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Equality of Opportunity in Health and Healthcare  

Florence Jusot and Sandy Tubeuf

Recent developments in the analysis of inequality in health and healthcare have turned their interest into an explicit normative understanding of the sources of inequalities that calls upon the concept of equality of opportunity. According to this concept, some sources of inequality are more objectionable than others and could represent priorities for policies aiming to reduce inequality in healthcare use, access, or health status. Equality of opportunity draws a distinction between “legitimate” and “illegitimate” sources of inequality. While legitimate sources of differences can be attributed to the consequences of individual effort (i.e. determinants within the individual’s control), illegitimate sources of differences are related to circumstances (i.e. determinants beyond the individual’s responsibility). The study of inequality of opportunity is rooted in social justice research, and the last decade has seen a rapid growth in empirical work using this literature at the core of its approach in both developed and developing countries. Empirical research on inequality of opportunity in health and healthcare is mainly driven by data availability. Most studies in adult populations are based on data from European countries, especially from the UK, while studies analyzing inequalities of opportunity among children are usually based on data from low- or middle-income countries and focus on children under five years old. Regarding the choice of circumstances, most studies have considered social background to be an illegitimate source of inequality in health and healthcare. Geographical dimensions have also been taken into account, but to a lesser extent, and more frequently in studies focusing on children or those based on data from countries outside Europe. Regarding effort variables or legitimate sources of health inequality, there is wide use of smoking-related variables. Regardless of the population, health outcome, and circumstances considered, scholars have provided evidence of illegitimate inequality in health and healthcare. Studies on inequality of opportunity in healthcare are mainly found in children population; this emphasizes the need to tackle inequality as early as possible.


Education and Social Mobility  

Helena Holmlund and Martin Nybom

Family background is a strong determinant of an individual’s educational achievement and labor market success. Using an economics framework, intergenerational persistence in socioeconomic status can be explained by a variety of factors, including parental investment behavior, credit constraints, and the degree of inequality in society. Genetic transmission from parents to children may also play a role. In addition, the skill formation process is governed by dynamics between different stages of a child’s life, such as complementarities between early and late investments or between informal and formal education. Education policy holds the promise of breaking the strong ties between family background and socioeconomic position by providing publicly accessible education for children of all backgrounds. However, the education system may also perpetuate social inequalities if well-off families are able to protect their children from downward mobility by, for example, moving to neighborhoods with high-quality schools and by providing networks that offer opportunities to succeed. However, a growing number of studies show that educational interventions can have long-lasting effects on students’ outcomes, in particular for disadvantaged students, and that they can be cost-effective. For example, reducing class size, increasing general education spending, tutoring, and improving teacher quality are policy levers that are shown to be successful in this regard. Shifting from selective to comprehensive school systems is also a policy that enhances equality of opportunity. While the evidence on credit constraints and their role for access to higher education is evolving, but still mostly U.S. focused and largely inconclusive, it is a key domain for shaping social mobility given the life-changing impacts that a university degree can have.