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In the February/March 2000 edition of the Boston Review , Norman Daniels, Bruce Kennedy and Ichiro Kawachi asked whether justice is good for one's health (Daniels et al , 2000). Their answer? Yes - and public health professionals should do what they can to promote a just society. Their argument ties current epidemiological research in the social determinants of health to Rawlsian political theory and suggests that unequal distributions of liberty, opportunities or resources can negatively influence the health of society.
Their paper sparked a series of replies, some of which were supportive, but many others of which were critical. Criticisms of the argument ranged from skepticism about their use of aggregate and individual-level data to more theoretical concerns about their characterization of justice. With regard to their claims about individual-level data, one primary point of concern has been about the causal link between wealth and health. For example, many health disparities can be traced back to differences in lifestyle between the rich and poor, some of which may be voluntary. One question is whether individuals who are poor are the same individuals who choose unhealthy lifestyles, or whether there is something about being poor that causally and non-voluntarily leads to unhealthy lifestyles. Daniels et al counter that the health disparities between the rich and poor arise from 'identifiable causal pathways,' but the nature of this causality is nevertheless unclear.
In this paper, we present an additional argument supporting the position that justice is good for one's health. We argue that the pathways through which social factors produce inequalities in sleep more strongly imply a unidirectional and non-voluntary causality than with most other public health issues. Our argument strengthens the so-called 'gradient argument' (section 1.1, below) by providing theoretical support for the view that there are identifiable, non-voluntary causal pathways to poor sleep. As sleep is associated with health (Colten et al , 2006), the argument can explain at least some of the widely observed social disparities in health, that are highlighted by the social determinants of health literature.
We approach this argument in the following manner. First, we give an overview of the paper by Daniels, Kennedy and Kawachi, focusing specifically on what we will be calling the 'gradient argument.' We then present the...