Social factors have a powerful influence on human health and longevity. Yet the social dimensions of health are often obscured in public discussions due to the overwhelming focus in health policy on medical care, individual-level risk factor research, and changing individual behaviours. Likewise, in philosophical approaches to health and social justice, the debates have largely focused on rationing problems in health care and on personal responsibility. However, a range of events over the past two decades such as the study of (...) modern famines, the global experience of HIV/AIDS, the international women’s health movement, and the flourishing of social epidemiological research have drawn attention to the robust relationship between health and broad social arrangements. In Health Justice, Sridhar Venkatapuram takes up the problem of identifying what claims individuals have in regard to their health in modern societies and the globalized world. Recognizing the social bases of health and longevity, Venkatapuram extends the ‘Capabilities Approach’ of Amartya Sen and Martha Nussbaum into the domain of health and health sciences. In so doing, he formulates an inter-disciplinary argument that draws on the natural and social sciences as well as debates around social justice to argue for every human being’s moral entitlement to a capability to be healthy. An ambitious integration of the health sciences and the Capabilities Approach, Health Justice aims to provide a concrete ethical grounding for the human right to health, while advancing the field of health policy and placing health at the centre of social justice theory. With a foreword by Sir Michael Marmot, chair of the WHO Commission on the Social Determinants of Health. (shrink)

The final report of the WHO's Commission on the Social Determinants of Health is the first to apply social epidemiological analysis to global health.

The Routledge Handbook of the Philosophy of Public Health is an outstanding reference source to this exciting subject and the first collection of its kind. Comprising over forty chapters by a team of international contributors the handbook covers the following central topics: What is global health?; methodology in public health science; social determinants and health equity; politics and economics; health policy and law; globalization; macroeconomics; securitization; and specific public health challenges such as obesity, cancer, alcohol, tobacco and infectious diseases. Essential (...) reading for students and researchers in political philosophy, bioethics, public health ethics and the philosophy of medicine the handbook will also be very useful for those in related fields, such public health professionals and epidemiologists. (shrink)

"In comparison to medicine, the professional field of public health is far less familiar. What is public health, and perhaps as importantly, what should public health be or become? How do causal concepts shape the public health agenda? How do study designs either promote or demote the environmental causal factors or health inequalities? How is risk understood, expressed, and communicated? Who is public health research centered on? How can we develop technologies so the benefits are more fairly distributed? Do people (...) have a right to public health? How should we integrate ethics into public health practice? The Routledge Handbook of Philosophy of Public Health addresses these questions and more, and is the first collection of its kind. Comprising twenty-six chapters by an international and interdisciplinary team of contributors, the handbook is divided into four clear parts: Concepts and Distinctions Reasons and Actions Distribution and Inequalities Rights and Duties. The Routledge Handbook of Philosophy of Public Health is a field-defining and sustained reflection on the various ethical, political, methodological and conceptual aspects of global public health. As such it is an essential reference source for students and scholars working in political philosophy, bioethics, public health ethics, and the philosophy of medicine, as well as for professionals and researchers in related fields such public health and epidemiology"--. (shrink)

I argue for a conception of health as a person's ability to achieve or exercise a cluster of basic human activities. These basic activities are in turn specified through free-standing ethical reasoning about what constitutes a minimal conception of a human life with equal human dignity in the modern world. I arrive at this conception of health by closely following and modifying Lennart Nordenfelt's theory of health which presents health as the ability to achieve vital goals. Despite its strengths I (...) transform Nordenfelt's argument in order to overcome three significant drawbacks. Nordenfelt makes vital goals relative to each community or context and significantly reflective of personal preferences. By doing so, Nordenfelt's conception of health faces problems with both socially relative concepts of health and subjectively defined wellbeing. Moreover, Nordenfelt does not ever explicitly specify a set of vital goals. The theory of health advanced here replaces Nordenfelt's (seemingly) empty set of preferences and society-relative vital goals with a human species-wide conception of basic vital goals, or ‘central human capabilities and functionings’. These central human capabilities come out of the capabilities approach (CA) now familiar in political philosophy and economics, and particularly reflect the work of Martha Nussbaum. As a result, the health of an individual should be understood as the ability to achieve a basic cluster of beings and doings—or having the overarching capability, a meta-capability, to achieve a set of central or vital inter-related capabilities and functionings. (shrink)

The present article identifies how social determinants of health raise two categories of philosophical problems that also fall within the smaller domain of ethics; one set pertains to the philosophy of epidemiology, and the second set pertains to the philosophy of health and social justice. After reviewing these two categories of ethical concerns, the limited conclusion made is that identifying and responding to social determinants of health requires inter-disciplinary reasoning across epidemiology and philosophy. For the reasoning used in epidemiology to (...) be sound, for its scope and (moral) purpose as a science to be clarified as well as for social justice theory to be relevant and coherent, epidemiology and philosophy need to forge a meaningful exchange of ideas that happens in both directions. (shrink)

This theoretical paper argues for prioritarianism as an ethical underpinning for digital health in contexts of extreme disadvantage. In support of this claim, the paper develops three prioritarian principles for making ethical decisions for digital health programme design, grounded in the normative position that the greater the need, the stronger the moral claim. The principles are positioned as an alternative view to the prevailing utilitarian approach to digital health, which the paper argues is not sufficient to address the needs of (...) the worst off. As researchers of digital health, we must ensure that the most globally marginalised are not overlooked by overtly technocentric implementation practices. Consequently, the paper concludes by advocating for use of the three principles to support stronger critical reflection on the ethics involved in the design and implementation of digital health programmes. (shrink)

The article discusses two areas at the intersection of social determinants of health research and social justice theory. The first section examines the affinity between social epidemiology and the capabilities approach. The second section examines how social epidemiology's expansion of the scope of the causal chain and determinants raises questions about epistemology and ontology in epidemiology as well as the field's link to the moral concern for human health.

Commentary on Pratt, B., and A. A. Hyder. 2016. Governance of transnational global health research consortia and health equity.

The COVID-19 pandemic is affecting countries across the globe. Only a globally coordinated response, however, will enable the containment of the virus. Responding to a request from policy makers for ethics input for a global resource pledging event as a starting point, this paper outlines normative and procedural principles to inform a coordinated global coronavirus response. Highlighting global connections and specific vulnerabilities from the pandemic, and proposing standards for reasonable and accountable decision-making, the ambition of the paper is two-fold: to (...) raise awareness for the justice dimensions in the global response, and to argue for moving health from the periphery to the centre of philosophical debates about social and global justice. (shrink)

Situating medical and scientific research within a framework or theory of social justice is long overdue. Attempting to extend principles of research ethics beyond the clinic and lab to other affected people or consequences tolerates or obfuscates injustice. While it must be done, the timescales, methodologies, and commitment to real-world impact are quite different in research ethics versus political philosophy.

This essay identifies three insights about global equity and justice in light of the COVID pandemic. It discusses the need for greater recognition of the role of the global order in the distributio...

As health policy-makers around the world seek to make progress towards universal health coverage, they must navigate between two important ethical imperatives: to set national spending priorities fairly and efficiently; and to safeguard the right to health. These imperatives can conflict, leading some to conclude that rights-based approaches present a disruptive influence on health policy, hindering states’ efforts to set priorities fairly and efficiently. Here, we challenge this perception. We argue first that these points of tension stem largely from inadequate (...) interpretations of the aims of priority setting as well as the right to health. We then discuss various ways in which the right to health complements traditional concerns of priority setting and vice versa. Finally, we set out a three-step process by which policy-makers may navigate the ethical and legal considerations at play. (shrink)

Gerontologists have proposed different concepts for ageing well such as ‘successful ageing’, ‘active ageing’, and ‘healthy ageing’. These conceptions are primarily focused on maintaining health and preventing disease. But they also raise the questions: what is a good life in old age and how can it be achieved? While medical in origin, these concepts and strategies for ageing well also contain ethical advice for individuals and societies on how to act regarding ageing and old age. This connection between gerontology and (...) ethics is overlooked by both schools of thought. We thus develop this research programme for a systematic geroethics in four steps. First, we analyze ‘successful ageing’ as put forward by Rowe and Kahn as a paradigmatic example of a gerontological conception of ageing well. Then, in a second step, we move from criticisms within gerontology to an ethical perspective; in particular, we want to clarify the problem of the claim of universal validity of conceptions of the good life. In a third constructive step, we explain how the ‘capabilities approach’ could be applied in this context as a normative foundation for the implicit normative assumptions of gerontological conceptions of ageing well, such as a particular choice of functionings, the ethical relevance of human agency, and the resulting claims of individuals towards society. Finally, using a concept developed by the German philosopher Ursula Wolf, we systematically develop the different aspects of the connection between ageing well and the theory of the good life in their full complexity and show their interconnectedness. (shrink)

ABSTRACT One of the most ambitious and sophisticated recent approaches to provide a theory of global health justice is Sridhar Venkatapuram's recent work. In this commentary, we first outline the core idea of Venkatapuram's approach to global health justice. We then argue that one of the most important elements of the account, Venkatapuram's basis of global health duties, is either too weak or assumed implicitly without a robust justification. The more explicit grounding of the duty to (...) protect and promote health capabilities is based on Martha Nussbaum's version of the capability approach. We argue that this foundation gives rise to humanitarian duties rather than duties of justice proper. Venkatapuram's second argument from the social determinants of health thesis is instead a stronger candidate for grounding duties of justice. However, as a justificatory argument, it is only alluded to and has not yet been spelled out sufficiently. We offer plausible justificatory steps to fill this gap and draw some implications for global health action. We believe this both strengthens Venkatapuram's approach and serves to broaden the basis for future action in the area of global health. (shrink)

The discussion about theories of health has recently had an important new input through the work of Sridhar Venkatapuram. He proposes a combination of Lennart Nordenfelt's holistic theory of health and Martha Nussbaum's version of the capability approach. The aim of the present article is to discuss and evaluate this proposal. The article starts with a discussion of Nordenfelt's theory and evaluates Venkatapuram’ critique of it, that is, of its relativism, both regarding goals and environment, and of (...) the subjectivist theory of happiness used. Then the article explains why Nordenfelt's idea of a reasonable environment is not a problem for the theory, and it critiques Venkatapuram's own incorporation of the environment into the concept of health, suggesting that this makes the concept too wide. It contends, moreover, that Venkatapuram's alternative theory retains a problem inherent in Nordenfelt's theory, namely, that health is conceived of as a second-order ability. It is argued that health should, instead, be defined as first-order abilities. This means that health cannot be seen as a capability, and also that health cannot be seen as a meta-capability of the kind envisioned by Venkatapuram. It is, furthermore, argued that the theory lacks one crucial aspect of health, namely, subjective wellbeing. Finally, the article tries to illustrate how health, in the suggested alternative sense, as first-order abilities, fits into Nussbaum's capability theory, since health as an ‘actuality’ is part of all the ‘combined capabilities’ suggested by Nussbaum. (shrink)

Sridhar Venkatapuram's Health Justice argues that health is a ‘metacapability’ – specifically, as the metacapability of having the ten ‘central human capabilities’ described by Martha Nussbaum. This cannot be right, as it provides no basis for distinguishing health from education, riches, or love. An amendment correcting this problem is suggested, namely that health is the involuntary, bodily aspect of the metacapability for the central capabilities. This amendment is defended against the objection that it fails to capture some important (...) aspects of mental health. (shrink)

Any theory of health justice requires an account of what areas of social life are important enough to be of public concern. What are the goods that ought to be provided as a matter of justice? This is what I will call the metric problem. The capabilities approach puts forward a particular solution to this problem. In this article I will discuss some issues of such an approach in relation to Sridhar Venkatapuram's well-known theory. Another problem I examine (...) is how to determine a threshold of provision within a theory of justice. What is enough in terms of health justice? I argue that we need such a threshold to avoid healthism, the expansion of the pursuit of health over and above the treatment and prevention of disease. This is an especially pertinent problem in public health, which is also the context of Venkatapuram's theory. (shrink)

One of the most ambitious and sophisticated recent approaches to provide a theory of global health justice is Sridhar Venkatapuram's recent work. In this commentary, we first outline the core idea of Venkatapuram's approach to global health justice. We then argue that one of the most important elements of the account, Venkatapuram's basis of global health duties, is either too weak or assumed implicitly without a robust justification. The more explicit grounding of the duty to protect (...) and promote health capabilities is based on Martha Nussbaum's version of the capability approach. We argue that this foundation gives rise to humanitarian duties rather than duties of justice proper. Venkatapuram's second argument from the social determinants of health thesis is instead a stronger candidate for grounding duties of justice. However, as a justificatory argument, it is only alluded to and has not yet been spelled out sufficiently. We offer plausible justificatory steps to fill this gap and draw some implications for global health action. We believe this both strengthens Venkatapuram's approach and serves to broaden the basis for future action in the area of global health. (shrink)

Objective To determine the knowledge and attitudes of healthcare personnel regarding the provision of non-beneficial futile care in the intensive care units at the major public hospitals in Trinidad and Tobago. Method Prospective data collection was done using a questionnaire administered to the medical and nursing staff of the intensive care units. The questionnaire was designed to capture the opinions regarding the futile care offered to terminally ill patients at the intensive care units. The responses were based on a five-point (...) Likert scale. The influence of factors such as age, gender, duration of work experience, religious belief, ethnicity, occupational category and educational status on the responses were analysed. Results A total of 274 completed responses were obtained from doctors and nurses. The frequency with which the respondents encountered ethical or legal problems in the intensive care unit varied widely from ‘daily’ to ‘yearly’. The majority felt that knowledge of ethics is important, and only 32% knew the legal issues pertaining to their work. Eighty percent of doctors and nurses had no knowledge of an existing Hospital Ethics Committee and its role in ethical dilemmas. Although 62% said their decisions regarding futile care will be influenced by their scientific knowledge, only 32% agreed to withdraw care. Eighty percent said that the government should pass appropriate laws regarding withdrawal of futile care. Conclusions Most healthcare providers in intensive care unit are not knowledgeable in the ethical and legal issues of non-beneficial futile care. There is a need to devise means to bring awareness and educate intensive care unit healthcare providers in this subject. (shrink)

Philosophers who study care—most often, care ethicists—are involved in an ongoing discussion about the concept of care. Despite the significant progress made in this discussion, certain conflicting images of care seem to persist in the literature. On one hand, as feminist theorists across disciplines have highlighted, care is a complex social practice that is mired in inequality and injustice. The deeply gendered nature of caring and the unequal division of care-work creates and cements structural inequalities. On the other hand, care (...) is also thought of as a moral value or an ideal. The ethics of care—a moral theory with decidedly feminist roots—is predicated on the idea that caring is somehow morally valuable. A discrepancy thus arises: care is a social practice that compounds injustices. But it is also a moral value. What is it about care that makes it malleable to such variations? To pick out this complexity and capture the conceptual nuances at play, this paper suggests that we frame the concept of care as a thick ethical concept. I will first demonstrate why this framing is helpful. Then, I will provide accounts of the descriptive and evaluative elements of the concept of care. I hope to show that it is through a thick conceptual framing that we can make sense of care—both as a complex social practice and an important moral value in the worlds that we inhabit. (shrink)

Drawing from the Boulding''s (1956) framework for general systems theory, the need to employ richer paradigm in the study of organizations (Pondy and Mitroff, 1979) is reiterated. It is argued that a better understanding of organizational ethical behavior is contingent upon viewing organizations as symbol processing systems of shared language and meanings. Further, it is proposed that organizations, like individuals, develop into collectivities of shared cognitions and rationale, over a period of time. The study adapts Kohlberg''s (1983) model of moral (...) development to examine if organizations can be viewed as passing through different stages of moral development depending on the type of moral reasoning employed to explain their behaviors in the face of ethical crises. Several cases raising questions about the ethics of corporate behavior were researched. An instrument entitled Organization Response Analysis was constructed using statements made by various spokespersons representing five of these organizations. The instrument was administered to 246 graduate and undergraduate students of business (N = 246). Results indicated a great degree of concurrence among respondents of differing genders, levels of education and work experience in determining the stages of moral development of organizations. Limitations of the current study and implications for future research and practice are discussed. (shrink)

Dr Devi Sridhar, Department of Politics and International relations, University of Oxford, All Souls College, High St, OX1 4AL UK, Email: devi.sridhar{at}politics.ox.ac.uk ' + u + '@' + d + ' '//--> Abstract This paper discusses the politics of access to essential medicines and identifies ‘space’ in the current system where health concerns can be strengthened relative to trade. This issue is addressed from a global governance perspective focusing on the main actors who can have the greatest impact. (...) These include developing country coalitions and citizens in developed countries though participation in civil society organisations. These actors have combined forces to tackle this issue successfully, resulting in the 2001 Doha Declaration on Public Health. The collaboration has been so powerful due to the assistance of the media as well as the decision to compromise with pharmaceutical companies and their host countries. To improve access to essential medicines, six C's are needed: coalitions, civil society, citizenship, compromise, communication and collaboration. CiteULike Connotea Del.icio.us What's this? (shrink)

Anita Chari revives the concept of reification from Marx and the Frankfurt School to spotlight the resistance to neoliberal capitalism now forming at the level of political economy and at the more sensate, experiential level of subjective transformation. Reading art by Oliver Ressler, Zanny Begg, Claire Fontaine, Jason Lazarus, and Mika Rottenberg, as well as the politics of Occupy Wall Street, Chari identifies practices through which artists and activists have challenged neoliberalism's social and political logics, exposing its inherent tensions and (...) contradictions. (shrink)

Embryonic stem cells are derived from the preimplantation embryo and can differentiate into virtually any other cell type, which is governed by lineage specific transcriptions factors binding to cis regulatory elements to mediate changes in gene expression. The reliance on transcriptional regulation to maintain pluripotency makes ESCs a valuable model to study the role of distal CREs such as enhancers in modulating gene expression to affect cell fate decisions. This review will highlight recent advance on transcriptional enhancers, focusing on studies (...) performed in ESCs. In addition, we argue that the Nanog locus, which encodes for an ESC-critical TF, is particularly informative because it contains multiple co-regulated genes and enhancers in close proximity to one another. The unique landscape at Nanog permits the study of ongoing questions including whether multiple enhancers function additively versus synergistically, determinants of gene specificity, and cell-to-cell variability in gene expression. Nanog encodes a transcription factor required to maintain ESC pluripotency. The Nanog locus is an ideal model to study enhancers because it contains multiple highly potent super-enhancers within a small region. Nanog and three super-enhancers are in close physical proximity but only two SEs are required for Nanog expression. (shrink)

Abstract The purpose of this paper is to empirically analyse the developmental stages of non-financial reporting in corporations, by interpreting the views of interviewees from major ethical corporations on the six major dimensions of non-financial reporting (identified in the literature) within each stage of the five-stage model of non-financial reporting (developed in this paper). This study is part of a series of papers on Triple Bottom Line reporting (TBL), and its relevance to corporate reporting practices. The TBL is perhaps the (...) pioneer for getting corporations thinking about non-financial reporting. While literature has been done extensively on the TBL framework, empirical data linking TBL and how it has helped, or even hindered corporations progressing through different stages in their non-financial reporting processes is missing. In order to facilitate this analysis, 40 interviews were conducted over 1 year, with 40 corporations selected from various sustainability indexes, focusing on corporations that adopt best practices in this area, and also have a TBL approach to non-financial reporting. The results of the analysis show that TBL certainly got corporations started in the journey of non-financial reporting but has not pushed them far enough to develop a more integrated approach to reporting nor clearly aligning their non-financial reporting performance with their financial performance and business strategy. Content Type Journal Article Category Original Paper Pages 1-33 DOI 10.1007/s13520-011-0010-4 Authors Kaushik Sridhar, Macquarie Graduate School of Management, Macquarie University, Sydney, Australia Journal Asian Journal of Business Ethics Online ISSN 2210-6731 Print ISSN 2210-6723. (shrink)

This paper outlines seven challenges in development assistance for health, which in the current financial context, have become even more important to address. These include the following: (1) the proliferation of initiatives, focusing on specific diseases or issues, as well as (2) the lack of attention given to reforming the existing focal health institutions, the WHO and World Bank. (3) The lack of accountability of donors and their influence on priority-setting are part of the reason that there is “initiavitis,” and (...) resistance to creating a strong UN system. (4) Other than absolute quantity of aid, three other challenges linked to donors relate to the quality of aid financing particularly the pragmatic difficulties of financing horizontal interventions, (5) the marginal involvement of developing country governments as aid recipients, and (6) the heavy reliance on Northern-based organizations as managers of funds. (7) The final challenge discussed focuses on two unintended consequences of the recent linking of health and foreign policy for international development assistance. The paper then provides three suggestions for ways forward: creating new mechanisms to hold donors to account, developing national plans and strengthening national leadership in health, and South-South collaboration. (shrink)

Over the past 20 years, international development assistance for health has increased, albeit for some diseases more than others. However, the triple crises of food, fuel, and finance have raised questions regarding whether aid flows will continue to increase, or even be maintained in the coming future. Health and education are often the first victims of budget cuts in times of limited funding and competing priorities as they are viewed to be in the realm of “low politics” as opposed to (...) security and military spending, which are seen as “high politics.” Cuts in overseas development aid will have a drastic impact on countries where external funding makes up a significant proportion of national health budgets. Although global health aid accounts for only 0.3% of total expenditures on health globally, in some countries like the Solomon Islands and Mozambique, for example, 82% and 66% of the national health budgets respectively come from external resources. WHO estimates that 23 countries have over 30% of their total health expenditures funded by donors. (shrink)

Very few studies have looked upon the construct of workplace spirituality in sales organization context. This paper integrates workplace spirituality with sales literature. The paper points out that self-interest transcendence is a common aspect in the workplace spirituality concept which emerged a decade ago and in most of the relationship-oriented selling characteristics—customer orientation, adaptability, service orientation, and ethical selling behavior. Based on the common aspect of self-interest transcendence, we propose that workplace spirituality could be a causal precursor to relationship-oriented selling (...) characteristics. We present guidelines for future research, implications for practice and a few potential downsides of workplace spirituality in sales organization. (shrink)

Spirituality is a hot topic of research in recent times in management arena. Though the organizational researchers have intensely started exploring this area, the studies related to selling organizations are few, and fewer are the studies related to selling organizations with individual as the unit of theory. The present study explores the relationship between ‘individual spirituality at work’ and sales professionals’ ‘job satisfaction’, ‘propensity to leave’ and ‘job commitment’. This work focuses on sales professionals across various industries. A cross-sectional survey (...) method is adopted. Correlation analysis is done to reveal the hypothesized relationships. The results reveal that sales professionals’ spirituality at work is positively related to job satisfaction and job commitment, and negatively related to propensity to leave. The results provide the relevance of spirituality at work to salespeople. The selling organizations can also utilize the information and promote the individual expression of spirituality at work. (shrink)

Abstract There is increasing evidence suggesting that environmental and social criteria are impacting the market in complex ways. The corporate world has demonstrated a willingness to respond to public pressure for improved performance on non–economic issues by embracing Triple Bottom Line (TBL) principles. TBL reporting has been institutionalized as a way of thinking for corporate sustainability. However, institutions are constantly changing and improving, while TBL has been fairly conservative in its approach to change. The more balanced focus on the economic, (...) the environmental and the social has provided a framework for institutions and markets around the world who want to focus indicators towards a sustainable future. This paper presents a criticism of the TBL approach that adds to the limited information on the pervasiveness of this approach. Content Type Journal Article Category Original Paper Pages 1-21 DOI 10.1007/s13520-012-0019-3 Authors Kaushik Sridhar, Net Balance Management Group, 332, Kent Street, Sydney, NSW 2000, Australia Grant Jones, Australian Catholic University, 8/20 Napier Street, NR House, North Sydney, NSW, Australia 2060 Journal Asian Journal of Business Ethics Online ISSN 2210-6731 Print ISSN 2210-6723. (shrink)

Jennifer Prah Ruger's book Health and Social Justice is a substantial contribution to the emerging scholarship at the intersection of health issues and the philosophy of social justice. This area has been getting increasing attention which is partially evidenced by the growing number of monographs being published on the subject. Prah Ruger proposes a bold and expansive theory of justice and health care policy that is informed by health economics, public policy, political science, and legal and political philosophy. The book (...) should interest individuals seeking to bridge health care policy with social justice debates, public health ethicists, and political philosophers interested in population level health issues. (shrink)

Ethical selling has been found to have significant influence on sales performance and relational selling behaviors. However, sales ethics was mostly explored through a negative lens and we depart from this tradition by using a positive lens. Using broaden-and-build theory, this paper examines the influence of flow on ethical selling. The mediating role of information sharing is also examined. Results from a study of 192 pharmaceutical salespeople in India suggest that flow influences ethical selling behavior via information sharing. The findings (...) imply that flow can serve as a driver for information sharing and ethical decision making among salespeople. The study contributes to the sales ethics literature by extending the application of positive psychology to the sales domain for the first time. (shrink)