Social Justice

SOCIAL JUSTICEThe origins of modern discussions of social justice areoften traced to the concept of giustizia sociale, firstarticulated in 1840 by the Jesuit priest Luigi Taparellid’Azeglio and made known more widely with thepublication of Antonio Rosmini’s La Costituzione secondola giustizia in 1848. A secular treatment appeared severalyears later in John Stuart Mill’s Utilitarianism, where herefers to his principle of utility as “the highest abstractstandard of social and distributive justice, towards whichall institutions and the efforts of all virtuous citizensshould be made in the utmost degree to converge” (Mill2001 [1861], 62).

Among early-twentieth-century political theoristssuch as Leonard Trelawny Hobhouse (1922) the centralissue of social justice was the proper distribution ofadvantages and disadvantages within society. As DavidMiller (1999) notes, the underlying assumption is thatindividuals, whose lives are highly interdependent andwhose life prospects are therefore markedly affected by theweb of social and institutional arrangements that bindthem together, are justified in making claims against oneanother for fairness in the distribution of benefits andburdens.

In the second half of the twentieth century, JohnRawls emerges as the major contemporary figure in thattradition, and his formulation of the central issues in ATheory of Justice (1999a [1971]) provides the point ofdeparture for virtually all of the current debates, includingthe following:

1. whether the notion of social justice, understood as anattribute of social structures, can be formulated asdistinct from, and indeed compatible with, ideals ofjustice by which individual agents and their actionsare assessed;

2. whether a conceptually clear, normatively plausiblespecification of the elements of the social structuresubject to moral assessment can be given;

3. whether the social structure subject to moralassessment is necessarily confined to domesticarrangements within a single nation-state; and

4. whether the purpose of social justice is to address onlythose inequalities that are caused by a particular formof social organization or, in addition, some inequal-ities not directly causally linked to the social structurebut nonetheless amenable to reduction by thealteration of social arrangements.

Contemporary discussions of social justice are so thorough-ly dominated by Rawls’s contributions that debates aboutthe very idea of social justice as a distinct subject ofjustice, as well as debates regarding the definition of the

basic structure, necessarily begin with critical andinterpretative discussions of his view. On the issues ofwhether the basic structure might be extended globallyand of which inequalities a social-structural theory ofjustice is meant to address, Rawls’s own views havereceded somewhat into the background of discussion, butthe basic terms of these debates continue to be set byhis work.

THE SUBJECT MATTER OF SOCIAL JUSTICE

In Rawls’s famous dictum, justice is the “first virtue ofsocial institutions” (1999a, 3). Social justice, on hisaccount, is concerned with fairness in the design of the“basic structure of society” (1999a, 3), a phrase he usesthroughout A Theory of Justice to refer to the majorinstitutions and social arrangements within a singlesociety, understood as “a more or less self-sufficientassociation of persons” bound together by rules that“specify a system of cooperation” (1999a, 4). For Rawls, asociety is a normatively unique form of human interactioninasmuch as the shared understanding among its par-ticipating members is that a society is a cooperativeventure for mutual advantage. Because a satisfactory lifefor anyone is possible only through complex and enduringprocesses of social cooperation, and because socialcooperation enables the production of a greater sum ofbenefits than would be possible for persons acting on theirown, distributive principles are needed for determiningthe proper division of social and economic advantages.

In his 2001 book, Justice as Fairness: A Restatement,Rawls adds renewed emphasis to the claim that thecooperative character of social organization is the “mostfundamental idea” (5) or “central organizing idea” of histheory (26). More precisely, a society within whichprinciples of social justice apply is conceived as a fairsystem of cooperation over time, extending from onegeneration to the next. In The Law of Peoples (1999),Rawls reaffirms a normatively laden empirical assumptionthat was implicit throughout A Theory of Justice: membersof a particular society have moral standing to assert claimsof distributive justice against one another, becausedomestic political and economic arrangements are uniquein their influence on the life prospects of individualsaffected by these arrangements.

Social justice is therefore cast as a set of requirementsof distributive justice inasmuch as its principles are meantto regulate the distribution of various kinds of primarysocial goods, including liberties, opportunities, and all-purpose resources such as income and wealth. Theconclusions of Rawls’s arguments are well-known. Basicliberties should be equal (the Principle of Equal BasicLiberties); inequalities in opportunities attributable tomorally arbitrary causes should be compressed (the Fair

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Equality of Opportunity Principle); and income andwealth should be distributed so as to maximize the shareavailable to the worst-off members of society (theDifference Principle). His overarching conclusion is thatthe totality of social arrangements must be beneficial toevery fully cooperating citizen, including the leastadvantaged, and the set of distributive principles hedefends thus provides the desiderata by which thosearrangements might be judged as just.

Rawls in his later work elaborates on a further aspectof a single society that explains the need for distributiveprinciples having purely domestic application. Citizens areentitled to press their claims for distributive justice againstone another because of their shared commitment toensuring fair terms of social cooperation among partieswho think of themselves as free and equal citizens. Hisassumption is that the necessary conditions for sustaininga democratic political order provide significant moralconstraints on permissible inequalities inasmuch asextreme inequalities in opportunity or wealth and incomehave a corrosive effect on one’s standing as an equalparticipant within a democracy.

By design, a number of questions of justice are thustreated as outside the scope of Rawls’s theory of socialjustice. Beyond the bounds of his theory are indivi-dual requirements of justice, such as the virtues of indi-vidual agents and the moral norms governing individualconduct within private associations, as well as therequirements of international justice, or moral normsgoverning the relations between nation-states.

While Rawls’s principles of social justice reflect anunderlying concern for human well-being, they aredistinct from natural duties of mutual aid and duties ofhumanitarian assistance that all individuals have toward allother individuals by virtue of their common humanity,rather than arising from citizenship or membership in aparticular society. The concern for human well-beingexpressed in universal principles of humanitarian assis-tance, for example, is typically manifested in duties totransfer resources in order to meet acute needs, whileprinciples of social justice have a different temporalhorizon and a different practical focus. Principles of socialjustice pertain to the norms, institutions, and socialarrangements under which the conditions for thefulfillment of human needs on an ongoing basis areachieved.

Moreover, even the humanitarian duties of assistancethat societies (as contrasted with individuals) have towardthe global poor are not thought of by Rawls as duties forwhich the aim is to bring the poor up to some minimalstandard of living. Nor is the goal to lessen the inequalitiesbetween the global rich and the global poor. The sole aimof assistance to “burdened societies” is to help them

develop just or decent domestic institutional arrangementsso that they may discharge their own duties to ensure thewell-being of their members (Rawls 1999b, 107).

The objections to Rawls’s portrayal of social justice asa normatively distinct set of moral concerns are various.One objection, considered more thoroughly below, is thatRawls’s conception of the kinds of social interdependencesufficient to trigger some duties of distributive justice istoo restrictive. Sympathetic critics, including SamuelScheffler (1995) and Dale Jamieson (1992) argue thatthe nature and extent of influence over life prospectsexerted by forms of global interdependence makes theexclusive focus on a single society as the locus of moralresponsibility for the life prospects of persons thus affectedseem anachronistic.

More fundamental are the objections of critics whooppose the very idea of social justice as a distinct categoryof morality. Robert Nozick, for example, in Anarchy,State, and Utopia, argues for the implausibility of any“patterned conception of justice” (1974, 220) that has asits aim some preferred distributive outcome. The objec-tion is that an outcome orientation treats the cumulativeconsequences of the actions of many separate individualmoral agents as potentially unjust, even when thoseactions involve no wrongdoing or breach of individualmoral duty. For Nozick, as long as there is no injusticein the acquisition or transfer of resources, then what-ever distributive pattern in resources or opportunitiesemerges from voluntary transactions and agreementsis just.

Friedrich Hayek argues similarly that virtues, proper-ly understood, are ascribable only to individual moralagents because “only human conduct can be called just orunjust” (1976, 31); “to speak of justice always impliesthat some person or persons ought, or ought not, to haveperformed some action” (33). But instances of socialinjustices refer to states of affairs characterized byinequalities (for example, in well-being, opportunities,economic rewards, and so on), for which there are noidentifiable agents who can be held individually account-able for unjust actions. Moreover, a theory of social justicecannot be rescued from incoherence by treating govern-ment as a moral agent. As Hayek puts it, “the demand for‘social justice’ is addressed not to the individual but tosociety—yet society, in the strict sense in which it must bedistinguished from the apparatus of government, isincapable of acting for a specific purpose” (64).

A different line of criticism accepts the underlyingnotion of a separate domain of justice by which socialarrangements, rather than individual agents and actions,might be assessed, but the objection is that a conceptionthat equates social justice with purely distributiveconcerns is overly narrow. Iris Marion Young (1990;

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2011) has outlined the claim that social justice should beconcerned with the real-world processes by which certaingrossly unequal distributive outcomes are systematicallyand routinely produced. Critics in this vein, includingYoung, argue for a wider conception of social justice thatreflects the importance of identifying and eliminating theroot causes of entrenched patterns of disadvantage,especially when they tend to reproduce and reinforceinstitutionalized forms of domination and control over thefates of some groups and individuals within society. Onthis view, the root causes of disadvantage are notnecessarily traceable to unequal distributive shares ofincome and wealth. Deeply unfair, exclusionary socialarrangements often explain the existence and persistenceof some of the worst distributive inequalities, and they areunjust because they reflect an underlying inequality inmoral status, even if gross inequalities in distributiveoutcomes are not the inevitable consequence.

Rawls replies to his various critics by saying thatmany of the sources of confusion surrounding his theoryof social justice stem from a failure to appreciate thedivision of moral labor among distinct levels of justice,which he subdivides into local, domestic, and globaljustice (2001, 11). Local justice involves principles thatapply to the voluntary transactions among individuals andthe interactions among members of associations such asthe family, religious institutions, unions, and universities.Principles of social justice—such as the DifferencePrinciple or the Principle of Fair Equality of Opportuni-ty—do not apply directly to these activities, for example,by requiring distribution of resources to family membersso as to maximize the distributive share of the leastadvantaged, or by dictating how religious organizationsshould choose their church hierarchy. Principles of socialjustice nonetheless regulate indirectly private transactionsand forms of association that are otherwise to be governedby local principles directly. His principles of social justiceare described as principles that regulate the “backgroundsocial framework” (2001, 10) within which privateassociational and market transactions occur. This charac-terization allows him to respond to both Nozick andYoung.

In response to Nozick’s claim that justice shouldconcern itself only with fairness in voluntary transactions,Rawls argues that it is impossible to judge what counts asfairness in a particular transaction apart from a theory ofsocial justice. Social institutions and their isolatedtransactions between individuals can be counted as justonly when they preserve over time the backgroundconditions that ensure the equal worth of the basicliberties to all citizens and fair equality of opportunity,both of which can be eroded by processes that involve thegenerational concentration of wealth and political influ-ence. In response to Young and others who object that his

theory is inadequately attentive to status inequalities thatmatter on their own, and which often explain how someof the most unjust distributive inequalities are produced,Rawls points to the fundamental purpose of thebackground framework of justice as preserving equalityof political and social standing among citizens as theoverarching explanation of his theory’s distributiveconcerns. A number of careful commentators on Rawls’swork as a whole, including Samuel Scheffler (2003) andNorman Daniels (2003) argue that what makes adistributive pattern unjust is not merely that it fails toconform to some antecedent notion of a preferreddistributional end-state, but the fact that some patternsof distribution are morally objectionable for the morefundamental reason that they are corrosive of equality ofstatus.

DEFINING THE BASIC STRUCTURE

A theory of social justice requires some account of thesocial arrangements that are the primary objects ofassessment. One approach to the identification of theconstituent elements of the basic structure involves anenumeration of illustrative examples. Among Rawls’sexamples are political constitutions, the organization ofmarkets, and the family, as well as various nonspecific“social practices” (1999a, 48). In addition, Rawlscharacterizes the basic structure by reference to the socialfunctions that some institutions perform, as well as byreference to the consequences various social arrangementshave for those persons who are affected by them.However, enumerative, functional, and consequentialcharacterizations often differ in their implications, andpolitical theorists following in Rawls’s footsteps havetaken divergent paths in developing their own accounts.

Perhaps Rawls’s most explicit attempt to providecriteria for the basic structure centers on the uniquelyconsequential impact that various domestic social arrange-ments exert on individual lives. For Rawls, “the basicstructure is the primary subject of justice because itseffects are so profound and present from the start”(1999a, 7). The basic structure of a society is viewed as asingle, unified scheme that affects the participants in socialarrangements insofar as it “influences their life prospects,what they can expect to be and how well they can hope todo” (1999a, 7). The impact of the sort that matters tosocial justice is both “profound and pervasive” (2001, 55).

A notable feature of Rawls’s consequential impactcriterion is that the morally pertinent aspects of a person’slife prospects that are affected are not limited to economicprospects or distributive shares of resources. For example,the basic structure determines the range of available socialopportunities that are said to be valuable because they areforms of human activity important to the realization of


Social Justice


the self and not merely valuable instrumentally for theeconomic rewards they produce. The basic structure alsodetermines an individual’s prospects for forming aconception of the good, setting a life plan, and exercisingcapacities for self-direction, and together they represent aconstellation of interests that Rawls describes as the“highest-order interests” of everyone affected by the basicstructure (1999a, 475–76). Even individual character isshaped by the basic structure. The “social system shapesthe wants and aspirations that its citizens come to have”(1999a, 259), Rawls argues, and it provides for eachcitizen the social basis for self-respect, which Rawls takesto be so valuable that they would do almost anything topreserve it. Moreover, it determines the extent to whichindividuals can cooperate as free and equal citizens inaccordance with ideals of democratic equality.

Arguably, all of the enumerated examples of social-structural elements of the basic structure are highlyconsequential in their impact on each of the morallydistinct interests that Rawls discusses. And yet, somearrangements, such as the family, which are included inhis lists of examples, and which exert a profound andpervasive impact, are not on his account regulated directlyby his principles. Other similarly consequential socialarrangements do not even appear on any of hisenumerative lists. Various manifestations of social ethosand norms of personal conduct, for example, influencelevels of compensation and the range of other nonfinancialopportunities available within society. Religious practicesand institutions, private schools and universities, andsocial customs also lock in differential life prospects innumerous ways—for example, by generating rigid gender-role expectations—but they are not counted by Rawls aspart of the basic structure.

The role of consequential impact in relation to thebasic structure thus remains unclear, as the discussion ofthe family most clearly reveals. At most, it seems to be anecessary but not sufficient condition for inclusion amongthe elements of the basic structure, and even inclusionamong the main elements of the basic structure is not asufficient condition triggering direct application of hisdistributive principles.

Another way in which the elements of the basicstructure are specified in Rawls’s theory is throughaccounts of the distinctive functional roles that the majorsocial arrangements are said to play. However, the kinds offunctional roles Rawls alludes to are diverse. MichaelBlake (2001) argues that given the overall structure ofRawls’s argument, what he should have claimed is that thedistinctive mark of the elements of the basic structure isthe uniquely coercive role of domestic laws. Indeed, innumerous places Rawls elucidates the elements of thebasic structure by noting their legally authoritative role in

specifying the basic rights and duties that citizens haveand by emphasizing the special social role of institutionsthat create a “public system of rules” (1999a, 74) thatassign not only rights and duties but powers andimmunities as well. All of these examples, as Blakeobserves, point to the seemingly unique functionalcharacteristics of the basic structure that are specific tolegal systems.

Nonetheless, other elements of the basic structure inRawls’s theory are identified by other functional roles thatdo not involve coercive state institutional arrangements.Rawls includes markets and other nongovernmentalinstitutions as parts of the basic structure because of theirfunctional role in determining the distribution of benefitsand burdens, social advantages, and opportunities. What-ever the merit of Blake’s account, it cannot provide thecomplete functional test that Rawls suggests. For not allcoercive legal rules have the profound and pervasiveimpact on the distribution of benefits and burdens amongpersons affected by them, and various customs, markets,and social practices function as centrally importantdistributive mechanisms without doing so by way oflegally coercive rules. Thus, the coercive function of legalinstitutions provides neither a necessary nor sufficientcriterion of the basic structure.

Rawls acknowledges from the outset of his Theory ofJustice the vagueness of his conception of the basicstructure, and in later writings he speculates that it may bebest to abstain from an attempt to provide a sharpcriterion or definition of social justice, leaving open anassessment of the sources of profound and pervasiveimpact on life prospects by examining contingentcircumstances that might arise. That open-endedness hasled to considerable speculation not only with regard towhich domestic social arrangements ought to be includedin the basic structure but also whether the basic structureproperly subject either to direct or indirect regulation byprinciples of distributive justice is confined necessarily tothe domestic context.

A GLOBAL BASIC STRUCTURE?

Critics—such as Joshua Cohen and Charles Sabel(2006)—of the exclusively nation-state focus that Rawlsand various Rawlsians defend have dubbed this position asa “strong-statist” view. They point to the existence ofother forms of global interaction having highly conse-quential impact, and which, accordingly, might besufficient to generate special duties of distributive justice,even if, for the sake of argument, they differ fromdistributive duties generated within the domestic context.

Robert E. Goodin (1988), Martha Nussbaum(2006), and others have made the criticism that theexistence of a national scheme of cooperation is neither a


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necessary nor sufficient condition for triggering duties ofdistributive justice. Many citizens—for example, thosewith profound physical and mental impairments—are notfully cooperating members of a domestic mutual benefitassociation, though they are surely owed some measure ofconcern as a matter of distributive justice, and manyindividuals who are deeply entrenched in ongoingcooperative associations that exert considerable impacton life prospects exist outside of the political andgeographic boundaries of any specific nation. The trendtoward greater global interdependence leads some to askwhether the current global order itself constitutes a“global basic structure” (Buchanan 2000, 700) that isproperly subject to moral appraisal and, in itself, sufficientto generate some international duties of distributivejustice.

For example, global economic institutions such as theWorld Bank, the International Monetary Fund, and theWorld Trade Organization often have a very large impacton residents of lesser developed nations, and amongnations with weak governmental structures, they mayexert as much influence as any other local or domesticfactor. A number of philosophers, including ThomasPogge (2004a) and Allen Buchanan (2000), argue thatwholesale changes in health and environmental laws, tradepolicies, subsidies for fragile domestic industries, and theprovision of social services have been required asconditions of international loans and eligibility forparticipation in international cooperative frameworks thatless-developed nations cannot realistically refuse. Theopponents of strong statism point in particular to whatthey take to be the contribution of externally imposedeconomic policies to increased poverty, which in turn hasa major impact on health, and intellectual property rulesthat have undermined the ability of the global poor toobtain vital lifesaving medications.

Strong statists sometimes reply to such challenges byarguing that, to the extent that there are global cooperativeschemes, they are still not unitary structures of the sortthat Rawls views as necessary in order to trigger duties ofdistributive justice. The global structure, as Michael Blake(2001) argues, lacks the high degree of institutionaldensity typically expected from arrangements that arelikely to exert the kind of profound impact on lifeprospects that occurs routinely in the domestic context.Even where the impact is significant, critics such asThomas Nagel (2005) claim that it is more episodic andsporadic than the pervasive and enduring impact thatdomestic institutions have over the course of a completelife of citizens and, indeed, over the course of successivegenerations. In short, the disagreement turns initially oncompeting empirical conjectures regarding the extent towhich the primary determinants of whether nations andthe people living in them are rich or poor are purely local

or whether some exogenous influences also play a largecausal role.

Alternatively, strong statists can concede that theglobal basic structure exerts a profound and pervasiveimpact on life prospects of many people independently ofnational boundaries, but they can still deny that this factalone is sufficient to trigger any globally applicable dutiesof distributive justice. For Blake, the further moraldifference lies in the unique form of coercion inherentin the exercise of state power. For Thomas Nagel, thefurther difference has to do with the morally unique roleof citizens within a democracy who collectively authorizethe creation of institutional arrangements that affect lifeprospects. David Miller (1999) and others, meanwhile,suggest that the further difference resides in a variety ofpurely domestic factors such as geographic proximity,shared history, cultural homogeneity or shared under-standings, special bonds of solidarity such as a commonethnic heritage or national identity, and the existence ofinstitutions necessary for the implementation and en-forcement of distributive principles.

Critics of strong statism, however, have a ready reply,especially to those who focus on the seeming uniquenessof state coercion and the imposition of a highlyconsequential social and economic order by democraticprocesses. They argue, for example, that global inequal-ities, when they are imposed upon the powerless, demandjustification no less than within the domestic context.They claim further that as a matter of empirical fact, manyof the transactions between the global affluent and theglobal poor are substantially nonvoluntary because theyoccur within the context of highly asymmetric politicaland economic interactions. Moreover, unlike the imposi-tion of terms of association through democratic processes,the imposition on a global scale is unilateral and thereforesuffers from a lack of a comparable buffer fromoverreaching by parties with stronger bargaining positionsthat a participatory role in decision-making on more equalterms provides.

The strong statist’s position, by contrast, views globaltransactions as substantially voluntary; therefore, theirposition resembles the views of libertarians outside of thedomestic context. Although egalitarian domestic socialarrangements are seen by statists as providing thebackground conditions necessary for assessing the fairnessof domestic voluntary transactions, they view cross-bordermarket exchanges and political negotiations in the sameway that libertarian theorists view all market exchanges orother voluntary bilateral interactions: that is, strongstatists such as Rawls (1999b) and Nagel (2005) agreethat as long as such transactions among nations or amongresidents of separate nations are free from coercion orfraud, there are no further moral restraints on the patternsof distribution that emerge.


Social Justice


NATURE, CHOICE, AND THE SCOPE OF SOCIALRESPONSIBILITY

Social-structural theories of justice, whether domestic orglobal in their scope of application, suppose thatdistributive principles meant to compress inequalities inresources, well-being, comparative advantage, or socialstanding share a crucial premise. They attach great moralsignificance to the existence of densely woven webs ofsocial interaction that are highly determinative of the lifeprospects of participating individuals. However, there aremany other inequalities caused by a variety of factors otherthan social-structural factors. We thus need some accountof the moral difference, if any, these causal differencesmake.

For simplicity we can distinguish three main sourcesof inequalities potentially relevant to social-structuraltheories of justice: inequalities that are attributable to theworkings of the social structure; inequalities that are aresult of the voluntary personal choices or behaviors ofindividual participants within a social structure; andinequalities that arise from natural differences in humanendowment or other merely fortuitous events that areneither caused by personal choice nor the operation of thesocial structure. Accordingly, we can map the logicalpossibilities for the ways in which the aims of social justicemight be conceived. The alternatives are (1) none; (2)causes of all three types; (3) social-structural causes only;(4) effects caused by voluntary personal choices; (5)natural causes; (6) natural and social causes; (7) naturaland personal causes; and (8) social and personal causes.The live options most prominent in the literature are (inorder of discussion): 1 (libertarianism); 6 (luck egalitari-anism); 3 (simple social-structural theories); and 2(complex social-structural theories).

Among the philosophical positions that emphasizepersonal responsibility are libertarians (type 1), who thinkthat none of the three causes of inequalities providessufficient warrant for overturning the distributive out-comes produced by the voluntary choices of individuals.Justice is not properly concerned with remedying what isoften called “cosmic inequalities” resulting from naturalfactors, reversing the consequences of the improvidentchoices of individuals, or addressing social-structuralcauses of inequality that, by definition, are not causedby identifiable agents whose conduct can be judged aswrong or unjust.

Luck egalitarians (type 6) argue that we shouldreform social structures in order to mitigate or compensatefor inequalities that are a product of either naturalcontingencies or social-structural design but that we donot need to address inequalities produced by the voluntarychoices of individuals. Luck egalitarians such as GeraldCohen (1989) and Richard Arneson (1989) capitalize on

an intuition that Rawls highlights: both natural and socialcauses of inequality in life prospects are deemed to bemorally arbitrary, and for that reason there seems to besome intuitive basis for thinking it unfair to permit lifeprospects to be so thoroughly determined and shaped byforces lying beyond an individual’s personal control. Theluck egalitarian is thus responsive to familiar worries aboutthe potential for erosion of personal responsibility, weresocial policy to be guided by the aim of smoothing out allinequalities, regardless of their source.

Nonetheless, purist versions of luck egalitarianism aresomewhat difficult to find, at least among those who workat the intersection of theories of social justice and health.Even among self-described luck egalitarians such asShlomi Segall (2010), the argument for excludingindividuals from health care coverage for conditions thatare a product of personal choice or lifestyle, on grounds ofwhat justice requires, are tempered by other moralconsiderations. Segall argues that we have reasons againstsuch exclusion, for example, based in duties that prohibitabandonment of others. Even if in principle the exclusionof treatment for ill health caused by risky or improvidentpersonal choice has some intuitive plausibility, as luckegalitarians insist, there are ancillary moral reasons whysocial policy should not ignore resulting inequalities.Moreover, Dan Wikler (2004) argues that the luckegalitarian ideal within health policy contexts is seriouslyflawed because of the inherent limits to our ability todisentangle the relative contributions of personal choice,social-structural influence, and natural contingencies.

The luck egalitarian position is problematic for theadditional reason that it wrongly presupposes that allchoice-induced inequalities are on a moral par. ElizabethAnderson (1989) offers the example of public policies thatexclude from health insurance coverage an individual whohas lost employer-provided coverage upon the death of aspouse because of an earlier decision to devote time to carefor dependent children and therefore rely upon theinsurance policy of an employed spouse. Luck egalitarian-ism is not merely unduly punitive in such a case; morefundamentally it treats arguably socially valuable personalchoices as equivalent to paradigmatically improvident orrisky choices for which some disincentive might bewarranted.

A simple version of a social-structural theory (type 3)would endorse distributive duties to address inequalitiesthat arise from the social structure itself but notinequalities that arise from voluntary personal choice orfrom natural contingency or “brute luck.” An attraction inhewing closely to social-structural causes of inequalities isthat it has the theoretical resources to explain why it mightseem unfair to assign to individuals the moral responsibil-ity for bad outcomes that lie beyond personal control.


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Because they are attributable to humanly alterable socialarrangements, Buchanan et al. (2000) argue that such badoutcomes are within the domain of social responsibility toprevent or ameliorate, it is not the responsibility of societyto address the full range of “cosmic” inequalitiesattributable to differences in natural endowment. Such atheory, then, is said to be more intuitively plausiblebecause it does not attempt to alter social arrangements inpursuit of eradicating inequalities which neither individualagents nor the collective decisions and interactions ofhuman beings had a role in generating.

However, there are very few obvious examples oftheorists who give a prominent place to social-structuralconcerns in the simple, backward-looking manner sug-gested, at least when it comes to matters of justice inhealth care and health policy. More common are complexaccounts that address at least some of the inequalities thatflow from all three sources (type 2). Worries about sortingout the overlapping causal streams certainly play a part inarguing for more complex views. But of particularimportance is the fact that few social-structural theorieslimit their concerns to remedying existing unjust inequal-ities caused by social-structural factors.

For example, few theories of social justice appearinterested exclusively in reducing health inequalities thathave arisen from and persist as a consequence of somemoral defect of the institutional structure, such asinstitutionalized racial discrimination. To be sure, thereare many, including Powers and Faden (2006), who arguethat deprivations and disadvantages that are attributable tosocial-structural causes generally take on a greater moralurgency than those that do not. But it would miss acrucial point of what most social-structural views areintended to do if their forward-looking concerns are notgiven equally prominent billing. One such argument isNorman Daniels’s (1985; 2008) claim that healthinequalities have a significant prospective effect onequality of opportunity. Powers and Faden (2006) andWolff and de-Shalit (2007) argue that health inequalitiesmay be unjust not only because they constitute anavoidable deprivation of some core element of well-beingthat is a constituent of a decent human life, but also forthe additional forward-looking reason that, quite often,they play a further causal role within densely wovenpatterns of disadvantage that tend to impede sufficientrealization of other core elements of human well-being.

Indeed, the ongoing and prospective focus of mostsocial-structural theories of justice is the essential pointthat Rawls highlights in his later writings. In Justice asFairness he emphasizes the overwhelming importance ofsecuring, on a continuing basis, the background condi-tions within which patterns of human interaction canproceed without the cumulative, corrosive effects of

inequalities that have further impact on a host of othervalues. Notably, social-structural theories occupy a uniqueniche among theories of justice. The prospective aims ofsocial-structural theories of justice intersect with theretrospective aims of corrective justice. While correctivejustice is meant to restore a level of well-being or socialstanding denied to persons and groups injured by a priorinjustice, social-structural justice provides a furtherremedial reason for attention to their condition. Inaddition, however, complex social-structural theories thatreflect concern for ensuring a fair basis for ongoingassociation require that participants be able to interactwith others without the burden of crippling disadvantages.In a similar vein, Thomas Pogge, whose theory aboutsocial justice is well-known for its heavy emphasis on theenduring effects of past injustices, points to what might becalled its preventive aims. He says that social justice ismeant “not merely [to] repair and compensate for theeffects of deprivations they have produced in the past,”but, even more important, to “avoid causing such damagein the first place insofar as reasonably possible” (Pogge2010, 28–29).

Given the prominent place that theories of socialjustice assign to its preventive and prospective aims,attention to at least some naturally caused inequalitiesseems unavoidable, but that attention is not based on theassumption that the aim of social justice is to eliminate allmorally arbitrary inequalities. While theories may differ intheir judgments of which inequalities are the mostappropriate basis for assessing social structures, they agreethat certain forms of deprivation and disadvantage areincompatible with the aim of ensuring just backgroundconditions within which ongoing and future interactionsoccur.

In sum, social-structural theories take their initial cuefrom a shared appreciation of the potential moralsignificance of highly consequential webs of historicaland ongoing forms of interaction, but they differ in avariety of important respects. They differ in the ways theyconceive of the elements of the basic structure that aresubject to appraisal. They differ in their judgments ofwhether the basic structure should be construed in purelydomestic terms or understood globally as well, and theydiffer in their assessments of the moral differences that thevarious causes of inequalities make to the assessment ofsocial-structural arrangements.

SEE ALSO Epistemic Injustice; Ethics: II. Task of Ethics;Global Health Inequalities and Inequities; HumanRights; Justice; Rights; Solidarity; Utilitarianism

BIBL IOGRAPHY

Anderson, Elizabeth S. 1999. “What Is the Point of Equality?”Ethics 109 (2): 287–337.


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Anderson, Elizabeth S. 2010. “Justifying the CapabilitiesApproach to Justice.” In Measuring Justice: Primary Goods andCapabilities, edited by Harry Brighouse and Ingrid Robeyns,81–100. Cambridge, UK: Cambridge University Press.

Arneson, Richard. 1989. “Equality and Equality of Opportunityfor Welfare.” Philosophical Studies 56:77–92.

Barry, Brian. 1982. “Humanity and Justice in Global Perspec-tive.” In Ethics, Economics, and Law, edited by J. RolandPennock and John W. Chapman, 219–52. New York: NewYork University Press.

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Madison PowersSenior Research Scholar,

Kennedy Institute of Ethics, andProfessor of Philosophy, Georgetown University

SOCIAL MEDICINEThroughout most of medical history the physician’s rolehas been seen predominantly as a personal one in which,for the most part, the one-to-one patient–physicianrelationship is the one that is considered in medicalethical principles. Although the shocking evidence of


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Social Justice

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