Ethics, science, and health policy: philosophical and trans-disciplinary contributions for a transformation of the health system.
Deadline: May 7, 2021
Publication date: July 2021
María Graciela de Ortúzar
Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina. CONICET-UNLP-UNPA
Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina. INCIHUSA, CONICET – UNCuyo
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In our globalized world, the COVID-19 health emergency has clearly demonstrated the importance of considering health as a public good. One could exemplify in human lives the advantages of countries that protect their populations with cooperative social insurance, as opposed to countries that leave these lives to the market. Despite the obvious superiority of the public system, it is this very system that is in crisis. The complexity of this crisis cannot be reduced only to its economic and financial aspects; even though few would doubt that the cause of structural economic injustices lies in the role played by laboratories, the health market, the food industry itself, and the strong inequalities at the base of the productive model that affect the social determinants of health. The economic transformation of the public health system is necessary. This system cannot be the weakest link in the chain when social inequality is critical (e.g., recharge of the public system due to increased unemployment and state subsidies to social welfare and private sectors).
Thinking about health in a broad sense also leads us to reflect on the same productive model that threatens our wellbeing (eco-determinants of health), access to drinking water, to food free of agro toxins, to a healthy environment, to social ties and systems of trust. However, given that inequalities are multiple, such a transformation will not be possible without a transformation in the epistemological and ethical dimension, incorporating the gender perspective, intercultural dialogue, and complementary knowledge that makes the right to health of marginalized ethnic groups respected. Thinking about health in a broad sense requires rethinking how to address the multiple inequalities that cross our people (social, cultural, epistemological, ethnic, gender). It is precisely migrant women and indigenous communities, marginalized ethnic groups whose rights have historically been violated, who resist and fight for the care of life, for the integral care of nature and the earth.
Thinking about the transformation of our health system from a philosophical approach in dialogue with the human and social sciences requires a critical review of its theoretical, methodological, and ethical assumptions, making explicit the relationships between ethics, science, and politics. In this emancipatory praxis, political philosophy, ethics, and bioethics play a significant role, broadening the horizons of justice (from distributive justice to recognition, to participation, to epistemic justice); and making explicit the values of emancipation: cultural, epistemic, gender, ethnic, political and economic. Along this path, the tensions and conflicts between distributive justice and justice of recognition have been transferred to the field of health; as well as the integrative proposal of integral and inter-sectoral (social, economic, cultural, gender, ethnic) health justice. Likewise, a particularly important concept for our people has been that of integral care, together with those of intercultural dialogue and complementary or diverse knowledge, epistemic justice. In this sense, we encourage the participation of women from indigenous communities and migrant groups, listening to their voices, experiences, and knowledge.
The purpose of this dossier is to invite authors who, through their work and reflections, allow us to think about how to transform a public health system, showing the necessary intersectionality and integration of knowledge, the commitment to care for others and nature, the respect for collective rights and multiple emancipations. The goal of this thematic presentation is to understand the meanings and scope of the ethical and social values that should sustain a new public health system with an intercultural and gender perspective.
In addition to the philosophical approach to this issue, we do not neglect the variety of perspectives, approaches, and methodological strategies that such a complex and lush subject matter makes possible and deserves. In this sense, we understand that the thematic axes that we propose could allow a transdisciplinary and inter-ideological approach to debates, discussions, and classic problems in the field of philosophy and science, as well as to the challenges opened towards the future from the present situation.
- The defense of health as a public good and the crisis of the health system.
- Debates between distributive justice and justice of recognition applied to health.
- The integral and intersectoral dimension of health: multiple inequalities,
- The triple discrimination of poor women with disabilities.
- Critical analysis of the conceptualization of interculturality in health/ intercultural dialogue/complementary knowledge.
- Participation of native communities and/or voices of communities in the health system.
- Tensions between regulation and emancipation in migrant groups.
- Right to self-determination of migrant women and women from indigenous communities or the need for a gender perspective in health.
- Vulnerability, psychosocial determinants, and eco-determinants of health.
- How to transform the health system: an ethical and political approach to public health.
Hoping to count in this dossier with the participation of communities and experts from the field of philosophical ethics, but also from various disciplines with which it dialogues, we seek to awaken critical reflection on the need to build interdisciplinary bridges, bridging the existing gap in the literature and in professional training regarding the intersection of gender perspectives and intercultural dialogue in health. One of the main contributions in this topic has been the intersectional approach (gender, race/ethnicity, social class), being also necessary to define and discuss what we mean by intersectionality and from what approach is this concept designed to promote equality of indigenous and migrant communities.