Justice and Public Health

The principle of "justice" has been examined in subfields of bioethics and has recently gained broader consideration (Daniels, Kennedy, & Kawachi, 1999). Within the rubric of justice and equity, the issue of socio-demographic disparities in health and access to health care warrants substantial examination. Although public health specialists and epidemiologists are already at the forefront of such investigations, anthropologists could take a stronger role by exploring how cultural competency and social structural factors contribute to disparities both nationally and internationally (e.g., Levin & Schiller, 1998). Specifically, some have argued for extending bioethics attention beyond biomedical matters within Western borders to the global arena (Brodwin, 2001; Das, 1999; Farmer, 1999). For instance, attention to the impact of globalization on policy-making requires that we consider public health issues of managing epidemics and disease given the increased international movement of people, including refugees, immigrants, and travelers (Das, 1999). Some anthropologists and bioethicists are beginning to create a code of ethics for public health (Callahan & Jennings, 2002; Kass, 2001; Levin & Fleischman, 2002). Similarly, international bioethics requires that we consider ethical pluralism, and recognize how local contexts shape the construction of ethical dilemmas; for instance, low-income countries raise moral issues of dealing with scarcity and equity rather than individualism (Brodwin, 2001).

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