Apparent dilemma

Bickenbach identifies an apparent dilemma for the
construction of health measures: they must either locate the burden of
health conditions entirely in the individual, which is unfair or misleading,
or they must take account of social and environmental contributions
to that burden, thereby ceasing to be measures of health performance
or attainment. He concludes that if policy makers are to take equality
in health care seriously, they should explore alternatives to health measures
and to the kind of cost-effectiveness analysis that employs them,
alternatives such as the “benchmarks of fairness” scheme proposed by
Norman Daniels and his colleagues.Despite their differing emphases and conflicting judgments, our contributors
develop common themes.Several of them scrutinize alleged
conceptual and empirical links between impairment and well-being,
and between health and well-being. Most claim that those links are
more tenuous or complex than is often supposed. Asch, Wasserman,
and Shakespeare, for example, argue that reproductive decision making
in its present social context is shaped by unjustified or overbroad
generalizations about the impact of impairments on well-being, ignoring
the highly variable effects of different impairments in different settings.