In recent years, scholars have begun to lay the groundwork to justify a distinct application of ethics to the field of public health. They have highlighted important features that differentiate public health ethics from bioethics, especially public health’s emphasis on population health rather than issues of individual health. Articulations of public health ethics also tend to emphasize the role of social justice compared to the predominance of autonomy in the bioethical literature. Now that the field of public health ethics is (...) developing a unique focus and a language of its own, including a code of ethics disseminated by the American Public Health Association, the future of public health ethics may well be global health ethics, focusing on issues of global justice. As public health ethics evolves from its nascent stage of reflection to a place of action and application in the national and global arenas, two interrelated developments will need to occur: public health professionals, including practitioners, policymakers, and scholars, will need a richer understanding of the ethical challenges practitioners face on a daily basis and scholars will need to develop useful tools that practitioners may employ for identifying and tackling these ethical challenges. (shrink)

The Employee Retirement Income Security Act is a federal law regulating the administration of private employer-sponsored benefits including health benefits . In general, since the federal government has exercised its authority to preempt state regulation of the administration of private employer-sponsored health plans, states are blocked from enforcing laws interfering with ERISA. As many states pursue health care reform experiments, ERISA preemption becomes relevant as a potential limit on the scope and type of reforms states are able to enact. The (...) dominant trend in ERISA litigation has been to preempt state legislation and litigation interfering with the administration of private employer-sponsored health plans, making large-scale state health care reform initiatives difficult. The purpose of this paper is to examine the trajectory of judicial interpretation of ERISA and to discuss what opportunities exist to facilitate health care initiatives given the constraints of ERISA preemption. (shrink)

Public health is concerned with how to improve the population’s health. At times, though, actions to improve the community’s health may collide with individual civil rights. For example, a public health response to a bioterrorism attack, such as smallpox, may require relaxing an individual’s due process protections to prevent the smallpox from spreading. This tension lies at the heart of public health policy. It also must be considered in discussing the concept of human rights in health.Proponents of incorporating the concept (...) of human rights in health emphasize the importance of both individual rights and collective rights. They argue that observing human rights is not only consistent with broad public health goals, but necessary to their attainment. To many human rights advocates, the concept is not limited to protecting against governmental intrusion. Accordingly, they emphasize the government’s obligation to promote attainment of human rights by, for instance, providing adequate health care. (shrink)

Many observers have argued that the US health care system could be more efficient, and achieve better outcomes if providers focused more on improving the community's health, not just the welfare of individual patients. The passage of the Affordable Care Act in 2010 seemed to herald the promise of such reforms, and greater integration of the health care and public systems. In this article, we reassess the quest for integration, a quest we call the “integration project.” After examining the modest (...) steps taken so far toward integration, we consider some conceptual barriers to integration as well as some of the risks it might portend for the public health system. Our assessment contributes to wide-ranging debates among public health advocates, practitioners, and policymakers as to the health care system's role in protecting public health, and how the public health system can best be organized to meet expected population health challenges. (shrink)

An ongoing debate among legal scholars and public health advocates is the role of litigation in shaping public policy. For the most part, the debate has been waged at a conceptual level, with opponents and proponents arguing within fairly well-defined boundaries. The debate has been based either on speculation of what litigation could achieve or on ideological grounds as to why litigation should or should not be used this way. With the exception of Rosenberg's study of how litigation shaped policy (...) in civil rights, abortion, and environmental matters, there is almost no empirical support for either position.In recent years, the most ardent proponents of litigation as public policy have been public health advocates. Perhaps out of frustration with the inability to achieve desired public health goals through the legislative branch of government, public health advocates have pursued litigation as an alternative strategy. Beginning with tobacco class action litigation in the early 1990s and continuing with litigation against gun manufacturers at the end of that decade, public health advocates have waged a veritable litigation assault aimed at changing how public health policy is formed. (shrink)

The second of five commentaries on “Bloomberg's Health Legacy: Urban Innovator or Meddling Nanny?” from the September‐October 2013.

The transformation of health-care delivery from fee-for-service medicine to managed care represents a fundamental philosophical shift away from the prevailing medical ethos that the needs of the individual patient take precedence over competing social values, such as reducing health-care costs. In managed care, financial incentives to reduce health-care utilization may result in denying an individual’s claim for medical services.Litigation challenging managed care’s resource allocation decisions often presents the need to resolve conflicting social policy goals, such as the tension between an (...) individual patient’s access to health care and a managed care organization’s need to restrain costs. Conflicts may arise when a patient’s desire for unconstrained health care clashes with a provider’s and an insurer’s cost containment strategies. In turn, cost containment strategies may raise questions about restrictions on physician autonomy and conflicts among stakeholders for control over resource allocation decisions. (shrink)

In 2004, the journal Health Matrix published a very interesting symposium volume titled “The Field of Health Law: Its Past and Future. As the title implies, the various commentators took both a retrospective and a prospective look at past trends and future prospects in health law. Some, including Clark Havighurst, Skip Rosoff and Walter Wadlington, wrote thoughtful essays on the development of health law over time and the implications of those trends. Others, including Rob Schwartz, Jim Blumstein, Rand Rosenblatt, and (...) Mark Hall and Carl Schneider, wrote equally thoughtful essays that reflected on the past but focused more on future directions and prospects. And one, Kep Wing, wrote a semi-dyspeptic essay debunking the entire field of health law.Taken together, these essays present a comprehensive view of how health law has developed so far and where its future might lie. Four themes emerge from the collected writings. First, there is considerable agreement on how and why health law has developed, but little agreement on where it is headed. (shrink)

In 2008, Representative John Read of Mississippi recently co-sponsored state legislation that would ban restaurants from serving obese customers. He later admitted that the bill was a publicity stunt,meant to “shed a little light on the number one problem in Mississippi.” Although controversial, Read’s bill exemplifies both the current perception of obesity as a national public health problem and the general sentiment underlying the types of interventions that are being considered to address this issue. The proposed legislation also demonstrates how (...) policymakers can use or, in this case misuse, information about obesity to generate significant discussion on an issue along with ill-conceived legal interventions.Information sharing and the methods used to share best practices are components of the fourth core element of public health legal preparedness. (shrink)

Each of us has written about the importance of reframing the debate over public health paternalism. Our individual explorations of the many and varied paths forward from libertarian “nanny state” objections to the “new public health” have been intimately informed by collaboration. This article represents a summary of our current thinking — reflecting the ground gained through many fruitful exchanges and charting future collaborative efforts.Our starting point is that law is a vitally important determinant of population health, and the interplay (...) among law, social norms, cultural beliefs, health behaviors, and healthy living conditions is complex. Anti-paternalists’ efforts to limit the scope of public health law to controlling only the proximal determinants of infectious diseases are utterly unjustifiable in the face of so much preventable death, disability, and disparity. Equally important, the anti-paternalism push is deeply counter-majoritarian and undemocratic, threatening to disable communities from undertaking measures to improve their own well-being. (shrink)

The Flint water crisis demonstrates the importance of adequate legal preparedness in dealing with complicated legal arrangements and multiple statutory responsibilities. It also demonstrates the need for alternative accountability measures when public officials fail to protect the public's health and explores mechanisms for restoring community trust in governmental public health.

This article introduces and defines the Health in All Policies concept and examines existing state legislation, with a focus on California. The article starts with an overview of HiAP and then analyzes the status of HiAP legislation, specifically addressing variations across states. Finally, the article describes California's HiAP approach and discusses how communities can apply a HiAP framework not only to improve health outcomes and advance health equity, but also to counteract existing laws and policies that contribute to health inequities.

The Michigan Department of Community Health stores almost 4 million dried blood spot specimens in the Michigan Neonatal Biobank. DBS are collected from newborns under a mandatory public health program to screen for serious conditions. At 24 to 36 hours of age, a few drops of blood are taken from the baby’s heel and placed on a filter paper card. The card is sent to the state public health laboratory for testing. After testing, MDCH retains the spots indefinitely for the (...) personal use of the patient and also, pursuant to a 2000 law, for possible research. (shrink)

Heath care and public health are typically conceptualized as separate, albeit overlapping, systems. Health care’s goal is the improvement of individual patient outcomes through the provision of medical services. In contrast, public health is devoted to improving health outcomes in the population as a whole through health promotion and disease prevention. Health care services receive the bulk of funding and political support, while public health is chronically starved of resources. In order to reduce morbidity and mortality, policymakers must shift their (...) attention to public health services and to the improved integration of health care and public health. In other words, health care and public health should be treated as two parts of a single integrated health system. Furthermore, in order to maximize improvements in health status, policymakers must consider the impact of all governmental policies on health. (shrink)

Law is an essential tool for public health practice, and the use of a systematic legal framework can assist with preventing chronic diseases and addressing the growing epidemic of obesity.The action options available to government at the federal, state, local, and tribal levels and its partners can help make the population healthier by preventing obesity and decreasing the growing burden of associated chronic diseases such as cardiovascular disease and Type 2 diabetes. The Centers for Disease Control and Prevention uses the (...) four-part systematic legal framework commonly referred to as “public health legal preparedness” to demonstrate the essential role law can play for any public health issue. This paper uses the “laws and legal authorities” component of the framework and should be considered in combination with the competencies, coordination, and information-best practices components of the framework. (shrink)

This paper is the companion to “Assessment of Information on Public Health Law Best Practices for Obesity Prevention and Control,” and the fourth of four action papers produced as part of the National Summit on Legal Preparedness for Obesity Prevention and Control, convened June 2008 by the Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation, and the American Society for Law, Medicine Ethics. The four action papers present options to address gaps in the four core elements of (...) public health legal preparedness as outlined in the relevant companion papers. The four core elements are: laws and legal authorities; legal competencies for public health professionals to apply those laws and authorities; coordination of law-based efforts across jurisdictions and sectors, and information on public health law best practices. (shrink)

Most philosophers of emotion endorse a compound account of the emotions: emotions are wholes made of parts; or, as I prefer to put it, emotions are mental states that supervene on other (mental) states. The goal of this paper is to ascertain how the intentionality of these subvening members relates to the intentionality of the emotions. Towards this end, I proceed as follows. First, I discuss the problems with the account Justin D'Arms and Daniel Jacobson offer of the intentionality (...) of the emotions; I argue their account is fundamentally misguided by virtue of being motivated by a misunderstanding of the nature of propositional attitudes. Second, I argue against Peter Goldie's claim that an affective component of an emotion contributes to its intentionality. Third, I offer my own compound account of emotions. I argue (1) emotions are mental states that supervene on other mental states, (2) the mental states that constitute the subvenience base of emotion can have nonconceptual and/or conceptual representational content, and (3) an emotion's intentionality supervenes on (but is often not identical to) the intentionality of only one of its subvening members, specifically, the evaluative representation. (shrink)

Public engagement in ethically laden pandemic planning decisions may be important for transparency, creating public trust, improving compliance with public health orders, and ultimately, contributing to just outcomes. We conducted focus groups with members of the public to characterize public perceptions about social distancing measures likely to be implemented during a pandemic. Participants expressed concerns about job security and economic strain on families if businesses or school closures are prolonged. They shared opposition to closure of religious organizations, citing the need (...) for shared support and worship during times of crises. Group discussions elicited evidence of community-mindedness, while some also acknowledged strong self-interest. Participants conveyed desire for opportunities for public input and education, and articulated distrust of government. Social distancing measures may be challenging to implement and sustain due to strains on family resources and lack of trust in government. (shrink)

In recent years, a number of prominent scholars have touted the use of litigation as an effective tool for making public health policy. For example, Stephen Teret and Michael Jacobs have asserted that product liability claims against car makers have played a significant role in reducing automobile-related injuries, Peter Jacobson and Kenneth Warner have argued that litigation against cigarette manufacturers has advanced the cause of tobacco control, and Phil Cook and Jens Ludwig have suggested that lawsuits against the (...) firearms industry can reduce gun violence. Critics have attacked this use of litigation as doing more harm than good to public health and as a misuse of the courts. This debate involves two distinct controversies: one over whether the public health benefits of litigation outweigh its costs and the other over the proper role of courts within our system of government. (shrink)

In recent years, a number of prominent scholars have touted the use of litigation as an effective tool for making public health policy. For example, Stephen Teret and Michael Jacobs have asserted that product liability claims against car makers have played a significant role in reducing automobile-related injuries, Peter Jacobson and Kenneth Warner have argued that litigation against cigarette manufacturers has advanced the cause of tobacco control, and Phil Cook and Jens Ludwig have suggested that lawsuits against the (...) firearms industry can reduce gun violence. Critics have attacked this use of litigation as doing more harm than good to public health and as a misuse of the courts. This debate involves two distinct controversies: one over whether the public health benefits of litigation outweigh its costs and the other over the proper role of courts within our system of government. (shrink)

Building on an illustrative case of a systemic environmental threat and its multi‐stakeholder response, this paper draws attention to the changing political impacts of corporations in the digital age. Political Corporate Social Responsibility (PCSR) theory suggests an expanded sense of politics and corporations, including impacts that may range from voluntary initiatives to overcome governance gaps, to avoiding state regulation via corporate political activity. Considering digitalization as a stimulus, we explore potential responsibilities of corporations toward public goods in contexts with functioning (...) governments. We show that digitalization—in the form of transparency, surveillance, and data‐sharing—offers corporations’ scope for deliberative public participation. The starry sky beetle infestation endangering public and private goods is thereby used to illustrate the possibility of expanding the political role of corporations in the digital sphere. We offer a contribution by conceptualizing data‐deliberation as a Habermasian variation of PCSR, defined as the (a) voluntary disclosure of corporate data and its transparent, open sharing with the public sector (b) along with the cooperation with governmental institutions on data analytics methods for examining large‐scale datasets (c) thereby complying with existing national and international regulations on data protection, in particular with respect to privacy and personal data. (shrink)

This book examines the origins and subsequent evolution of multicellularity. The transition from unicellular to multicellular life was one of a few major events in the history of life that created new opportunities for more complex biological systems to evolve.

Motile bacteria respond to environmental cues to move to more favorable locations. The components of the chemotaxis signal transduction systems that mediate these responses are highly conserved among prokaryotes including both eubacterial and archael species. The best‐studied system is that found in Escherichia coli. Attractant and repellant chemicals are sensed through their interactions with transmembrane chemoreceptor proteins that are localized in multimeric assemblies at one or both cell poles together with a histidine protein kinase, CheA, an SH3‐like adaptor protein, CheW, (...) and a phosphoprotein phosphatase, CheZ. These multimeric protein assemblies act to control the level of phosphorylation of a response regulator, CheY, which dictates flagellar motion. Bacterial chemotaxis is one of the most‐understood signal transduction systems, and many biochemical and structural details of this system have been elucidated. This is an exciting field of study because the depth of knowledge now allows the detailed molecular mechanisms of transmembrane signaling and signal processing to be investigated. BioEssays 28:9–22, 2006. © 2005 Wiley Periodicals, Inc. (shrink)

We present here an approach to the fine structure of L based solely on elementary model theoretic ideas, and illustrate its use in a proof of Global Square in L. We thereby avoid the Lévy hierarchy of formulas and the subtleties of master codes and projecta, introduced by Jensen [3] in the original form of the theory. Our theory could appropriately be called ”Hyperfine Structure Theory”, as we make use of a hierarchy of structures and hull operations which refines the (...) traditional Lα -or Jα-sequences with their Σn-hull operations.§1. Introduction. In 1938, K. Gödel defined the model L of set theory to show the relative consistency of Cantor's Continuum Hypothesis. L is defined as a unionof initial segments which satisfy: L0 = ∅, Lλ = ∪α<λLα for limit ordinals λ, and, crucially, Lα + 1 = the collection of 1st order definable subsets of Lα. Since every transitive model of set theory must be closed under 1st order definability, L turns out to be the smallest inner model of set theory. Thus it occupies the central place in the set theoretic spectrum of models.The proof of the continuum hypothesis in L is based on the very uniform hierarchical definition of the L-hierarchy. The Condensation Lemma states that if π : M → Lα is an elementary embedding, M transitive, then some ; the lemma can be proved by induction on α. If a real, i.e., a subset of ω, is definable over some Lα,then by a Löwenheim-Skolem argument it is definable over some countable M as above, and hence over some, < ω1. This allows one to list the reals in L in length ω1 and therefore proves the Continuum Hypothesis in L. (shrink)

Recent developments in global business gave rise to innovative forms of digital-exchange, facilitated by a new big data-based infrastructure – the sharing economy platform. SEPs are rapidly expanding, challenging the political-economic order and the classical division of work in society. Against the background of the current sustainability crisis, we discuss the increasingly momentous role of SEPs as a potential driver toward a more sustainable economy and society. Drawing on the theoretical lens of political CSR theory, we first outline how SEPs (...) are applying institutional strategies to gain a competitive advantage, thereby shaping contexts in their favor and triggering an erosion of foundations of social sustainability. However, SEPs also strive for legitimacy by taking over novel social responsibilities via profound digital capacities. Thus SEPs carry the potential to contribute to a more sustainable future economy. Our chapter considers future pathways of platform CSR regimes and a democratization of SEPs building on political CSR theory. (shrink)

In this paper, we suggest some of the dimensions of the problematic concept of Alzheimer Disease as a natural disease discerned by increasingly sophisticated medical scientific progress. Taking a page from Max Weber concerning unique events, we show some of the conceptual building blocks and social processes that have coalesced into the perception of certain phenomena as abnormalities that are seen as implicated in the development of a degenerative disease distinct from the process of normal, but variable, brain aging. We (...) note some of the decisions and social forces pushing for particular conceptualizations, interpretations, and reifications of brain alterations. In so doing, we suggest that the mystery of the "there" may not be much different from, and probably is, the mystery of the "everywhere". (shrink)

Emotion can be communicated through multiple distinct modalities. However, an often-ignored channel of communication is posture. Recent research indicates that bodily posture plays an important role in the perception of emotion. However, research examining postural communication of emotion is limited by the variety of validated emotion poses and unknown cohesion of categorical and dimensional ratings. The present study addressed these limitations. Specifically, we examined individuals’ (1) categorization of emotion postures depicting 5 discrete emotions (joy, sadness, fear, anger, and disgust), (2) (...) categorization of different poses depicting the same discrete emotion, and (3) ratings of valence and arousal for each emotion pose. Findings revealed that participants successfully categorized each posture as the target emotion, including disgust. Moreover, participants accurately identified multiple distinct poses within each emotion category. In addition to the categorical responses, dimensional ratings of valence and arousal revealed interesting overlap and distinctions between and within emotion categories. These findings provide the first evidence of an identifiable posture for disgust and instantiate the principle of equifinality of emotional communication through the inclusion of distinct poses within emotion categories. Additionally, the dimensional ratings corroborated the categorical data and provide further granularity for future researchers to consider in examining how distinct emotion poses are perceived. (shrink)

COVID-19 has revealed that science needs to learn how to better deal with the irreducible uncertainty that comes with global systemic risks as well as with the social responsibility of science towards the public good. Further developing the epistemological principles of new theories and experimental practices, alternative investigative pathways and communication, and diverse voices can be an important contribution of history and philosophy of science and of science studies to ongoing transformations of the scientific enterprise.

Practical medical decisions are closely integrated with ethical and religious beliefs in the Philippines. This is shown in a survey of Filipino physicians' attitudes towards severely compromised neonates. This is also the reason why the ethical analysis of critical care practices must be situated within the context of local culture. Kagandahang loob and kusang loob are indigenous Filipino ethical concepts that provide a framework for the analysis of several critical care practices. The practice of taking-from-the-rich-to-give-to-the-poor in public hospitals is not (...) compatible with these concepts. The legislated definition of death and other aspects of the Philippine Law on Organ Transplants also fail to be compatible with these concepts. Many ethical issues that arise in a critical care setting have their roots outside the seemingly isolated clinical setting. Critical care need not apply only to individuals in a serious clinical condition. Vulnerable populations require critical attention because potent threats to their lives exist in the water that they drink and the air that they breathe. We cannot ignore these threa ts even as we move inevitably towards a technologically dependent, highly commercialized approach to health management. (shrink)

Scientific realists claim we can justifiably believe that science is getting at the truth. But they have long faced historical challenges: various episodes across history appear to demonstrate that even strongly supported scientific theories can be overturned and left behind. In response, realists have developed new positions and arguments. As a result of specific challenges from the history of science, and realist responses, we find ourselves with an ever increasing data-set bearing on the (possible) relationship between science and truth. The (...) present volume introduces new historical cases impacting the debate, and advances the discussion of cases that have only very recently been introduced. At the same time, shifts in philosophical positions affect the very kind of case study that is relevant. Thus the historical work must proceed hand in hand with philosophical analysis of the different positions and arguments in play. It is with this in mind that the volume is divided into two sections, entitled “Historical cases for the debate,” and “Contemporary scientific realism”. All sides agree that historical cases are informative with regard to how, or whether, science connects with truth. Defying proclamations as early as the 1980s announcing the death knell of the scientific realism debate, here is that rare thing: a philosophical debate making steady and definite progress. Moreover, the progress it is making concerns one of humanity’s most profound and important questions: the relationship between science and truth, or, put more boldly, the epistemic relation between humankind and the reality in which we find ourselves. (shrink)