Should equity in health be target number 1?

Policy measures to reduce socioeconomic health differences (SEHD)must be preceded by an analysis of the possibilities and desirabilityof a reduction. This paper argues that it is necessary to pursueequality in health, conceived as equal opportunities to achievehealth. This principle is justified as part of the principleof maximizing individual freedom of choice, and requires thateveryone has the opportunity to be as healthy as possible. Bymeans of this principle a distinction can be made between unjust,unavoidable, and acceptable health inequalities. The determinantsof SEHD which lead to inequalities considered unjust must besubject to policy. These are living conditions (physical andsocial environment and health care) and conditions of choice(e.g. the knowledge of an individual about the health risksof a certain behaviour). Even if SEHD are considered inequities,sometimes conflicting interests will make it difficult to proposea health policy to redress these inequities. These are partlythe consequence of the intersectoral character of a policy aimedat equality of opportunities to attain health, in which theimportance of health has to be weighed against other goals.Moreover the impact of such a policy on the individual freechoice has to be critically weighed. Finally in the contextof health care policy, conflicts between the principle of equalityand maximizing health can be expected.