Significant inequalities in health status exist within developing countries, where the poorest face considerably higher mortality and morbidity rates than wealthier groups do. Yet most of these wealthier groups enjoy health levels that are far below those of people in the industrial countries. The most prominent normative response to this situation has been an equality-demanding norm, stipulating that we strive to make health outcomes more equal even within the developing countries. In this article, I argue that under current resource constraints, institutional arrangements seeking to ensure commonly accepted egalitarian goals would engender the decrease of health status of many who do not currently enjoy particularly high levels of health. Although an alternative view, the prioritarian view, can avoid some of the negative implications of the egalitarian view, it too is untenable given the current resource constraints. We should instead develop a threshold norm that characterizes minimally adequate health status. An institutional order is just with respect to health to the extent that participants in this order do not (avoidably) fail to reach this threshold. One implication is that redistribution of resources is limited within any developing country, and thus redistribution must take place from industrialized to poorer nations.
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