Maxwell J Smith1, Alison Thompson2, Ross E G Upshur3. 1. School of Health Studies, Faculty of Health Sciences, Western University, Arthur and Sonia Labatt Health Sciences Building, Room 331, 1151 Richmond Street, London, ON, N6A 5B9, Canada. maxwell.smith@uwo.ca. 2. Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada. 3. Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5G 1L4, Canada.
Abstract
OBJECTIVES: 'Social justice' and 'health equity' are core values in public health. Yet, despite their normative character, the numerous normative accounts of social justice and equity are rarely acknowledged, meaning that these values are often unaccompanied by an explanation of what they require in practice. The objective of this study was to bridge this normative scholarship with information about how these 'core values' are integrated and interpreted by Canadian public health policy-makers. METHODS: Twenty qualitative interviews with public health policy-makers recruited from public health organizations in Canada, analyzed using an 'empirical ethics' methodology that combined empirical data with normative ethical analysis involving theories of justice. FINDINGS: Participants viewed health equity and social justice as distinct, where the former was perceived as 'clearer'. Health equity was conceptualized as focusing attention to 'proximal' disparities in access to services and 'materialistic' determinants of health, whereas social justice was conceptualized as focusing on structural issues that lead to disadvantage. Health equity was characterized as 'neutral' and 'comfortable', whereas social justice was characterized as 'political' and 'uncomfortable'. CONCLUSION: These findings indicate that health equity dominates the discursive space wherein justice-based considerations are brought to bear on public health activities. As a result, 'uncomfortable' justice-based considerations of power imbalances and systematic disadvantage can be eschewed in practice in favour of attending to 'proximal' inequities. These findings reveal the problematic ways in which considerations of justice and equity are, and are not, being taken up in public health policy, which in turn may have negative implications for the public's health.
OBJECTIVES: 'Social justice' and 'health equity' are core values in public health. Yet, despite their normative character, the numerous normative accounts of social justice and equity are rarely acknowledged, meaning that these values are often unaccompanied by an explanation of what they require in practice. The objective of this study was to bridge this normative scholarship with information about how these 'core values' are integrated and interpreted by Canadian public health policy-makers. METHODS: Twenty qualitative interviews with public health policy-makers recruited from public health organizations in Canada, analyzed using an 'empirical ethics' methodology that combined empirical data with normative ethical analysis involving theories of justice. FINDINGS:Participants viewed health equity and social justice as distinct, where the former was perceived as 'clearer'. Health equity was conceptualized as focusing attention to 'proximal' disparities in access to services and 'materialistic' determinants of health, whereas social justice was conceptualized as focusing on structural issues that lead to disadvantage. Health equity was characterized as 'neutral' and 'comfortable', whereas social justice was characterized as 'political' and 'uncomfortable'. CONCLUSION: These findings indicate that health equity dominates the discursive space wherein justice-based considerations are brought to bear on public health activities. As a result, 'uncomfortable' justice-based considerations of power imbalances and systematic disadvantage can be eschewed in practice in favour of attending to 'proximal' inequities. These findings reveal the problematic ways in which considerations of justice and equity are, and are not, being taken up in public health policy, which in turn may have negative implications for the public's health.
Entities:
Keywords:
Bioethics; Health equity; Health policy; Public health; Social justice
Authors: Casper G Schoemaker; Jeanne van Loon; Peter W Achterberg; Frank R J den Hertog; Henk Hilderink; Johan Melse; Robert A A Vonk; Hans van Oers Journal: Health Res Policy Syst Date: 2020-08-24
Authors: Thea van Roode; Bernadette M Pauly; Lenora Marcellus; Heather Wilson Strosher; Sana Shahram; Phuc Dang; Alex Kent; Marjorie MacDonald Journal: Int J Equity Health Date: 2020-09-15