Advertisement

Public Health as Social Justice? A Qualitative Study of Public Health Policy-Makers’ Perspectives

  • Maxwell J. SmithEmail author
  • Alison Thompson
  • Ross E. G. Upshur
Article

Abstract

Social justice is often described as the ‘foundation of public health.’ Yet, outside of the theoretical literature the polysemous nature of the concept is rarely acknowledged. To complement recent contributions to normative theory specifically motivated by questions of social justice in public health, this study explores public health policy-makers’ perspectives on the meaning and role of social justice in their practice. This study involved twenty qualitative, semi-structured interviews with public health policy-makers recruited from two programmatic areas of public health [chronic disease prevention (CDP) and public health emergency preparedness and response (PHEPR)] within public health organizations in Canada. Participants’ perspectives appeared to be influenced by the perceived goals belonging to the programmatic area of public health in which they practiced. Those involved in PHEPR indicated that justice-based considerations are viewed as a ‘constraint’ on the aims of this area of practice, which are to minimize overall morbidity and mortality, whereas those involved in CDP indicated that justice-based considerations are ‘part and parcel’ of their work, which seeks primarily to address the unique health needs of (and thus, disparities between) population groups. The aims and activities of different programmatic areas of public health may influence the way in which social justice is perceived in practice. More ought to be done (in theory and in practice) to interrogate how the unique contributions that individual programmatic areas of public health can and should cohere in order to realize the broader aim that public health has as an institution to promote social justice.

Keywords

Social justice Utilitarianism Public health Chronic disease prevention Public health emergency preparedness and response Public health ethics 

Notes

References

  1. Beauchamp, D. E. (1976). Public health as social justice. Inquiry, 13(1), 3–14.PubMedGoogle Scholar
  2. Bellefleur, O., & Keeling, M. (2016). Utilitarianism in public health. Montreal: National Collaborating Centre for Healthy Public Policy.Google Scholar
  3. Bernts, T., d’Anjou, L., & Houtman, D. (1992). Citizenship and social justice. Social Justice Research, 5(2), 195–212.Google Scholar
  4. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.Google Scholar
  5. Brinkmann, S., & Kvale, S. (2015). InterViews: Learning the craft of qualitative research interviewing (3rd ed.). Thousand Oaks, CA: Sage Publications, Inc.Google Scholar
  6. Buchanan, D. R. (2008). Autonomy, paternalism, and justice: Ethical priorities in public health. American Journal of Public Health, 98(1), 15–21.PubMedPubMedCentralGoogle Scholar
  7. Callahan, D., & Jennings, B. (2002). Ethics and public health: Forging a strong relationship. American Journal of Public Health, 92(2), 169–176.PubMedPubMedCentralGoogle Scholar
  8. Childress, J. F., Faden, R. R., Gaare, R. D., Gostin, L. O., Kahn, J., Bonnie, R. J., et al. (2002). Public health ethics: Mapping the terrain. The Journal of Law, Medicine, & Ethics, 30(2), 170–178.Google Scholar
  9. Commission on Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva: World Health Organization.Google Scholar
  10. Daniels, N. (2007). Just health: Meeting health needs fairly. New York: Cambridge University Press.Google Scholar
  11. Elster, J. (1993). Local justice: How institutions allocate scarce goods and necessary burdens. New York: Russell Sage Foundation.Google Scholar
  12. Faden, R., & Powers, M. (2008). Health inequities and social justice: The moral foundations of public health. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 51(2), 151–157.PubMedGoogle Scholar
  13. Fierlbeck, K. (2010). Public health and collaborative governance. Canadian Public Administration, 53(1), 1–19.Google Scholar
  14. Giacomini, M., Hurley, J., & DeJean, D. (2014). Fair reckoning: A qualitative investigation of responses to an economic health resource allocation survey. Health Expectations, 17(2), 174–185.PubMedGoogle Scholar
  15. Gostin, L. O. (2003). Public health ethics: Traditions, profession, and values. Acta Bioethica, 9(2), 177–188.Google Scholar
  16. Green, J., & Thorogood, N. (Eds.). (2004). Developing qualitative research designs. In Qualitative methods for health research (pp. 27–50). Los Angeles: Sage Publications, Inc.Google Scholar
  17. Gubrium, A., Barcelos, C., Buchanan, D., & Gubrium, E. (2014). ”When nothing matters, things just happen”: Young Parenting, women’s reflections on caring, health, and justice. International Quarterly of Community Health Education, 34(2), 121–137.Google Scholar
  18. Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18(1), 59–82.Google Scholar
  19. Hoepfl, M. C. (1997). Choosing qualitative research: A primer for technology education researchers. Journal of Technology Education, 9(1), 47–63.Google Scholar
  20. Hume, D. (1998 (1751)). An enquiry concerning the principles of morals. Oxford: Oxford University Press.Google Scholar
  21. Jennings, B., & Arras, J. (2008). Ethical guidance for public health emergency preparedness and response: Highlighting ethics and values in a vital public health service. Atlanta: Centers for Disease Control and Prevention.Google Scholar
  22. Kass, N. E. (2001). An ethics framework for public health. American Journal of Public Health, 91(11), 1776–1782.PubMedPubMedCentralGoogle Scholar
  23. Kass, N. E. (2004). Public health ethics: From foundations and frameworks to justice and global public health. The Journal of Law, Medicine, & Ethics, 32(2), 232–242.Google Scholar
  24. Kirkwood, K. (2010). In the name of the greater good? Emerging Health Threats Journal, 2(E12), 1–3.Google Scholar
  25. Krieger, N., & Birn, A.-E. (1998). A vision of social justice as the foundation of public health: Commemorating 150 years of the spirit of 1848. American Journal of Public Health, 88(11), 1603–1606.PubMedPubMedCentralGoogle Scholar
  26. Levy, B. S., & Sidel, V. W. (2006). Social injustice and public health. New York: Oxford University Press, Inc.Google Scholar
  27. Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage Publications, Inc.Google Scholar
  28. Mason, M. (2010). Sample size and saturation in PhD studies using interviews. In Forum: Qualitative social research (Vol. 11, No. 3).Google Scholar
  29. Mill, J. S. (1962 (1861)). John Stuart Mill: Utilitarianism, on liberty, and essay on Bentham. New York: Penguin Books USA Inc.Google Scholar
  30. Nussbaum, M. (2000). Women and human development: The capabilities approach. Cambridge: Cambridge University Press.Google Scholar
  31. Patton, M. Q. (2001). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: Sage Publications, Inc.Google Scholar
  32. Powers, M., & Faden, R. (2006). Social justice: The moral foundations of public health and health policy. New York: Oxford University Press.Google Scholar
  33. Rawls, J. (1999). A theory of justice (2nd ed.). Cambridge, MA: Harvard University Press.Google Scholar
  34. Ruger, J. P. (2010). Health and social justice. New York: Oxford University Press.Google Scholar
  35. Sabbagh, C., & Golden, D. (2007). Reflecting upon etic and emic perspectives on distributive justice. Social Justice Research, 20(3), 372–387.Google Scholar
  36. Salloch, S., Wäscher, S., Vollmann, J., & Schildmann, J. (2015). The normative background of empirical-ethical research: First steps towards a transparent and reasoned approach in the selection of an ethical theory. BMC Medical Ethics, 16, 20.PubMedPubMedCentralGoogle Scholar
  37. Sandelowski, M. (1995). Sample size in qualitative research. Research in Nursing & Health, 18(2), 179–183.Google Scholar
  38. Segall, S. (2009). Health, luck, and justice. Princeton: Princeton University Press.Google Scholar
  39. Sen, A. (2002). Why health equity? Health Economics, 11(8), 659–666.PubMedGoogle Scholar
  40. Sen, A. (2009). The idea of justice. Cambridge: Belknap Press of Harvard University.Google Scholar
  41. Shenton, A. K. (2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information, 22(2), 63–75.Google Scholar
  42. Smith, M. J. (2015). Health equity in public health: Clarifying our commitment. Public Health Ethics, 8(2), 173–184.Google Scholar
  43. Smith, M. J., Thompson, A., & Upshur, R. E. G. (2018). Is ‘health equity’ bad for our health? A qualitative empirical ethics study of public health policy-makers’ perspectives. Canadian Journal of Public Health, 109(5), 633–642.PubMedGoogle Scholar
  44. Thompson, A., Robertson, A., & Upshur, R. (2003). Public health ethics: Towards a research agenda. Acta Bioethica, 9(2), 157–163.Google Scholar
  45. Tod, A. M., & Hirst, J. (2014). Public health for a fairer society. In A. M. Tod & J. Hirst (Eds.), Health and inequality: Applying public health research to policy and practice (pp. 1–14). London: Routledge.Google Scholar
  46. Törnblom, K., Jasso, G., & Vermunt, R. (2007). Theoretical integration and unification: A focus on justice. Social Justice Research, 20(3), 263–269.Google Scholar
  47. Trotter, G. (2008). The illusion of legitimacy: Two assumptions that corrupt health policy deliberation. The Journal of Medicine and Philosophy, 33(5), 445–460.PubMedGoogle Scholar
  48. Veatch, R. (2005). Disaster preparedness and triage: Justice and the common good. The Mount Sinai Journal of Medicine, 72(4), 236–241.PubMedGoogle Scholar
  49. Venkatapuram, S. (2011). Health justice: An argument from the capabilities approach. Cambridge: Polity Press.Google Scholar
  50. Venkatapuram, S. (2016). Social justice. In Oxford University Press (Ed.), Oxford bibliographies. Oxford: Oxford University Press.Google Scholar
  51. Walzer, M. (1983). Spheres of justice: A defense of pluralism and equality. New York: Basic Books, Inc.Google Scholar
  52. Wilkinson, R. G., & Pickett, K. E. (2010). The spirit level: Why equality is better for everyone. London: Penguin Books.Google Scholar
  53. Wilson, J. (2009). Towards a normative framework for public health ethics and policy. Public Health Ethics, 2(2), 184–194.Google Scholar
  54. Wolff, J. (2007). Models of distributive justice. In N. Foundation (Ed.), Empathy and fairness. Chichester: Wiley.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of Health Sciences, School of Health StudiesWestern UniversityLondonCanada
  2. 2.Leslie Dan Faculty of PharmacyUniversity of TorontoTorontoCanada
  3. 3.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada

Personalised recommendations