to minimise health & social problems
This is one view. What do you think of it?
We are expected to apply the idea of equality in professional practice, & in the UK we have legislation we must follow (The Equality Act, 2010)
So what is ‘equality’? What is ‘egalitarianism’?
In order to proceed, let us think of EQUALITY (& INEQUALITY) as an issue of SOCIAL JUSTICE.
What is the connection between EQUALITY & JUSTICE?
Justice is primarily related to the actions of individuals. That is, a person has responsibility for their own actions, and their actions can be just or unjust.
So an individual (or a group of individuals) can behave justly, or unjustly. She (or they) can treat others justly, or unjustly.
So we are each responsible for our own actions, and can behave rightly or wrongly towards others, in terms of justice.
But what if the SITUATION or CIRCUMSTANCE in which we are acting is itself unjust?
Do we then have a responsibility to change that situation – to make it just? It seems too demanding of an individual to say that they alone are responsible for making situations just.
Instead, we can say that we must rely on COLLECTIVE actions, in order to create concrete conditions of social justice.
How can we do this? There are different approaches, & one involves EQUALITY
One way that we will explore is the idea that the JUST SOCIETY is one that is organized around the establishment of social institutions and structures that uphold the PRINCIPLE OF EQUALITY, within which each of us can best fulfil our responsibilities to behave justly.
Rawls: ‘A Theory of Justice’ (1971) – sees justice as a matter of fairness
How is this Principle to be understood?
The Principle of Equality answers the question ‘equality of what?’ in terms of EQUAL OPPORTUNITIES.
So, we can say that public institutions must be organized so that they offer equal opportunities. But, equal opportunities for WHAT exactly?
What is it that we should have equal opportunities for, in a socially just society? Good question!!
We could perhaps say that public institutions of health care & social care must be organized in terms of EQUITY: i.e. the fair distribution of what people need for health & wellbeing (e.g. medicines, treatments, support, hospitals, etc)
SO in Health & Social Care we could say that what is required are equal opportunities for welfare (via fair distribution of resources)
What about people’s different needs?
What about the fact that some people are less advantaged or more vulnerable in society than others?
What about the fact we have limited resources?
What are my responsibilities with respect to equality if I am a health professional?
We shall discuss these questions on the module.

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