 Much of the literature in public health ethics that has addressed summary measures has looked at their role in cost-utility  analysis.[6]  In cost-utility analysis, a summary measure is used to identify how to secure the most health for the resources available. The goal is to establish comparative value for money, with an eye to ensuring efficiency in resource allocation. In addition to ethical concerns about the construction of summary measures and the assumptions on which they are built, cost-utility analysis raises additional concerns of justice because it, like cost-benefit analysis and utilitarian theorizing more generally, is indifferent to questions of distribution. As a contingent matter, it is often the case that public health interventions that are good value-for-money advance the health of disadvantaged groups relative to their powerful counterparts. This is because a little money can often go a long way towards improving the health of those who have relatively little and whose health prospects are bleak. Consider, for example, investing in childhood immunizations and vitamin supplementation in low- and middle-income countries. That said, the worry remains that when public health policy rests on cost-utility analyses, the resultant priorities or allocations may entail injustices of various sorts. For example, policymaking that is mainly or largely driven by cost-utility findings may perpetuate or even exacerbate existing unjust health disparities when health gains are more efficiently secured for those who are better off or fail to treat fairly the needs of persons with rare diseases, diseases with poor outcomes, and diseases that are very expensive to prevent or treat.