Vienna Public Health Equity Project, 2023

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Contemporary public health and healthcare are navigating a complex landscape marked by limited resources, conflicting individual and collective preferences, and the challenge of improving efficiency while maintaining quality. This scenario raises a multitude of ethical and moral questions, necessitating state intervention through stewardship and governance. Governments worldwide strive to enhance utility, value for money, and health equity, guided by principles of distributive and procedural justice. The moral underpinnings of public health activities, such as overall benefit, collective efficiency, distributive fairness, and harm prevention, are crucial in addressing global health resource challenges. These considerations encompass efficiency, equity, rights, and other ethical issues. The distribution of resources, whether based on noncorrelative or correlative principles, is a key aspect of justice in public health. Public health efforts are also focused on mitigating the adverse effects of socio-economic determinants on health outcomes and addressing health disparities. This is particularly vital for vulnerable, high-risk, and marginalized groups who face unique challenges like historic injustices, discrimination, and specific social or physical needs. The project at hand delves into the concepts outlined by Peragine, focusing on measuring individual opportunity sets, assessing inequality in opportunity distribution, and designing mechanisms to enhance 'opportunity equality'. A representative survey of Vienna's population (N=1411) explores various dimensions: Socio-demography: This module gathers data on gender, age, education, and migration background. Health: It assesses individual health status, chronic conditions, multimorbidity, and health-related behaviors. Socio-economic status: This includes occupation, net income, asset wealth, and other indicators of social or economic capital. Access to healthcare: Respondents provide insights into their experiences with healthcare access, including barriers and needs. Affordability of healthcare: Questions revolve around health-related expenditures and attitudes towards healthcare coverage and benefits. Provision of healthcare: This focuses on the quality and timeliness of medical interventions and healthcare services. Justice-Fairness attitudes: The survey captures attitudes towards social/distributive justice and fairness in socio-economic and health-related aspects. Preferences for health policy and redistribution: This module explores public vs. private health insurance preferences and allocation preferences for the public health budget. Solidarity & Reciprocity: Estimating solidarity through measures of social trust, cooperative behavior, sharing, helping, and expressions of solidarity. Overall, this comprehensive approach aims to address the intricate interplay of ethical, moral, and practical considerations in public health and healthcare, emphasizing the need for equitable and just solutions in a resource-constrained environment.

Contemporary public health and health care face resource constraints, self-regarding versus other-regarding preferences, and strains to become more efficient at less costs, while maintaining quality. Thus, diverse distinct ethical and moral questions and challenges arise. These concerns inevitably imply some involvement of the state that has to intervene through stewardship and governance. In doing so governments seek to promote (aggregate) utility, increase value for money, and foster health equity, while adhering to principles of distributive and procedural justice (Hecht et al. 2019). Globally nations have found a wealth of ways to reach and improve on these objectives. “Moral justifications for public health activities, including overall benefit, collective efficiency, distributive fairness, and harm prevention, are considered by way of examining global human resources for health, with an eye to efficiency, equity, rights, and other ethical issues” (Merritt & Hyder 2019, p. 109). In striving for justice “we must also consider how to distribute whatever is measured. Noncorrelative principles do not try to correlate how much each individual receives with other facts about that individual, whereas correlative principles do” (Persad 2019, p. 36). Public health aims to mitigate the negative effects of socio-economic determinants of health outcomes, as well as countering health disparities (Venkatapuram 2019). These patterns and gradients, which harm individual, community and public health, are even exacerbated for vulnerable, high-risk and marginalised populations. Such health “stressors may include historic injustices, discrimination and stigmatization, and unique social or physical needs, limitations, or vulnerabilities. […] Included groups are ageing populations, children and adolescents, persons with mental illness, persons with disabilities, sexual and gender minorities, and immigrants and refugees” (Bernheim & Fenton 2019, p. 175).Contemporary public health and health care face resource constraints, self-regarding versus other-regarding preferences, and strains to become more efficient at less costs, while maintaining quality. Thus, diverse distinct ethical and moral questions and challenges arise. These concerns inevitably imply some involvement of the state that has to intervene through stewardship and governance. In doing so governments seek to promote (aggregate) utility, increase value for money, and foster health equity, while adhering to principles of distributive and procedural justice (Hecht et al. 2019). Globally nations have found a wealth of ways to reach and improve on these objectives. “Moral justifications for public health activities, including overall benefit, collective efficiency, distributive fairness, and harm prevention, are considered by way of examining global human resources for health, with an eye to efficiency, equity, rights, and other ethical issues” (Merritt & Hyder 2019, p. 109). In striving for justice “we must also consider how to distribute whatever is measured. Noncorrelative principles do not try to correlate how much each individual receives with other facts about that individual, whereas correlative principles do” (Persad 2019, p. 36). Public health aims to mitigate the negative effects of socio-economic determinants of health outcomes, as well as countering health disparities (Venkatapuram 2019). These patterns and gradients, which harm individual, community and public health, are even exacerbated for vulnerable, high-risk and marginalised populations. Such health “stressors may include historic injustices, discrimination and stigmatization, and unique social or physical needs, limitations, or vulnerabilities. […] Included groups are ageing populations, children and adolescents, persons with mental illness, persons with disabilities, sexual and gender minorities, and immigrants and refugees” (Bernheim & Fenton 2019, p. 175). The project is ultimately addressing what Peragine (1999, p. 37) called:”(i) the measurement of individuals’ opportunity sets, (ii) the measurement of the degree of inequality present in a distribution of opportunities, and (iii) the design of redistribution mechanisms intended to increase the degree of `opportunity equality'”.