Samia A. Hurst - Böcker

The Global Burden of Disease Study (GBD) is one of the largest-scale research collaborations in global health, distilling a wide range of health information to provide estimates and projections for more than 350 diseases, injuries, and risk factors in 195 countries. Its results are a critical tool informing researchers, policy-makers, and others working to promote health around the globe. A study like the GBD is, of course, extremely complex from an empirical perspective. But it also raises a large number of complex ethical and philosophical questions that have been explored in a series of collaborations over the past twenty years among epidemiologists, philosophers, economists, and policy scholars. The essays in this volume address issues of current and urgent concern to the GBD and other epidemiological studies, including rival understandings of causation, the aggregation of complex health data, temporal discounting, age-weighting, and the valuation of health states. The volume concludes with a set of chapters discussing how epidemiological data should and should not be used. Better appreciating the philosophical dimensions of a study like the GBD can make possible a more sophisticated interpretation of its results, and it can improve epidemiological studies in the future, so that they are better suited to produce results that can help us to improve global health.

Health systems need to set priorities fairly. In one way or another, part of this important task will fall to physicians. How do they make judgments about resource stewardship, and how should they do so? How can they make such decisions in a manner that is compatible with their clinical duties to patients? In this book, philosophers, bioethicists, physicians, lawyers and health policy experts make the case that priority setting and rationing contribute significantly to the possibility of affordable and fair healthcare and that clinicians play an indispensable role in that process. The book depicts the results of a survey of European physicians about their experiences with rationing and other cost containment strategies, and their perception of scarcity and fairness in their health care systems. Responding to and complementing these findings, commentators discuss why resource allocation and bedside rationing is necessary and justifiable. The book explores how bedside rationing relates to clinical judgments about medical necessity and medical indications, marginal benefits, weak evidence based medicine, off-label use. The book highlights how comparative studies of health care systems can advance more effective and fair bedside rationing through learning from one another. From a practical standpoint, the book offers a number of strategies for health care systems and clinicians to work in tandem to allocate and ration resources as fairly as possible: how to foster more attention to fairness when rationing at the bedside, how to avoid exacerbating health disparities when allocating resources, how to teach about bedside rationing to students, how to discuss rationing more explicitly in the public arena and in the doctor's office.

Of every thousand children born in Iceland, two will die before their first birthday, but in Mozambique the death rate is sixty times higher. Even within countries - including some of the wealthiest - inequalities in longevity and health can be substantial. In recent years, epidemiologists have documented the extent of these inequalities both between and within countries, stimulating in turn research both on their sources and on possible means for their alleviation. These extensive and influential efforts in research and in policy development have raised health inequalities to a prominent position among the central concerns of both national and global health. Less attention has been given to careful analysis and refinement of some key concepts and values that guide and motivate these studies of health inequalities. The essays in this book demonstrate the need to identify and debate alternative positions on the choice of measures of health inequality; the definitions of 'inequality' and 'inequity' in health, and their interrelationship; the ethical basis for attaching priority to narrowing gaps in longevity and health among individuals, groups, and societies; and the possible solutions to a series of puzzles involving uncertainty and variable population size.The authors of these essays are philosophers, economists, epidemiologists, and physicians contributing to our understanding of ethical issues in population health. Their contributions will be of interest to anyone interested in inequalities in health, including specialists in health policy, public health, epidemiology, moral philosophy, demography, and health economics.