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      Social distancing, social justice, and risk during the COVID-19 pandemic


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          Social distancing is an important and necessary measure to help arrest the spread of SARS-CoV-2 during the COVID-19 pandemic. However, it does place persons who are socially or politically marginalized, including those who are of lower socio-economic status, at risk of further harms. In other words, marginalized or disadvantaged persons are at risk of both contracting SARS-CoV-2 and the risk of harms that may come about because of the social distancing measures themselves. Finally, a third layer of risk faced by marginalized persons would be the overuse of utility (i.e., maximize the benefit of resource x) as the primary ethics principle upon which to make allocation decisions, since oftentimes it is resource-intensive to help those in positions of social marginality. This three-fold risk of harm to which marginalized persons are subjected runs counter to the very notion of social justice that underpins public health. Social distancing in a socially just manner requires dialoguing with affected populations and providing social supports to marginalized persons, regardless of the associated costs.


          La distanciation sociale est importante et nécessaire pour endiguer la propagation du SRAS-Cov-2 durant la pandémie de COVID-19. Elle expose toutefois les personnes socialement ou politiquement marginalisées, dont les personnes de faible statut socioéconomique, à des préjudices supplémentaires. Autrement dit, les personnes marginalisées ou défavorisées sont vulnérables au SRAS-Cov-2 et aux préjudices qui peuvent se manifester en raison des mesures de distanciation sociale. Enfin, les personnes marginalisées sont exposées à un troisième niveau de risque : la surutilisation du principe d’utilité (c.-à-d. maximiser les avantages de la ressource x) dans la prise des décisions d’allocation des ressources, car il faut souvent beaucoup de ressources pour aider les personnes en marge de la société. Ce triple risque de préjudice auquel sont exposées les personnes marginalisées va à l’encontre de la notion même de justice sociale, qui est la pierre d’assise de la santé publique. Pour être socialement juste, la distanciation sociale nécessite un dialogue avec les populations touchées et l’offre de soutiens sociaux aux personnes marginalisées, indépendamment des coûts associés.

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          What does social justice require for the public's health? Public health ethics and policy imperatives.

          Justice is so central to the mission of public health that it has been described as the field's core value. This account of justice stresses the fair disbursement of common advantages and the sharing of common burdens. It captures the twin moral impulses that animate public health: to advance human well-being by improving health and to do so particularly by focusing on the needs of the most disadvantaged. This Commentary explores how social justice sheds light on major ongoing controversies in the field, and it provides examples of the kinds of policies that public health agencies, guided by a robust conception of justice, would adopt.
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            Disadvantaging the disadvantaged: When public health policies and practices negatively affect marginalized populations.

            Public health is intimately related to social justice, which is why practice and research in the field seek to improve the social determinants of health. Despite the best intentions of those working in public health, however, some policies and practices inadvertently further disadvantage pre-existing marginalized populations. In this paper, we provide a diagnosis of possible reasons why this phenomenon might occur. We posit that the challenges associated with further marginalizing certain populations stem from a) not acknowledging the normative aspects of apparently objective data, b) a misunderstanding and an uncritical alignment of public health goals with the ethics theory of utilitarianism, and c) assuming that those working in public health might be able to fully understand the experiences of marginalized populations. It is our view that the trend of public consultation with marginalized persons, the explicit teaching of ethics and philosophy of science in graduate departments of public health, and the increased use of health equity impact assessments might help protect against public health policies and practices that disadvantage marginalized populations.
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              Disaster preparedness and triage: justice and the common good.

              "Triage" is a term generally referring to the social practice of sorting or categorizing. While it originally had an innocent, commercial meaning referring to sorting crops according to quality, the term quickly took on a more ominous meaning referring to classifying battlefield casualties into three groups: those too well-off to be treated and then, among those more seriously wounded, one group that will get medical attention and another that will not. The moral problem is how to distinguish between the latter two groups. The Hippocratic oath has been utterly useless in helping us do this sorting, since the oath commands the clinician to remain loyal to the individual patient and give no attention to the choice between two patients with different needs. Baker and Strosberg show that historically the British sorted following utilitarian principles, giving priority to the patients who could benefit the most even if they were not in greatest need, while the French arranged patients who could be helped in order of greatest need even if it was not maximally efficient to do so. Understanding how contemporary organ transplant policy utilizes triage can help us clarify our mass disaster triage policy. Two organ transplant examples--tissue typing for kidneys and geographical priority for allocating livers--show that American social policy, when forced to choose between allocating on the basis of efficiency or allocating on the basis of justice, will consider both principles, but give equal or dominant priority to justice--even though this priority is understood to be relatively inefficient. Since health care professionals have a recognized preference for efficiency over justice and lay people are inclined towards justice, leaving mass disaster triage policy in the hands of health professionals will predictably structure the policy in a way that conflicts with the moral priorities of the lay population. Formal public debate that recognizes the conflict between efficiency and equity--professional and lay priorities--is therefore essential.

                Author and article information

                Can J Public Health
                Can J Public Health
                Canadian Journal of Public Health = Revue Canadienne de Santé Publique
                Springer International Publishing (Cham )
                8 July 2020
                : 1-3
                [1 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, Sydney Health Ethics, Sydney School of Public Health, , University of Sydney, ; Building 1, Level 1, Medical Foundations Building, 92/94 Parramatta Rd, Camperdown, NSW 2050 Australia
                [2 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, Marie Bashir Institute for Infectious Diseases and Biosecurity, , University of Sydney, ; Camperdown, Australia
                [3 ]GRID grid.39381.30, ISNI 0000 0004 1936 8884, School of Health Studies, Faculty of Health Sciences, , Western University, ; Room 222, Labatt Health Sciences Building, London, Ontario N6A 5B9 Canada
                © The Canadian Public Health Association 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                Special Section on COVID-19: Commentary

                ethics,bioethics,infectious diseases,coronavirus,health policy,éthique,bioéthique,maladies infectieuses,politique de santé


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