Public Health
The Nordic Committee on Bioethics organised a conference in Reykjavik in August 2010 to hear expert views and discuss ethical issues relating to public health. The programme was divided into three sessions: 1) Individual Freedom and Public Health, 2) Health Responsibility and Life Style, and 3) Social Equality and Justice. The speakers offered a wide multidisciplinary perspective on these topics.
The Nordic Committee on Bioethics organised a conference in Reykjavik in August 2010 to hear expert views and discuss ethical issues relating to public health. The programme was divided into three sessions: 1) Individual Freedom and Public Health, 2) Health Responsibility and Life Style, and 3) Social Equality and Justice. The speakers offered a wide multidisciplinary perspective on these topics. I feel privileged to be the editor of this book to which most of the speakers sent their valuable contributions. The structure of the book follows the programme of the conference.
The first session of the conference framed the theme, and provided insights. Haraldur Briem raises the ethical question as how to protect people from dangerous communicable diseases while at the same time taking into account individual rights and freedom of movement. Kalle Grill defends the thesis that liberty is an important value, but with no claim to priority. Helena Kääriäinen discusses population screenings using neonatal screening of genetic diseases as an example. The major problem in the programmes relates to their quality. Thus, she stresses that population screenings require careful planning, and appropriate pre-test information. Stefán Hjörleiffson, on his part, considers pros and cons of screening programmes. In his opinion, benefits do not usually outweigh the harms andthe costs.
The second session focused on health responsibility and life style. Many of today’s burdening health problems are related to life style, and unfortunately often correlate with lower socioeconomic status. But who is responsible for individuals’ health in the end? To what extent can the state use paternalistic measures to guide people to the right course? Ole Faergeman thinks that too little attention is given to the impact of climate change on health. He sees policy-makers have failed to react to climate change partly due to corporate structures in the state. Bjørn Hofmann examines the question “do people have a right to live an unhealthy life?” Even though many theories might justify public health intervention to induce people to live healthy lives, the answer does not seem simple; not least due to a difficulty to define key concepts. Ástríður Stefánsdóttir suggests in her contribution that a major epidemic of our times, obesity, should first and foremost be seen as a social problem because an increasing number of children and adults are living in an environment that makes it more and more difficult for them to lead healthy lives. Tinna Laufey Ásgeirsdóttir argues that efficiency is one of multiple possible ethical barometers that we can use for individual and societal guidance. In her view, ethical and economic analyses are two ways of describing or weighing the various possible means to optimal decision making, one being a subset of the other. Pekka Louhiala contemplates in his text whether it is necessary for a good life to be healthy. He concludes that happiness cannot be measured by scientific terms, but require evaluations that are formed in a social settings.
In the third session of the conference, Social equality and justice, poverty was identified as one of the key causes underlying poor health and increasing health inequalities. The overall challenge concern policy-making in all fields; daily living conditions, environment, equal distribution of resources, market responsibility. Moreover, these policies should have a life-course perspective. Particular focus should be targeted on marginalised or vulnerable populations. But above all, it was claimed, effective health improvement policies and practices should be purely evidence-driven and evidencebased. In the third part of this book these ideas are developed further. Geir Gunnlaugsson highlights the importance of the early years for the development of the child, and later health in adulthood. He also notes that low social position is in fact an important determinant per se; possibly through stress and the consequences it has on the human body. Janne Nikkinen argues that Nordic welfare state has not been able to manage socio-economic factors affecting childhood adequately: health inequalities exist and are rising in the Nordic countries. Finally, Ketil Lenert Hansen discusses how the Sami livingin the Nordic countries experience prejudices and discrimination both as individuals and as a group.
The texts in this book plunge into the core of today’s public health challenges. Interestingly, several texts claim that current politics fail to see the upstream causes in deeper political structures that result in major public health problems. It is evident that more discussion and more evidence are needed in the society to improve public health, and to maintain confidence in the just and fair Nordic welfare state.
(from Sirpa Soini’s Forword)