Safe workplaces and safe workers

Individual variation in sensitivity to risk

A theory of just health care must be compatible with other components of our general theory of justice. In particular, where such a theory pursues equality in a vigorous fashion – for example, through a principle guaranteeing fair equality of opportunity – it must be compatible with the liberties we ought to grant providers, patients, and recipients of preventive care. In chapters 6 and 7, I explored these limits on the fair equality of opportunity account of just health care. In this chapter I examine another such limit on my account. I consider a context in which the demands of fair equality of opportunity for access to jobs may be in conflict with the requirement of the fair equality of opportunity account that we provide stringent health protection in the workplace. In a sense, there is a threat that the equal opportunity principle is in conflict with itself. This conflict requires some explanation.

The fair equality of opportunity account of just health care implies that it is important to seek equity in the distribution of the risk of disease, not just its treatment. Such equity will be possible only if there is stringent regulation of exposure to health hazards in the workplace, for such exposure imposes substantial risks on particular groups of workers. In Chapter 7, I considered this implication of the theory with reference to a particular feature of health hazard regulation in the United States, namely, the requirement that the Occupational Safety and Health Administration reduce worker exposure to hazards to the degree it is technologically feasible to do so.