Healthy enough? A capability approach to sufficiency and equality

Sufficiency’ approaches to social and global justice stress that everyone must have enough. According to some advocates of this approach, only sufficiency is important, not equality. Martha Nussbaum, who is often classified as a sufficiency advocate, has defied this stricture against egalitarianism by contending that, in several domains, nothing is adequate short of equality. She cites political freedoms as her most persuasive example and suggests that the same may be true of the capability for health care. However, she does not explore this idea in depth: the idea that, in the domain of health, nothing short of equal capabilities is adequate. I explore this by clarifying the main concepts, such as adequacy and capability, in the domain of health. By these means I address three further questions. First, which is primary and which is derivative: capability for health care or capability for health? Second, does duration matter? If we can understand adequate health at a moment, in terms of ranges of physiological and psychological functioning, does adequacy not also imply durability? If so, then, third, is it possible to specify the length of an adequately healthy life, at least as a reasonable expectation? I argue that, due to human diversity and the imperfect state of medical knowledge, we cannot form a reasonable expectation of the length of an adequately healthy life for each person. Nevertheless, duration still matters. Therefore, we must recognize inadequately healthy lives in the only way that we can, by recognizing social disparities in health outcomes. In this sense, nothing short of equality is adequate.