[Equality and brotherhood--values worth preserving in the health services]

This article is the last in a series on virtues and values in medicine and health care. Its point of departure relates to the heritage of the great French 1789 revolution. Equality in society is hardly attainable, but equity in health care, providing health care according to need rather than according to wealth, has been a highly valued aim for the post-war Norwegian health services. The political ideas of this development came from the socialist labour movement as well as from Christian ideas of charity, merging to form the institutions of the post-war welfare states. Fraternity, brotherhood, or in its modern version solidarity, is based on the very nature of man as a social being, but has also been a tool to create political power necessary to achieve equity. Mounting research evidence on inequality and health shows that what makes a difference to health is more a matter of people's relative income and status in society rather than their absolute material standard of living. The values of equity and solidarity are challenged by recent neo-liberalist and populist movements. Market models in the health services tend to turn health services into commodities and patients into consumers. This has implications for medicine beyond the financial impact. Utilitarian arguments tend to favour more user fees for medical services and drugs, the emergence of private services and health insurance, the result being a drift towards greater inequality in health and access to health services. However, recent research on value preferences suggests that issues related to equality are gaining support in several European countries.