Professor M. G. Marmot et al. conducted two studies, Whitehall I and Whitehall II, in which they studied morbidity and mortality in the British civil service sector in the 1960s and the 1980s. British civil servants are under the same plan with the National Health Service, so the studies controlled for access to healthcare. But what these famous studies found was that morbidity and mortality still correlated with income. Further research and analysis has concluded that it is job satisfaction and social status more so than income that determines health outcomes. Does an individual feel like she has control over the work she does? Is she stressed out a lot? How does she feel about herself in relationship to those around her? Does she feel healthy? Does she like her life? Those who feel in control of their lives, feel valued by society, and feel good about their health actually end up living longer and healthier lives on average compared to those who don’t share these beliefs.
Deep structural inequalities exist in every society, and social justice groups work toward greater social equality everywhere. Does the notion that social inequalities are hurting people in a physiological way change the way we feel about the mission of equality? Is health so fundamentally different that individuals who accept economic inequality might mobilize over health inequality? It is certainly implicated in the right to a dignified life, a concept underpinning the human rights movement as whole. It may be though that the social inequalities on their own terms are an equal evil, because the limitations on one’s abilities to pursue her interests are as inimical to human rights as worse health.
Do these studies impact the way we feel about torts? If punching someone is a tort and it causes fleeting physical harm that may not affect their life as a whole in any way, what about disparaging remarks that hurt someone’s self-esteem? These studies seem to indicate that the harsh words may have more of an effect on health than the punch, so should the perpetrator have to compensate for the theoretical diminution of the other’s life expectancy?
What about the government’s role in promoting public health? There is a strong case for the government to take part in reducing social inequalities, but what about an active effort to shape an individual’s self-perceptions? Campaigns convincing people that they are healthy or valued, or innovations to encourage social support and community-building may have an impact on life expectancy in the same way as actual healthcare. Is it proper for the government to shape one’s ideas about herself? It is one thing to offer healthcare services, or even have campaigns encouraging people to pursue certain services or avoid certain deleterious actions, but shaping self-perception seems fundamentally different. Do individuals have a right to never have their government harm their self-esteem as part of their right to health? What if prayer was demonstrated to increase life expectancy in the same way that increasing social status does? Would it be justified in the same way for the government to promote prayer?
In the end, it may be that whenever one person meets another, a social hierarchy will form – one person will feel better about themselves and the other will feel slightly worse. The goal of society should then perhaps to be to ensure that there is an independent probability each time one enters a new social setting of receiving a favorable position in the hierarchy. One’s position in the hierarchy should not be predetermined by factors such as race, disability, gender, but based entirely on the interests of the social group, which should be different from group to group. As long as there is an opportunity for mobility between groups, there exists the potential for inequality to at least be determined by lottery, if inequality is inevitable, rather than social construct. Lottery distribution of inequality with mobility could be the most fair of unfair outcomes.