Summary

This chapter argues that the construct of health and the nature of health care systems and, in turn, of equity in health and health care are in significant part cultural phenomena. This is in distinction to the universalism with respect to these issues that is usually the case in health economics assessments of both health and equity.

Acknowledgement that these are cultural phenomena, and that the literature on the social determinants of health indicates that being comfortable in one's culture is good for our health, means that globally there is a need to protect the diversity of societies and of cultures. Further, the nature of a society and its culture are heavily influenced by the economic system in which they exist. This chapter, therefore, argues that an important way of protecting the diversity of societies and of cultures is through the preservation of the diversity of economic systems.

Such preservation of diversity can be undermined by the impact of neo-liberalism's individualism and its adverse effects on the development of a sense of community. This can result in reducing social capital, which in turn can adversely affect population health and its distribution.

In the light of these observations, a new paradigm for the economics of health equity is proposed, based not on the values of individuals qua individuals, but more on the values of communities. Adopting a communitarian stance provides a new and potentially more useful approach to the economic analysis of equity in health and health care.