Why the Social Gradient in Health-Related Behaviour is Unjust : An Unconditionalist Perspective

Lower socio-economic position is consistently associated with a higher likelihood of engaging in health-damaging behaviours, a phenomenon known as the social gradient in health-related behaviour (SGHB). This article examines and endorses an unconditionalist view, according to which the SGHB is unjust in all cases because it results from structural injustice. This position is contrasted with a conditionalist view, which holds that the SGHB is unjust if and only if it stems from an unequal distribution of the social conditions normatively required for autonomous health-related choices and that a residual gradient may be justified once these conditions are met. Several influential approaches to health justice fall within this conditionalist framework. Despite their substantive differences, these conditionalist approaches share a deeper normative commitment to evaluative individualism. This foundation supports three critiques of unconditionalism: that it entails health perfectionism, that it neglects individuals as agents, and that it relies on a controversial empirical theory that threatens consensus. The first two critiques are considered unpersuasive, while the third raises genuine theoretical and practical challenges.