Presentation Transcript

1. Ethics

   Population Perspective
2. Epidemiology A science that uses strategies and methods to determine the causes of diseases in communities. Epidemiology is essential for public health, because if we do not understand how diseases are caused, then we cannot take the appropriate measures.
3. Public Health and Ethics Public Health can be considered from the perspective of ethics because it is not only interested in discovering the causes of diseases within a population, but also with curing diseases, preventing suffering, and making the populations as a whole healthier. It can be argued that health is an essential human good that has as much value as life itself has. Therefore, institutions and organizations that provide health care to the public (or are the guardians of the public’s health) have a moral responsibility to do so in the most fair, impartial, and effective manner.
4. The Preventive Paradox A certain law (e.g., the seat belt law) or a certain behavior (e.g., a diet with less cholesterol) can have significant effects on a total population yet little effect on any particular person. The probability that wearing your seat belt will provide a health benefit for you personally might be incredibly slim 1 in 4 million in any one car ride and 1.2% (.0012) over your entire lifetime. However, we know that if everyone wears their seatbelts, then 10,000 lives will be saved every year!
5. Social and Ecological Causes The causes of ill health come from various sources: Lack of access to health care. Exposure to pathogens. Clean air and water. Genetic makeup.
6. Epidemiology Here are some of the kinds of questions epidemiology is concerned with (population perspective). Why has health improved? Why has tuberculosis reemerged as a serious threat? Why do Chinese and Japanese have lower rates of heart disease and cirrhosis than Europeans and Americans?
7. Institutionalized Inequity Institutionalized inequities are unfair/unjust circumstances that are “built-into” the system. No one person or group is necessarily responsible for its occurring, even though certain groups benefit unfairly and others are harmed unfairly by the system.
8. Institutional Inequities Institutionalized inequities may have no malicious intentions; they might be archaic policies, laws, customs, or bureaucracies that were put into place many generations ago and continue today. They might be negative and harmful unintended consequences of existing policy. Others institutional inequities might continue because powerful groups benefit from them, and therefore they support and advocate the status quo.
9. Health and Populations Differences To understand health risks and how public health can be improved we must understand health differences among groups and populations.
10. Individual vs. Population Perspective Individual Population What caused John’s heart attack? Why has John’s cholesterol increased? What causes a specific group to have greater heart disease? Why is heart disease increasing in group A much faster than in the rest of the population?
11. Race versus Social Class Vicente Navarro studies how race and social class relate to the quality of public health. Navarro notes that the US has statistics on race and public health but not on social class and public health. Moreover, he also points out that the US is the only industrialized nation that does not have such data.
12. Navarro Navarro tries to demonstrate that even though the US does not maintain statistics on how the quality of health care relates to social classes in the US, it is the most salient and problematic relationship.
13. Race vs. Class Life expectancy for whites is 75 years Life expectancy for blacks is 69 years Mortality differentials cannot be explained solely by race. We must also take into consideration Class.
14. Social Class Occupation Education Income Blue-collar workers usually have more labor intensive jobs, lower education levels, and lower income levels than professionals, who usually have managerial jobs.
15. Heart and cerebravascular disease Black males to white males 1.2 higher Black females to white females 1.5 higher Blue-collar workers to professional/managerial workers 2.3 higher
16. Morbidity The morbidity (sickness, disease and ill health) rate of people making 10,000 or less was 4.6 times higher than those making 35,000 or more. The morbidity difference between black and whites is only 1.9 times higher.
17. Is Poor Health a Race Issue? 19% of blacks and 16 % of whites earning less than 20,000 were in poor health. Only 7.6% of blacks and 5.1% of whites earning more than 20,000 were in poor health. If we consider poor health by occupation/social class we have similar results. Blue-collar workers are in poorer health 2.9 more than professionals.
18. Health, Classes and Ethics What ethical issues arise as a consequences of the data on health and social class? DISCUSS
19. Some Conclusions Could we argue that there are institutionalized inequities for the lower social classes in the US with respect to the quality of public health? Might these inequities stem from and be interrelated with other institutionalized inequities such as education? Could it be argued that the poorer, uneducated members of the US population are caught in a vicious circle; that is, being poor means little education and poor health, poor health and little education means staying poor?