The question of whether problems with the social determinants of health that might impact decision-making justify denying eligibility for assisted dying has recently come to the fore in debates about the legalisation of assisted dying. For example, it was central to critiques of the 2021 amendments made to Canada’s assisted dying law. The question of whether changes to a country’s assisted dying legislation lead to descents down slippery slopes has also come to the fore—as it does any time (...) a jurisdiction changes its laws. We explore these two questions through the lens of Canada’s experience both to inform Canada’s ongoing discussions and because other countries will confront the same questions if they contemplate changing their assisted dying law. Canada’s Medical Assistance in Dying law has evolved through a journey from the courts to Parliament, back to the courts, and then back to Parliament. Along this journey the eligibility criteria, the procedural safeguards, and the monitoring regime have changed. In this article, we focus on the eligibility criteria. First, we explain the evolution of the law and what the eligibility criteria were at the various stops along the way. We then explore the ethical justifications for Canada’s new criteria by looking at two elements of the often-corrosive debate. First, we ask whether problems with the social determinants of health that might impact decision-making justify denying eligibility for assisted dying of decisionally capable people with mental illnesses and people with disabilities as their sole underlying medical conditions. Second, we ask whether Canada’s journey supports slippery slope arguments against permitting assisted dying. All data relevant to the study are included in the article. (shrink)

A growing body of empirical research examines the effects of the so-called “social determinants of health” on health and health inequalities. Several high-profile publications have issued policy recommendations to reduce health inequalities based on a specific interpretation of this empirical research as well as a set of normative assumptions. This article questions the framework defined by these assumptions by focusing on two issues: first, the normative judgments about the fairness of particular health inequalities; and second, the policy recommendations (...) issued on this basis. We argue that the normative underpinnings of the approach are insufficiently supported and that the policy recommendations do not necessarily follow from the arguments provided. Furthermore, while many of the policies recommended—such as improving people's living conditions and reducing inequalities in wealth and power—are justified in their own right, the way these recommendations are tied to health is problematic. (shrink)

Political theorists generally defend the moral importance of health care by appealing to its purported importance in promoting good health and saving lives. Recent research on the social determinants of health demonstrates, however, that health care actually does relatively little to promote good health or save lives in comparison with other social and environmental factors. This article assesses the implications of the social determinants of health literature for existing theories of health care justice, and outlines (...) a new approach that can justify publicly subsidized comprehensive health care despite its limited contribution to good health. Even if health care plays a relatively limited role in promoting good health, it remains morally important because of the care it provides to individuals. As such, it can be justified in terms of care ethics. When health care is justified primarily in terms of care rather than health, however, the goals of a just health-care system shift. The measure of a just health-care system is no longer strictly its ability to generate good health outcomes but also its ability to provide individuals with accessible, good quality daily care. This different focus has important consequences for the way we think about the institutions of a just health-care system as well as for the delivery and allocation of medical goods and services. (shrink)

To provide effective care physicians must attend, not just to medical issues, but also to the social determinants of health — racial factors, food insecurity, housing instability, transportation barriers and beyond. Social determinants also include a largely underrecognized dimension: legal vulnerabilities such as rental evictions and debt adjudications. Yet rarely do medical trainees have an opportunity to witness legal vulnerabilities, firsthand.

Amidst the climate of crisis surrounding the rise in opioid-related overdose in the USA, early in 2019, Google and Deloitte launched ‘Opioid360’. Here came a platform combining browser histories, credit, insurance, social media, and traditional survey data to sell the service of risk calculation in population health. Opioid360's approach to automating risk calculation not only promised to identify persons ‘at risk’ of opioid dependence, but also paved the way for broader applications anticipating common chronic diseases and coordinating logistical operations (...) involved in pandemic response. Beginning with this experimental platform, this paper develops an analysis of the Big Data mode of risk calculation - an epistemological and political shift that involves technology companies, investors, insurers, governments, and public health institutions. The analysis focuses on the re-emergence of ‘social determinants of health’ in the rhetoric accompanying novel analytic platforms that estimate, calculate, and compute individual health risks. While the treatment of SDOH has always been a site of political contestation within the discipline of public health, powerful interests are crystallising around the concept and instrumentalising it in platforms that sell algorithmic prediction. Silicon Valley's breed of asset-oriented technoscience appears not only to be amplifying the behaviouralist elements of public health. Among the stakes of the Big Data mode is the paradoxical retreat from changing social conditions that contribute to the prevalence of health and illness in populations; and instead, the promotion of an apparatus for pricing and exchanging individual risk or excluding from services those who bear risk most acutely. (shrink)

It is natural to think that there is a tight connection between whether someone is responsible for some outcome and whether it is appropriate to hold her accountable for that outcome. And this natural thought naturally extends to health: if someone is responsible for her health, then, all else being equal, she is accountable for it. Given this, some have thought that responsibility for health has an important role to play in distributing the benefits and burdens of healthcare. But there (...) is a reason for caution. That health is influenced by social, economic, and environmental factors is a matter of consensus. And some have argued that in light of these social determinants of health, individuals are not typically responsible for their health, rendering inappropriate policies that employ a responsibility‐for‐health criterion. This debate implicates a number of overlapping concepts and questions that are often difficult to pull apart. And I worry that those who maintain that social determinants undermine responsibility for health have latched on to the wrong target. The social determinants of health are relevant to such policies, but, I argue, not by globally undermining responsibility. Rather, social determinants are sometimes responsibility‐undermining, sometimes responsibility‐preserving, and often relevant to whether we should hold individuals accountable for their health regardless of their responsibility. This calls for a more nuanced appraisal of the ways in which the social determinants of health are relevant to such policies. And here I attempt to provide one. (shrink)

Although the federal government and several state governments have recognized that structural discrimination limits less privileged groups’ ability to be healthy, the measures adopted to eliminate health disparities do not address structural discrimination. Historical and modern-day structural discrimination in employment has limited racial and ethnic minority individuals’ economic conditions by segregating them to low wage jobs that lack benefits, which has been associated with health disparities. Health justice provides a community-driven approach to transform the government’s efforts to eliminate health disparities, (...) by acknowledging the problem of structural discrimination; empowering less privileged groups to create and implement structural change; and providing support to redress harm. (shrink)

Volume 19, Issue 10, October 2019, Page 52-54.

Introducción: se presenta un ensayo cuyo objetivo es fijar posiciones frente al resumen del Informe de la Comisión sobre Determinantes Sociales de la Salud (CDSS) proponer las acciones políticas que los movimientos sociales en salud deben emprender. Análisis: las recomendaciones de la CDSS no enfocan el problema en toda su compleja naturaleza y en especial desconoce la influencia decisiva de la formación económica social sobre la situación crítica de la salud en el mundo. Acción: se propone la unidad de (...) los movimientos sociales que actúan en el campo de salud para luchar contra los efectos de las políticas económicas y sociales dominantes en el mundo: reducción del papel del estado, privatización de servicios, desregulación laboral, privatización de la seguridad social, políticas migratorias y otras. Denunciemos toda política neoliberal en relación con la salud, practiquemos la solidaridad con los que luchan contra esas políticas, derrotemos el monopolio mediático neoliberal, enfocar el problema de los DSS como asunto político social, no técnico y defendamos el papel protagónico del estado, único capaz de asegurar servicios de salud al alcance de todos. Conclusión: "Nuestro deber es luchar", como nos advirtió Fidel Castro. Introduction: An essay is presented in order to set positions against the Report´s summary of the Commission on social determinants of public health (CSDPH) that suggests the political actions to be undertaken by Health social movements. Analysis: The CSDPH recommendations do not focus the problem in all its complex nature and do not recognize the decisive influence of the social economic formation on the critical situation of Health in the world. Action: unity of social movements acting in the field of health to fight against the effects of the dominant economic and social policies of today´s world: reduction of the role of the State, privatization of services, labour deregulation, privatization of social security, migratory policies and others. We denounce any neo-liberal policy in relation to Health. Let´s support those who struggle against those policies; let´s defeat the neoliberal media monopoly, let´s focus on the problem of social determinants as a sociopolitical issue , not as a technical one; let´s defend the leading role of the State, the only one capable to ensure health services to everyone. Conclusion: As Fidel Castro expressed: "Our duty is to fight. (shrink)

Lectures delivered in the Dept. of Philosophy of the University of Pennsylvania during the spring semester of 1967. Includes bibliographical references.

Many ethical issues are posed by public health interventions. Although abstract theorizing about these issues can be useful, it is the application of ethical theory to real cases which will ultimately be of benefit in decision-making. To this end, this paper will analyse the ethical issues involved in Childsmile, a national oral health demonstration programme in Scotland that aims to improve the oral health of the nation's children and reduce dental inequalities through a combination of targeted and universal interventions. With (...) Scotland's level of dental caries among the worst in Europe, Childsmile represents one of the largest programmes of work aimed at combating oral health inequalities in the UK. The areas of ethical interest include several contrasting themes: reducing health inequalities and improving health; universal and targeted interventions; political values and evidence base; prevention and treatment; and underlying all of these, justice and utility. (shrink)

The pervasive effects of early childhood experiences on health at older ages, documented with methods from life course epidemiology, have served to refocus many public health efforts towards understanding the impact of both cumulative disadvantage and what are known as "sensitive periods" and "critical periods" in shaping health trajectories. While the impact of early childhood experiences has been well-studied, much less attention has been focused on other periods of the life course that might also serve as critical junctures in shaping (...) exposures and risks, periods that may also influence biological pathways leading to poor health in late life. This is especially important as we examine social and economic... (shrink)

In 2005, the relative risk of death was 30% higher for African Americans than White Americans, with differences in cardiovascular mortality accounting for the largest portion of this disparity (Cen...

People’s health is hugely affected by where they live, their occupational status and their socio-economic position. It has been widely argued that the presence of such social determinants in health provides good reasons to reject luck egalitarianism as a theory of distributive justice in health. The literature provides different reasons why this responsibility-sensitive theory of distributive justice should not be applied to health. The critiques submit that the social circumstances undermine or remove people’s responsibility for their health; (...) responsibility sensitive health policies would adversely affect those who are worst off and; the luck egalitarian approach to health distracts from the important task of rectifying socio-economic influences on people's health and provides individualistic solutions to collective problems. But for each of these variants of the critique luck egalitarianism provides suitable answers. The literature on social determinants is no detriment to the project of applying luck egalitarianism to health. (shrink)

The paper describes a project in which the thesis of the social determinants of health is used in order to help identify groups that will be among the least advantaged members of society, when disadvantage is understood in terms of lack of genuine opportunity for secure functioning. The analysis is derived from the author's work with Avner de-Shalit in Disadvantage (Oxford University Press, 2007).

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.

Maria Ossowska, leading philosopher of the Warsaw school, here sets out to show that moral ideas can be examined with scientific rigor. She proposes a sociology of morals that can be verified by observation and is philosophically based on the development of descriptive ethics.

In their article, Cho and Martinez-Martin (2023) argue that developers and users of digital simulacra for modelling health and disease should involve a continued focus on causality of health states...

In this article, we suggest that the evidence regarding the social determinants of health calls for a deep re‐thinking of our understanding of distributive justice. Focusing on John Rawls's theory of distributive justice in particular, we argue that a full reckoning with the social determinants of health requires a re‐working of Rawls's principles of justice. We argue first that the social bases of health – a Rawlsian conception of the social determinants of health (...) – should be considered a social primary good. We argue second that including the social bases of health as a social primary good would lead the parties to the original position to choose an additional principle of justice and assign it lexical priority over Rawls's second principle. According to this principle, inequalities in people's share of the social bases of health are to be arranged so as to improve the health status of those least advantaged on the social health gradient. -/- . (shrink)

ABSTRACT In spite of vast global improvements in living standards, health, and well‐being, the persistence of absolute poverty and its attendant maladies remains an unsettling fact of life for billions around the world and constitutes the primary cause for the failure of developing states to improve the health of their peoples. While economic development in developing countries is necessary to provide for underlying determinants of health – most prominently, poverty reduction and the building of comprehensive primary health systems – (...) inequalities in power within the international economic order and the spread of neoliberal development policy limit the ability of developing states to develop economically and realize public goods for health. With neoliberal development policies impacting entire societies, the collective right to development, as compared with an individual rights‐based approach to development, offers a framework by which to restructure this system to realize social determinants of health. The right to development, working through a vector of rights, can address social determinants of health, obligating states and the international community to support public health systems while reducing inequities in health through poverty‐reducing economic growth. At an international level, where the ability of states to develop economically and to realize public goods through public health systems is constrained by international financial institutions, the implementation of the right to development enables a restructuring of international institutions and foreign‐aid programs, allowing states to enter development debates with a right to cooperation from other states, not simply a cry for charity. (shrink)

The WHO Commission on the Social Determinants of Health revealed that there is a 28-year disparity between the life expectancy in the poorest postcode and the richest postcode of Glasgow (CSDH, 2008). There are two sets of questions that it is important to ask about health inequalities like these: first, epidemiological questions about the mechanisms that cause inequalities in health and the measures that are effective in reducing them. Second, normative questions about which inequalities in health are wrong (...) and why they are wrong. The papers in this symposium result from the inaugural conference of UCL's Centre for Philosophy, Justice and Health (CPJH) and focus on the relationship between these epidemiological and normative questions. (shrink)

The paper attempts to walk some first steps toward a unified and empirically oriented theory of both the structure and the history of physics. Physics is considered a structured whole made up of three interconstitutive elements (conceptual system, object, experimental procedures). This conceptual system is always already interpreted while it is this interpretation which ties the system to our overall experience thereby making it understood. It is argued that our experience is always ideologically (and thence socially) determined and that this (...) interpretation inevitably harbours the ideological element in the form of scientifically unwarranted ideological "assumptions." The character of such "assumptions" is discussed, some examples are given and some consequences for the history of physics are drawn. (shrink)

"Individual and social determinants of human development. The positive psychology perspective".

Study of the social determinants of consciousness is one of the more timely problems of contemporary philosophy. It requires a complex study of various factors determining the social nature of human consciousness and the cultural-historical mediation of humankind's reflection of the world. Esthetics, which studies the phenomenon of esthetic consciousness, has a place among these scientific disciplines.

In spite of vast global improvements in living standards, health, and well-being, the persistence of absolute poverty and its attendant maladies remains an unsettling fact of life for billions around the world and constitutes the primary cause for the failure of developing states to improve the health of their peoples. While economic development in developing countries is necessary to provide for underlying determinants of health – most prominently, poverty reduction and the building of comprehensive primary health systems – inequalities (...) in power within the international economic order and the spread of neoliberal development policy limit the ability of developing states to develop economically and realize public goods for health. With neoliberal development policies impacting entire societies, the collective right to development, as compared with an individual rights-based approach to development, offers a framework by which to restructure this system to realize social determinants of health. The right to development, working through a vector of rights, can address social determinants of health, obligating states and the international community to support public health systems while reducing inequities in health through poverty-reducing economic growth. At an international level, where the ability of states to develop economically and to realize public goods through public health systems is constrained by international financial institutions, the implementation of the right to development enables a restructuring of international institutions and foreign-aid programs, allowing states to enter development debates with a right to cooperation from other states, not simply a cry for charity. (shrink)

The author intends this book to be a theoretical contribution to the sociology of knowledge. Her main effort is to isolate and describe what she takes to be four irreducible systems of knowledge which dictate, for those who share in them, "thinking and action concerned with the nature of the world." The four systems of knowledge, which she calls magical, religious, mystical and scientific, are connected to specific types of thought. There are three basic types of thought connection: empirical, rational, (...) and abstractive. Empirical thought establishes connections at the purely observational level, whereas rational thought, of which mathematical and metaphysical systems are examples, makes connections only at the theoretic level. By contrast, abstractive thinking connects the observational and theoretic levels. Magical thought is purely empirical. Mystical thought accepts the evidence of empirical observation, but seeks to abstract the individual's thought to a theoretic end state which is not rational. Religious knowledge combines rational connections among concepts with abstractive connection of concepts to observables, but the religious concepts are not identified with any empirical objects. Finally, scientific thought combines rational, empirical and abstractive thought. Each of these four systems of knowledge has a characteristic conception of power. In a magical system, power consists of the ability to gain observable ends. For mystical knowledge systems, power is the individual's achievement of escape from empiricism and rationalism. In religious systems individuals may have authority, but power belongs exclusively to "god." In scientific systems of knowledge, power "consists of ability to theoretically anticipate or explain empirical transformations." Likewise, each of the four systems of knowledge is related in some way to certain social situations. In the light of these theoretical distinctions, the author examines a number of theories and developments in social science and the history of thought. She finds Malinowski's distinctions between magic, religion and science quite inadequate. Weber's sociology of religion fares better. She invokes the development of planetary astronomy, of mechanics, and of evolutionary biology to illustrate her definition of science. Finally, the problem of knowledge in the modern world is seen to be due not to an overemphasis on science as she defines it, but to the persistence of magical thought in the political, economic and social spheres. Though the author's efforts at definition are interesting, this is in many ways a difficult and unsatisfying book. Written in a lapidary style, which is lacking both in grace and connectives, the book utilizes historical and sociological data very selectively. No reference is made to what has been done in the sociology of knowledge by Scheler, Mannheim, Berger and Luckmann. Finally, the book bristles with questionable epistemological assumptions and with statements which seem quite incompatible with the findings of recent work in the study of religion.--H. F. (shrink)

There are a number of important links and similarities between public health and safety. In this extended essay, Gregg D. Caruso defends and expands his public health-quarantine model, which is a non-retributive alternative for addressing criminal behavior that draws on the public health framework and prioritizes prevention and social justice. In developing his account, he explores the relationship between public health and safety, focusing on how social inequalities and systemic injustices affect health outcomes and crime rates, how poverty (...) affects brain development, how offenders often have pre-existing medical conditions (especially mental health issues), how involvement in the criminal justice system itself can lead to or worsen health and cognitive problems, how treatment and rehabilitation methods can best be employed to reduce recidivism and reintegrate offenders back into society, and how a public health approach could be successfully applied within the criminal justice system. Caruso's approach draws on research from the health sciences, social sciences, public policy, law, psychiatry, medical ethics, neuroscience, and philosophy, and he delivers a set of ethically defensible and practically workable proposals for implementing the public health-quarantine model. The essay begins by discussing recent empirical findings in psychology, neuroscience, and the social sciences that provide us with an increased understanding of the social and neurological determinants of health and criminal behavior. It then turns to Caruso's public health-quarantine model and argues that the model provides the most justified, humane, and effective approach for addressing criminal behavior. Caruso concludes by proposing a capability approach to social justice grounded in six key features of human well-being. He argues that we cannot successfully address concerns over public health and safety without simultaneously addressing issues of social justice—including the social determinants of health (SDH) and the social determinants of criminal behavior (SDCB)—and he recommends eight general policy proposals consistent with his model. (shrink)

Variability in the symptom experience in patients diagnosed with chronic conditions may be related to social determinants of health (SDoH). The purpose of this critical review was to (1) summarize the existing literature on SDoH and symptom clusters (i.e., multiple, co‐occurring symptoms) in patients diagnosed with common chronic conditions, (2) evaluate current variables and measures used to represent SDoH, (3) identify gaps in the evidence base, and (4) provide recommendations for the incorporation of SDoH into future symptom cluster (...) research. We identified 118 articles including information on SDoH in chronic condition symptom cluster research. Articles primarily focused on cancer populations. Few articles had the explicit purpose of investigating relationships between SDoH and symptom clusters, and the inclusion of SDoH was often limited to variables used to describe samples. Future studies should be designed to “move beyond Table 1” in their utilization of SDoH as variables and examine relationships between SDoH and symptom clusters. Attention should be paid to the appropriateness of measures being used to collect information on SDoH, and analysis methods that estimate causal connections between variables should be considered. Research regarding the relationship of SDoH with symptom clusters in patients with chronic conditions has the potential to reveal mechanisms of symptom disparities and guide changes to alleviate these disparities. (shrink)

Recent epidemiological research on the social determinants of health has been used to attack an important framework, associated with Norman Daniels, that depicts healthcare as special. My aim is to rescue the idea that healthcare has special importance in society, although specialness will turn out to be mainly limited to clinical care. I build upon the link between Daniels's theory and the work of John Rawls to develop a conception of public justification liberalism that is suitable to the (...) field of justice and health. I argue that, from the perspective of public justification liberalism, (clinical) healthcare deserves special status. (shrink)

Recent frameworks, models, and reports highlight the critical need to address social determinants of health for achieving health equity in the United States and around the globe. In the United States, data play an important role in better understanding community‐level and population‐level disparities particularly for local health departments. However, data‐driven decision‐making—the use of data for public health activities such as program implementation, policy development, and resource allocation—is often presented theoretically or through case studies in the literature. We sought (...) to develop a preliminary model that identifies the factors that contribute to data‐driven decision‐making in US local health departments and describe relationships between them. Guided by implementation science literature, we examined organizational‐level capacity and individual‐level factors contributing to using data for decision‐making related to social determinants of health and the reduction of county‐level disparities. This model has the potential to improve implementation of public health interventions and programs aimed at upstream structural factors, by elucidating the factors critical to incorporating data in decision‐making. (shrink)

Social determinants of health are a subject of growing interest, yet criticisms have emerged about the way determinants are conceptualized in nursing. A tendency to focus on readily observable living conditions and measurable demographic characteristics can divert attention, it has been said, from the less visible underlying processes which shape social life and health. To illustrate how the analytic perspective determines what becomes visible or invisible as a “determinant” in health, this paper presents a case exemplar. (...) Drawing from news reports and research in real estate economics and urban policy analysis, it explores a single local infectious illness outbreak through a series of progressively more abstract units of inquiry, considering mechanisms of lending and debt financing, housing supply, property valuation, tax policy, change in the structure of the financial industry, and international patterns of migration and capital flow, among other factors, which contributed in various ways to creating unsafe living conditions. An analytic exercise calling attention to dynamism and complexity in social processes, the paper offers a political‐economy‐based approach that serves as a cautionary note against oversimplification in discussions of health causality. (shrink)