Health, wealth and fairness based on gender: the support for ethical principles.

Sex differences in health, and the reality of a gender system, are well-known, but we know little about how this connects to opinions on fairness and desired change. This study aims to explore two principal questions: how to compare the position of women and men within-state and how to choose between-states, where a state is defined as a situation in which individuals have a particular set of resources, rights and duties, and if components in the set are altered, a new state for the same individuals appears. Based on various normative rules (monistic view or separate spheres, equity as choice or ethics of care, equity by attainment or shortfall; variants of welfarism, feminism and conservatism), a survey among Swedish public health workers was carried out. The results demonstrate a major rejection of the idea of compensation between health, power, influence and resources, and of considering past processes when judging fairness as to women and men. Moreover, most respondents believe that a biologically based difference in health is fair and reject health maximization as a guiding principle. The support for gender equality is strong when contrasted with the conservative goal, and subsists when contrasted against the Pareto criterion and trading-off health/income as well. Results that call for additional research and exchange of views include that common notions in research and policy-making are rejected by a majority, and that females and males differ considerably when judging change from a societal perspective.