PoPulationand Public HealtH etHics

that freedom from preventable diseases, such as many infections and waterborne
illnesses, is a requirement for normal human functioning, and thus
is a fundamental human right. From the point of view of liberalism, then,
lack of access to clean running water, basic sanitation and adequate housing
is unjust, because it constitutes a violation of fundamental human rights, regardless
of its impact on H1N1 morbidity or mortality.
A second answer to the original question, rooted in the philosophical doctrine
of egalitarianism, requires us to determine whether these conditions represent
an inequitable distribution of resources and/or outcomes. Three factors are
important in making this decision. First, we must agree that the currency of
justice — that is, the thing being distributed — is important enough to be of
concern. Most would agree, for example, that access to a life-saving medical
treatment meets this criterion, while access to red jelly beans does not. Second,
we must determine whether the unequal distribution of a resource or
outcome among particular populations is of concern. For example, unequal
distribution of transplanted organs by socio-economic status may be considered
unacceptable, while unequal distribution by age or underlying health
status may not. Finally, we must determine whether the cause of an unequal
distribution is relevant and, if so, whether it warrants intervention. For example,
men generally have lower life expectancy than women. Some argue
that this inequality is due primarily to genetic or physiologic differences, so
it is unavoidable and thus cannot be seen as unjust. Others argue that this
inequality is due to social factors such as increased pressure on males to engage
in risky behaviors, so it is avoidable and thus unjust.
Most egalitarians would likely consider the inequalities described in the
case narrative to be unjust. The currency of justice in this case — safe drinking
water, adequate sanitation and housing — is widely considered to be a
fundamental human right, so it is clearly important enough to warrant consideration.
The inequality in this case puts First Nations communities at a
disadvantage relative to other ethnic groups and the overall Canadian population.
As this inequality further disadvantages a population that is already
subject to considerable social and economic disadvantage, it constitutes an
inequity from the perspective of populations affected. 2 (We should note here
that this judgment might change in the case of the first “scenario shift.”) The
case of causation is somewhat more complicated, and will be addressed in
detail below. For now, we can say that: (1) unsafe drinking water, inadequate
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