Philosophy of public health, methodology, normativity

1. Philosophy of Public Health:
The Entanglement of Conceptual,
Methodological, and Normative
Questions
Federica Russo
Philosophy | Humanities | Amsterdam
russofederica.wordpress.com |
@federicarusso

2. Overview
Cross-cutting and domain-specific questions
The health sciences and public health
Domain-specific questions to be address with
cross-cutting concepts: conceptualising
health&disease
Concepts and actions
What policies should follow from specific concepts?
On the non-neutrality of philsci
What normative framework for public health?
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3. CROSS-CUTTING AND
DOMAIN-SPECIFIC QUESTIONS
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4. The distinction
Cross-cutting questions
How do we explain? What are causes/effects? When is
an experiment/model/method valid? …
Domain-specific questions
What are genes? What is Higgs mechanism? What is
agency? What is a pathology? …
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5. Still worth distinguishing?
Yes, to foster unity of philsci rather than crystalise
fragmentation
Yes, to precisely pinpoint where value-neutrality
philsci falls short
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6. HEALTH SCIENCES AND
PUBLIC HEALTH
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7. New special sciences
Recent additions to the range of options
A long process to legitimise interest in them
What’s so interesting, then?
Methods: experimental, observational, data/technology-
driven, …
Concepts: health-related, borrowed from bio-chemistry
or social science, …
Actions: diagnosis/prognosis, treatment, public health
interventions, …
Contextualisation: historical, cultural, political, …
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8. CONCEPTUALISING
HEALTH & DISEASE
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9. A domain-specific question
Essential to the field, and with its own
tradition
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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10. Cross-cutting concepts for
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
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11. 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
Here: practices in which we causally understand
health&disease by studying biological and social
factors
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12. 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
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13. 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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14. CONCEPTS AND ACTIONS
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15. 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
Philosophy is part and parcel of science/policy, not a
cherry on the cake
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16. The specific argument
IF the social has active causal role in
health&disease
THEN what public health interventions
should follow?
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17. OBESITY AND
FOOD LABELLING
An example
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18. 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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19. THE NON-NEUTRALITY OF
PHILSCI
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20. So far …
Philsci questions / problems / concepts are non-
neutral from an ethico-political perspective
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What’s next …
How to set up the normative question?

21. A set of questions
• Which ethico-political principles / values are at
work?
• Role of scientists / experts
• Relation between scientists and policy makers
• Design decision making process with science,
policy makers, the public
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What Science /
Evidence /
Concepts
What Actions

22. CURRENT
PUBLIC HEALTH ETHICS
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23. Existing approaches
Branching out from bioethics
Focuses on population, ethics at group level
Problem-based, concrete moral/political
questions/dilemmas
Often, ethical theory comes before the problem
Social factors and health
Equity, justice, tensions in policies, …
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24. Division of labour?
• Health Sci / Epi >> methods
• Phil Sci/Health >> concepts
• Ethics-PolPhil >> norms
But these questions are in fact tangled!
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25. NORMATIVE CONCEPTS
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26. Value-promoting concepts
Ladeness may have 2 directions:
i. Values that influence our
concepts/methods
ii. Our concepts that influence the values
we promote
(i) is much more studied than (ii)
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27. ‘Health’ is certainly normative in the practice
of public health
But ‘health’ is also normative at the level of
the scientific concept
Whether social factors are proximate – rather
than distant – causes is likely to make a
difference on the actions taken
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28. AGAIN ON OBESITY
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29. 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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30. TO SUM UP AND CONCLUDE
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31. Cross-cutting and domain-
specific
An old distinction, but worth using
For conceptual clarity
To foster dialogues between phil of different special
sciences
To achieve unity, if possible at all, or at least synergy
Causality, evidence, explanation
Cross-cutting concepts that can be used to ask domain-
specific questions, e.g. about health&disease
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32. 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
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33. Philsci and ethics-political phil
How to connect
epistemological/methodological questions to
normative questions?
Which values are promoted by our (non-
neutral) sci-concepts?
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34. Philosophy of Public Health:
The Entanglement of Conceptual,
Methodological, and Normative
Questions
Federica Russo
Philosophy | Humanities | Amsterdam
russofederica.wordpress.com |
@federicarusso