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Summary articles Advances in Health and Society
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Matthews, D. (2015): The case against equality of opportunity. Commentary on VOX media.Matthews states that striving for equality of opportunity is a bad ideal even though a lot of people
think it would be perfect to achieve this. Huge amount of time, money and intellectual effort is
devoted to this idea that a just world is one in which opportunity is equal even if outcomes aren’t.
Arguments against equality of opportunity:
It would require turning a country into a dystopian, totalitarian nightmare
It ensures that only the smartest and hardest-working end up victors, it assumes there
always be an underclass who deserve it
Some of the most important inequalities of opportunity cannot be addressed by
governments
o Pure inequality of opportunity is illiberal
o Equality of opportunity promises sufficient AND equivalent opportunities
o This means that more affluent families could not send their kids to private schools,
daycare or no after-school tutors or after school violin lessons, there could be no
inheritances
o Some of the skills parents teach their children are more valuable than others on
average, but all of them are valuable to someone (with equality of opportunity it
would be banned to teach a child something more valuable)
o Equality of opportunity would make every parenting choice a matter of public
policy, to be regulated accordingly, it’s a deeply illiberal ideal.
o "It's actually very difficult to imagine what completely equal opportunity would look
like in a world where families are different and some parents can give their children
different advantages."
There are other important values, next to equality, like freedom of parents to raise children
how they like, importance of goals others than money or social standing
It is a not ethical ideal, it is a way to abandon people who were given opportunities and
squandered them, so equality of opportunity leaves some people out (especially the less
smart) and those people don’t deserve to be abandoned
o Genes play a huge role in earnings
o So with pure equality of opportunity, some people will do better than others and it
still creates inequality
o Some people will do worse because of poverty, deprivation or lead poisoning
o The motivation to work hard and make a serious effort isn't simply a personal choice.
It's the result of millions of environmental and genetic factors.
How would we ever know if the opportunity were equal even if it was possible and
desirable? It is very difficult to measure as opposed to outcomes. Outcomes like wealth,
income, health we can measure! And by measuring the outcomes we can see the progress of
politics and we have goals to strive for!
The sooner we stop talking about mobility and opportunity and start talking about poverty
and suffering, the sooner we can solve problems of inequality.
Equality of opportunity is usually defined in opposition to equality of outcomes. The difference is that
while equality of outcomes promises gains for every poor person, equality of opportunity explicitly
leaves some people out.
,Bricard, D., Jusot, F., Trannoy, A., & Tubeuf, S. (2013). Inequality of opportunity in health and the
principle of natural reward: evidence from European countries. In: Inequality after the 20th Century:
Papers from the Sixth ECINEQ Meeting. Edited by Pedro Rosa Dias and Owen O’Donnell.
Introduction
Distinction between:
Legitimate causes of health inequalities = efforts, people can be held responsible for it
(healthy lifestyles)
o Principle of natural reward = Equality of opportunity principles recommend first to
respect the impact of individual responsibility (effort) on the otcome
Illegitimate causes of health inequalities = circumstances, individual should not be held
responsible (social and family background)
o Principle of compensation = compensate for the impact of characteristics
independent of individual responsibility (circumstances)
One requires therefore distinguishing the respective contributions of efforts and circumstances to
overall health inequalities, so that policy-makers are able to identify the effort which should be
rewarded and the circumstances that should be compensated.
Distinction between effort and circumstances is at the core of the implementation of equality of
opportunity policies and is based on the concept of individual responsibility. The challenge is that the
two components (effort and circumstances) cannot be assumed to be independent and one needs to
decide how the correlation between them should be treated. It a topic of hot debate.
Smokers example: would we hold sons of smokers less responsible to smoke than sons of
non-smokers?
o Roemer viewpoint = sons of smokers are less responsible (effort should be respected
inasmuch as effort is disembodied from the impact of circumstances, in other words
the correlation between efforts and circumstances is considered as circumstances
and is independent from individual responsibility.)
equality of opportunity requires that effort is purged from any
contamination coming from circumstances so that it represents pure
individual effort.
According to Roemer’s viewpoint, targeting determinants of health related
behaviours which are beyond individual responsibility would be also
normatively justified.
o Barry viewpoint = parental circumstances are not relevant and both sons are as
much responsible (Barry – effort should be entirely rewarded and correlation
between effort and circumstances should not be acknowledged)
individual effort has to be fully respected whatever the influence of past
circumstances on effort decisions.
According to the viewpoint adopted, the magnitude of inequalities of opportunity in smoking will
differ and this will have important implications on the implementation of the principle of natural
reward and the principle of compensation.
In the case of France: inequalities of opportunities represent 46% of observed health inequalities
regardless of the normative view adopted. They conclude that the share of inequality related to
circumstances is very large in comparison with the share of inequalities related to efforts in France.
This article quantifies and compares inequality of opportunity in health in different European
countries and assess whether it empirically matters to adopt Barry (effort should be rewarded) or
Roemer (circumstances matter more than personal responsibility) view on the magnitude of
,inequalities of opportunity in each of these countries. So the investigation will be on if the correlation
between effort and circumstances differ between countries.
Recent research has shown that persistent socioeconomic health inequalities exist in general
population. They stress the importance of social aspects in the explanation of systematic differences
in health status. The indicators of socioeconomic status:
Education
Income
Occupation
Wealth
Etc
The results of this study show differences in inequalities of opportunity across European countries
with larger inequalities in Austria, France, Spain and Germany, and lower inequalities in Sweden,
Poland, Belgium, the Netherlands and Switzerland. The share of inequalities of opportunity in health
inequalities due to circumstances and efforts varies from 30% in the less unequal countries to 80% in
the most unequal countries, whereas it represents 50% at the aggregate level. The way the
correlation between efforts and circumstances is changing the measure of inequalities of opportunity
also varies between countries where the difference between the alternative scenarios is not
significant such as Switzerland and Sweden and countries where adopting a Roemerian approach
matters more and induces a maximum of about 20% increase of the measurement of inequalities of
opportunity. At the aggregate level, the difference between the alternative scenarios represents an
increase of 16.8% in the Roemer measure
Methods
The association between health status and respectively circumstances and efforts is measured and
then predicted variables are used to measure the magnitude of health inequalities and to compare
inequality of opportunity in health between countries.
Discussion
These results contribute to the debate on whether it is individual healthrelated behaviours (efforts)
or poor past conditions (circumstances) that should be tackled to reduce effectively inequalities of
opportunity in health and health inequalities in general. Social background, parents’ health and
parents’ health-related behaviours represent factors beyond the realm of individual responsibility,
they are socially or morally unacceptable sources of inequality and they legitimate public
interventions.
Homework 31-08-21
Questions:
1) Write down Matthews’ arguments against equality of opportunities.
1. Equality of opportunity would make every parenting choice a matter of public policy, to
be regulated accordingly, it is illiberal
2. Equality of opportunities leaves some people out (those who squandered their
opportunities or are less smart)
3. There are other important values, like freedom
4. with pure equality of opportunity, some people will do better than others due to genetics
and it still creates inequality
5. you don’t know if the opportunities were equal (mobility statistics, intergenerational
elasticity of income don’t tell us something about the equality of opportunity), because it
is difficult to measure them, you can however measure the outcomes which gives you
information about poverty, health etc which should be the goals to strive for!
, 2) What do you think of the SES indicators that Bricard et al. use?
They use social conditions indicators:
1. occupation (7 categories) of the main breadwinner during childhood,
2. number of books at home when the respondent was a child (proxy of parents educational
level),
3. number of rooms per household when the respondent was 10 (household conditions),
4. the number of facilities available in the accommodation at the age of 10
5. two indicators of financial difficulties during childhood (hunger episodes and self-reported
economic hardships before age 16)
they represent the SES of these people during their childhood so it could be that it is not true
anymore.
Tutorial 31-08-21
Equality of opportunity – American dream (you can achieve everything if you work hard enough for
it), it’s nice ideal but it is not quite the case, it is easier if you are from a wealthy background
Michael Marmot: Americans who want to live the American dream should move to Sweden where
social mobility is bigger.
Social mobility = moving from socio-economic classes
High social mobility – high opportunity to switch to higher class, between generations
difference in income (Denmark scores highest and Poland is the lowest), US is also really low
Matthew’s paper: there is nothing to strive for to reach high social mobility
Image of America as giving equal opportunities to become rich or poor. But there are people who
criticize the inequality of outcome. Some people become really rich, because of better abilities. But is
there equal opportunity? Equal opportunity proves unequal talent.
Special privilege – positive discrimination, people who need it more should get more
Matthew’s (2015): the case against equality of opportunity
Movie – good will hunting, shows how talent makes it easier to climb the ladder
Is it fair that if someone has a talent then he climbs higher?
Arguments against equality of opportunity:
- It’s impossible
You cannot measure opportunities, you can measure outcomes (like health or poverty),
then you know what you are striving for and you can see the progress
- We don’t want everybody to become computer genius, we need other occupations, we need
variety
- Most smart people succeed and those less smart are left behind (they become the upper
class)
- Regulation would be impossible (restricting freedom of parenting), unethical, if you’re taking
this to the extreme you won’t allow parents to give their children extra lessons
It will become authoritarian state, no liberal
- Opportunity is not always what is needed (example when you are born disabled), it is not
always the solution
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