Public Health/Ethics
Ethics
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A dilemma in public health ethics is dealing with the conflict between individual rights and maximizing right to health.[1](p28) Public health is justified by consequentialist utilitarian ideas,[1](p153) but is constrained and critiqued by liberal,[1] deontological, principlist and libertarian philosophies[1](pp99,95,74,123) Stephen Holland argues that it can be easy to find a particular framework to justify any viewpoint on public health issues, but that the correct approach is to find a framework that best describes a situation and see what it implies about public health policy.[1](p154)
Definition of Health and its Implications
[edit | edit source]The definition of health is vague and there are many conceptualizations. Public health practitioners definition of health can different markedly from members of the public or clinicians. This can mean that members of the public view the values behind public health interventions as alien which can cause resentment amongst the public towards certain interventions.[1](p230) Such vagueness can be a problem for health promotion.[1](p241) Critics have argued that public health tends to place more focus on individual factors associated with health at the expense of factors operating at the population level.[2](p9)
Challenges of Public Health
[edit | edit source]Historically, public health campaigns have been criticized as a form of "healthism", as moralistic in nature rather than being focused on health. Medical doctors, Petr Shkrabanek and James McCormick wrote a series of publications on this topic in the late 1980s and early 1990s criticizing the UK's the Health of The Nation campaign. These publications exposed abuse of epidemiology and statistics by the public health movement to support lifestyle interventions and screening programs.[3](p85)[4] A combination of inculcating a fear of ill-health and a strong notion of individual responsibility has been criticized as a form of "health fascism" by a number of scholars, objectifying the individual with no considerations of emotional or social factors.[5](p8)[4](p7)[6](p81)
Conflicting aims
[edit | edit source]Some programs and policies associated with public health promotion and prevention can be controversial. One such example is programs focusing on the prevention of HIV transmission through safe sex campaigns and needle-exchange programs. Another is the control of tobacco smoking. Many nations have implemented major initiatives to cut smoking, such as increased taxation and bans on smoking in some or all public places. Supporters argue by presenting evidence that smoking is one of the major killers, and that therefore governments have a duty to reduce the death rate, both through limiting passive (second-hand) smoking and by providing fewer opportunities for people to smoke. Opponents say that this undermines individual freedom and personal responsibility, and worry that the state may be encouraged to remove more and more choice in the name of better population health overall.
Psychological research confirms this tension between concerns about public health and concerns about personal liberty: (i) the best predictor of complying with public health recommendations such as hand-washing, mask-wearing, and staying at home (except for essential activity) during the COVID-19 pandemic was people's perceived duties to prevent harm but (ii) the best predictor of flouting such public health recommendations was valuing liberty more than equality.[7]
Simultaneously, while communicable diseases have historically ranged uppermost as a global health priority, non-communicable diseases and the underlying behavior-related risk factors have been at the bottom. This is changing, however, as illustrated by the United Nations hosting its first General Assembly Special Summit on the issue of non-communicable diseases in September 2011.[8]
References
[edit | edit source]- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Holland, Stephen (2015). Public health ethics (Second ed.). Cambridge. ISBN 978-0-7456-6218-3. OCLC 871536632.
- ↑ Valles, Sean A. (2018). Philosophy of population health : philosophy for a new public health era. London. ISBN 978-1-351-67078-4. OCLC 1035763221. https://www.worldcat.org/oclc/1035763221.
- ↑ Fitzpatrick, Michael (2002-01-04). The Tyranny of Health: Doctors and the Regulation of Lifestyle (in en). Routledge. ISBN 978-1-134-56346-3. https://books.google.com/books?id=qpqBAgAAQBAJ&pg=PA85.
- ↑ 4.0 4.1 Fiona, Sim; Martin, McKee (2011-09-01). Issues In Public Health (in en). McGraw-Hill Education (UK). ISBN 978-0-335-24422-5. https://books.google.com/books?id=Jn8xC6_UW8YC&pg=PA7.
- ↑ Fitzpatrick, Katie; Tinning, Richard (2014-02-05). Health Education: Critical perspectives (in en). Routledge. ISBN 978-1-135-07214-8. https://books.google.com/books?id=rm3MAgAAQBAJ&pg=PA8.
- ↑ Zembylas, Michalinos (2021-05-06). Affect and the Rise of Right-Wing Populism: Pedagogies for the Renewal of Democratic Education (in en). Cambridge University Press. ISBN 978-1-108-83840-5. https://books.google.com/books?id=YzorEAAAQBAJ&pg=PA81.
- ↑ Byrd, Nick; Białek, Michał (2021). "Your Health vs. My Liberty: Philosophical beliefs dominated reflection and identifiable victim effects when predicting public health recommendation compliance during the COVID-19 pandemic". Cognition 212: 104649. doi:10.1016/j.cognition.2021.104649. PMID 33756152. PMC 8599940. //www.ncbi.nlm.nih.gov/pmc/articles/PMC8599940/.
- ↑ United Nations. Press Conference on General Assembly Decision to Convene Summit in September 2011 on Non-Communicable Diseases. New York, 13 May 2010.