Expert answer:How would you communicate social justice perspecti
Solved by verified expert:Scenario You are the Director of the local public health department. You are at a social event one evening with many political leaders and influential community members. You meet one particularly influential person who is an avowed “market justice” advocate (even if he or she doesn’t use that terminology). You introduce yourself. The person looks puzzled and replies, “Public health, huh? You know, I don’t know much about public health. What are you guys all about? What do you do? What are your values?” How would you respond?QuestionWhat would you tell this person to communicate the social justice perspective and values to this market-justice leader in the community?Discuss 2–3 of the principles on influencing others and surviving as a leader that you would want to apply in this scenario. (Chose from Develop Network, Be willing to compromise and negotiate, Building bridges through knowledge of other subject areas, Join and interact with colleagues in professional associations, Share expertise, Seek out expertise, Remain open to take advice from experienced people)APA format with proper references and in text citations, no plaigarismPls avoid grammatical jargons and passive expressions. ThanksNB You may find the sttached files useful
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S O C I A L
J U S T I C E
What Does Social Justice
Require For The Public’s
Health? Public Health Ethics
And Policy Imperatives
Social justice demands more than fair distribution of resources in
extreme public health emergencies.
by Lawrence 0. Gostin and iVIadison Powers
ABSTRACT: Justice is so central to the mission of pubiic health that it has been described
as the field’s core vaiue. This account of justice stresses the fair disbursement of common
advantages and the sharing of common burdens. It captures the twin moral impulses that
animate pubiic health: to advance human weil-being by improving health and to do so particularly by focusing on the needs of the most disadvantaged. This Commentary explores
how social justice sheds light on major ongoing controversies in the field, and it provides examples of the kinds of poiicies that pubiic heaith agencies, guided by a robust conception
of justice, wouid adopt. [Health Affairs 25, no. 4 (2006): 1053-1060; 10.1377/hlthaff
.25.4.1053]
J
USTICE IS VIEWED AS SO CENTRAL TO THE MISSION of public health that it
has been described as the field’s core value: “The historic dream of public
health…is a dream of social justice,”‘ This Commentary addresses a single question of extraordinary social and political importance: What does social justice require for the public’s health? Our thesis is that justice can be an important organizing principle for public health.
Justice alone cannot determine the “correct” pohcy or supply an answer to every question regarding the broad direction for pubhc health; neither can any other
single organizing principle. However, there are certain core commitments that all
who embrace even a modest conception of social justice recognize as important,
and those commitments can shed light on the major ongoing controversies in the
field: the legitimate scope of public health, the balance between public health and
Larry Gostin (gostin@law.georgetown.edu) is associate dean and aprofessor at the Georgetown University Law
Center in Washington, D.C; director ofthe university’s Centerfor Law and the Public’s Health; and a professor at
thefohns Hopkins Bloomberg School ofPublic Health in Baltimore, Maryland. Madison Powers is director and
senior research scholar at the Kennedy Institute of Ethics, Georgetown University, and an associate professor in its
Department ofPhilosophy.
H E A L T H A F F A I R S – Volume 25, N u m b e r 4
DOI 10,1377/hltha£f.25.4.1053 ©2006 Project HOPE-Tlie Pcople-to-People Health Foundation, Inc,
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C O M M E N T A R Y
civil liberties, and the appropriate roles of the federal government and the states.
More importantly, this paper shows how public health based on social justice
gives rise to important policy imperatives such as improving the public health system, reducing socioeconomic disparities, addressing health determinants, and
plarming for health emergencies with an eye on the needs of the most vulnerable.
Before examining the major controversies and making policy recommendations,
we provide our particular account of justice in public health.
What is ‘Justice,’ And How important is it in Pubiic Heaith?
Among the most basic and commonly understood meanings of justice is fairness
or reasonableness, especially in the way people are treated or decisions are made.-^
Our account of justice stresses the fair disbursement of common advantages and
the sharing of common burdens. It captures the twin moral impulses that animate
public health: to advance human well-being by improving health and to do so by
focusing on the needs of the most disadvantaged. An integral part of bringing good
health to all is the task of identifying and ameliorating patterns of systematic disadvantage that undermine the well-being of people whose prospects for good
health are so limited that their life choices are not even remotely like those of others.’ These two aspects of justice—health improvement for the population and fair
treatment of the disadvantaged—create a richer understanding of public health.
A core insight of social justice is that there are multiple causal pathways to numerous dimensions of disadvantage. These include poverty, substandard housing,
poor education, unhygienic and polluted environments, and social disintegration.
These and many other causal agents lead to systematic disadvantage not only in
health, but also in nearly every aspect of social, economic, and political life. Inequalities beget other inequalities, and existing inequalities compound, sustain,
and reproduce a multitude of deprivations.”*
Our account of social justice is interventionist, not passive or market-driven,
vigorously addressing the determinants of health throughout the lifespan. It recognizes that there are multiple causes of ill and good health, that policies and
practices affecting health also affect other valued dimensions of life, and that
health is intimately connected to many of the important goods in life. Empirical inquiries, therefore, are critical to justice in public health. Data can help determine
who are most vulnerable and at greatest risk, how best to reduce the risk or ameliorate the harm, and how to fairly distribute services and benefits.
The Justice Perspective in Pubiic Heaith
The field of public health is in the midst of a crisis of public confidence. American culture openly tolerates the expression and enjoyment of wealth and privilege
and is inclined to view health as a matter of personal responsibility. Meanwhile,
the public has become skeptical of government’s ability to ameliorate the harshest
consequences of socioeconomic disparities. At its deepest level, some believe that
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J U S T I C E
government’s purpose should not be to redress economic and social disadvantage,
and this may be doubly so for administrative agencies dedicated to public health
and the pursuit of science. We believe that it is time to rethink this view, and the
justice perspective offers an alternative. Values of socioeconomic fairness are just
as important to health as the prevailing values of personal license and free enterprise. The justice perspective offers a different way of seeing problems that have
long plagued the field of public health.
• Legitimate scope of tiie pubiic iieaitii enterprise. Perhaps the deepest,
most persistent critique of pubhc health is that the field has strayed beyond its natural boundaries. Instead of focusing solely on narrow interventions for discrete injuries and diseases, the field has turned its attention to broader health determinants. It
is when pubHc health strays into the social/political sphere in matters of war, violence, poverty, and racism that critics become most upset.
The justice perspective does not provide a definitive defense against claims of
overreaching. But social justice does provide a counterweight to the prevailing political view of health as primarily a private matter. The justice perspective shows
why health is a matter of public concern, with the state having a role not only in
the traditional areas of infectious diseases and sanitation, but also in emerging areas such as chronic diseases caused by diet, lifestyle, and the environment. Public
health agencies have an obhgation to address the root causes of ill health, even
while they recognize that socioeconomic determinants have many causes, and solutions, that are beyond public health’s exclusive expertise.
• Baiancing Individuai and coiiective interests. The exercise of the state’s coercive power has been highly contentious throughout U.S. history. When pubhc
health officials act, they face troubling confhcts between the collective benefits of
population health on the one hand, and personal and economic interests on the
other. Pubhc health powers encroach on fundamental civil liberties such as privacy,
bodily integrity, and freedom of movement and association. Sanitary regulations
similarly intrude on economic hberties such as freedom of contract, pursuit of professional status, and use of personal property. Justice demands that government take
actions to safeguard the pubhc’s health, but that it do so with respect for individuals
and sensitivity to the needs of the underprivileged.
In the realm of public health and civil liberties, then, both sides claim the mantle of justice. Finding an appropriate balance is not easy and is fraught with controversy. What is most important to justice is abiding by the rule of law, which requires modern public health statutes that designate clear authority to act and
provide fair processes. Pohcymakers, therefore, should modernize antiquated
public health laws to provide adequate power to reduce major risks to the population but ensure that government power is exercised proportionately and fairly.^
Fairness requires just distributions of burdens and benefits to all, but also procedural due process for people subjected to compulsory interventions.
Certainly, the justice perspective cannot answer many of the most perplexing
HEALTH AFFAIRS – Volume 25, Number 4
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problems at the intersection of pubhc health and civil hberties such as paternahstic interventions (for example, seat belt laws) or the exercise of powers in health
emergencies (for example, avian flu or bioterrorism). These and many other problems pose major dilemmas for the field that neither considerations of justice nor
traditional arguments based in beneficence can readily resolve. However, a more
serious failure of pubhc policy would be a failure to recognize and give great
weight to the demands of social justice when faced with such challenges.
• Nationai, state, and local public heaith functions. The arguments for and
against the centralization of pohtical power have remained largely the same over the
course of U.S. history and are part of entrenched pohtical ideologies. There is no
simple resolution, and initially it might seem that the justice perspective can shed
httle hght on this contentious area. Considerations of social justice do not side with.
either of the traditional combatants in the federahsm debates, as they neither favor
federal nor state action. What justice does do is insist that governmental action address the major causes of ill health, particularly among the disadvantaged; that commitment has major impHcations for pohtical and social coordination.
The justice perspective’s emphasis on the multicausal and interactive determinants of health suggests that strategic opportunities for prevention and amelioration of ill health arise at every level of governmental interaction. The challenge of
combating the threat of systematic disadvantage can be met only with a systematic response among all levels of government. The level of government best situated for dealing with pubhc health threats depends on the evidence identifying
the nature and origin of the specific threat, the resources available to each unit for
addressing the problem, and the probability of strategic success.
lSlational obligations. The national government has a duty to create the capacity to
undertake essential pubhc health services. A national commitment to capacity
building is important because public needs for health and well-being are universal
and compelling. The federal government should recognize these needs and invest
in a strong public health system. Certain problems demand national attention. A
health threat, such as epidemic disease or environmental pollution, might span
many states, regions, or the whole country. Further, the solution to problems such
as those related to foreign or interstate commerce could be beyond the jurisdiction
of individual states. Finally, states simply might lack the expertise or resources to
mount an effective response in a major pubhc health emergency.
State/local obligations. Armed with sufficient resources and tools, states and localities have an obhgation to fulfill core pubhc health functions such as diagnosing
and investigating health threats, informing and educating the pubhc, mobilizing
community partnerships, and enforcing state health laws. States and locahties are
closer to the people and to the problems causing ill health. Dehvering pubhc
health services requires local knowledge and direct pohtical accountabihty. States
and localities are also often the preferable unit of government when dealing with
complex, poorly understood problems. In such cases, the idea of a “laboratory of
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the states” enables local officials to seek innovative solutions.
Harmonized engagement. Because justice emphasizes the multicausal, interactive
character of health threats, a system of overlapping and shared responsibility
among federal, state, and local governments will most often be required. Governments at all levels have differing degrees of responsibility. This insight v^as illustrated poignantly during the response to the Gulf Coast hurricanes. It was not
that a particular political unit should have had primacy. Rather, each should have
played a unique role in a well-coordinated effort.
The Policy imperatives Of The Justice Perspective
The pubhc health community has not been successful in gaining attention to or
resources for its core mission and essential services. Outside of health emergencies, the pubhc does not demonstrate any particular interest in public health as a
priority, and this lack of interest shows in chronic underfunding. From a fiscal
perspective, only a tiny fraction of health dollars goes to prevention and population-based services.* Even when attention and resources are ample, it is usually in
immediate response to some actual or perceived threat. This leads not to core, stable funding and attention but, rather, to a “disease du jour” mentality. This type of
response creates silos, disproportionately funds biomedical solutions, and poses a
“no-win” situation for pubhc health agencies, which must respond to the latest
fashion but seldom gain the kind of ongoing pohtical attention and economic resources they need to improve the public’s health.
The justice perspective offers an opportunity to change this dynamic, and the
remainder of this Commentary offers concrete proposals based on the imperatives
of population improvement and just distribution of benefits.
• The public health system. Justice, with its concern for human well-being, requires a serious commitment to the pubhc’s health. It is for that reason that justice
demands a tangible, long-term pledge to the pubhc’s health and the needs of the
least well-off. Such a commitment, as countless reports have made clear, is lacking.”
Funding for prevention and population-based services is inordinately low, and categorical funding for special programs such as bioterrorism and avian flu is limited to
a single issue and is time restricted.
To assure that actions can be taken to protect, promote, and provide for the
health of the pubhc, there must be a substantial and stable commitment to the
pubhc’s health at the federal, state, and local levels. Given the gravity and importance of the situation. Congress and the executive branch should create a Trust
Fund for Pubhc Health to provide generous and stable resources to rebuild the
eroded pubhc health infrastructure and implement core public health functions.
Nongovernmental trust-fund approaches, implemented in other countries, should
also be explored. The Pubhc Health Leadership Initiative, estabhshed by the Trust
for America’s Health (TFAH), recommends annual, sustained spending of $1.5-$2
bilhon increase to ensure an adequate public health infrastructure.^
HEALTH AFFAIRS – Volume 25, Number 4
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• Addressing health determinants. If justice is outcome oriented, then inevitably public health must deal wath the underlying causes of poor and good health. The
key health determinants include the built environment (for example, transportation
and buildings); the natural environment (for example, clean air and water); the informational environment (for example, health information and advertising restrictions); the social environment (for example, social networks and support); and the
economic environment (socioeconomic status),’ These are all public health problems, but they are not solvable solely by pubhc health agencies. Pubhc health researchers and agencies can provide the intellectual tools for understanding the factual basis of the problems pohcymakers face. They can act directly and as conveners
that mobihze and coordinate government agencies, health care institutions, businesses, the media, academia, and the community.
Obesity policy offers an apt illustration of the numerous ways that public
health, together with its partners, can act on the root causes of ill health. By a combination of zoning, public construction, taxation, incentives, regulation, and
health information, the state could encourage citizens to eat healthier diets and
maintain more active lifestyles. This could be accomplished by changing the inner
city, for example, to favor supermarkets over fast foods, recreational facilities and
green spaces over roads, mass transportation over automobiles, and so forth. It
could involve transformation of schools to ensure healthier snacks and lunches,
physical activity, and health education. Critics complain that diet and lifestyle are
personal choices outside the appropriate realm of government. However, there is
nothing inherently wrong with having the state make healthier choices easier for
people to make,
• Fair treatment of the disadvantaged. Fair distribution of burdens and benefits, as discussed, is a core attribute of justice. Allocations based on the market or
political influence favor the rich, powerful, and socially connected. Even neutral or
random allocations can be unjust because they do not benefit those with greatest
need. For example, health officials who direct a population to evacuate or shelter in
place should foresee that the poor will not have private transportation or the means
to stock up on food or supphes. For that reason, justice requires pubhc health officials to devise plans and programs with particular attention to the disadvantaged.
Fair distributions should be integral to pubhc health pohcy and practice, but they
take on particular importance when planning for health emergencies or when there
is extreme scarcity.
Health emergencies threaten the entire community, but the poor and disabled
are at heightened risk. Social justice thus demands more than fair distribution of
resources in extreme health emergencies, A failure to act expeditiously and v^dth
equal concern for all citizens, including the poor and less powerful, predictably
harms the whole community by eroding public trust and undermining social cohesion. It signals to those affected and to everyone else that the basic human needs
of some matter less than those of others, and it thereby fails to show the respect
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“Tfie aims of public health deserve a great deal more societal
attention and resources than the political community has allowed.”
due to all members of the community. Social justice thus encompasses not only a
core commitment to a fair distribution of resources, but it also calls for policies of
action that are consistent with the preservation of human dignity and the showing of equal respect for the interests of all members of the community.
• Planning for emergencies involving scarce iife-saving resources. Health
emergencies pose the potential for mass illness and death, often resulting in extreme
scarcity of medical countermeasures, hospital beds, and other essential resources.
Rarely v ^ there be sufficient stockpiles or surge capacity to meet mass needs. For
example, the U.S. influenza preparedness plan anticipates marked shortages of vaccines, antiviral medications, and medical equipment …
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