As noted in Section 2, one of the structural features of public health is that the individuals and groups affected by its policies and programs are not uniformly benefited or burdened. When the burdens of a policy fall heavily on those who are already disadvantaged, the justificatory hurdle is particularly high. This concern is at the heart of many environmental justice controversies such as the locating of hazardous waste facilities and hazardous industries in low-income communities and countries. Global efforts to prevent and contain pandemic influenzas have also placed significant burdens on the world's poor. For example, a principal strategy employed to prevent avian influenza H5N1 from becoming a human pandemic is the destruction of infected birds and the banning of household poultry in urban settings. Many families and women affected by this policy relied on their backyard poultry as their only disposable source of income and have been economically devastated as a consequence. Without express focus on the interests of disadvantaged people, the moral concerns this policy raises, particularly in the absence of appropriate compensation and alternative livelihood opportunities, might well go unnoticed (Bellagio Working Group 2007 in Other Internet Resources; Faden & Karron 2009; Uscher-Pines, Duggan, Garoon, Karron, & Faden 2007).
Public health resources are always in short supply and priority setting in public health policy and practice is always morally challenging. Yet another important set of tasks for public health ethics is working to ensure that considerations of justice are prominent in the setting of public health priorities in health care services and in prevention and health threat programming (Norheim et al. 2014). In that regard, one focus for public health ethics is evaluating the role that formal economic and decision theory methods such as cost benefit, cost effectiveness and cost utility analysis should play in public health, including the continuing examination of the moral assumptions embedded in these methods. Formal methods have been used to varying degrees by public health authorities in numerous countries in such diverse contexts as determining what risks should be regulated in environmental health and injury prevention policy and in setting priorities for public health goals and coverage decisions for health care systems. Embedded in these methods are morally controversial assumptions. If the discount rate applied to future financial costs and benefits is also applied to future health benefits, preventive interventions are disvalued relative to interventions whose health benefits occur in the present (Schwappach 2007). Also problematic are “willingness to pay” measures as proxies of the value of benefits or risk reduction. Arguably, these measures reify the preferences of the privileged and fail to provide sufficient moral justification when risks materialize (Gafni 1991).
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- Fall '19
- Public health ethics