The WHO Commission on Social Determinants of Health has documented pervasive inequalities in health in many countries. These are clearly associated with unfair distribution of the social determinants of health. Policies directed at reducing this unfair distribution should be promoted across all sectors and institutions responsible for securing equal opportunities and freedom for all citizens. This article argues that such policies will need to balance the competing goals of reducing social group inequalities in health and improving average health. We need a public debate about how to make such difficult choices. This paper outlines a framework that can help us structure our thinking about this dilemma.

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