Background: Inclusion or not of a treatment strategy in the publicly financed health care is really a matter of prioritisation. In Sweden priority setting decisions are governed by law in which it is stated that decisions should be guided by firstly the principle of need and secondly the principle of cost-effectiveness.

Our society is obsessed with health. At every second, everywhere, we are surrounded and overwhelmed by distressing calls on how vital it is to adopt a healthy lifestyle. While incorporating a healthy diet and physical exercise into our routines are the foremost commandments, everything from tobacco to refined sugars, trans fat, excessive alcohol, caffeine, and even eggs are declared public evils. Yet there is hope: medicines will save us! And indeed medicines exist available for all kinds of human afflictions. (...) There are pills to help you relax and forget about stress, while some others, on the contrary, can keep you miraculously alert. There are pills that heal your most unbearable pains, physical or emotional, wherever their location — the head, back, quadriceps, heart, or soul. Though they may cause your stomach to burn, that is easily remedied by taking a complementary pill that will neutralize your stomach acidity with only some minor and negligible side effects elsewhere. There are also magic pills that promise you happiness, by giving you the power to thrive and the endurance to conquer the world. They ignite your hunger for achievement, but also for extra sugar and saturated fat. (shrink)

In recent works, Shlomi Segall suggests and defends a luck egalitarian approach to justice in health. Concurring with G. A. Cohen’s mature position he defends the idea that people should be compensated for “brute luck”, i.e. the outcome of actions that it would be unreasonable to expect them to avoid. In his defense of the luck egalitarian approach he seeks to rebut the criticism raised by Norman Daniels that luck egalitarianism is in some way too narrow and in another (...) too wide to uphold justice in health and health care distribution. He points out that a pluralistic outline of luck egalitarianism taking into account the moral requirement of meeting everyone’s basic needs can avoid this line of criticism. In this article I argue against the application of such pluralistic luck egalitarianism in matters of health distribution. First of all, Segall has not shown that luck egalitarianism handles well health distributions above a threshold of basic needs. Secondly, his way of avoiding Elizabeth Anderson’s abandonment objection is theoretically problematic. Finally, I argue that luck egalitarianism in general fails to acknowledge the moral foundation of health and health care as a basic human entitlement. Thus I conclude that luck egalitarianism fails to take health needs seriously and that it cannot therefore uphold justice in health. (shrink)

The issue of mental health among college students is of increasing concern during the COVID-19 outbreak. Since course characteristics of engineering college students determine the particularities of their mental health, the specific objectives of this study were: to analyze the relationship between physical activity, parental psychological control, basic psychological needs, anxiety, and mental health in Chinese engineering college students during COVID-19 pandemic; and to examine the mediation effect of anxiety between the relationship of basic (...) psychological needs and mental health. A cross-sectional study was conducted among several universities in Shandong Province, China. We randomly selected 254 Chinese engineering college students from these colleges. Participants who were given questionnaires completed the Physical Activity Rating Scale, Basic Needs Satisfaction in General Scale, Parental psychological control Questionnaire, the Beck anxiety inventory, and the Kessler 10 scale. The mediation model was conducted to assess the mediation effect of anxiety between the relationship of basic psychological needs and mental health. Among 254 Chinese college students majoring in engineering, the results showed that their mental health was in the mid-level range. Besides, physical activity and basic psychological needs is positively correlated with mental health, respectively, while parental psychological control is not correlated with mental health. Anxiety is negatively associated with mental health. Mediation analysis revealed that anxiety played a mediation role in the relationship between basic psychological needs and mental health. In conclusion, mental health of Chinese engineering college students deserves extensive attention during the COVID-19 pandemic. Proper intervention on physical activity, basic psychological needs, and anxiety may be beneficial to improve their mental health. In addition, meeting basic psychological needs is beneficial to reduce anxiety and improve mental health further. (shrink)

The concept of basic healt.h care has grown steadily in importance in recent years as more and more of those who reflect on the issue of a right to health care conclude that we need to distinguish between kinds of health care to which people do have a right and others to which they do not have a right. There is little consensus on where to draw this line. But there does seem to be general agreement that, (...) if this distinction is valid, it is so because some kinds of health care are less important, less essential, less something than others, and because the right to health care (if there is such a thing) extends only to those kinds of health care that are more important, more essential, more whatever-it-is. A number of authors have used the term 'basic' to represent this something and this is the term which I shall use. In this article, I shall offer a theory of what we mean by basic health care. I shall do this by developing, in Section 1 of the paper, a general theory of kinds of needs. In Section 2 I will give a brief account of the special moral significance of the levels of need which I designate as basic. In Sections 3-4 1 shall try to identify, in the context of the health care resources available in our society, the health care needs which fall into the previously developed categories of basic need. (shrink)

ObjectiveTo reveal the relationship between parental phubbing, basic psychological needs satisfaction, self-esteem, and depression and to explore the impact of parental phubbing on depression.MethodsA total of 819 junior high school students responded to the parental phubbing scale, basic psychological needs satisfaction scale, self-esteem scale, and depression scale in combination.Results Parental phubbing was significantly correlated with satisfaction of basic psychological needs, self-esteem, and depression. Parental phubbing can not only be used to directly predict depression in (...) junior middle school students but also has an indirect impact on depression through three pathways: a separate mediating effect on basic psychological needs satisfaction, a separate mediating effect on self-esteem and a chain mediating effect on both.ConclusionParental phubbing is a risk factor for depression, which can negatively affect the mental health of junior high school students. (shrink)

According to HealthCare.gov, by improving access to quality health for all Americans, the Affordable Care Act (ACA) will reduce disparities in health insurance coverage. One way this will happen under the provisions of the ACA is by creating a new health insurance marketplace (a health insurance exchange) by 2014 in which “all people will have a choice for quality, affordable health insurance even if a job loss, job switch, move or illness occurs”. This does not (...) mean that everyone will have whatever insurance coverage he or she wants. The provisions of the ACA require that each of the four benefit categories of plans (known as bronze, silver, gold and platinum) provides no less than the benefits available in an “essential health benefits package”. However, without a clear understanding of what criteria must be satisfied for health care to be essential, the ACA’s requirement is much too vague and open to multiple, potentially conflicting interpretations. Indeed, without such understanding, in the rush to provide health insurance coverage to as many people as is economically feasible, we may replace one kind of disparity (lack of health insurance) with another kind of disparity (lack of adequate health insurance). Thus, this paper explores the concept of “essential benefits”, arguing that the “essential health benefits package” in the ACA should be one that optimally satisfies the basic needs of the people covered. (shrink)

The UN Convention of the Rights of the Child (CRC) in the 1990s becomes a landmark and has now been ratified by every other country of the world. Bring hope for a better world—for all children was highlighted as one of the most far-sighted human right instrument in the convention. Yet access to basic livelihood needs such as clean drinking water, primary health services, primary education, recreation and other urban infrastructure becomes a nightmare for millions of children (...) and youth in the developing world and particularly in metropolitan cities in India. The Indian children are living in varying residential environment, comprised of residential colonies of rich, high-raised flats of middle and low-income groups and the economically weaker sections living in slums and squatter colonies. The conventional method of planning residential neighbourhood lacks in indentifying the varying needs of children while building urban infrastructure. As a result there is a large gap in getting access to basic livetihood needs for children of rich and poor. The basic question becomes, is the urban child and youth population just as a numerical variable in planning infrastructure needs in metropolitan cities? This article attempts to analyse the situation in some of the selected residential areas in Delhi. (shrink)

This paper addresses a theory of intergenerational justice that we refer to as “needs-based sufficientarianism”. According to needs-based sufficientarianism, the present generation ought to enable future generations to meet their basic needs — for example, their needs for drinkable water, food and health care. Our aim is to explain and defend this theory in a programmatic way. First, we introduce what we regard as the most plausible variant of needs-based sufficientarianism. Then we argue (...) that this variant is superior to several alternative ways of thinking about intergenerational justice. In particular, we defend basic needs as the currency of intergenerational justice and sufficiency as its principle. Our arguments for these claims are neither fully comprehensive nor fully conclusive. Yet, we hope that they suffice to show that needs-based sufficientarianism is a major contender, with significant pro tanto advantages over other views. (shrink)

Human rights advocates often use inflated and thus underspecified terminologies when addressing the content of their claims. One example of such loose terminology is the term ‘well-being’, as currently employed in connection with a definition for the right to health. What I call the ‘well-being conception of health’ conflates the distinct ideas of basic and non-basic health needs, as well as those of individual autonomy and freedom. I call this the conflation problem. This paper (...) argues for the need of an understanding of the right to health, nuanced enough to capture not only these distinct ideas, but also their moral relevance for the common good. (shrink)

Workplace bullying is a phenomenon that can have serious detrimental effects on health, work-related attitudes, and the behavior of the target. Particularly, workplace bullying exposure has been linked to lower level of general well-being, job satisfaction, vigor, and performance and higher level of burnout, workplace deviance, and turnover intentions. However, the psychological mechanisms behind these relations are still not well-understood. Drawing on psychological contract and self-determination theory (SDT), we hypothesized that perceptions of contract violation and the frustration of (...) class='Hi'>basic needs mediate the relationship between workplace bullying exposure and well-being, attitudinal, and behavioral outcomes. Self-reported data were collected among employees with different working backgrounds (N= 1,257)viaAmazon's Mechanical Turk in an online survey. Results showed that feelings of contract violation and frustration of basic needs accounted for unique variation in well-being, work satisfaction, burnout, vigor, and turnover intentions, pointing to individual contributions of both psychological mechanisms. However, when controlled for frustration of basic needs, feelings of psychological contract violation were no longer a mediator between workplace bullying exposure and work performance. Helping employees to deal effectively with workplace bullying exposure might buffer its negative effects and reduce their experienced frustration of basic needs, preserving their well-being, vigor, and work performance and, eventually, prevent burnout. The present study is the first to concurrently elucidate the proposed psychological mechanisms and unique contributions of psychological contract violation and frustration of basic needs in the context of workplace bullying. (shrink)

A just social arrangement must guarantee a right to health care for all. This right should be understood as a positive right to basic human functional capabilities. The present article aims to delineate the right to health care as part of an account of distributive justice in health care in terms of the sufficiency of basic human functional capabilities. According to the proposed account, every individual currently living beneath the sufficiency threshold or in jeopardy of (...) falling beneath the threshold has a legitimate claim to justice. People's entitlements to health care should not be determined on the basis of brute luck and their efforts to maintain healthy lifestyles. The prioritization of competing claim-rights of individuals is guided by two allocation principles: number and benefit-size weighted sufficiency (among people beneath the threshold) and need-weighted utilitarianism (among people above the threshold). (shrink)

Initiating and maintaining sports and exercise behaviour are usually discussed in terms of strategies for promoting health. In the present study, we analysed a sample of extreme endurance sport athletes and set out to predict exercise addiction, which is a facet of a sport-related health risk. We therefore draw on self-determination theory (Deci & Ryan, 1985, 2000), according to which low basic psychological need satisfaction can lead to excessive compensatory behaviour. We aim to disentangle the effects of (...) need satisfaction in the activity itself (exercising) and outside the activity (work/leisure) on exercise addiction. Furthermore, we propose anxious self-motivation as a mediator and tested whether it links low basic need satisfaction with exercise dependence. A correlational study with 323 multi-triathlon athletes confirmed our hypothesis that need satisfaction in work/leisure (but not in sports) is negatively related to exercise addiction. Furthermore, only need for competence in both domains (sport, work/leisure) is associated with anxious self-motivation. Mediation models showed that low competence satisfaction leads to anxious self-motivation that in turn predicts exercise addiction. The results are discussed critically in terms of their practical and theoretical implications for promoting health through sport and exercise. (shrink)

The transition from university to working life appears a critical period impacting human service workers’ long-term health. More research is needed on how psychological factors affect the risk. We aimed to investigate how subgroups, based on self-efficacy, psychological flexibility, and basic psychological needs satisfaction ratings, differed on self-rated health, wellbeing, and intention to leave. A postal survey was sent to 1,077 recently graduated psychologists in Sweden, response rate 57.5%, and final sample 532. A hierarchical cluster analysis (...) resulted in a satisfactory eight-cluster solution. We identified two at-risk subgroups, displaying the lowest scores on health and wellbeing, and one potential low-risk subgroup with the highest ratings on said variables. The “Low risk?” group rated high on all three psychological constructs, a positive transition to working life, a work environment where resources balanced relatively high emotional demands, good health, and wellbeing. Almost the complete opposite ratings characterized the potential risk groups. “Quitting?” scored significantly higher than “Getting sick?” on self-efficacy and psychological flexibility as well as actively seeking new employment and reporting daily thoughts on leaving the profession. We suggest that a combination of low self-efficacy and psychological flexibility could increase the risk of individuals staying despite suboptimal working conditions. With combined higher self-efficacy and psychological flexibility, individuals in similar circumstances appear more inclined to quit. We conclude that the ways recently graduated psychologists rate their self-efficacy, psychological flexibility, and basic needs satisfaction appear to be reflected in their self-rated health and wellbeing. (shrink)

Norman Daniels, in applying Rawls’ theory of justice to the issue of human health, ideally presupposes that society exists in a state of moderate scarcity. However, faced with problems like climate change, many societies find that their state of moderate scarcity is increasingly under threat. The first part of this essay aims to determine the consequences for Daniels’ theory of just health when we incorporate into Rawls’ understanding of justice the idea that the condition of moderate scarcity can (...) fail. Most significantly, I argue for a generation-neutral principle of basic needs that is lexically prior to Rawls’ familiar principles of justice. The second part of this paper aims to demonstrate how my reformulated version of Daniels’ conception of just health can help to justify action on climate change and guide climate policy within liberal-egalitarian societies. (shrink)

Although the world has experienced remarkable progress in health care since the last half of the 20th century, global health inequalities still persist. In some poor countries life expectancy is between 37-40 years lower than in rich countries; furthermore, maternal and infant mortality is high and there is lack of access to basic preventive and life-saving medicines, as well a high prevalence of neglected diseases, HIV/AIDS, tuberculosis, and malaria. Moreover, globalization has made the world more connected than (...) before such that health challenges today are no longer limited within national or regional boundaries, making all persons equally vulnerable. Because of this, diseases in the most affluent countries are closely connected with diseases in the poorest countries. In this paper, we argue that, because of global health inequalities, in a situation of equal vulnerability, there is need for global solidarity not only as a means of reducing health inequalities, but also as a way of putting up a united force against global health challenges. We argue for an African approach to solidarity in which the humanity of a person is not determined by his/her being human or rational capacity, but by his/her capacity to live a virtuous life. According to this view of solidarity, because no one is self-sufficient, no individual can survive alone. If we are to collectively flourish in a world where no individual, nation or region has all the health resources or protection needed for survival, we must engage in solidarity where we remain compassionate and available to one another at all times. (shrink)

ObjectivesFrom a self-determination theory perspective, the purpose of this cross sectional study was to better understand how to motivate hospitalized older adults’ behaviors and test an integrative model of the role of causality orientations and a supportive/controlled environment on basic need satisfaction, motivation for health oriented physical activity, positive and negative affective states, depressive symptoms, apathy, and boredom.MethodsOlder adults in French hospital units completed self-report questionnaires and socio-demographic data were also collected.ResultsPartial least squares path modeling results showed that (...) participants’ autonomy orientation positively associated with the perception of a supportive environment was related to need satisfaction, autonomous motivation for health-oriented physical activity, and high scores on positive affective states. Conversely, participants’ impersonal orientation positively associated with the perception of a controlled environment was related to undermining need satisfaction, controlled motivation for health-oriented physical activity, and amotivation, and high scores on both negative affective states, and boredom.ConclusionThe present results indicate that taking into account personality factors in hospital units can be useful and health professionals should take an interest both in the patients’ causality orientations and the supportive nature of the environment in order to understand better how to motivate patients’ behaviors. The present study points to the need to focus on all motivational dynamics which allow patients’ need satisfaction. (shrink)

This paper suggests that the focus on abortion legalization in the aftermath of the Zika outbreak is distracting for policy and lawmakers from what needs to be done to address the outbreak effectively. Meeting basic health needs, together with research and development conducive to a vaccine or treatment for the Zika virus should be priorities.

We live in tragic times. Millions are sheltering in place to avoid exacerbating the Coronavirus (COVID-19) pandemic. How should we respond to such tragedies? This paper argues that the human right to health can help us do so because it inspires human rights advocates, claimants, and those with responsibility for fulfilling the right to try hard to satisfy its claims. That is, the right should, and often does, give rise to what I call_ the virtue of creative resolve_. This (...) resolve embodies a fundamental commitment to finding creative solutions to what appear to be tragic dilemmas. Contra critics, we should not reject the right even if it cannot tell us how to ration scarce health resources. Rather, the right gives us a response to apparent tragedy in motivating us to search for ways of fulfilling everyone’s basic health needs. (shrink)

The moral value of health : health as a basic human need -- The human right to health and its corresponding responsibilities -- States and natural persons as subjects of justice -- Pharmaceutical transnational corporations as subjects of justice -- The global health governance of the global health crisis.

It is argued that human needs are not facts (properties, states, processes, relations) about people, but are values. The reasons presented for this position are (1) that needs are goal oriented and goals are things people value, (2) that ‘need’ functions as a basic motivational term, and (3) that disagreements about what people need are disagreements in attitude toward, and emotional attachment to, things variously considered to be valuable. If human needs are not facts, then, of (...) course, health or medical needs are not. Viewing health or medical needs as discoverable facts, rather than values, engenders certain difficulties in the following areas of concern: (a) Deciding when surgery is necessary and when unnecessary; (b) Defining the concepts of health and disease; (c) Evaluating some consequences of the development of medical science and technology; and (d) Understanding the alleged conflict between patients' health needs and their human rights. CiteULike Connotea Del.icio.us What's this? (shrink)

This article investigates what notions of “just health care” are found at three Swedish hospitals among health care personnel and whether these notions are relevant to what priorities are actually made. Fieldwork at all three hospitals and 114 in-depth interviews were conducted. Data have been subject to conceptual and ethical analysis and categorisation. According to our findings, justice is an important idea to health care personnel at the studied hospitals. Two main notions of just health care (...) were found. The main idea was the notion of “equal treatment according to need”, the basic idea being that differences in treatment should be justified by differences in needs. The competing idea that merit should affect the treatment received is occasionally encountered, the idea here being that patients, by acting irresponsibly, may no longer deserve to be treated strictly according to needs. In practice, priorities are made on grounds that only partly comply with the basic idea of justice in health care, as it is understood by staff at the studied hospitals. Exceptions are made due to regional differences, considerations of cost-effectiveness, economic incentives, tradition, the daily patient flow, research, private alternatives, patient influence and favouritism of health care personnel. (shrink)

El presente trabajo es un estudio descriptivo y con un enfoque sincrónico que da muestra de las deficiencias de los profesores universitarios al redactar textos científicos. Este estudio tiene como objetivo proponer varias acciones de superación para perfeccionar el manejo del lenguaje y el arte de redactar de los docentes de la Universidad de Ciencias Médicas "Dr. Faustino Pérez Hernández" de la provincia Sancti Spíritus que cursan la octava edición de la Maestría en Ciencias de la Educación de la Universidad (...) de Sancti Spíritus "José Martí Pérez". Para darle cumplimiento a este propósito, se aplicaron varios métodos y técnicas de recolección de datos a una muestra seleccionada al azar de informantes y de sus publicaciones, lo que permitió fundamentar la existencia de varias problemáticas en la redacción científica de dichos profesores y la necesidad de implementar formas organizativas básicas del proceso de educación de posgrado para su inmediata y eficaz aplicación. The present work is a descriptive study grounded in a synchronic approach that identifies the deficiencies of university professors when writing scientific texts. This study aims to propose several measures to improve the use of language and the art of writing of teachers of the " Dr. Faustino Pérez Hernández" University of Medical Sciences in Sancti Spíritus, Cuba who are participating in the eighth edition of the Master's Degree in Educational Sciences program at the "José Martí Pérez" University, also located in Sancti Spiritus. Several methods and techniques of data collection were applied to a random sample of informants and their scientific articles. This allowed for the detection of several problems in scientific writing and the need to implement basic organizational forms of postgraduate education for immediate and effective application. (shrink)

This paper relates human rights to public health ethics and policies by discussing the nature and moral justification of human rights generally, and the right to health in particular. Which features of humanity ground human rights? To answer this question, as an alternative to agency and capabilities approaches, the paper offers the “fundamental conditions approach,” according to which human rights protect the fundamental conditions for pursuing a good life. The fundamental conditions approach identifies “basic health”—the adequate (...) functioning of the various parts of our organism needed for the development and exercise of the fundamental capacities—as the object of a human right. A human right to basic health entails human rights to the essential resources for promoting and maintaining basic health, including adequate nutrition, basic health care, and basic education. Duty bearers include every able person in appropriate circumstances, as well as governments and government agencies, private philanthropic foundations, and transnational corporations. (shrink)

Privacy is a key ethical principle in occupational health services. Its importance is emphasised in several laws, in ethical codes of conduct as well as in the literature, yet there is only very limited empirical research on privacy in the occupational health context. Conceptual questions on privacy in the occupational health context are discussed. The baseline assumption is that, in this context, privacy cannot be approached and examined only from the employee’s vantage point but the employer’s point (...) of view must also be taken into account, and that the concept has several dimensions . Even though privacy is a basic human need, there is no universally accepted definition of the concept and no consensus on whether an organisation can have privacy in the same way as people do. Many of the challenges surrounding privacy in the context of occupational health seem to be associated with the dual loyalties of occupational health professionals towards the employee and employer and with their simultaneous duties of disseminating and protecting information . Privacy is thus not an absolute value, but more research is needed to understand its multidimensional nature in the context of occupational health. (shrink)

It is accepted throughout the world today that a new approach is needed to health care, one that brings to the forefront the role of economic development. This situation has also increased the importance of the health care sector and health data have begun to take a significant place in countries’ development indicators. Health care services as a basic indicator of social and economic development in Turkey, as in the rest of the world, continue to (...) gain in importance. However, there is a significant difference between health indicators for Turkey, which is a candidate for full membership of the European Union, and European Union countries. (shrink)

This paper reflects on Lawrence Gostin’s Global Health Law. In so doing seeks to contribute to the debate about how global health justice is best conceived and achieved. Gostin’s vision of global health is one which is communal and in which health is directly connected to other justice concerns. Hence the need for health-in-all policies, and the importance of focusing on basic and communal health goods rather than high-tech and individual ones. This paper (...) asks whether this broadly communal vision of global health justice is best served by making the right to health central to the project. It explores a number of reasons why rights-talk might be problematic in the context of health justice; namely, structurally, rights are individual and state-centric and politically, they are oppositional and better suited to single-issue campaigns. The paper argues that stripping rights of their individualist assumptions is difficult, and perhaps impossible, and hence alternative approaches, such as those Gostin endorses based on global public goods and health security, might deliver much, perhaps most, global health goods, while avoiding the problems of rights-talk. (shrink)

Can proposing a policy of equal access to health care be justified on Christian grounds? The notion of a “Christian justification” with regard to Christians' political activity is explored in relation to the New Testament texts. The less demanding policy of granting “rights to (basic) health care,” the meaning of Jesus' healing activities, early Christian welfare schemes, and Christian grounds for the ascription of “rights” are each discussed. As a result, with some stretching of the neighbor-love and (...) missionary imperatives it is proposed that a basic health care policy can be legitimized. With regard to equal access to health care, however, all attempts to derive an equalizing imperative from the spiritual “equality among humans” or by way of the “love your neighbor as yourself” imperative are shown to fail. Particular attention is given to whether “attending to the least of my brothers' needs” obliges Christians to satisfy those needs optimally, as well as to the personal involvement aspect of the love-commandment in its simultaneously spiritual and temporal orientations. (shrink)

The future will be controlled by those nations which most intelligently allocate their resources. Our nation's capital is the stored flexibility needed by our children to meet the future. How we allocate our nation's limited resources and capital will dictate the kind of lives our children will lead. We are not correctly or intelligently allocating our nation's health care resources. There are serious internal contradictions in a society that no longer produces the radios, televisions, or video recorders it invented, (...) yet pays for all patients receiving lung transplants and artificial hearts. While moving our basic value-producing industries - steel and automobiles - abroad, we continue to manufacture MX missiles and artificial hearts. We give heart transplants to smokers, but we close our steel mills. We spend freely on military and medicine, yet we refuse to spend enough to succeed in international trade. We overtreat sick people but undertreat our sick economy. Like the fading southern family in William Faulkner novels that "takes sick," as a nation we are treating our illnesses at the expense of our livelihoods. (shrink)

The human intestinal ecosystem, previously called the gut microflora is now known as the Human Gut Microbiota. Microbiome research has emphasized the potential role of this ecosystem in human homeostasis, offering unexpected opportunities in therapeutics, far beyond digestive diseases. It has also highlighted ethical, social and commercial concerns related to the gut microbiota. As diet factors are accepted to be the major regulator of the gut microbiota, the modulation of its composition, either by antibiotics or by food intake, should be (...) regarded as a fascinating tool for improving the human health. Scientists, the food industry, consumers and policymakers alike are involved in this new field of nutrition. Defining how knowledge about the HGM is being translated into public perception has never been addressed before. This raises the question of metaphors associated with the HGM, and how they could be used to improve public understanding, and to influence individual decision-making on healthcare policy. This article suggests that a meeting of stakeholders from the social sciences, basic research and the food industry, taking an epistemological approach to the HGM, is needed to foster close, innovative partnerships that will help shape public perception and enable novel behavioural interventions that would benefit public health. (shrink)

The authors describe the ethical considerations underlying the inclusion of mental health services into a prioritized health care system. The Oregon Health Plan is a process for defining and delivering basic health services to an entire state. As the plan was developed, the mental health community needed to decide whether or not to participate in the process and, if so, how. Lengthy discussions among mental health consumers, family members, and providers led to a (...) strategy that emphasized the integration of mental health and chemical dependency services into a comprehensive and universal health care program. This approach appears to have achieved relative parity for mental health. (shrink)

The coronavirus pandemic has shattered our world with increased morbidity, mortality, and personal/social sufferings. At the time of this writing, we are in a biomedical race for protective equipment, viral testing, and vaccine creation in an effort to respond to COVID threats. But what is the role of health humanities in these viral times? This article works though interdisciplinary connections between health humanities, the planetary health movement, and environmental humanities to conceptualize the emergence of “planetary health (...) humanities.” The goal of this affinity linkage is to re-story health humanities toward promotion of planetary health and community well-being. Wellbeing is critical because the main driver of environmental destruction and decreasing planetary health is coming from non-sustainable definitions of wellbeing. We need the arts and humanities to help reimagine the possibility of a sustainable community wellbeing. For health humanities, a basic role and narrative identity starts to emerge—we should become a planetary health humanities. (shrink)

America's patchwork quilt of health care coverage is coming apart at the seams. The system, such as it is, is built upon an inherently problematic base: employment. By definition, an employment-based approach, by itself, will not assure universal coverage of the entire population. If an employment-based approach is to be the centerpiece of a system that provides universal coverage, special attention must be paid to all the categories of individuals who are not employees – children, unemployed spouses or singles, (...) the unemployable ill and disabled, persons between jobs, students, retirees, the elderly. Moreover, in a purely voluntary employment-based arrangement, some employers will not provide insurance at all, and others will provide inadequate coverage, necessitating other special provisions for coverage. As a consequence, about one out of six people now has no health coverage whatsoever, and even more have inadequate coverage. All the while, the rapidly-increasing transaction costs of sustaining this grossly inadequate pluralistic system eat up sufficient funds to provide basic benefits to the entire population. The time for systematic reforms has come and gone; what is now needed is action to prevent disaster, followed by a complete rebuilding of this country's health coverage system. Although perhaps more likely to be tried than more radical, completely nationalized, ones, stepwise reforms may not go far enough to cure the significant ills of the current employment-based system. Passage of inadequate reforms, then, could well set the stage for nationalized health care in the not too distant future. (shrink)

The new South African constitution commits the government to guarantee "basic health services" for every child under 18. Primary health care for pregnant women and children under six and elements of essential primary health care have received priority. At present, there is little analysis of the moral considerations involved in making choices about more advanced or costly health care which may, arguably, also be "basic". This paper illustrates some of the tensions in setting priorities (...) for a just macro-allocation of children's health care, given the realities of need and scarce resources, and the commitment to equality of basic opportunities. (shrink)

This article sketches how liberal principles can be coherently set alongside the stewardship responsibilities of regulators. It indicates how this bears on the legitimacy of public health interventions in general and interventions of the kind associated with New York City’s public health programme in particular. The key idea is that stewardship responsibilities relate to the essential infrastructural conditions for human well-being; these conditions need to be protected because they are the staging for all human activity. Liberal principles, by (...) contrast, presuppose that the basic conditions for human well-being are in place; and, given this presupposition, they present a view about how humans should live, about how they should interact and transact and about how they should flourish. Where regulators are guided by a liberal ethic, they act illegitimately if they try to dictate how individuals should lead their lives; but, acting under their stewardship jurisdiction, regulators may legitimately intervene if they are trying to protect the conditions that are essential for any kind of human life. The article concludes by suggesting that while it is a good thing that New York City’s policies provoke debate about the legitimacy of public health interventions, it is the infrastructural conditions, and not the superstructural activities, that are the regulatory priority. (shrink)

Around the world the wealthy can get their lives extended while the poorget little basic medical help. Over the same years that the field ofbioethics has prospered and expanded, this disparity has increased.Reasons for the failure of bioethics to successfully address thishealth/wealth issue include its identification with the cognitiveand social authority of medicine; its gatekeeping behavior;its funding sources; its questionable use of ``principlism'' andits emphasis on crises and dilemmas to the neglect of ``housekeeping''issues. The work of most women in (...) bioethics rarely addresses thehealth/wealth issue; if it does, their work may be ignored, aswere the recommendations of Canadian feminists working under governmentgrants. To achieve equity in health care, the structure of both medicineand bioethics needs to be changed. Yet, since bioethicists generallyhave accepted the status quo, this seems unlikely to happen. (shrink)

Ethical beliefs may vary across cultures but there are things that must be valued as preconditions to any cultural practice. Physical and mental abilities vital to believing, valuing and practising a culture are such preconditions and it is always important to protect them. If one is to practise a distinct culture, she must at least have these basic abilities. Access to basic healthcare is one way to ensure that vital abilities are protected. John Rawls argued that access to (...) all-purpose primary goods must be ensured. Amartya Sen and Martha Nussbaum claim that universal capabilities are what resources are meant to enable. Len Doyal and Ian Gough identify physical health and autonomy as basic needs of every person in every culture. When we disagree on what to prioritize, when resources to satisfy competing demands are scarce, our common needs can provide a point of normative convergence. Need-based rationing, however, has been criticized for being too indeterminate to give guidance for deciding which healthcare services to prioritize and for tending to create a bottomless-pit problem. But there is a difference between needing something (first-order need) and needing to have the ability to need (second-order need). Even if we disagree about which first-order need to prioritize, we must accept the importance of satisfying our second-order need to have the ability to value things. We all have a second-order need for basic healthcare as a means to protect our vital abilities even if we differ in what our cultures consider to be particular first-order needs. (shrink)

Citizens in wealthy liberal democracies are typically expected to see to basic needs like food, clothing, and shelter out of their own income, and those without the means to do so usually receive assistance in the form of cash transfers. Things are different with health care. Most liberal societies provide their citizens with health care or health care insurance in kind, either directly from the state or through private insurance companies that are regulated like public (...) utilities. Except perhaps for small co-pays or deductibles, citizens are not expected to see to their health needs out-of-pocket, at least for some basic level of care. Instead, when a citizen gets sick, the state or her insurance company foots the... (shrink)

One of the ways to address the effects of skilled worker emigration is to restrict the movement of skilled workers. However, even if skilled workers have responsibilities to assist their compatriots, what if other parties, such as affluent countries or source country governments, do not fulfil their fair share of responsibilities? This discussion raises an interesting problem about how to think of individual responsibilities under partial compliance where other agents (including affluent countries, developing states, or other individuals) do not fulfil (...) their fair share of responsibilities. What is fair to expect from them? Taking health worker emigration as a case in point, I discuss whether the individual health workers’ fair share of responsibilities to address basic health care needs decreases or increases when the other parties do not fulfil their share. First, I review the responsibilities that different stakeholders may hold. Second, I argue that there are strong reasons against increasing or decreasing health workers’ fair share of responsibilities in a situation of partial compliance. I also argue that it is unfair for non-complier states to enforce health workers to fulfil their fair share or take up the slack. (shrink)

This paper focuses on an emergency basic income as a tool for avoiding financial insecurity during the time of pandemic. The authors argue that paying each resident a monthly cash amount for the duration of the crisis would serve to protect them from the economic fallout.They suggest three reasons why the EBI proposal is particularly well-suited to play an important role in a comprehensive public health response to COVID-19: it offers an immediate and agile response; it prioritizes the (...) most vulnerable in the affected population; and it promotes a solidaristic response to the pandemic crisis. To go beyond the need to shut down and restart an EBI assistance scheme each time a pandemic hits, the authors propose considering turning the program into a permanent feature. (shrink)

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in (...) order to ensure that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework. (shrink)

A socialist health service cannot be a socialist island in a sea of capitalism, as the record of the British National Health Service shows. Nonetheless, since health is a basic need, it can be a key component of the advocacy of socialism. I propose two central socialist principles. On the basis of these I suggest that a socialist health system would emphasise care rather than service; insist on democratic structures and control of resources; and require (...) the prohibition of private medicine. (shrink)

The pursuit of health is one of the most basic and prevalent concerns of humanity. In order to better attain and preserve health, a fundamental and unified description of the concept is required. Using Paul Tillich's ontological framework, I introduce a complete characterization of health and disease is that is useful to the philosophy of medicine and for health-care workers. Health cannot be understood merely as proper functioning of the physical body or of the (...) separated levels of body, mind, and soul. Rather, the multidimensional unity that is the essence of human life requires a new understanding of health as balanced self-integration within the multiple human dimensions. The ontological description of health and disease has concrete implications for how health-care workers should approach healing. It calls for a multidimensional approach to healing in which particular healing is needed and helpful if it considers the other realms of the human. It reveals the importance of accepting limited health as well as the value of faith understood as an ultimate concern because of its ability to wholly integrate the person. (shrink)

Patients and their physicians frequently make important health care decisions with incomplete information. Memory fails; records are incomplete; the onset of significant events is confused with other life stories; and even the most basic information about medications, laboratory tests, allergies, and problems is often the result of guesswork. As providers and as patients, we suffer because information vital to health care is not available when and where it is needed. Data required for care are dispersed across various (...) settings and represented in a range of formats; incentives to bring these data together do not exist.In recent years, four specific approaches have emerged to address patient-centered information access. The first model attempts to consolidate all care into a single care delivery and financing system. This model — prevalent in many European countries — is to some degree extant at Kaiser-Permanente and other integrated care and financing systems. This model is ideal if and when one organization is responsible for all care delivery and financing. Such models present “one-stop shopping” for managing health information, coordinating care, communicating with providers and support groups, and ensuring both payment and accountability. (shrink)

Article 25 of the Universal Declaration of Human Rights reads as follows: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.” I shall refer to the right postulated here as “the right to an adequate standard of living” or “The Right.”.

The international disparities in health and health-care provision comprise the gravest problem of medical ethics. The implications are explored of three theories of justice: an expanded version of Rawlsian contractarianism, Nozick's historical account, and a consequentialism which prioritizes the satisfaction of basic needs. The second too little satisfies medical needs to be cogent. The third is found to incorporate the strengths of the others, and to uphold fair rules and practices. Like the first, it also (...) involves obligations transcending those to an agent's relations and fellow-citizens. These conclusions are applied to international health-care provision, which they would transform. (shrink)

Motivation has been the subject of much research in the sport psychology literature, whereas athlete mental health has received limited attention. Motivational complexities in elite sport are somewhat reflected in the mental health literature, where there is evidence for both protective and risk factors for athletes. Notably, few studies have linked motivation to mental health. Therefore, the key objective of this study was to test four mental health outcomes in the motivational sequence posited by the Hierarchical (...) Model of Intrinsic and Extrinsic Motivation: motivational climate  basic psychological needs  motivation  mental health outcomes. Elite team-sport athletes (140 females, 75 males) completed seven psychometric inventories of motivation-related and mental health variables. Overall, the athletes reported positive motivational patterns, with autonomous motivation and task climate being more prevalent than their less adaptive counterparts. Elevated depressive symptoms and poor sleep quality affected nearly half of the cohort. Structural equation modelling supported pathways between motivational climate, basic needs, motivation, and mood, depressive symptoms, sleep quality, and trait anxiety. Specifically, a task climate was positively associated with the three basic psychological needs, and an ego climate was positively associated with competence. Autonomy and relatedness had positive and negative associations with autonomous and controlled forms of motivation, respectively. Controlled motivation regulations were positively associated with the four mental health outcomes. Integrated regulation had a negative association with anxiety, and intrinsic regulation had a positive association with depressive symptoms. These findings highlight the complexities of and interrelations between motivation and mental health among athletes, and support the importance of considering mental health as an outcome of motivation. (shrink)

This article will examine the Catholic concept of global justice within a health care framework as it relates to women's needs for delivery doctors in the developing world and women's demands for assisted reproduction in the developed world. I will first discuss justice as a theory, situating it within Catholic social teachings. The Catholic perspective on global justice in health care demands that everyone have access to basic needs before elective treatments are offered to the (...) wealthy. After exploring specific discrepancies in global health care justice, I will point to the need for delivery doctors in the developing world to provide basic assistance to women who hazard many pregnancies as a priority before offering assisted reproduction to women in the developed world. The wide disparities between maternal health in the developing world and elective fertility treatments in the developed world are clearly unjust within Catholic social teachings. I conclude this article by offering policy suggestions for moving closer to health care justice via doctor distribution. (shrink)

An orthodoxy has arisen which claims that there is a crisis in the United States health care system such that the system needs to be reformed. This essay challenges that orthodoxy by showing that we do not have a health care system in the United States. We have a non-system of health care, just as we do for virtually all basic social institutions. Challenging the current orthodoxy surfaces two ethical issues that have been ignored: creating (...) a health care system will (a) cause resurgent paternalism and (b) pose a threat to moral pluralism. Keywords: Health care policy, managed care, paternalism, moral pluralism, institutional integrity, total quality management, continuous quality improvement CiteULike Connotea Del.icio.us What's this? (shrink)