Description
GLBH 108
Critical Response 2
Select one reading (article, chapter) assigned and develop a two pages Critical Response Paper.
The critical response, alongside some commentary, represents an analysis of another author’s writing. Your paper must contain a critical review of the readings selected. The critical response should be a space for you to react honestly to class material, relate readings to things we have discussed in class or material you have learned elsewhere, and analyze the author’s main points and positionality. The critical response is NOT a summary of the readings. It should be analytical.
Here are some questions that might help you frame your critical responses (you do not need to answer all of these questions in your response):
What is the author’s main point? What evidence does the author use to support their claim, and do you think the evidence is compelling? Why or why not?
Do you agree with the author’s argument? Why or why not? Does the argument challenge your views in any way?
Does this reading relate to anything else we have discussed in class? Does it relate to anything you have learned, read or watched outside of class? How do the concepts here build off of others, and can those concepts be extrapolated to other topics or ideas?
Structuring your essay
The introduction is used to establish your main argument (thesis statement) regarding the work analyzed.
The body is focused on your response to the article/chapter selected. The ideas stated should help to develop the main argument presented in the introduction. Remember that you should always apply critical thinking in this kind of essay and be able to back up any statement you make. You could sustain your arguments by providing evidence (examples) or supporting your perspective by referring to other authors. You need to cite at least two readings from the syllabus, even though your response mainly addresses one reading.
Your conclusion should bring all of the points you have made together in a manner that supports your writing’s main argument, as set out in the introduction.
Your references must include at least two readings from the syllabus and should follow the APA style. Make sure only to reference the sources that were cited in the paper.
Evaluation.
Introduction. 4%
Body. 16%
Conclusion. 4%
References. 1%
FORMAT.
Pages (2 – not including references)
Times New Roman 12
Double spaced
APA style for references and citations.
Unformatted Attachment Preview
Bioethical Inquiry (2015) 12:57–61
DOI 10.1007/s11673-014-9605-5
CRITICAL PERSPECTIVES
Teaching Corner: The Prospective Case Study
A Pedagogical Innovation for Teaching Global Health Ethics
Kearsley A. Stewart
Received: 3 August 2014 / Accepted: 9 September 2014 / Published online: 29 January 2015
# Journal of Bioethical Inquiry Pty Ltd. 2015
Abstract Over the past decade, global health has
emerged as one of the fastest growing academic programs in the United States. Ethics training is cited
widely as an essential feature of U.S. global health
programs, but generally it is not deeply integrated into
the global health teaching and training curricula. A
discussion about the pedagogy of teaching global health
ethics is long overdue; to date, only a few papers specifically engage with pedagogy rather than competencies or content. This paper explores the value of case
study pedagogy for a full-semester graduate course in
global health ethics at an American university. I address
some of the pedagogical challenges of teaching global
health ethics through my innovative use of case study
methodology—the Bprospective case study^ (PSC).
Keywords Global health ethics . Pedagogy . Teaching .
Prospective case study
Introduction
Over the past decade, global health has emerged as one
of the fastest growing academic programs in the United
States (Merson and Chapman 2009). At all educational
levels, from undergraduate liberal arts (Hill, Ainsworth,
K. A. Stewart (*)
Duke Global Health Institute, Duke University,
310 Trent Drive, Durham, North Carolina 27708, USA
e-mail: [email protected]
and Partap 2012) to postgraduate medical residency
(Kerry et al. 2013; Khan et al. 2013) and increasingly
in interdisciplinary classroom settings (Wipfli, Press,
and Kuhn 2013), U.S. universities continue to build,
and benefit from, their global health programming
(Merson 2014). The bulk of published literature on
teaching global health ethics focuses on establishing
competencies for overseas short-term training for medical students (Crump, Sugarman, and WEIGHT 2010),
developing online self-directed modules (DeCamp et al.
2013), and facilitating the institutional review board
(IRB) process in the context of international, collaborative research between high-income countries (HIC) and
low- and middle-income countries (LMIC) (although
Yassi et al. 2013 is an excellent example of a new
framework for global health IRBs). Ethics training is
cited widely as an essential feature of U.S. global health
programming, but generally it is not integrated deeply
into global health teaching and training curricula (Cole
et al. 2013). A discussion about the pedagogy of teaching global health ethics is long overdue; to date, only a
few papers specifically engage with pedagogy rather
than competencies or content (Hanson 2010; Dwyer
2011; Jackie et al. 2012; Cole et al. 2013). In a 2010
report, Health Professionals for a New Century:
Transforming Education to Strengthen Health Systems
in an Interdependent World, the Commission on Education of Health Professionals for the 21st century observed that the field of public health offered little consideration about why and how to teach public health
(Frenk et al. 2010). The same lament is true for global
health ethics (Stewart, Keusch, and Kleinman 2010).
58
A graduate course in global health ethics shares one
of the central objectives of most graduate courses in bioand medical ethics: Guide students to gain confidence
applying their classroom study of a range of ethical
values, principles, and theories to their future practices
confronting the complex, iterative, and uncertain ethical
challenges of improving human health. However, unlike
biomedicine, the core skills for global and public health
practitioners do not focus on the doctor–patient dyad but
rather on understanding that the health of a single patient
is enmeshed in a complex system of individual behaviors, family and community relationships, environmental surroundings, and economic limitations (Stewart
2008). Global health reaches beyond even public health
to examine the deleterious effects of structural injustices
on both individual and population health and to seek
ways to change, or at least challenge, those injustices
(see Battams and Matlin 2013 for a current and concise
summary of the ongoing debate to define global health).
In addition, graduate students in global health programs
reflect the intellectual and career diversity that is a
hallmark of the field: Some are practicing medicine,
others are returning Peace Corps volunteers, a few want
to train for a career in health policy or diplomacy. Rather
than attempt another definition of the emerging field of
global health ethics (see Stapleton et al. 2014 for a
current perspective; see also two excellent textbooks
by Benatar and Brock 2011 and Pinto and Upshur
2013), this paper will focus briefly on pedagogy specific
to teaching global health ethics. My discussion reflects
the context of a two-credit semester core course in
global health ethics, required for all students enrolled
in a two-year Master of Science in Global Health (MScGH) degree program at Duke University in preparation
for a 10-week summer research experience. I outline the
value of teaching global health ethics through case
studies and, in particular, introduce my innovation in
case study methodology—the Bprospective case study^
(PSC).
Pedagogies of Teaching and Learning Global Health
Ethics
More than the Bart,^ Bscience,^ or even Bcraft^ of teaching, pedagogy also can refer to learning: learning theories, learning styles, learning tools, etc. Cole et al.
(2013) reviewed three pedagogical approaches that
show promise for fostering good practice in global
Bioethical Inquiry (2015) 12:57–61
health: transformative education, experiential learning,
and critical pedagogy. Transformative education
(Arnold et al. 1991) begins with an initial student experience, then moves to reflection, discovery, analysis,
generalization, and future action based on the previous
experience. Experiential learning is similar to transformative education but with a stronger emphasis on reflection about self and service to a community. Finally,
Freire’s (1970) critical pedagogy emphasizes student
reflection before beginning an academic or field experience in an effort to unmask and critique the assumptions, privilege, and power dynamics that enable student
participation in such an experience. Neither transformative education nor experiential learning seem well suited
to a graduate seminar on global health ethics whose
main objective is to prepare students for summer field
research. While Freire’s message is certainly central to
teaching global health ethics, the prose can be offputting to some students. In developing my pedagogical
approach to teaching global health ethics for graduate
students, I focus instead on metacognition and fostering
student ability to confront moral ambiguity in the context of ethical decision-making.
In its 2000 landmark study, How People Learn:
Brain, Mind, Experience, and School, the National Research Council synthesized decades of research into
three key findings about learners and learning. The third
key finding addressed metacognition (National Research Council 2000, 18), defined variously as the ability to think about one’s own thinking, to conduct selfassessment through self-reflection, to discover what you
do not know while simultaneously recognizing when
you are learning and deepening your own conceptual
frameworks, or to adapt previous knowledge to new
circumstances among other definitions (see Chick
2013 for an overview of the scholarship on metacognition). The bioethicist Dwyer, after many years of teaching bioethical principles and theories of justice, no longer leads students to parse the differences between
Rawls, Singer, and Pogge. Instead, he focuses student
learning on Bresponsibility and responsiveness^ to bring
them closer to wrestling with Bthe breadth and depth of
moral concern in the realm of global health^ (Dwyer
2011, 324). Dwyer’s approach spoke directly to the
many conundrums I faced in my graduate classroom:
Students attend my global health ethics course because
they must, not because they freely choose to; most
students do not know how, or have the patience, to read
philosophy or ethical theory; and in most students’
Bioethical Inquiry (2015) 12:57–61
minds, ethics means studying medical error, egregious
breeches of clinical trial protocols, and infamous cases
such as the Tuskegee syphilis or Willowbrook hepatitis
experiments. Finally, but perhaps most distressing of all,
for the students, ethics education primarily signifies the
fear and loathing of seeking IRB approval for their
master’s projects. The challenge was evident immediately: How could I transform Dwyer’s Bresponsibility
and responsiveness^ insights into a class that engaged
some of the self-reflection central to all three of Cole
et al.’s recommended pedagogies, was rooted in a
metacognitive perspective rather than a selfimprovement approach, and emphasized global health
ethics as an emerging field students actively defined
through their innovative fieldwork? Equally important,
the course needed to feature a productive assignment
that genuinely and concretely strengthened each student’s project and advanced everyone toward IRB approval. I wanted to achieve all this without ceding one
minute of my class to standardized, didactic research
ethics and responsible conduct of research training materials. My solution was to rework the classic of medical
ethics instruction—the case study.
The Prospective Case Study Assignment
Teaching and learning with case studies is a fundamental
feature of bioethics education. It also is a standard pedagogical tool for business, management, policy, and law
programs. Case studies illustrate a specific issue and test
students’ analysis skills. They are usually based on recent
Breal-life^ examples or historical events with a focus on
what not to do, rather than what to do. Cases for teaching
also can be assembled to better illustrate a specific learning objective; the Christensen Center at the Harvard
Business School is a pioneer in the case writing method
for teaching. Currently, case study research is enjoying a
renaissance. Recent, well-received papers have debunked
some of the perceived weaknesses of case studies and
case study research. Flyvberg (2006), Bitekine (2008),
Tsang (2014), and Ketokivi and Choi (2014) all note that
case study research can generate hypotheses, test and
elaborate theories, and compensate for some of the shortcomings of general theoretical, context-independent
(deductive) knowledge. Global health pedagogy reflects
this revival of interest in case studies. Global health is
frequently taught through case studies; one of the most
popular global health textbooks in the United States is
59
organized around case studies (Skolnik 2012). Teaching
global health research ethics is often case-focused as well
(Cash et al. 2009). In addition, several alliances and
organizations have developed significant web-based collections of global health cases for teaching (see, for
example, the Center for Global Development,1 the Harvard Global Health Delivery Project,2 and Unite for
Sight3). Despite this plethora of case study resources for
teaching global health, few of these case studies engage
ethics sufficiently to satisfy an ethicist. Of those that do
raise ethical issues related to the case, it is generally
around research ethics or challenges of international collaboration. Most importantly, they are nearly all retrospective; they look backward at what went wrong, not
forward at what ethically needs to be done to make it
right. They ask: What would you have done in this
situation? I wanted to ask my students: Imagine all the
possible ethical situations you may face, what will you do
in each of these situations?
The prospective case study (PCS) assignment (a
2,000-word analysis of anticipated ethical dilemmas for
the summer master’s research projects) accounts for half
of the course grade; the other half is based on weekly
reflection papers about the assigned readings and on
discussion participation. The PCS is composed of two
distinct parts: (a) the 2,000-word written product and (b) a
20-minute NIH-style peer review panel of the PCS assignment. During the first third of the course, students
read basic background materials defining bioethics, public
health ethics, global health ethics, moral duties of researchers and participants, etc. The next third is devoted
to reading global health case studies that I choose ad hoc
to ensure that the entire class reads a case study that is
related in some way to every project in the class. For
example, in one recent cohort I needed to find case studies
that were related to: the ethics of consenting children for
HIV/AIDS research in Haiti; training rural Indian health
care providers in an experimental medical device to detect
cervical cancer; introducing a validated but novel and
resource-intensive mental health intervention in Nepal;
interviewing patients about neurosurgical outcomes in a
public hospital in east Africa; interviewing noncitizen
patients in the emergency department of a large public
hospital in Qatar; taking blood samples to study interspecies disease transmission at a bonobo sanctuary in the
1
http://www.cgdev.org/page/case-studies.
http://www.globalhealthdelivery.org/case-studies/.
3
http://www.uniteforsight.org/global-health-university/courses.
2
60
Bioethical Inquiry (2015) 12:57–61
Democratic Republic of the Congo; observing Egyptian
health care workers who simultaneously work in the
public and private sectors; and observing men who have
sex with men cruising for partners in west-central China!
During the final weeks of the course, each project is
presented and discussed by a two- or three-student panel,
in the style of an NIH peer-review panel (National Institutes of Health 2011). The panel review is the highlight of
the class: Students are amazed to discover the range of
topics and methods their peers are pursuing, plus they see
the strengths and weaknesses of their own project in a
fresh light by sitting and listening to a panel of their peers
present their PCS to the class for a discussion.
Each alternate week for two months, students submit
one section of the five total sections in the PCS, thereby
slowly developing a first draft:
Week 1 Introduction: Describe your study.
Week 3 General ethics background: Literature review of other similar cases that may apply to your
specific case and which are critical for you to know.
Week 5 Your case study: Identify potential problems and clearly discuss relevant issues. A decision
tree might be helpful in exploring all possible options and outcomes. Plus, be sure to clearly distinguish and engage both themes:
a) Your specific (potential) research ethics problems: What specific Responsible Conduct of
Research (RCR) or research ethics guidelines
are relevant? Are these issues rooted in your
research design? Methods? Sampling strategy?
Specimen collection? Intervention? Budget?
History of previous work in the area?
b) Broader, more general ethical and moral problems that you may encounter in the process of
conducting your research. What are the (1)
facts, (2) values, (3) principles, and (4) loyalties
that describe your case? Do they come into
conflict with each other?
Week 7 Judgment/action plan/conclusion: Engage
ethical theories, moral concepts, and principles to
discuss all possible solutions, then defend your
solution against obvious rebuttals and clarify your
logic in choosing it
Week 9 References; Appendix A: IRB; Appendix B
… (if necessary): Maps, abbreviations, tables,
figures, etc.
Students then submit a complete draft of their PCS to
their peer-review panel. The panel has one week to
analyze, critique, and improve the PCS. The peerreview panel works together to develop a critical but
supportive and constructive analysis of the draft. The
class presentation is about 15 minutes, plus five minutes
for audience questions and panel and author responses.
Panel members can consult directly with the author at any
time to clarify information in the draft case study. During
the panel presentation, the rest of the class is expected to
pay close attention to the presentation and to write down
a few comments and questions on paper. I instruct the
audience to focus their questions and comments on clarifying points, omitted information, and suggestions for
improvements to the case, not improvements to the presentation. All handwritten audience questions are submitted to the author at the end of the presentation.
Summary
This paper briefly describes the rationale for, and the
implementation of, the prospective case study assignment as a first step toward developing pedagogical
innovations appropriate for teaching global health ethics
at the master’s level in the United States. As developed
here, in addition to standard didactic approaches to
ethics education, the PCS introduces active learning,
group work, peer instruction, and multiple opportunities
for students to engage in self-reflection and become
aware of their own learning (metacognition). Students
leave the seminar with the sense that they not only spent
an entire course strengthening their own projects but
also did so in collaboration with their colleagues, the
professor, and a body of ethics readings that now makes
perfect sense to them and will serve as a confidencebuilding tool as they embark on their projects.
References
Arnold, R., B. Burke, C. James, D. Martin, and B. Thomas. 1991.
Educating for a change. Toronto: Between the Lines and the
Doris Marshall Institute for Education and Action.
Battams, S., and S. Matlin. 2013. Discussing a definition of global
health. Geneva: Global Health Programme at The Graduate
Institute. http://graduateinstitute.ch/files/live/sites/iheid/files/
sites/globalhealth/shared/1894/Publications/Publications%
202013/Definition_Global_Health_v3.pdf. Accessed August
2, 2014.
Bioethical Inquiry (2015) 12:57–61
Benatar, S., and G. Brock, eds. 2011. Global health and global
health ethics. Cambridge: Cambridge University Press.
Bitekine, A. 2008. Prospective case study design: Qualitative
method for deductive theory testing. Organizational
Research Methods 11(1): 160–180.
Cash, R., D. Wikler, A. Saxena, and A. Capron, eds. 2009.
Casebook on ethical issues in international health research.
Geneva: World Health Organization.
Chick, N. 2013. Metacognition: Thinking about one’s thinking.
Vanderbilt University Center for Teaching. http://cft.
vanderbilt.edu/guides-sub-pages/metacognition/. Accessed
December 6, 2014.
Cole, D.C., L. Hanson, K.D. Rouleau, K. Pottie, and N. Arya. 2013.
Teaching global health ethics. In An introduction to global
health ethics, edited by A.D. Pinto and R.E.G. Upshur, 148–
158. Hoboken, NJ: Routledge, Taylor and Francis.
Crump, J.A., J. Sugarman, and the Working Group on Ethics
Guidelines for Global Health Training (WEIGHT). 2010.
Ethics and best practice guidelines for training experiences
in global health. The American Journal of Tropical Medicine
and Hygiene 83(6): 1178–1182.
DeCamp, M., J. Rodriguez, S. Hecht, M. Barry, and J. Sugarman.
2013. An ethics curriculum for short-term global health
trainees. Globalization and Health 9: 5.
Dwyer, J. 2011. Teaching global health ethics. In Global health
and global health ethics, edited by S. Benatar and G. Brock,
319–328. Cambridge: Cambridge University Press.
Flyvberg, B. 2006. Five misunderstandings about case-study research. Qualitative Inquiry 12(2): 219–245.
Freire, P. 1970. Pedagogy of the oppressed. New York:
Continuum.
Frenk, J., L. Chen, Z.A. Bhutta, and the Commission on Education
of Health Professionals for the 21st Century. 2010. Health
professionals for a new century: Transforming education to
strengthen health systems in an interdependent world. The
Lancet 376(9756): 1923–1958.
Hanson, L. 2010. Global citizenship, global health, and the internationalization of curriculum: A study of transformative potential. Journal of Studies in International Education 14(1):
70–88.
Hill, D.R., R.M. Ainsworth, and U. Partap. 2012. Teaching global
public health in the undergraduate liberal arts: A survey of 50
colleges. The American Journal of Tropical Medicine and
Hygiene 87(1): 11–15.
Jackie, A., A. Panella, O. Morris, et al. 2012. Global health on the
move: Dissecting health interventions through a social medicine immersion course. Social Medicine 6(3): 189–197.
61
Kerry, V.B., R.P. Walensky, A.C. Tsai, et al. 2013. US medical
specialty global health training and the global burden of
disease. Journal of Global Health 3(2): 020406. doi:10.
7189/jogh.03.020406.
Ketokivi, M., and T. Choi. 2014. Renaissance of case research as a
scientific method. Journal of Operations Management 32(5):
232–240.
Khan, O.A., R. Guerrant, J. Sanders, et al. 2013. Global health
education in U.S. medical schools. BMC Medical Education
13: 3. doi:10.1186/1472-6920-13-3.
Merson, M.H., and P.K. Chapman. 2009. The dramatic expansion
of university engagement in global health: Implications for
U.S. policy. Washington, DC: Center for Strategic and
International Studies Health Policy Center.
Merson, M.H. 2014. University engagement in global health. The
New England Journal of Medicine 370(18): 1676–1678.
National Institutes of Health. 2011. NIH peer review revealed.
www.youtube.com/watch?v=fBDxI6l4dOA. Accessed
December 6, 2014.
National Research Council. 2000. How people learn: Brain, mind,
experience, and school, expanded ed. Washington, DC:
National Academies Press.
Pinto, A.D., and R.E.G. Upshur, eds. 2013. An introduction to global
health ethics. Hoboken, NJ: Routledge, Taylor and Francis.
Skolnik, R. 2012. Global health 101, 2nd ed. Burlington, MA:
Jones and Bartlett Learning.
Stapleton, G., P. Schröder-Bäck, U. Laaser, A. Meershoek, and D.
Popa. 2014. Global health ethics: An introduction to prominent theories and relevant topics. Global Health Action 7:
23569. doi:10.3402/gha.v7.23569.
Stewart, K.A. 2008. Anthropological perspectives in bioethics. In
International encyclopedia of public health, volume 1, edited
by K. Heggenhougen and S. Quah, 184–193. San Diego:
Academic Press.
Stewart, K.A., G. Keusch, and A. Kleinman. 2010. Introduction:
Values and moral experience in global health: Bridging the
local and the global. Global Public Health 5(2): 115–121.
Tsang, E.W.K. 2014. Generalizing from research findings: The
merits of case studies. International Journal of Management
Reviews 16(4): 369–383.
Wipfli, H., D.J. Press, and V. Kuhn. 2013. Global health education:
A pilot in trans-disciplinary digital instruction. Global Health
Action 6: 1–7. doi:10.3402/gha.v6i0.20747.
Yassi, A., J. Breilh, S. Dharamsi, K. Lockhart, and J.M. Spiegel.
2013. The ethics of ethics reviews in global health research:
Case studies applying a new paradigm. Journal of Academic
Ethics 11(2): 83–101.
This article was downloaded by: [Northwestern University]
On: 7 July 2010
Access details: Access Details: [subscription number 921714881]
Publisher Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 3741 Mortimer Street, London W1T 3JH, UK
Global Public Health
Publication details, including instructions for authors and subscription information:
http://www.informaworld.com/smpp/title~content=t716100712
Values and moral experience in global health: Bridging the local and the
global
K. A. Stewarta; G. T. Keuschb; A. Kleinmanc
a
Department of Anthropology and Global Health Studies Program, Northwestern University,
Evanston, IL, USA b Department of International Health and Center for Global Health and
Development, Boston University, Boston, MA, USA c Department of Anthropology and Department of
Global Health and Social Medicine, Harvard University, Cambridge, MA, USA
Online publication date: 08 March 2010
To cite this Article Stewart, K. A. , Keusch, G. T. and Kleinman, A.(2010) ‘Values and moral experience in global health:
Bridging the local and the global’, Global Public Health, 5: 2, 115 — 121
To link to this Article: DOI: 10.1080/17441690903484201
URL: http://dx.doi.org/10.1080/17441690903484201
PLEASE SCROLL DOWN FOR ARTICLE
Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf
This article may be used for research, teaching and private study purposes. Any substantial or
systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or
distribution in any form to anyone is expressly forbidden.
The publisher does not give any warranty express or implied or make any representation that the contents
will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses
should be independently verified with primary sources. The publisher shall not be liable for any loss,
actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly
or indirectly in connection with or arising out of the use of this material.
Global Public Health
Vol. 5, No. 2, March 2010, 115121
INTRODUCTION
Downloaded By: [Northwestern University] At: 20:10 7 July 2010
Values and moral experience in global health: Bridging the local and
the global
Over the past several decades, political conflicts, economic volatility and large-scale
cultural and social changes, have strongly influenced not only the global health
problem and solution frameworks, but also the very way we conceive of global health
as a public good. As politicians, business people and cultural elites employ the
language of global health to shape discourse and policies focused on displaced and
migratory peoples, they have, perhaps unwittingly, broadened the classic public
health agenda. As a consequence, that agenda now includes violence and its
traumatic consequences, the health (and mental health) impact of natural and social
catastrophes, other health-related problems from obesity to substance abuse, and the
effect of pharmaceutical and digital technology innovations not previously
considered to be core public health issues. They expand and reformulate the
traditional spheres of public health, and challenge classic public health values.
As a result, debates shaping global health research, ethics, policy and
programmes have developed along two parallel tracks. One can be characterised
as a neo-liberal approach combining economics (liberalisation of trade and
financing; publicprivate partnerships; cost-effectiveness analysis), disease-specific
and biotech programmes and security concerns. The other has focused on human
rights, social justice and equity frameworks with a broader, more inclusive model of
the determinants of health. This perspective calls for a transformation of the current
fractured system of global health governance into a transparent and accountable
system better equipped to address the world’s global health agendas. The latter
approach embraces public health as one of the essential features of a new moral
commitment to remake the world, similar to the environmental/climate change
movement. In fact, in 2002, the American Public Health Association explicitly
affirmed in their professional code of ethics, Principles of the ethical practice of public
health, that the pursuit of public health is an ‘inherently moral’ obligation.1
Very recently, the two approaches appear to be converging around a values focus
to bolster arguments in favour of increased resource allocation for global health
programmes. Values embodied by individual behaviours are often rooted in cultural
interests or shaped by hegemonic norms that, at times, appear to be so natural as to
be invisible. Similarly, values are so central to political life, policy-makers freely
admit that political discourse that appropriates the values debate builds political
support, consequently driving policy goals. Although for different reasons, values in
these two spheres are often unclear and not well articulated. For the political realm,
the result is that values are neither consistently applied nor shared across diverse
policy sectors. What is new, however, is an emerging recognition that the ‘social
context’ of values must be explored before we can begin to understand the meaning
of any value, whether personal, political or invoked directly in reference to global
ISSN 1744-1692 print/ISSN 1744-1706 online
# 2010 Taylor & Francis
DOI: 10.1080/17441690903484201
http://www.informaworld.com
116
Introduction
Downloaded By: [Northwestern University] At: 20:10 7 July 2010
health. Where is the values debate in global health headed, and what can public
health, the social sciences and the humanities contribute to the discussion?
Background
Global health values are under-theorised and lack concise definitions. To address
this issue, the authors jointly convened a workshop entitled, ‘Values and moral
experiences in global health: Bridging the local and the global’, held in May 2007 at
Harvard University. The conference was co-sponsored with support from Harvard,
Boston and Northwestern Universities. Drawing on an interdisciplinary and
international group of scholars and practitioners, this workshop explored the
emerging values discourse as it relates to global health priority-setting, policy,
governance, practice and research. The workshop posed several broad questions:
What values are deeply embedded in the most important global health policies and
programmes? How do we combine moral philosophy, applied (empirical) bioethics,
economics and public health, and engage people in the high-income countries to
improve the health of people in resource-poor settings? How do we change this
engagement from a charitable/humanitarian value to a fundamental shared value
that withstands the inevitable periodic global economic downturns? How do we
balance multiple, often conflicting, values to find consensus for setting priorities in
global health policy and research agenda? How do we translate insights from highly
specific, local cultural contexts into theoretical frameworks for effective global
health governance that transcend local boundaries? Participants explored the
relevance of political, ethical and economic theories to global health governance,
or offered assessments of specific global-acting entities, such as the UN agencies,
World Bank and World Health Organisation (WHO). The articles to follow, in this
Special Issue of Global Public Health, while based on workshop presentations,
represent the product of new working groups assembled afterward to reflect new
thinking informed by the debates and discussions at the workshop.
Moral experiences, religion and global health values
Values can be situated in two spheres: first, actual moral experiences of people in
their local worlds whose practices regarding what really matters can, and often do,
diverge from their ethical aspirations; and second, lay aspirations and more
disciplined professional articulations of ethical responsibilities. Emmanuel Levinas
argued that ethics should precede all acts, as an affirmation first of the suffering of
others, after which analysis and action can follow (Bernasconi and Wood 1998).
Further, suffering in and of itself is ethically useless, and its moral utility is the
recognition of responsibility by those around the sufferer. While Levinas was an
ethicist who explicitly built his ethical approach out of religious commitments, the
origins of American bioethics include important contributions by religionists who
explicitly avoid religious language and metaphors. More recently, however, practicing
public health professionals have drawn upon liberation theology and social justice
frameworks to raise awareness and financial support for global health initiatives. For
example, Paul Farmer and Jim Kim, in their work in Haiti, Peru and Rwanda, clearly
recognise the connection between political structures and health inequities and,
therefore, focus their efforts on political will to improve health. Others, like former
Global Public Health
117
US Senator and physician Bill Frist, use evangelicalism and the prosperity ministries
to attempt to reduce health inequalities through the ideology of individual
responsibility and sheer determination. The essays presented here, focus on the
implication for global health of values animated by individual and local commitment
but routinised by institutionalisation through macro-level health policies (see the
articles by Feierman et al. and Yang et al.).
Downloaded By: [Northwestern University] At: 20:10 7 July 2010
Va
