Ethical Considerations in Public Health Policy
Ethics Consideration 2: Public vs. Private Goods
Public Goods Are Easier to Support
Public goods are things that:
Potentially affect each person in a population
Most people see as having a beneficial outcome
Individuals cannot unilaterally bring about
Source: Anomaly. Public health and public goods. Public Health Ethics. 2011; 4(3):251-259.
Reducing Pollution is a Public Good
Do we se benefit to fixing the problem? Yes
Are we all susceptible? Yes
Is it unilaterally? Can we fix it individually? Can’t be done alone, there’s other factors ex: cars, airplanes, trucks….
Eradicating Disease is a Public Good
Assuring Food Safety is a Public Good
Are These Public Goods?
Teen pregnancy
Obesity prevention
Sexually transmitted infections prevention
Homelessness prevention
Improved health care access
Social determinants of health
Equity and social justice
Ethics Consideration 3: Tragedy vs. Managing the Commons
Tragedy of the Commons
Influential economist Adam Smith famously argued (hundreds of years ago) that pursuit of individual goals would lead the free market to benefit society.
Biologist Garrett Hardin countered (in 1968) that unfettered individual actions—even while rational on an individual basis—will destroy collective resources.
He called this situation the “tragedy of the commons” and anticipated “ruin to all” if appropriate regulation were not imposed to manage common resources.
The Public Health Commons
Many public health issues require ethical consideration of the use of public resources.
We need to decide whether and how to manage these resources appropriately and for the public good.
And before we can address a tragedy of the commons in public health, there must be a perception that a “commons” exists.
Example: Antibiotic Use
Issue: antibiotics are starting to fail, bacteria becoming more resistant
The Commons: effective antibiotics
Tragedy: over using antibiotics by MD,farmers,patients,etc
Source: https://www.cdc.gov/media/releases/2016/p0503-unnecessary-prescriptions.html
Example: Health Care
Issue: long wait time(limited resources, impact people’s health)
The Commons: put resources at risk, protect healthcare
Tragedy: overuse medicine, use inappropriately
Example: Climate Change
Source: NASA. Global Climate Change: Vital Signs of the Planet. Updated Sep 23, 2020. Available at: https://climate.nasa.gov/evidence/
Issue:
The Commons:
Tragedy:
Example: COVID-19
Issue:
The Commons:
Tragedy:
Examples of Managing the Commons
Antibiotics: USDA Organic certification requires no use of antibiotics in animals. There are no other rules or punishments for livestock or health care.
Health care: In other countries, government regulates the training of providers and allocation of medical resources.
Climate change: 190+ nations set rules in the Paris Climate Accord in 2016 to limit greenhouse gas emissions. The rules were voluntary.
COVID-19: LA and other major cities instituted a set of policies for re-opening businesses safely. They included fines for rule-breakers.
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