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Value-promoting concepts
in the health sciences and public health
Federica Russo
Philosophy &ILLC, University of Amsterdam
russofederica.wordpress.com |
@federicarusso
Overview
The health sciences and public health
Conceptualising health&disease and the normative character of disease
causation
Concepts/Methods and actions
What policies should follow from specific concepts?
Directions of value-ladenness
From values to concepts&methods
From concepts&methods to values&actions
An example: obesity and food labelling policies
2
CONCEPTUALISING
HEALTH & DISEASE
3
A core question across
the health sciences and public health
What is normal and what is pathological
Biologically, statistically, experimentally, socially, politically,
historically, …
Dimensions of the question
Metaphysical, Epistemological, Methodological, Normative
4
How I tackle
the question of conceptualization of
health&disease
{What is …?} >> {How do we study …?}
Scientific practice first
How do we study health&disease?
What are the causes and mechanisms of health&disease?
{What is X} is answered by {How we study X}
Yes, I derive metaphysics from epistemology
5
Causes & mechanisms of
health & disease
Several types of practices in the health sciences
Biomedical research; clinical practice; EBM; narratives;
(public health) interventions; …
Variety of practices to study what makes us
healthy/sick
My focus: practices in which we causally
understand health&disease by studying biological
and social factors
6
Bio-social causes of health&disease
Historically, 19th century public health is much about social factors
Recently, characterised as ‘the causes of causes’
Sociology of health / social epidemiology
Health&disease are associated with social factors
Inequalities in health are associated with inequalities at the social level
Health&disease happen in a social context
7
Descriptive and normative
Descriptively: plenty of research to establish correlations
<social social factors>--<health&disease>
Normatively: social factors are active causes in the mechanisms of
health&disease
We need a concept of causation/mechanisms that accounts for the mixed
nature of health&disease
Social factors are proximate, not distant causes
8
CONCEPTS AND ACTIONS
9
A general argument
IF we conceptualise X such-and-such
THEN what actions should follow?
Replace X by your favourite: health, evidence, probability, …
Normativity is double
PhilSci concepts are non-neutral
PhilSci and Ethics are part and parcel of science/policy, not a cherry on the
cake
10
The specific argument
IF the social has active causal role in health&disease
THEN what public health interventions should follow?
11
DIRECTIONS OF VALUE-LADENNESS
12
Value-promoting concepts
13
A long-standing, valuable and rich tradition on value-
ladeness and inductive risk.
Notice: ladenness goes in 2 directions:
1) Values influence our concepts/methods
2) Values are influenced by concepts and methods
1) is much more studied than 2)
‘Health’ is certainly normative in the practice of public health
See rich literature in public health ethics
But ‘health’ is also normative at the level of the scientific
concept&methods
Whether social factors are proximate – rather than distant –
causes makes a difference to which actions we decide to
undertake
14
OBESITY AND
FOOD LABELLING
An example
15
Social causes, biological interventions
Obesity ‘epidemic’
Wide recognition of social factors (besides biological ones)
Top priority for EU health policy
EU announces to tackle social factors (e.g. behaviour)
One of the biggest actions: regulating food labelling
Ultimately tackles the biology of obesity
Claims to target food industry, but in fact it makes info available and leaves
the choice to the individual person
Pulls in opposite directions with actions to improve on competitiveness of
SMEs
16
Social factors
are proximate causes of obesity
What to do with
Food labelling?
Food industry?
Marketing?
What consequences to draw from a concept that would (naturally?) lead to
paternalist attitudes?
How to reconcile it with (justified?) libertarian intuitions?
Is a ‘libertarian paternalism’ a viable option?
…
17
TO SUM UP AND CONCLUDE
18
Concepts and actions
A causal conceptualisation of health&disease
Social factors are proximate causes, on par with biological ones
A controversial point on its own
Despite the large body of literature on social factors and health
More controversial still
What actions should follow from this conceptualisation
19
Division of labour?
• Health Sci / Epi >> methods
• Phil Sci/Health >> concepts
• Ethics-PolPhil >> norms
But these questions are in fact tangled!
20
Philsci and ethics-political phil
How to connect epistemological/methodological questions
to normative questions?
Which values are promoted by our (non-neutral) sci-
concepts?
Setting the stage for more science-informed ethics or ethics-
aware philsci
21
Value-promoting concepts
in the health sciences and public health
Federica Russo
Philosophy &ILLC, University of Amsterdam
russofederica.wordpress.com |
@federicarusso

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Value-promoting concepts in the health sciences and public health

  • 1. Value-promoting concepts in the health sciences and public health Federica Russo Philosophy &ILLC, University of Amsterdam russofederica.wordpress.com | @federicarusso
  • 2. Overview The health sciences and public health Conceptualising health&disease and the normative character of disease causation Concepts/Methods and actions What policies should follow from specific concepts? Directions of value-ladenness From values to concepts&methods From concepts&methods to values&actions An example: obesity and food labelling policies 2
  • 4. A core question across the health sciences and public health What is normal and what is pathological Biologically, statistically, experimentally, socially, politically, historically, … Dimensions of the question Metaphysical, Epistemological, Methodological, Normative 4
  • 5. How I tackle the question of conceptualization of health&disease {What is …?} >> {How do we study …?} Scientific practice first How do we study health&disease? What are the causes and mechanisms of health&disease? {What is X} is answered by {How we study X} Yes, I derive metaphysics from epistemology 5
  • 6. Causes & mechanisms of health & disease Several types of practices in the health sciences Biomedical research; clinical practice; EBM; narratives; (public health) interventions; … Variety of practices to study what makes us healthy/sick My focus: practices in which we causally understand health&disease by studying biological and social factors 6
  • 7. Bio-social causes of health&disease Historically, 19th century public health is much about social factors Recently, characterised as ‘the causes of causes’ Sociology of health / social epidemiology Health&disease are associated with social factors Inequalities in health are associated with inequalities at the social level Health&disease happen in a social context 7
  • 8. Descriptive and normative Descriptively: plenty of research to establish correlations <social social factors>--<health&disease> Normatively: social factors are active causes in the mechanisms of health&disease We need a concept of causation/mechanisms that accounts for the mixed nature of health&disease Social factors are proximate, not distant causes 8
  • 10. A general argument IF we conceptualise X such-and-such THEN what actions should follow? Replace X by your favourite: health, evidence, probability, … Normativity is double PhilSci concepts are non-neutral PhilSci and Ethics are part and parcel of science/policy, not a cherry on the cake 10
  • 11. The specific argument IF the social has active causal role in health&disease THEN what public health interventions should follow? 11
  • 13. Value-promoting concepts 13 A long-standing, valuable and rich tradition on value- ladeness and inductive risk. Notice: ladenness goes in 2 directions: 1) Values influence our concepts/methods 2) Values are influenced by concepts and methods 1) is much more studied than 2)
  • 14. ‘Health’ is certainly normative in the practice of public health See rich literature in public health ethics But ‘health’ is also normative at the level of the scientific concept&methods Whether social factors are proximate – rather than distant – causes makes a difference to which actions we decide to undertake 14
  • 16. Social causes, biological interventions Obesity ‘epidemic’ Wide recognition of social factors (besides biological ones) Top priority for EU health policy EU announces to tackle social factors (e.g. behaviour) One of the biggest actions: regulating food labelling Ultimately tackles the biology of obesity Claims to target food industry, but in fact it makes info available and leaves the choice to the individual person Pulls in opposite directions with actions to improve on competitiveness of SMEs 16
  • 17. Social factors are proximate causes of obesity What to do with Food labelling? Food industry? Marketing? What consequences to draw from a concept that would (naturally?) lead to paternalist attitudes? How to reconcile it with (justified?) libertarian intuitions? Is a ‘libertarian paternalism’ a viable option? … 17
  • 18. TO SUM UP AND CONCLUDE 18
  • 19. Concepts and actions A causal conceptualisation of health&disease Social factors are proximate causes, on par with biological ones A controversial point on its own Despite the large body of literature on social factors and health More controversial still What actions should follow from this conceptualisation 19
  • 20. Division of labour? • Health Sci / Epi >> methods • Phil Sci/Health >> concepts • Ethics-PolPhil >> norms But these questions are in fact tangled! 20
  • 21. Philsci and ethics-political phil How to connect epistemological/methodological questions to normative questions? Which values are promoted by our (non-neutral) sci- concepts? Setting the stage for more science-informed ethics or ethics- aware philsci 21
  • 22. Value-promoting concepts in the health sciences and public health Federica Russo Philosophy &ILLC, University of Amsterdam russofederica.wordpress.com | @federicarusso

Editor's Notes

  1. Thanks for the invite Thanks for flexibility to do this online Public health gaining attention in phil community, not just from ethics perspective. I got to public health coming from causality / biomed / modelling. As my thinking about these themes progresses, I am faced with difficulty of different types of questions that intersect and get tangled. I want to talk about one aspect of this tangle, surely there are many others.
  2. Ultimately want to say we need to deal with the tangle, not pretend it is not there. Step back: distinction btw cross-cutting and domain-specific questions. May serve as double-edged sword: partly at the basis of the tangle, and partly creates illusion we can get rid of it. Focus on health sciences and public health, explain how, in my case, these two types of questions were tangled. Here we stay mainly at conceptual/method level. Explain how, I think extra layer of complexity arises: normative aspects are also entangled. Last part, discuss how we could set-up discourse on non-neutrality of phil sci and develop framework for normative questions in public health, *given* the tangle with phil sci questions/concepts.
  3. I am deliberately borrowing Canguillhem ‘normal and pathological’ as I can’t find a better expression to condense all these dimensions
  4. This is how *I* tackle the question Implicit: I take the study of causes-mechs at the core of science. NOT that this is the only thing they do, but what they aim for. Even descriptive / observational is instrumental to understand whats and whys. See e.g. Schramme on classic concepts of disease. OK to distinguish meta/epi/axiologic aspects. But it seems that these are intertwined!
  5. See David Teira on evidence and drug safety!! David’s work really important and needs to be streamlined and extended! N.B. existing debate in epidemiology whether discipline ipso facto concerned with policy or not. Both views exist. Ultimately about whether epidemiologists should translate *results* into policy interventions. HERE: pose similar question, but at stage earlier than results >> concepts and methods
  6. Seems much needed. See chronic diseases that are preventable, still on the rise. Obesity epidemic. Even for infectious diseases, urgency may be related to underestimation of soc factors
  7. See again e.g. David’s work on evidence in drug regulation
  8. These questions often discussed from the perspective of autonomy and the role of the patient / citizen. See e.g. Boniolo on deliberative democracy and deliberation in biomed ethics Here: whether one should take sci-concepts to their (undesirable?) consequence?
  9. Here mention Schramme: he has an argument that health is value-laden in PH> so in context of action. Sure. But it is value-laden, or value-promoting ALSO at the conceptual/methodological level