KNAW-NIAS workshop “Substance use and mental health. Causal questions and interdisciplinary research”

1. Causal Pluralism and
Public Health
Federica Russo
Philosophy & ILLC | University of Amsterdam
russofederica.wordpress.com |@federicarusso
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2. Outline
 How to ask philosophical questions about causation
 And make philosophy relevant to science and policy
 Causal pluralism
 The selection of relevant philosophical questions and scientific problems of causality
 Public health challenges and the role of values
 Why questions of causal metaphysics matter
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3. Philosophizing about causation
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4. Causality is a key concept
 In every-day contexts
 Had I heard the alarmclock, I wouldn’t have missed the bus
 When I switch the button, the light turn on/off
 In scientific contexts
 Poverty causes delinquency
 SARS-CoV-2 causes respiratory difficulties
 In decision contexts
 Increasing tobaco taxation reduces smoking
 School closure for 2 weeks limits positive Covid cases
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5. But what is causation?
 A long-standing, ever-green question in philosophy
 From the Greeks, and possibly before
 Key conceptual shifts from the scientific revolution owards
 Ups and downs in contemporary thinking
 The typical philosophical questions:
 What is causation / causality?
 What are causes?
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6. Not one, but many questions
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7. Making sense of
a vast intellectual enterprise
 Philosophical theorising about causes
 Long history, ups and downs, harsh criticisms, dominant views, etc.
 Expansion of philosophical theorising about causes
 Beyond physics, attention to the special sciences, medicine, and
epidemiology
 Attention to questions about use, besides traditional metaphysics,
epistemology, and semantics
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8. Causal pluralism
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Causality cannot be reduced to one single concept
but has to be analysed using several concepts

9. Types of causing
Anscombian pluralism: pulling, pushing, binding, …
Aristotelian causes
Concepts of causation
Hall: Dependence vs production
Types of inferences
Inferential bases, inferential targets.
Epistemic causality
Sources of evidence
Difference-making and mechanisms
Methods for causal inference
Quantitative, qualitative, observational, experimental, …
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10. 5 philosophical questions
Metaphysics
What is causality? What kind of things are causes
and effects?
Semantics
What does it mean that A causes B?
Epistemology
What notions guide causal reasoning?
Methodology
How to establish whether A causes B? Or how much
of A causes B?
Use
What to do once we know that A causes B?
5 scientific problems
Inference
Does A cause B? To what extent?
Prediction
What to expect if A does (not) cause B?
Explanation
How does A cause or prevent B?
Control
What factors to hold fixed to study the relation
between A and B?
Reasoning
What considerations enter in establishing whether /
how / to what extent A causes B?
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11. Use
Metaphysics
Semantics Epistemology
Methodology
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12. The causal mosaic
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13. Tiles for the Causal
Mosaic
…
necessary and sufficient;
levels; evidence;
probabilistic causality; counterfactuals;
manipulation and invariance; processes;
mechanisms; information;
dispositions;
exogeneity; Simpson’s paradox;
regularity; variation;
action; inference;
validity; truth;
…
To be arranged by:
Philosophical Questions
Metaphysics, Semantics,
Epistemology,
Methodology, Use
Scientific Problems
Inference, Prediction,
Explanation, Control,
Reasoning
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14. A causal mosaic
A picture made of tiles
Each tile has a role that
Is determined by the scientific problem / philosophical question
it addresses
Stands in a relation with neighbouring concepts
A causal mosaic is dynamic, partly depends on scientists’
/ philosophers’ perspectives
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15. Public health challenges and
the benefits of a pluralistic approach
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16. Six causal challenges
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17. 1. [Causal Narrative] Choose the most effective way to explain disease and then
intervene (direct paths versus very indirect paths)
2. [Level of aggregation] Pitch the right or best level of intervention: individual versus
population, different types of social aggregation
3. [Types of factors] Choose the right or best factor(s) to intervene upon: bio-chemical
and/or socio-economic factors. Partly dependent on one’s metaphysical views about
disease causation
4. [Cause vs risk] Understand the conceptual borders between “risk” and “cause”, with
implications for the actionability of risks and causes, and to the communication to
general public
5. [Evidential pluralism] Assess the evidence and choose methods to form the
knowledge base and to design interventions. Assess how much evidence of
correlation and/or of mechanisms is needed to have a solid enough knowledge base
6. [Causes and norms] Concepts of health and disease are not “causally neutral”
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18. 1. [Causal Narrative] Choose the most effective way to explain disease and then
intervene (direct paths versus very indirect paths)
2. [Level of aggregation] Pitch the right or best level of intervention: individual versus
population, different types of social aggregation
3. [Types of factors] Choose the right or best factor(s) to intervene upon: bio-chemical
and/or socio-economic factors. Partly dependent on one’s metaphysical views about
disease causation
4. [Cause vs risk] Understand the conceptual borders between “risk” and “cause”, with
implications for the actionability of risks and causes, and to the communication to
general public
5. [Evidential pluralism] Assess the evidence and choose methods to form the
knowledge base and to design interventions. Assess how much evidence of
correlation and/or of mechanisms is needed to have a solid enough knowledge base
6. [Causes and norms] Concepts of health and disease are not “causally
neutral”
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19. Conceptualising
health & disease
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20. 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
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21. Conceptualizing health&disease, from a
practice perspective
{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 / methodology
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22. 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
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23. Bio-social causes of health&disease
 Historically, 19th century public health was 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
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24. 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
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25. Concepts and actions
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26. 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
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27. The specific argument
IF the social has active causal role in health&disease
THEN what public health interventions should follow?
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28. Use &
Values
Metaphysics
Semantics Epistemology
Methodology
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29. Directions of value-ladenness
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30. Value-promoting concepts
A long-standing, valuable and rich tradition on value-ladenness 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), especially in science studies, STS, PH / bioethics
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31. The normative character of
‘health & disease’
 ‘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
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32. Obesity and
food labelling
An example
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33. 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
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34. To sum up and conclude
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35. Philosophy at the service of public health
 Evergreen philosophical questions about causation can be made relevant to the
practice of science and in policy contexts
 Causal pluralism is a way to
 Promote looking at practices of science and policy design more closely
 Design conceptual approaches to causality (and evidence) that
 Help in the practice of evidence generation and assessment and policy design
 Connect questions about concepts&methods to questions about action&values
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36. Causal Pluralism and
Public Health
Federica Russo
Philosophy & ILLC | University of Amsterdam
russofederica.wordpress.com |@federicarusso
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Thanks for your attention

37. 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?
…
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