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 desirability of a reduction. This paper argues that it is necessary to pursue equality in health, conceived as equal opportunities to achieve health. This principle is justified as part of the principle of maximizing individual freedom of choice, and requires that everyone has the opportunity to be as healthy as possible. By means of this principle a distinction can be made between unjust, unavoidable, and acceptable health inequalities. The determinants of SEHD which lead to inequalities considered unjust must be subject to policy. These are living conditions (physical and social environment and health care) and conditions of choice (e.g. the knowledge of an individual about the health risks of a certain behaviour). Even if SEHD are considered inequities, sometimes conflicting interests will make it difficult to propose a health policy to redress these inequities. These are partly the consequence of the intersectoral character of a policy aimed at equality of opportunities to attain health, in which the importance of health has to be weighed against other goals. Moreover the impact of such a policy on the individual free choice has to be critically weighed. Finally in the context of health care policy, conflicts between the principle of equality and maximizing health can be expected.