The Place of Solidarity in Public Health Ethics

Abstract

When we consider the literature that has been produced exploring approaches to public health ethics, it is rare to fi nd any mention of solidarity. One obvious conclusion is that solidarity is a meaningless or superfl uous consideration. We suggest that this is not the right conclusion to draw, and that we must fi rst understand what solidarity is and then consider what difference it might make to thinking about issues in public health ethics. In this paper we, fi rst, outline some of the existing approaches to public health ethics and suggest that they often involve a set of questionable assumptions about the nature of social relations as well as a clear commitment to particular values. A failure of imagination in relation to solidarity is not, however, an argument against taking the concept seriously. Second, we propose a particular account of solidarity, suggest reasons why it is important for thinking about ethical issues in public health, and suggest how it relates to other relevant values. We argue that it is essential to engage with the issue of where we ought to place solidarity within our debates and frameworks for public health ethics.

How do ‘Public’ Values Influence Individual Health Behaviour? An Empirical-Normative Analysis of Young Men’s Discourse Regarding HIV Testing Practices: Table 1.

“…These data also reveal how individual and collective agentic practices relate to recent conceptualization(s) of the normative concept of solidarity (Dawson and Jennings, 2012). As Dawson and Jennings (2012) describe, individuals acting on the basis of solidarity do so not for individual benefit (necessarily), but rather for moral concerns for Others.…”

“…Thus, within this subset of discourses, influences of social capital on participants' HIV testing practices were discursively emphasized by the role of social relations and mutual benefits (i.e., to both individuals and collectives). This discourse does not feature the various qualities of relational solidarity (seen in other discourses) in which reciprocal or symmetric power relations are potentially unimportant and not necessarily required (Dawson and Jennings, 2012;Prainsack and Buyx, 2011).…”

“…As yet, it remains somewhat unclear as to 'where' relational concepts or values should be situated (e.g., within: policy, the individual, the community or all of these) (cf., Buyx, 2011, 2012;Dawson and Jennings, 2012;Dawson and Verweij, 2012;Krishnamurthy, 2013). Similarly, the extent to which relational and public values empirically influence the 'autonomous' decisions or health practices of individuals and populations (e.g., young men) also remains largely unexplored-particularly within the realm of infectious diseases.…”

“…Alternatively, emerging theoretical work has argued that public health interventions, including HIV testing initiatives, ought to be subject to normative inquiry that considers 'public' values. This emerging body of literature reflects on how relational concepts (e.g., solidarity, reciprocity, health equity) also represent important considerations within public health (e.g., Baylis et al, 2008;Dawson, 2010;Prainsack and Buyx, 2011;Dawson and Jennings, 2012;Dawson and Verweij, 2012).…”

“…Nonetheless, while this growing body of literature has provided much theoretical guidance on how these concepts should inform the practice of public health, including policy and decision-making processes, the extent to which relational normative considerations may (or ought to) inform and shape the health-related practices of the 'public' remains less clear (Dawson and Jennings, 2012).…”