Health disparities in the US and China

Health disparities across a population are among the most profound indicators of social inequalities that we can find.  And the fact of significant disparities across groups is a devastating statement about the circumstances of justice under which a society functions.  These disparities translate into shorter lives and lower quality of life for whole groups of people, relative to other groups.

Both the United States and China appear to display significant health disparities across their populations. Here are a couple of studies that draw attention to these facts.

United States

Here is an important new study on the question of health disparities in the United States by public health researchers at Harvard and UCSF.  The study is "Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States". And the answer the researchers provide to the question above is that the US possesses very significant health disparities across segments of its population. The study is worth reading in detail.

The authors analyze mortality statistics by county, and they break the data down by incorporating racial and demographic characteristics. The data groups fairly well around the eight Americas mentioned in the title:


Here is how they describe their findings:

The gap between the highest and lowest life expectancies for race-county combinations in the United States is over 35 y. We divided the race-county combinations of the US population into eight distinct groups, referred to as the “eight Americas,” to explore the causes of the disparities that can inform specific public health intervention policies and programs.

And here is their conclusion:

Disparities in mortality across the eight Americas, each consisting of millions or tens of millions of Americans, are enormous by all international standards. The observed disparities in life expectancy cannot be explained by race, income, or basic health-care access and utilization alone. Because policies aimed at reducing fundamental socioeconomic inequalities are currently practically absent in the US, health disparities will have to be at least partly addressed through public health strategies that reduce risk factors for chronic diseases and injuries.

For example, their data show that "the life expectancy gap between the 3.4 million high-risk urban black males and the 5.6 million Asian females was 20.7 y in 2001." This is an enormous difference in longevity for the two groups; and it is a difference that tags fundamental social structures that influence health and risk across these two populations.

Here is a time-series graph of the behavior of longevity for the eight Americas:
So what are the factors that appear to create these extreme differences in mortality across socioeconomic and racial groups in America? They consider health care access and utilization; homicide; accidents; and HIV as primary potential causes of variations in mortality for a group. Most important of all of these factors for the large populations appear to be the health disparities that derive from access and utilization.  And here they offer an important set of recommendations:

Opportunities and interventions to reduce health inequalities include (1) reducing socioeconomic inequalities, which are the distal causes of health inequalities, (2) increasing financial access to health care by decreasing the number of Americans without health plan coverage, (3) removing physical, behavioral, and cultural barriers to health care, (4) reducing disparities in the quality of care, (5) designing public health strategies and interventions to reduce health risks at the level of communities (e.g., changes in urban/neighborhood design to facilitate physical activity and reduce obesity), and (6) designing public health strategies to reduce health risks that target individuals or population subgroups that are not necessarily in the same community (e.g., tobacco taxation or pharmacological interventions for blood pressure and cholesterol).

These findings are squarely relevant to assessing the justice of our society. The country needs to recognize the severity of the "health/mortality equity" issue, and we need to make appropriate policy reforms so that these disparities begin to lessen.

China

Several research papers address these issues for the case of China.  One is a World Bank working paper by David Dollar called "Poverty, Inequality, and Social Disparities During China's Economic Reform" (link).  Dollar notes that China has dramatically reduced its poverty rate over the past 25 years, whereas its income inequality measures have increased sharply during the same period. (Albert Park and Sangui Wang review the poverty statistics for this period in China Economic Review; link.)  They conclude that these inequalities between rural and urban populations, and between well educated urban professionals and the urban working class, have also resulted in significant inequalities in health status and outcomes for the various sub-populations.

Shenglan Tank, Qingyue Meng, Lincoln Chen, Henk Bekedam, Tim Evans, and Margaret Whitehead review the current evidence available on health equity in China in "Tackling the challenges to health equity in China" (link).  "Although health gains have continued, concern for the equitable distribution of social benefits of economic progress has grown" (25).  Further:

Disparities in income and wealth between the urban and rural areas, between the eastern and western regions, and between households have widened substantially. In 1990, the richest province had a GDP per person more than seven times larger than the poorest province, but by 2002, the same ratio had grown to 13 times greater.41The Gini coefficient, a measure of income inequality,42increased for China as a whole from 0•31 in 1978–79 to 0•45 in 2004. The level of income inequality in China is now similar to that in the USA, roughly comparable to that in the most inequitable Asian countries—Philippines and Thailand—and approaching the notoriously inequitable levels in Brazil and Mexico. (29-30)

The authors quote Amartya Sen on health equity (Amartya Sen, Why health equity"; link):

Health equity cannot be concerned only with health in isolation. Rather it must come to grips with the larger issue of fairness and justice in social arrangements, including economic allocations, paying attention to the role of health in human life and freedom.  Health equity is most certainly not just about the distribution of health, not to mention the even narrower focus on the distribution of health care. Indeed, health equity has an enormously wide reach and relevance.

And inequalities in personal income in different provinces lead to highly different levels of ability to fund public amenities in these provinces, with large effects on public health in poor provinces:

Living conditions differ greatly between areas of different affluence. Safe drinking water is available to 96% of the population of large cities but to less than 30% in poor rural areas. Differences in access to effective sanitation are even larger, 90% of residents in large cities have adequate sanitation, compared with less than 10% in poor rural areas (figure 6).

Two graphs capture the big picture:

In figure 1 the data demonstrate a strong correlation between life expectancy and average income for China's provinces and municipalities, from just about 65 years for the poorest regions to 78 years in Shanghai region.  Figure 2 demonstrates major inequalities in child health between rural and urban locations.  The authors further report that infant mortality also varies dramatically across regions: "Rural infant mortality rates are nearly five times higher in the poorest rural counties than in the wealthiest countries -- 123 versus 26 per 1000 live births, respectively" (26). One important source of data on these issues that these researchers use is the Chinese National Health Service survey of 1998; link.

The most detailed analysis of health disparities in China I've been able to find is a paper published in 2010 by Feinian Chen, Yang Yang, and Guangya Liu, "Social Change and Socioeconomic Disparities in Health over the Life Course in China: A Cohort Analysis" (link).  They make use of the China Health and Nutrition Survey to allow for a longitudinal study of health in several segments of China's population. (Here is a description of the CHNS.) Their conclusion:

Using data from the China Health and Nutrition Survey, we find significant socioeconomic status (SES) differences in the mean level of health and that these SES differentials generally diverge over the life course. We also find strong cohort variations in SES disparities in the mean levels of health and health trajectories. (126)

It would appear that studies of health status in China disaggregated by population segments are not yet as fully developed as one would wish.  The CHNS appears to have limited data coverage (much more limited than the national census, for example), and none of the studies mentioned in these articles appear to disaggregate down to levels lower than the province.  But the summary findings of all three of these articles point in the same direction: it is probable that there are significant inter-regional and inter-sectoral inequalities in health outcomes for the sub-populations corresponding to these segments.

Health disparities in the US and China

Health disparities across a population are among the most profound indicators of social inequalities that we can find.  And the fact of significant disparities across groups is a devastating statement about the circumstances of justice under which a society functions.  These disparities translate into shorter lives and lower quality of life for whole groups of people, relative to other groups.

Both the United States and China appear to display significant health disparities across their populations. Here are a couple of studies that draw attention to these facts.

United States

Here is an important new study on the question of health disparities in the United States by public health researchers at Harvard and UCSF.  The study is "Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States". And the answer the researchers provide to the question above is that the US possesses very significant health disparities across segments of its population. The study is worth reading in detail.

The authors analyze mortality statistics by county, and they break the data down by incorporating racial and demographic characteristics. The data groups fairly well around the eight Americas mentioned in the title:


Here is how they describe their findings:

The gap between the highest and lowest life expectancies for race-county combinations in the United States is over 35 y. We divided the race-county combinations of the US population into eight distinct groups, referred to as the “eight Americas,” to explore the causes of the disparities that can inform specific public health intervention policies and programs.

And here is their conclusion:

Disparities in mortality across the eight Americas, each consisting of millions or tens of millions of Americans, are enormous by all international standards. The observed disparities in life expectancy cannot be explained by race, income, or basic health-care access and utilization alone. Because policies aimed at reducing fundamental socioeconomic inequalities are currently practically absent in the US, health disparities will have to be at least partly addressed through public health strategies that reduce risk factors for chronic diseases and injuries.

For example, their data show that "the life expectancy gap between the 3.4 million high-risk urban black males and the 5.6 million Asian females was 20.7 y in 2001." This is an enormous difference in longevity for the two groups; and it is a difference that tags fundamental social structures that influence health and risk across these two populations.

Here is a time-series graph of the behavior of longevity for the eight Americas:
So what are the factors that appear to create these extreme differences in mortality across socioeconomic and racial groups in America? They consider health care access and utilization; homicide; accidents; and HIV as primary potential causes of variations in mortality for a group. Most important of all of these factors for the large populations appear to be the health disparities that derive from access and utilization.  And here they offer an important set of recommendations:

Opportunities and interventions to reduce health inequalities include (1) reducing socioeconomic inequalities, which are the distal causes of health inequalities, (2) increasing financial access to health care by decreasing the number of Americans without health plan coverage, (3) removing physical, behavioral, and cultural barriers to health care, (4) reducing disparities in the quality of care, (5) designing public health strategies and interventions to reduce health risks at the level of communities (e.g., changes in urban/neighborhood design to facilitate physical activity and reduce obesity), and (6) designing public health strategies to reduce health risks that target individuals or population subgroups that are not necessarily in the same community (e.g., tobacco taxation or pharmacological interventions for blood pressure and cholesterol).

These findings are squarely relevant to assessing the justice of our society. The country needs to recognize the severity of the "health/mortality equity" issue, and we need to make appropriate policy reforms so that these disparities begin to lessen.

China

Several research papers address these issues for the case of China.  One is a World Bank working paper by David Dollar called "Poverty, Inequality, and Social Disparities During China's Economic Reform" (link).  Dollar notes that China has dramatically reduced its poverty rate over the past 25 years, whereas its income inequality measures have increased sharply during the same period. (Albert Park and Sangui Wang review the poverty statistics for this period in China Economic Review; link.)  They conclude that these inequalities between rural and urban populations, and between well educated urban professionals and the urban working class, have also resulted in significant inequalities in health status and outcomes for the various sub-populations.

Shenglan Tank, Qingyue Meng, Lincoln Chen, Henk Bekedam, Tim Evans, and Margaret Whitehead review the current evidence available on health equity in China in "Tackling the challenges to health equity in China" (link).  "Although health gains have continued, concern for the equitable distribution of social benefits of economic progress has grown" (25).  Further:

Disparities in income and wealth between the urban and rural areas, between the eastern and western regions, and between households have widened substantially. In 1990, the richest province had a GDP per person more than seven times larger than the poorest province, but by 2002, the same ratio had grown to 13 times greater.41The Gini coefficient, a measure of income inequality,42increased for China as a whole from 0•31 in 1978–79 to 0•45 in 2004. The level of income inequality in China is now similar to that in the USA, roughly comparable to that in the most inequitable Asian countries—Philippines and Thailand—and approaching the notoriously inequitable levels in Brazil and Mexico. (29-30)

The authors quote Amartya Sen on health equity (Amartya Sen, Why health equity"; link):

Health equity cannot be concerned only with health in isolation. Rather it must come to grips with the larger issue of fairness and justice in social arrangements, including economic allocations, paying attention to the role of health in human life and freedom.  Health equity is most certainly not just about the distribution of health, not to mention the even narrower focus on the distribution of health care. Indeed, health equity has an enormously wide reach and relevance.

And inequalities in personal income in different provinces lead to highly different levels of ability to fund public amenities in these provinces, with large effects on public health in poor provinces:

Living conditions differ greatly between areas of different affluence. Safe drinking water is available to 96% of the population of large cities but to less than 30% in poor rural areas. Differences in access to effective sanitation are even larger, 90% of residents in large cities have adequate sanitation, compared with less than 10% in poor rural areas (figure 6).

Two graphs capture the big picture:

In figure 1 the data demonstrate a strong correlation between life expectancy and average income for China's provinces and municipalities, from just about 65 years for the poorest regions to 78 years in Shanghai region.  Figure 2 demonstrates major inequalities in child health between rural and urban locations.  The authors further report that infant mortality also varies dramatically across regions: "Rural infant mortality rates are nearly five times higher in the poorest rural counties than in the wealthiest countries -- 123 versus 26 per 1000 live births, respectively" (26). One important source of data on these issues that these researchers use is the Chinese National Health Service survey of 1998; link.

The most detailed analysis of health disparities in China I've been able to find is a paper published in 2010 by Feinian Chen, Yang Yang, and Guangya Liu, "Social Change and Socioeconomic Disparities in Health over the Life Course in China: A Cohort Analysis" (link).  They make use of the China Health and Nutrition Survey to allow for a longitudinal study of health in several segments of China's population. (Here is a description of the CHNS.) Their conclusion:

Using data from the China Health and Nutrition Survey, we find significant socioeconomic status (SES) differences in the mean level of health and that these SES differentials generally diverge over the life course. We also find strong cohort variations in SES disparities in the mean levels of health and health trajectories. (126)

It would appear that studies of health status in China disaggregated by population segments are not yet as fully developed as one would wish.  The CHNS appears to have limited data coverage (much more limited than the national census, for example), and none of the studies mentioned in these articles appear to disaggregate down to levels lower than the province.  But the summary findings of all three of these articles point in the same direction: it is probable that there are significant inter-regional and inter-sectoral inequalities in health outcomes for the sub-populations corresponding to these segments.

Health disparities in the US and China

Health disparities across a population are among the most profound indicators of social inequalities that we can find.  And the fact of significant disparities across groups is a devastating statement about the circumstances of justice under which a society functions.  These disparities translate into shorter lives and lower quality of life for whole groups of people, relative to other groups.

Both the United States and China appear to display significant health disparities across their populations. Here are a couple of studies that draw attention to these facts.

United States

Here is an important new study on the question of health disparities in the United States by public health researchers at Harvard and UCSF.  The study is "Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States". And the answer the researchers provide to the question above is that the US possesses very significant health disparities across segments of its population. The study is worth reading in detail.

The authors analyze mortality statistics by county, and they break the data down by incorporating racial and demographic characteristics. The data groups fairly well around the eight Americas mentioned in the title:


Here is how they describe their findings:

The gap between the highest and lowest life expectancies for race-county combinations in the United States is over 35 y. We divided the race-county combinations of the US population into eight distinct groups, referred to as the “eight Americas,” to explore the causes of the disparities that can inform specific public health intervention policies and programs.

And here is their conclusion:

Disparities in mortality across the eight Americas, each consisting of millions or tens of millions of Americans, are enormous by all international standards. The observed disparities in life expectancy cannot be explained by race, income, or basic health-care access and utilization alone. Because policies aimed at reducing fundamental socioeconomic inequalities are currently practically absent in the US, health disparities will have to be at least partly addressed through public health strategies that reduce risk factors for chronic diseases and injuries.

For example, their data show that "the life expectancy gap between the 3.4 million high-risk urban black males and the 5.6 million Asian females was 20.7 y in 2001." This is an enormous difference in longevity for the two groups; and it is a difference that tags fundamental social structures that influence health and risk across these two populations.

Here is a time-series graph of the behavior of longevity for the eight Americas:
So what are the factors that appear to create these extreme differences in mortality across socioeconomic and racial groups in America? They consider health care access and utilization; homicide; accidents; and HIV as primary potential causes of variations in mortality for a group. Most important of all of these factors for the large populations appear to be the health disparities that derive from access and utilization.  And here they offer an important set of recommendations:

Opportunities and interventions to reduce health inequalities include (1) reducing socioeconomic inequalities, which are the distal causes of health inequalities, (2) increasing financial access to health care by decreasing the number of Americans without health plan coverage, (3) removing physical, behavioral, and cultural barriers to health care, (4) reducing disparities in the quality of care, (5) designing public health strategies and interventions to reduce health risks at the level of communities (e.g., changes in urban/neighborhood design to facilitate physical activity and reduce obesity), and (6) designing public health strategies to reduce health risks that target individuals or population subgroups that are not necessarily in the same community (e.g., tobacco taxation or pharmacological interventions for blood pressure and cholesterol).

These findings are squarely relevant to assessing the justice of our society. The country needs to recognize the severity of the "health/mortality equity" issue, and we need to make appropriate policy reforms so that these disparities begin to lessen.

China

Several research papers address these issues for the case of China.  One is a World Bank working paper by David Dollar called "Poverty, Inequality, and Social Disparities During China's Economic Reform" (link).  Dollar notes that China has dramatically reduced its poverty rate over the past 25 years, whereas its income inequality measures have increased sharply during the same period. (Albert Park and Sangui Wang review the poverty statistics for this period in China Economic Review; link.)  They conclude that these inequalities between rural and urban populations, and between well educated urban professionals and the urban working class, have also resulted in significant inequalities in health status and outcomes for the various sub-populations.

Shenglan Tank, Qingyue Meng, Lincoln Chen, Henk Bekedam, Tim Evans, and Margaret Whitehead review the current evidence available on health equity in China in "Tackling the challenges to health equity in China" (link).  "Although health gains have continued, concern for the equitable distribution of social benefits of economic progress has grown" (25).  Further:

Disparities in income and wealth between the urban and rural areas, between the eastern and western regions, and between households have widened substantially. In 1990, the richest province had a GDP per person more than seven times larger than the poorest province, but by 2002, the same ratio had grown to 13 times greater.41The Gini coefficient, a measure of income inequality,42increased for China as a whole from 0•31 in 1978–79 to 0•45 in 2004. The level of income inequality in China is now similar to that in the USA, roughly comparable to that in the most inequitable Asian countries—Philippines and Thailand—and approaching the notoriously inequitable levels in Brazil and Mexico. (29-30)

The authors quote Amartya Sen on health equity (Amartya Sen, Why health equity"; link):

Health equity cannot be concerned only with health in isolation. Rather it must come to grips with the larger issue of fairness and justice in social arrangements, including economic allocations, paying attention to the role of health in human life and freedom.  Health equity is most certainly not just about the distribution of health, not to mention the even narrower focus on the distribution of health care. Indeed, health equity has an enormously wide reach and relevance.

And inequalities in personal income in different provinces lead to highly different levels of ability to fund public amenities in these provinces, with large effects on public health in poor provinces:

Living conditions differ greatly between areas of different affluence. Safe drinking water is available to 96% of the population of large cities but to less than 30% in poor rural areas. Differences in access to effective sanitation are even larger, 90% of residents in large cities have adequate sanitation, compared with less than 10% in poor rural areas (figure 6).

Two graphs capture the big picture:

In figure 1 the data demonstrate a strong correlation between life expectancy and average income for China's provinces and municipalities, from just about 65 years for the poorest regions to 78 years in Shanghai region.  Figure 2 demonstrates major inequalities in child health between rural and urban locations.  The authors further report that infant mortality also varies dramatically across regions: "Rural infant mortality rates are nearly five times higher in the poorest rural counties than in the wealthiest countries -- 123 versus 26 per 1000 live births, respectively" (26). One important source of data on these issues that these researchers use is the Chinese National Health Service survey of 1998; link.

The most detailed analysis of health disparities in China I've been able to find is a paper published in 2010 by Feinian Chen, Yang Yang, and Guangya Liu, "Social Change and Socioeconomic Disparities in Health over the Life Course in China: A Cohort Analysis" (link).  They make use of the China Health and Nutrition Survey to allow for a longitudinal study of health in several segments of China's population. (Here is a description of the CHNS.) Their conclusion:

Using data from the China Health and Nutrition Survey, we find significant socioeconomic status (SES) differences in the mean level of health and that these SES differentials generally diverge over the life course. We also find strong cohort variations in SES disparities in the mean levels of health and health trajectories. (126)

It would appear that studies of health status in China disaggregated by population segments are not yet as fully developed as one would wish.  The CHNS appears to have limited data coverage (much more limited than the national census, for example), and none of the studies mentioned in these articles appear to disaggregate down to levels lower than the province.  But the summary findings of all three of these articles point in the same direction: it is probable that there are significant inter-regional and inter-sectoral inequalities in health outcomes for the sub-populations corresponding to these segments.

How can justice be causal?

Is social justice an empirical characteristic of a set of social arrangements? And can social justice be a causal factor in processes of social change or social stability?

Before justice could be considered an empirical feature of a set of social arrangements, we would need to have a more specific understanding of what we mean by the term. And we would need to be able to "operationalize" this complex concept in order to be able to apply it to different social arrangements. But neither of these tasks is insurmountable; certainly not more so than defining and applying the ideas of fascism, liberal democracy, or welfare state to specific societies.

So let's begin with a simple, applicable definition of justice. Let's focus on just three dimensions of a society's functioning: distribution of access to society's wealth; the degree of abuse of power and its contrary, reliable legal protections of the person; and the extent of individual freedoms. Injustice involves --

• exploitation and inequality
• unwarranted coercion by the state or private organizations
• the abuse of people's freedoms.

A society is more just when it involves less of any of these features. And each of these dimensions seems measurable.

But immediately a problem arises. Each of these features requires a key normative judgement. Exploitation is the unfair division of the fruits of productive activity among the participants. The qualifier "unwarranted" requires that we supply a normative theory of the state. And "abuse" of freedom isn't simply restriction on freedom; it is the unjustified or unequal restriction on freedom. So in order to measure any of these characteristics in a particular social context it isn't enough to know who gets what or who does what to whom; we need a background set of normative ideas that allow us to judge which kinds of treatment and inequality count as exploitation, coercion, or the abuse of freedom.

This is where Amartya Sen's ideas about capabilities, realizations, and freedoms are practical and useful. We might substitute "capabilities realization deficit" for exploitation. Here we might argue that a society that leaves a significant portion of its population in material conditions where they cannot fulfill most of their basic human capabilities is for that reason unjust. We might measure the gap in human development between the top quintile and the bottom quintile as an estimate of the degree of exploitation that is prevalent in a given society. We may not know in detail how the system of distribution works, but the severity of the gap gives reason to believe that a portion of the society is being treated unfairly.  The Human Development Index provides a basis for beginning to assess different countries along these lines (link).

Second, we might measure coercion and legality by the estimating the degree to which a society has effectively implemented a working system of law that is applied equally. The World Bank has made some efforts in this direction through its Worldwide Governance Indicators (link; working paper here).  This gives us an empirical measure of the degree of lawlessness and unchecked state power that exists in various societies.

We might measure freedoms by aggregating observable features of democratic participation in various societies.  The Economist has constructed a Democracy Index that was first implemented in 2006 (link). This gives us an empirical way of assessing the rough degree of involvement citizens can have in public decision-making; or in other words, it is a measure of the degree to which it is possible for citizens to exercise their freedoms in a public space.

So we might imagine a "justice index" for a society that aggregates measures like these into an overall assessment of the degree of justice the society currently demonstrates.  It would then be interesting to see how societies differ in this measure, and how other important social characteristics may be correlated with this measure.  I haven't done this experiment, but here's what we might expect: higher injustice ratings correspond to greater likelihood of social conflict, lower productivity, and lower community and civic engagement.

What mechanisms might be hypothesized that would originate in these core aspects of a society's justice profile and its various outcomes?  Here we can identify a couple of factors that would support a causal interpretation.  For example, absolute or relative deprivation can cause people to rebel as they struggle to create social changes that protect their interests.  Further, as Barrington Moore demonstrated in Injustice, the conviction that basic social arrangements are unfair can also move people to activism and resistance -- as we seem to be seeing in the Occupy Wall Street movement.  These factors derive from the distributive arrangements of a society: injustice can provoke resistance.  Similar statements can be made about state violence and lawlessness. We have seen in Libya, Syria, and Morocco that state violence against protesters can actually have the effect of strengthening and broadening resistance.

So these aspects of injustice can have effects on mobilization and resistance by a population. Are there other effects that injustice can have?  As noted earlier (link), Pickett and Wilkinson argue in The Spirit Level: Why Greater Equality Makes Societies Stronger that inequalities of income have surprisingly strong associations with a variety of social ills.  This could be developed into an argument that social justice and injustice lead to behaviors that either promote or undermine social welfare.

Finally, it seems plausible to imagine that the intangibles that accompany a harmonious society -- a population of people who generally feel that they are fairly treated by their basic institutions and their fellow citizens -- will lead to a variety of other social goods, including cooperation, civic engagement, and economic productivity.  Conversely, it is plausible to suppose that a dis-harmonious society would give rise to the negatives of these qualities: less cooperation, less civic involvement, and less economic productivity.

So two things seem true.  First, it does seem possible to "measure" injustice (supported, of course, by a normative theory of why various kinds of inequality are illegitimate).  And second, it does seem plausible that the features of a society that constitute its injustice may also have causal consequences for social unrest, social wellbeing, and social cooperation.  And these are certainly significant social consequences.

(Perhaps there is an analogous set of questions at the individual level: Is "virtue" a specific empirical characteristic of a person's character? And can virtue be a causal factor in the individual's life outcomes and level of happiness?)

How can justice be causal?

Is social justice an empirical characteristic of a set of social arrangements? And can social justice be a causal factor in processes of social change or social stability?

Before justice could be considered an empirical feature of a set of social arrangements, we would need to have a more specific understanding of what we mean by the term. And we would need to be able to "operationalize" this complex concept in order to be able to apply it to different social arrangements. But neither of these tasks is insurmountable; certainly not more so than defining and applying the ideas of fascism, liberal democracy, or welfare state to specific societies.

So let's begin with a simple, applicable definition of justice. Let's focus on just three dimensions of a society's functioning: distribution of access to society's wealth; the degree of abuse of power and its contrary, reliable legal protections of the person; and the extent of individual freedoms. Injustice involves --

• exploitation and inequality
• unwarranted coercion by the state or private organizations
• the abuse of people's freedoms.

A society is more just when it involves less of any of these features. And each of these dimensions seems measurable.

But immediately a problem arises. Each of these features requires a key normative judgement. Exploitation is the unfair division of the fruits of productive activity among the participants. The qualifier "unwarranted" requires that we supply a normative theory of the state. And "abuse" of freedom isn't simply restriction on freedom; it is the unjustified or unequal restriction on freedom. So in order to measure any of these characteristics in a particular social context it isn't enough to know who gets what or who does what to whom; we need a background set of normative ideas that allow us to judge which kinds of treatment and inequality count as exploitation, coercion, or the abuse of freedom.

This is where Amartya Sen's ideas about capabilities, realizations, and freedoms are practical and useful. We might substitute "capabilities realization deficit" for exploitation. Here we might argue that a society that leaves a significant portion of its population in material conditions where they cannot fulfill most of their basic human capabilities is for that reason unjust. We might measure the gap in human development between the top quintile and the bottom quintile as an estimate of the degree of exploitation that is prevalent in a given society. We may not know in detail how the system of distribution works, but the severity of the gap gives reason to believe that a portion of the society is being treated unfairly.  The Human Development Index provides a basis for beginning to assess different countries along these lines (link).

Second, we might measure coercion and legality by the estimating the degree to which a society has effectively implemented a working system of law that is applied equally. The World Bank has made some efforts in this direction through its Worldwide Governance Indicators (link; working paper here).  This gives us an empirical measure of the degree of lawlessness and unchecked state power that exists in various societies.

We might measure freedoms by aggregating observable features of democratic participation in various societies.  The Economist has constructed a Democracy Index that was first implemented in 2006 (link). This gives us an empirical way of assessing the rough degree of involvement citizens can have in public decision-making; or in other words, it is a measure of the degree to which it is possible for citizens to exercise their freedoms in a public space.

So we might imagine a "justice index" for a society that aggregates measures like these into an overall assessment of the degree of justice the society currently demonstrates.  It would then be interesting to see how societies differ in this measure, and how other important social characteristics may be correlated with this measure.  I haven't done this experiment, but here's what we might expect: higher injustice ratings correspond to greater likelihood of social conflict, lower productivity, and lower community and civic engagement.

What mechanisms might be hypothesized that would originate in these core aspects of a society's justice profile and its various outcomes?  Here we can identify a couple of factors that would support a causal interpretation.  For example, absolute or relative deprivation can cause people to rebel as they struggle to create social changes that protect their interests.  Further, as Barrington Moore demonstrated in Injustice, the conviction that basic social arrangements are unfair can also move people to activism and resistance -- as we seem to be seeing in the Occupy Wall Street movement.  These factors derive from the distributive arrangements of a society: injustice can provoke resistance.  Similar statements can be made about state violence and lawlessness. We have seen in Libya, Syria, and Morocco that state violence against protesters can actually have the effect of strengthening and broadening resistance.

So these aspects of injustice can have effects on mobilization and resistance by a population. Are there other effects that injustice can have?  As noted earlier (link), Pickett and Wilkinson argue in The Spirit Level: Why Greater Equality Makes Societies Stronger that inequalities of income have surprisingly strong associations with a variety of social ills.  This could be developed into an argument that social justice and injustice lead to behaviors that either promote or undermine social welfare.

Finally, it seems plausible to imagine that the intangibles that accompany a harmonious society -- a population of people who generally feel that they are fairly treated by their basic institutions and their fellow citizens -- will lead to a variety of other social goods, including cooperation, civic engagement, and economic productivity.  Conversely, it is plausible to suppose that a dis-harmonious society would give rise to the negatives of these qualities: less cooperation, less civic involvement, and less economic productivity.

So two things seem true.  First, it does seem possible to "measure" injustice (supported, of course, by a normative theory of why various kinds of inequality are illegitimate).  And second, it does seem plausible that the features of a society that constitute its injustice may also have causal consequences for social unrest, social wellbeing, and social cooperation.  And these are certainly significant social consequences.

(Perhaps there is an analogous set of questions at the individual level: Is "virtue" a specific empirical characteristic of a person's character? And can virtue be a causal factor in the individual's life outcomes and level of happiness?)

How can justice be causal?

Is social justice an empirical characteristic of a set of social arrangements? And can social justice be a causal factor in processes of social change or social stability?

Before justice could be considered an empirical feature of a set of social arrangements, we would need to have a more specific understanding of what we mean by the term. And we would need to be able to "operationalize" this complex concept in order to be able to apply it to different social arrangements. But neither of these tasks is insurmountable; certainly not more so than defining and applying the ideas of fascism, liberal democracy, or welfare state to specific societies.

So let's begin with a simple, applicable definition of justice. Let's focus on just three dimensions of a society's functioning: distribution of access to society's wealth; the degree of abuse of power and its contrary, reliable legal protections of the person; and the extent of individual freedoms. Injustice involves --

• exploitation and inequality
• unwarranted coercion by the state or private organizations
• the abuse of people's freedoms.

A society is more just when it involves less of any of these features. And each of these dimensions seems measurable.

But immediately a problem arises. Each of these features requires a key normative judgement. Exploitation is the unfair division of the fruits of productive activity among the participants. The qualifier "unwarranted" requires that we supply a normative theory of the state. And "abuse" of freedom isn't simply restriction on freedom; it is the unjustified or unequal restriction on freedom. So in order to measure any of these characteristics in a particular social context it isn't enough to know who gets what or who does what to whom; we need a background set of normative ideas that allow us to judge which kinds of treatment and inequality count as exploitation, coercion, or the abuse of freedom.

This is where Amartya Sen's ideas about capabilities, realizations, and freedoms are practical and useful. We might substitute "capabilities realization deficit" for exploitation. Here we might argue that a society that leaves a significant portion of its population in material conditions where they cannot fulfill most of their basic human capabilities is for that reason unjust. We might measure the gap in human development between the top quintile and the bottom quintile as an estimate of the degree of exploitation that is prevalent in a given society. We may not know in detail how the system of distribution works, but the severity of the gap gives reason to believe that a portion of the society is being treated unfairly.  The Human Development Index provides a basis for beginning to assess different countries along these lines (link).

Second, we might measure coercion and legality by the estimating the degree to which a society has effectively implemented a working system of law that is applied equally. The World Bank has made some efforts in this direction through its Worldwide Governance Indicators (link; working paper here).  This gives us an empirical measure of the degree of lawlessness and unchecked state power that exists in various societies.

We might measure freedoms by aggregating observable features of democratic participation in various societies.  The Economist has constructed a Democracy Index that was first implemented in 2006 (link). This gives us an empirical way of assessing the rough degree of involvement citizens can have in public decision-making; or in other words, it is a measure of the degree to which it is possible for citizens to exercise their freedoms in a public space.

So we might imagine a "justice index" for a society that aggregates measures like these into an overall assessment of the degree of justice the society currently demonstrates.  It would then be interesting to see how societies differ in this measure, and how other important social characteristics may be correlated with this measure.  I haven't done this experiment, but here's what we might expect: higher injustice ratings correspond to greater likelihood of social conflict, lower productivity, and lower community and civic engagement.

What mechanisms might be hypothesized that would originate in these core aspects of a society's justice profile and its various outcomes?  Here we can identify a couple of factors that would support a causal interpretation.  For example, absolute or relative deprivation can cause people to rebel as they struggle to create social changes that protect their interests.  Further, as Barrington Moore demonstrated in Injustice, the conviction that basic social arrangements are unfair can also move people to activism and resistance -- as we seem to be seeing in the Occupy Wall Street movement.  These factors derive from the distributive arrangements of a society: injustice can provoke resistance.  Similar statements can be made about state violence and lawlessness. We have seen in Libya, Syria, and Morocco that state violence against protesters can actually have the effect of strengthening and broadening resistance.

So these aspects of injustice can have effects on mobilization and resistance by a population. Are there other effects that injustice can have?  As noted earlier (link), Pickett and Wilkinson argue in The Spirit Level: Why Greater Equality Makes Societies Stronger that inequalities of income have surprisingly strong associations with a variety of social ills.  This could be developed into an argument that social justice and injustice lead to behaviors that either promote or undermine social welfare.

Finally, it seems plausible to imagine that the intangibles that accompany a harmonious society -- a population of people who generally feel that they are fairly treated by their basic institutions and their fellow citizens -- will lead to a variety of other social goods, including cooperation, civic engagement, and economic productivity.  Conversely, it is plausible to suppose that a dis-harmonious society would give rise to the negatives of these qualities: less cooperation, less civic involvement, and less economic productivity.

So two things seem true.  First, it does seem possible to "measure" injustice (supported, of course, by a normative theory of why various kinds of inequality are illegitimate).  And second, it does seem plausible that the features of a society that constitute its injustice may also have causal consequences for social unrest, social wellbeing, and social cooperation.  And these are certainly significant social consequences.

(Perhaps there is an analogous set of questions at the individual level: Is "virtue" a specific empirical characteristic of a person's character? And can virtue be a causal factor in the individual's life outcomes and level of happiness?)

Rawls's framework for global justice

Rawls's A Theory of Justice was immediately received as a major and progressive contribution to the theory of justice within existing societies. His Law of Peoples (1999) was intended to carry his basic ideas about justice to the international realm.  (Here is a PDF of a preliminary version of the title essay of the book as published in Critical Inquiry in 1993.) Here is how he defined the goal of a law of peoples in 1993:

The law of peoples ... is a family of political concepts along with principles of right justice, and the common good that specify the content of a liberal conception of justice worked up to extend to and apply to international law. It provides the concepts and principles by reference to which that law is to be judged. (43)

In contrast to the reception A Theory of Justice received, his work on the international part of the theory has not had much influence, and was roundly criticized for being too accepting of international inequalities.   Philip Pettit put the point this way in his contribution to Rex Martin and David Reidy's Rawls's Law of Peoples: A Realistic Utopia:

John Rawls's work on the law of peoples is notorious for its anti-cosmopolitan stance: roughly, its insistence that those of us in well-ordered societies do not owe to the members of other societies the sort of justice we owe to one another. (38)

This is exactly the critique that Philippe van Parijs offered to Rawls prior to publication of the book (link).

Given that Rawls's intuitions seem to have been solidly progressive in other spheres, it is worth considering why he took this very limited view of the obligations of justice in the global context. Why did he begin with the perspective of peoples rather than persons?  (Here I'll make use of the 1993 statements of the view.)

A number of the critics put their cases in terms of Rawls's anti-cosmopolitanism.  "Cosmopolitanism" is the view that we are all citizens of the world, and we have positive moral relationships with each other no matter what nation issues our passports.  No one would deny that everyone has some kinds of moral relationships to everyone else -- for example, the obligation not to impose harm on innocent people.  But cosmopolitanism extends to the idea of positive obligations -- the obligation to render assistance as well as the obligation to refrain from gratuitous harm.  The contrary to cosmopolitanism might be called "nationalism", but this implies assumptions that Rawls would presumably not have accepted.  So let's call it "bounded people-ism": the claims of justice that a person has against other persons extend only to other members of his/her people and government.

One deep reason for the direction that Rawls took was the assumption he made about how to make use of the original position and the veil of ignorance in arriving at principles of international justice.  If this framework involved all human beings, then the results would have been very similar to the argument made in the case of a well-ordered society: inequalities need to be the least system possible consistent with maximizing the position of the least-well-off stratum of society.  However, Rawls chose instead to include "peoples" rather than "persons" in the argument from the original position in the case of international justice. What is a people?

By peoples I mean persons and their dependents seen as a corporate body and as organized by their political institutions, which establish the powers of government. In democratic societies persons will be citizens; in hierarchical and other societies they will be members. (41)

And he directly addresses the question of why it should be peoples rather than persons whose perspectives are represented in the original position for international justice:

Wouldn't it be better to start with the world as a whole, with a global original position, so to speak, and discuss the question whether, and in what form, there should be states, or peoples, at all? ... I think there is no clear initial answer to this question. We should try various alternatives and weigh their pluses and minuses. Since in working out justice as fairness I begin with domestic society, I shall continue from there as if what has been done so far is more or less sound. So I simply build on the steps taken until now, as this seems to provide a suitable starting point for the extension to the law of peoples. A further reason for proceeding thus is that peoples as corporate bodies organized by their governments now exist in some form all over the world. (42-43)

So his reasons for beginning with this premise are, first, we have to start somewhere and there isn't a philosophically compelling reason to favor persons over peoples in this setting; and second, peoples (and states) exist as actors in the world, so it is feasible to begin the analysis at this level. This way of formulating the original position is designed to establish fair terms of interaction between societies -- or in other words,

... fair conditions under which the parties, this time as representatives of societies well ordered by liberal conceptions of justice, are to specify the laws of peoples and the fair terms of their cooperation. (45)

This formulation, of course, immediately precludes certain questions, including all questions of difference in outcomes for the least-well-off in the various societies.  The fact that the LWO in country X are worse off than the LWO in country Y cannot be a factor in this deliberation, and therefore there cannot emerge a positive obligation to transfer resources from society Y to X to ameliorate this difference.

Here are the principles that Rawls arrives at through this construction:

1. Peoples (as organized by their governments) are free and independent, and their freedom and independence is to be respected by other peoples.
2. Peoples are equal and parties to their own agreements.
3. Peoples have the right of self-defense but no right to war.
4. Peoples are to observe a duty of nonintervention.
5. Peoples are to observe treaties and undertakings.
6. Peoples are to observe certain specified restrictions on the conduct of war (assumed to be in self-defense).
7. Peoples are to honor human rights. (46)

In the final version of the argument in 1997 he adds a final principle:

8. Peoples have a duty to assist other peoples living under unfavorable conditions that prevent their having a just or decent political and social regime.

Later in 1993 he comments on the idea of a human right:

Human rights have, then, these three roles:
1. Their being fulfilled is a necessary condition of a regime's legitimacy and of the decency of its legal order.
2. Their fulfillment is also sufficient to exclude justified and forceful intervention by other peoples, say by economic sanctions or, in grave cases, by military force.
3. "They set a moral limit to pluralism" among peoples. (59)

Several things are evident from these lists.  First, the obligations represented here are indeed minimalist; basically, they are limitations on the use of coercive means by peoples (states) to achieve their ends.  Even the 8th principle added in the 1997 version creates an obligation only to assist other peoples in achieving a just political regime.  Second, there are no requirements of distributive justice in this list of principles.  Each society has internal requirements of distributive justice; but there is no inter-society requirement of distributive justice.  The fact that there are large inequalities of resources between countries is not a basis for a claim of injustice, according to these principles.

This framework has been strongly criticized by philosophers and others who found that it was far too accepting of global inequalities.  Alan Buchanan focuses on the global inequality part of the story in his 2000 contribution in Ethics. Buchanan holds that even representatives of peoples would not have overlooked the significant inequalities imposed on peoples by the global economic system.  He maintains that the original position concerned with international justice would have to take into account two important facts:

There is a global basic structure, which, like the domestic basic structure, is an important subject of justice because it has profound and enduring effects on the prospects of individuals and groups, including peoples in Rawls's sense.

The populations of states are not "peoples" in Rawls's sense and are not likely to become so without massive, unjustifiable coercion, but rather are often conflicting collections of "peoples" and other groups. (700-1) 

The first fact, if recognized, would ensure that the international original position would necessarily take into account the inequalities created by this system for different peoples.  He also believes that the second fact raises salient issues for the international original position.  Essentially the issue here is this: what happens when the multiple peoples of a single state come into conflict? By making the assumptions that "peoples within unified states" are the agents within the international original position, Rawls makes it impossible to arrive at principles of international justice that would specify just behavior in the face of civil war or secessionist movements. This approach makes it impossible to address intrastate conflict.

Tom Pogge extends his own critique of Rawls's position on international distributive justice in a Fordham Law Review article (link) (also included in Martin and Reidy's Rawls's Law of Peoples: A Realistic Utopia).  Fundamentally, Pogge is highly critical of Rawls's failure to arrive at an international theory of justice that provides a basis for critique of global inequalities. In this piece he argues that Rawls's two theories are in fact inconsistent with each other.

As indicated above, much of this body of criticism has to do with the view that Rawls's Law of Peoples creates only the most limited obligations across peoples.  His view is not "cosmopolitan".  But a more fundamental criticism, which Buchanan hints at, is that there is a major strand of injustice embedded within the world system that is wholly invisible within Rawls's formulation of the law of peoples.  This is the fact that global institutions may create systematically imbalanced economic relations among states, with the result that some states are in a position to take unfair advantage of other states. This is a form of injustice that would not be accepted within the terms of a domestic society. But there is no basis within the framework of the law of peoples to identify and criticize these types of injustices.

These criticisms are surely correct.  As a theory of global justice, the Law of Peoples doesn't begin to provide enough of a normative basis to arrive at sound judgments about international arrangements.  I began by asking how it came to pass that Rawls presented such a limited theory of international justice. The best answer I can offer is that he was focusing on the wrong issues.  He focused on issues of war and interstate violence, and he did not sufficiently bring into his view the empirical realities associated with a highly unequal world economic structure.  And this is puzzling, since questions of global inequalities -- of resources, of power, and of self-determination -- were certainly widely debated at Harvard in the 1970s and 1980s while Rawls's thinking on this subject was developing.

(In addition to critics, Rawls has some defenders in this area.  Samuel Freeman provides an extensive and reasoned response to many of these criticisms of Rawls's theory of international justice here (link).)

Rawls's framework for global justice

Rawls's A Theory of Justice was immediately received as a major and progressive contribution to the theory of justice within existing societies. His Law of Peoples (1999) was intended to carry his basic ideas about justice to the international realm.  (Here is a PDF of a preliminary version of the title essay of the book as published in Critical Inquiry in 1993.) Here is how he defined the goal of a law of peoples in 1993:

The law of peoples ... is a family of political concepts along with principles of right justice, and the common good that specify the content of a liberal conception of justice worked up to extend to and apply to international law. It provides the concepts and principles by reference to which that law is to be judged. (43)

In contrast to the reception A Theory of Justice received, his work on the international part of the theory has not had much influence, and was roundly criticized for being too accepting of international inequalities.   Philip Pettit put the point this way in his contribution to Rex Martin and David Reidy's Rawls's Law of Peoples: A Realistic Utopia:

John Rawls's work on the law of peoples is notorious for its anti-cosmopolitan stance: roughly, its insistence that those of us in well-ordered societies do not owe to the members of other societies the sort of justice we owe to one another. (38)

This is exactly the critique that Philippe van Parijs offered to Rawls prior to publication of the book (link).

Given that Rawls's intuitions seem to have been solidly progressive in other spheres, it is worth considering why he took this very limited view of the obligations of justice in the global context. Why did he begin with the perspective of peoples rather than persons?  (Here I'll make use of the 1993 statements of the view.)

A number of the critics put their cases in terms of Rawls's anti-cosmopolitanism.  "Cosmopolitanism" is the view that we are all citizens of the world, and we have positive moral relationships with each other no matter what nation issues our passports.  No one would deny that everyone has some kinds of moral relationships to everyone else -- for example, the obligation not to impose harm on innocent people.  But cosmopolitanism extends to the idea of positive obligations -- the obligation to render assistance as well as the obligation to refrain from gratuitous harm.  The contrary to cosmopolitanism might be called "nationalism", but this implies assumptions that Rawls would presumably not have accepted.  So let's call it "bounded people-ism": the claims of justice that a person has against other persons extend only to other members of his/her people and government.

One deep reason for the direction that Rawls took was the assumption he made about how to make use of the original position and the veil of ignorance in arriving at principles of international justice.  If this framework involved all human beings, then the results would have been very similar to the argument made in the case of a well-ordered society: inequalities need to be the least system possible consistent with maximizing the position of the least-well-off stratum of society.  However, Rawls chose instead to include "peoples" rather than "persons" in the argument from the original position in the case of international justice. What is a people?

By peoples I mean persons and their dependents seen as a corporate body and as organized by their political institutions, which establish the powers of government. In democratic societies persons will be citizens; in hierarchical and other societies they will be members. (41)

And he directly addresses the question of why it should be peoples rather than persons whose perspectives are represented in the original position for international justice:

Wouldn't it be better to start with the world as a whole, with a global original position, so to speak, and discuss the question whether, and in what form, there should be states, or peoples, at all? ... I think there is no clear initial answer to this question. We should try various alternatives and weigh their pluses and minuses. Since in working out justice as fairness I begin with domestic society, I shall continue from there as if what has been done so far is more or less sound. So I simply build on the steps taken until now, as this seems to provide a suitable starting point for the extension to the law of peoples. A further reason for proceeding thus is that peoples as corporate bodies organized by their governments now exist in some form all over the world. (42-43)

So his reasons for beginning with this premise are, first, we have to start somewhere and there isn't a philosophically compelling reason to favor persons over peoples in this setting; and second, peoples (and states) exist as actors in the world, so it is feasible to begin the analysis at this level. This way of formulating the original position is designed to establish fair terms of interaction between societies -- or in other words,

... fair conditions under which the parties, this time as representatives of societies well ordered by liberal conceptions of justice, are to specify the laws of peoples and the fair terms of their cooperation. (45)

This formulation, of course, immediately precludes certain questions, including all questions of difference in outcomes for the least-well-off in the various societies.  The fact that the LWO in country X are worse off than the LWO in country Y cannot be a factor in this deliberation, and therefore there cannot emerge a positive obligation to transfer resources from society Y to X to ameliorate this difference.

Here are the principles that Rawls arrives at through this construction:

1. Peoples (as organized by their governments) are free and independent, and their freedom and independence is to be respected by other peoples.
2. Peoples are equal and parties to their own agreements.
3. Peoples have the right of self-defense but no right to war.
4. Peoples are to observe a duty of nonintervention.
5. Peoples are to observe treaties and undertakings.
6. Peoples are to observe certain specified restrictions on the conduct of war (assumed to be in self-defense).
7. Peoples are to honor human rights. (46)

In the final version of the argument in 1997 he adds a final principle:

8. Peoples have a duty to assist other peoples living under unfavorable conditions that prevent their having a just or decent political and social regime.

Later in 1993 he comments on the idea of a human right:

Human rights have, then, these three roles:
1. Their being fulfilled is a necessary condition of a regime's legitimacy and of the decency of its legal order.
2. Their fulfillment is also sufficient to exclude justified and forceful intervention by other peoples, say by economic sanctions or, in grave cases, by military force.
3. "They set a moral limit to pluralism" among peoples. (59)

Several things are evident from these lists.  First, the obligations represented here are indeed minimalist; basically, they are limitations on the use of coercive means by peoples (states) to achieve their ends.  Even the 8th principle added in the 1997 version creates an obligation only to assist other peoples in achieving a just political regime.  Second, there are no requirements of distributive justice in this list of principles.  Each society has internal requirements of distributive justice; but there is no inter-society requirement of distributive justice.  The fact that there are large inequalities of resources between countries is not a basis for a claim of injustice, according to these principles.

This framework has been strongly criticized by philosophers and others who found that it was far too accepting of global inequalities.  Alan Buchanan focuses on the global inequality part of the story in his 2000 contribution in Ethics. Buchanan holds that even representatives of peoples would not have overlooked the significant inequalities imposed on peoples by the global economic system.  He maintains that the original position concerned with international justice would have to take into account two important facts:

There is a global basic structure, which, like the domestic basic structure, is an important subject of justice because it has profound and enduring effects on the prospects of individuals and groups, including peoples in Rawls's sense.

The populations of states are not "peoples" in Rawls's sense and are not likely to become so without massive, unjustifiable coercion, but rather are often conflicting collections of "peoples" and other groups. (700-1) 

The first fact, if recognized, would ensure that the international original position would necessarily take into account the inequalities created by this system for different peoples.  He also believes that the second fact raises salient issues for the international original position.  Essentially the issue here is this: what happens when the multiple peoples of a single state come into conflict? By making the assumptions that "peoples within unified states" are the agents within the international original position, Rawls makes it impossible to arrive at principles of international justice that would specify just behavior in the face of civil war or secessionist movements. This approach makes it impossible to address intrastate conflict.

Tom Pogge extends his own critique of Rawls's position on international distributive justice in a Fordham Law Review article (link) (also included in Martin and Reidy's Rawls's Law of Peoples: A Realistic Utopia).  Fundamentally, Pogge is highly critical of Rawls's failure to arrive at an international theory of justice that provides a basis for critique of global inequalities. In this piece he argues that Rawls's two theories are in fact inconsistent with each other.

As indicated above, much of this body of criticism has to do with the view that Rawls's Law of Peoples creates only the most limited obligations across peoples.  His view is not "cosmopolitan".  But a more fundamental criticism, which Buchanan hints at, is that there is a major strand of injustice embedded within the world system that is wholly invisible within Rawls's formulation of the law of peoples.  This is the fact that global institutions may create systematically imbalanced economic relations among states, with the result that some states are in a position to take unfair advantage of other states. This is a form of injustice that would not be accepted within the terms of a domestic society. But there is no basis within the framework of the law of peoples to identify and criticize these types of injustices.

These criticisms are surely correct.  As a theory of global justice, the Law of Peoples doesn't begin to provide enough of a normative basis to arrive at sound judgments about international arrangements.  I began by asking how it came to pass that Rawls presented such a limited theory of international justice. The best answer I can offer is that he was focusing on the wrong issues.  He focused on issues of war and interstate violence, and he did not sufficiently bring into his view the empirical realities associated with a highly unequal world economic structure.  And this is puzzling, since questions of global inequalities -- of resources, of power, and of self-determination -- were certainly widely debated at Harvard in the 1970s and 1980s while Rawls's thinking on this subject was developing.

(In addition to critics, Rawls has some defenders in this area.  Samuel Freeman provides an extensive and reasoned response to many of these criticisms of Rawls's theory of international justice here (link).)