Abstract :
Richardson and Shiell provide helpful overviews of our article, make a number
of important points about the difficulties and challenges of research in this area,
and offer some thought-provoking suggestions on the priorities for research. We
focus below on a few minor points of disagreement, where we choose to give a
slightly different emphasis.
Shiell’s starting point is the 2008 WHO Commission Report on the Social
Determinants of Health (Commission on the Social Determinants of Health,
2008). As Shiell points out, this supra-national report – for perfectly understandable
reasons – takes a ‘single issue’ approach that focuses on the objective of reducing
health inequality, treating all other equity considerations (e.g. liberty) as merely a
constraint on the pursuit of the focal objective. Of course, national government agencies
actually responsible for decision making may be forced to take a more nuanced –
or, if you prefer, messy – approach that considers multiple, potentially conflicting,
efficiency and equity objectives of the diverse kinds outlined in our paper.
