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21 Cards in this Set

  • Front
  • Back
Emergence of Health Care Ethics
- emerged in 1960s and 1970s
- motivations after med scandals ed Tuskegee Syphilis Studies, radiation, nazi exper, compulsory sterilization of women with learning disabilities
- and after new ethical questions eg IVF, Life support, surrogacy, genetic testing etc
Population Health:
The study of the health status and disease burden of a population
Health of the Public:
The health burden and disease profile of a whole population
Public Health:
the efforts made by a population to promote health and protect itself from disease
Richard Mohr’s view of public health:
‘No literal sense exists in which there could be such a thing as a public health. To say the public has a health is like saying the number seven has a colour: such a thing cannot have such a property. You have health or you lack it, and I have health or lack it, because we each have a body with organs that function or do not function. But the public, an aggregate of persons similarly disposed as persons, has no such body of organs with functions which work or fail.’
What is a public good? (gov has a responsibility)
- cannot readily be sourced by individual members of a society for themselves-it needs to be provided communally (eg transport systems)
- non-rivalrous or semi-rivalrous- you using it does not prevent someone else using it (or only does under certain conditions eg congestion)
- are valuble to all/ many
- require cooperation
why does gov have a responsibility over public goods?
- because it is public and hard to one individual to take care of
- so gov distributes taxes evenly
- protect public good
- intervene in private lives where necessary
pure public good
- bother non-rivalrous and it is not possible to limit its use to those who have contributed to it (or the costs attached to limiting it in this way would be astronomically high). Eg Clean water, clean air, unpolluted seas
club goods
which are goods that can only be secured collectively but to which access can be limited in some way (eg sky television; gym memberships; music on i-tunes).
Population health as a public good
• Requires cooperation- Individuals are unable to construct and support the large institutional and intellectual network needed to generate knowledge of public health for themselves
• Non-rivalrous
• Can’t limit access- its focus is on improving the health of populations rather than individuals, everyone benefits from its availability.
Public Health as a public good:
Requires collaboration- effectively an institution or network of institutions, it is not a good which individuals can supply independently.
• Only rivalrous at low level- and some of the benefits it might produce (eg greater social stability; low rates of contagious ds and benefits assoc with being part of an overall healthier population such as opp for greater economic prosperity) are non-rivalrous
• Some access not limitable- access to at least some aspects of public health (its ‘macro-products’-like herd immunity) is not able to be limited (although access to others, eg vaccination or health checks might be).
The Health of the Public as a public good:
• Requires cooperation- health profile of the society in which he lives is not, once again, something that an individual can guarantee for himself.
• Non-rivalrous- health of others does not affect own access to health, although might affect access
• Hard to limit access
• Good for everyone
Health is important:
As a prospective patient- as recipients
As a citizen- as guardians of the health of the public
As a prospective patient health is important because…
- as (prospective) patients: in our private capacity, the health care that is available to us and the manner in which it is delivered, matters a great deal. In this sense, we are largely recipients of health care that is tailored to our individual needs
As a citizen health is important because…
• As citizens: in our public capacity, the disease burden and profile of our society matters to us in 2 ways.
1)matters personally because it will effect how well our life goes (both directly- the risk that we will experience disease, and indirectly- like security and prosperity, which can be affected by the health of the pop).
2) matters as citizens who have a responsibility to play our part in protecting public goods. In this sense, we are guardians of the health of the population and the arrangements that support it, not merely recipients
Public Goods, Health and Collective Action Problems
We have personal investment in our own health status and a less direct investment in the health status of the pop. Our opp will generally be enhanced if we live in a society in which there are low levels of ds, high levels of eco and cultural activity. Maintaining this requires sacrifices:
-Low level sacrifices- easy to do Eg sanitary arrangements, washing your hands after toileting and so forth.
-Mid- level sacrifices: Eg paying taxes, having vaccinations
-High- level sacrifices: undergoing isolation or quarantine during a disease outbreak.
-That is a result that everyone wants to achieve, worthwhile if everyone/ most people do but systems usually have a certain margin of error built into them
- some individuals might free-ride on the efforts of others.
- could result in collective action problem.
Define collective action problem:
everyone might, on balance, prefer to make the necessary small sacrifices and enjoy the attendant large benefit, fear that others will not cooperate inhibits cooperation, which produces an outcome that everyone prefers less.- to help with cooperating legislation can be put in place so 2nd best scenario: everyone/ vast majority cooperates secured.
What Should the Goals of Public Health Be?
a) Improve the health of the population
b) Improve the welfare through improving health
c) Achieving these goals in an ethically acceptable way
What Should the Goals of Public Health Be?
:Improve the Health of the Population (which will be composed of sub-populations).
Ensure access to health care; improve quality; act beyond health care system (eg sanitation, exercise choices)
What Should the Goals of Public Health Be?: Improve Welfare Through Improving Health:
• improvements in health status = access to social goods- jobs
• improvements in health inequalities= more equality and distribution of welfare
What Should the Goals of Public Health Be?:
Achieving These Goals in an Ethically Acceptable Way
You can achieve the goals of public in a number of different ways, some of which might be ethically problematic.
• levelling down objection to equalising agenda
• The problem of balancing welfare against liberty. Improving health might take away certain liberties
• This relates to ques of proportionality: when does a proposed government measure ask just enough of citizens to ensure the good is preserved and no more?
Example: folic acid in bread and cereals; fluoride in water; seatbelts