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J Med Ethics. 2018 Jun;44(6):371-375. doi: 10.1136/medethics-2017-104321. Epub 2018 Mar 6.

Chronic disease as risk multiplier for disadvantage.

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Programa de Estudios Sociales en Salud, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.


This paper starts by establishing a prima facie case that disadvantaged groups or individuals are more likely to get a chronic disease and are in a disadvantaged position to adhere to chronic treatment despite access through Universal Health Coverage. However, the main aim of this paper is to explore the normative implications of this claim by examining two different but intertwined argumentative lines that might contribute to a better understanding of the ethical challenges faced by chronic disease health policy. The paper develops the argument that certain disadvantages which may predispose to illness might overlap with disadvantages that may hinder self-management, potentially becoming disadvantageous in handling chronic disease. If so, chronic diseases may be seen as disadvantages in themselves, describing a reproduction of disadvantage among the chronically ill and a vicious circle of disadvantage that could both predict and shed light on the catastrophic health outcomes among disadvantaged groups-or individuals-dealing with chronic disease.


distributive justice; ethics; health care for specific diseases/groups; right to healthcare; social aspects

Conflict of interest statement

Competing interests: None declared.

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