Justice, health, and healthcare

Healthcare (including public health) is special because it protects normal functioning, which in turn protects the range of opportunities open to individuals. I extend this account in two ways. First, since the distribution of goods other than healthcare affect population health and its distribution, I claim that Rawls's principles of justice describe a fair distribution of the social determinants of health, giving a partial account of when health inequalities are unjust. Second, I supplement a principled account of justice for health and healthcare with an account of fair process for setting limits of rationing care. This account is provided by three conditions that comprise "accountability for reasonableness."     

Fragility,uncertainty, and healthcare

Medicine seeks to overcome one of the most fundamental fragilities of being human, the fragility of good health. No matter how robust our current state of health, we are inevitably susceptible to future illness and disease, while current disease serves to remind us of various frailties inherent in the human condition. This article examines the relationship between fragility and uncertainty with regard to health, and argues that there are reasons to accept rather than deny at least some forms of uncertainty. In situations of current ill health, both patients and doctors seek to manage this fragility through diagnoses that explain suffering and provide some certainty about prognosis as well as treatment. However, both diagnosis and prognosis are inevitably uncertain to some degree, leading to questions about how much uncertainty health professionals should disclose, and how to manage when diagnosis is elusive, leaving patients in uncertainty. We argue that patients can benefit when they are able to acknowledge, and appropriately accept, some uncertainty. Healthy people may seek to protect the fragility of their good health by undertaking preventative measures including various tests and screenings. However, these attempts to secure oneself against the onset of biological fragility can cause harm by creating rather than eliminating uncertainty. Finally, we argue that there are good reasons for accepting the fragility of health, along with the associated uncertainties.     

Justice,Health, and Healthcare

Healthcare (including public health) is special because it protects normal functioning, which in turn protects the range of opportunities open to individuals. I extend this account in two ways. First, since the distribution of goods other than healthcare affect population health and its distribution, I claim that Rawls's principles of justice describe a fair distribution of the social determinants of health, giving a partial account of when health inequalities are unjust. Second, I supplement a principled account of justice for health and healthcare with an account of fair process for setting limits or rationing care. This account is provided by three conditions that comprise "accountability for reasonableness."     

Demographics, affect, and adolescents' health behaviors.

Considerable research has established that a relationship exists between demographics, emotions, and physical health complaints. Much less is known about the association between demographics, affect, and actual health behaviors, particularly in youngsters. Accordingly, this paper presents findings on the relationship between affect, demographics, and health-related lifestyle among 139 public high school students, a population generally believed to be at high risk for the development of detrimental health habits. Covariation between affect, health practices, and demographics was examined using stepwise multiple regression analyses which revealed distinctive demographic and affective correlates of different health behaviors. The implications of these results are discussed and directions for future research are noted.     

Early environment, emotions, responses to stress, and health

A harsh early family environment is related to mental and physical health in adulthood. An important question is why family environment in childhood is associated with these outcomes so long after its initial occurrence. We describe a program of research that evaluates a model linking these variables to each other. Specifically, we hypothesize that low social competence and negative emotional states may mediate relations between a harsh early family environment and physiological/neuroendocrine responses to stress, as well as long-term health outcomes. We report evidence that the model characterizes self-rated health, cortisol responses to stress, and, in males only, elevated cardiovascular responses to stress. We discuss how the social context of early life (such as SES) may affect the family environment in ways that precipitate adverse health consequences. Perspectives on comorbidities in physical and mental health are discussed.     

How internet users find, evaluate, and use online health information: a cross-cultural review.

The Internet has become a favored source to find health information. Worldwide, about 4.5% of all Internet searches are for health-related information. However, research has found that the quality of online health information is mixed, which raises serious concerns about the impact of this information. This paper reviews relevant research to understand how health information on the Internet is retrieved, evaluated, and used. Most users of online health information are looking for information about specific health conditions because they or someone they know was diagnosed with a medical condition. They typically use general search engines to find online health information and enter short phrases, often misspelled. They seldom go beyond the first page of a search. Both their search and evaluation skills are limited although they are concerned about the quality of online health information. They avoid sites with overt commercialism, but often do not pay attention to indicators of credibility. Online health information is used to fill an information void which can enhance coping and self efficacy, affects health-related decisions and behavior of users and their friends and family, and is often discussed with health care providers. There are cross-cultural differences in the types of sites used as well as how online information is used. Based on the research reviewed in this paper, three major recommendations are suggested. Professionals should recommend sites. Professionals should promote more effective search and evaluation techniques. Professionals should be involved in developing and promoting uniform standards for health and mental health sites.     

Mindfulness,Mysticism, and Narrative Medicine

Mindfulness based interventions (MBIs) are rapidly emerging in health care settings for their role in reducing stress and improving physical and mental health. In such settings, the religious roots and affiliations of MBIs are downplayed, and the possibilities for developing spiritual, even mystical, states of consciousness are minimized. This article helps rebalance this trend by using the tools of medical humanities and narrative medicine to explore MBI as a bridge between medical and spiritual approaches to health related suffering. My narrative medicine method draws insights from the arts and humanities that are rarely used in standard clinical research but are increasingly common among medical humanities and narrative medicine scholars. The specific path I take will be to work through historical, linguistic, and philosophic dimensions of mindfulness and mysticism as relevant to illness, suffering, death, and dying. I close with two case examples in which mindfulness is used as an intentionally spiritual practice for health concerns.     

Neuroeconomics,health psychology,and the interdisciplinary study of preventative health behavior

The goal of this article is to introduce readers to theories, tools, and evidence from the field of neuroeconomics and to describe how health psychology and neuroeconomics can be mutually informative in the study of preventative health behaviors. Preventative health behavior here refers to both individual actions that impact one's health (e.g., exercise) and broader behavioral patterns, such as those captured in personality constructs. Although neuroeconomic researchers have begun to incorporate health‐relevant behaviors into their studies, the full potential of this research to inform preventative health models is as yet unrealized. What is needed to “translate up” is the unification of rich theoretical content from health psychology with investigations by neuroeconomic researchers of the decision‐making process during health‐relevant choices. We identify choice as a central, shared feature across models of preventative health behavior that can serve as an inroad for neuroeconomics to contribute to existing models and highlight commonalities that might not otherwise be apparent. A central premise of our argument is that, because health decisions are nearly always multiply determined, a more precise and mechanistic understanding of how choices are made is an important but understudied topic in health psychology. A partnership between health psychologists and neuroeconomic researchers can yield valuable insights into how preventative health choice is made and to identify targets and methods for intervention.     

Religion, Social Capital, and Health

Religion??s association with better physical health has been partially explained by health behaviors, psychosocial variables, and biological factors; but these factors do not fully explain the religion?Chealth connection. In concert with the religion and health literature, a burgeoning literature has linked social capital with salubrious health outcomes. Religious organizations are recognized in the social capital literature as producers and facilitators of social capital. However, few studies have examined the potential mediating role of social capital in the religion?Chealth relationship. Thus data from the 2006 Social Capital Community Benchmark Survey were analyzed for 10,828 adults. The composite unstandardized indirect effect from religion to social capital onto health was significant (???=?0.098; p?<?0.001). The unstandardized direct pathway from religion to self-reported health (???=?0.015; p?=?0.336) indicated that social capital is a mediator in the religion?Chealth relationship. Among the demographic variables investigated, only age and income had a significant direct effect on self-reported health.     

Mental Health Counseling: Past,Present, and Future

This article examines the significant events in the history of mental. health care that have contributed to the development of a specialty within the counseling profession referred to as mental health counseling. The development of credentials for the specialty and the issues currently facing mental health counseling are discussed, and a perspective on directions for the future is offered.     

Social ethics,the philosophy of medicine,and professional responsibility

The social ethics of medicine is the study and ethical analysis of social structures which impact on the provision of health care by physicians. There are many such social structures. Not all these structures are responsive to the influence of physicians as health professionals. But some social structures which impact on health care are prompted by or supported by important preconceptions of medical practice. In this article, three such elements of the philosophy of medicine are examined in terms of the negative impact on health care of the social structures to which they contribute. The responsibilities of the medical profession and of individual physicians to work to change these social structures are then examined in the light of a theory of profession.     

Managed Care, Catholic Vision, and the Claims of Justice

There are numerous challenges posed to Roman Catholic healthcare institutions by recent developments in health care delivery.Some are practical, involving the acceptable limits of accommodationto and collaboration with secular networks of health care delivery.Others, quite often implicated in the first set, are explicitlytheological. What does it mean to be a distinctively Roman Catholichealth care institution? What are the nature and the scope ofRoman Catholic institutional identity? More broadly, what isthe moral relevance of themes in Roman Catholic social teachingto the provision of health care? This issue of Christian Bioethicsaddresses these questions with a spirited exchange among itsauthors. They offer noticeably different perspectives on thegeneral cogency of Roman Catholic social teaching and differentstrategic recommendations for Roman Catholic institutions tomaintain, or recover, their distinctive presence in health caredelivery.     

Psychological resources, positive illusions, and health

Psychological beliefs such as optimism, personal control, and a sense of meaning are known to be protective of mental health. Are they protective of physical health as well? The authors present a program of research that has tested the implications of cognitive adaptation theory and research on positive illusions for the relation of positive beliefs to disease progression among men infected with HIV. The investigations have revealed that even unrealistically optimistic beliefs about the future may be health protective. The ability to find meaning in the experience is also associated with a less rapid course of illness. Taken together, the research suggests that psychological beliefs such as meaning, control, and optimism act as resources, which may not only preserve mental health in the context of traumatic or life-threatening events but be protective of physical health as well.     

Gay,Lesbian, and Bisexual Adolescents: A Critical Challenge to Counselors

Meeting the health care needs of gay, lesbian, and bisexual teenagers has become a public health imperative, and mental health professionals should be prepared for the challenge. The stigma of homosexuality often gives rise to psychosocial problems for adolescents, who are in the process of sexual identity development. The stigma also may complicate delivery of appropriate, ethical, and sound mental health treatment. Suggestions are offered to support healthy development, to assist recovery from stigma, and to avert the disastrous consequences of suicide and AIDS.     

The Structure and Dynamics of Worry: Theory, Measurement, and Cross-National Replications

This article presents a comprehensive conceptualization of the structure of worry and the relation of worry to mental health and well-being. It is assumed that worries have two facets, namely, the object of a worry (e.g., self, close others, society, the world) and the domain of a worry (the field of life with which it is concerned). The object of a worry is presumed to be more important than its domain in determining the impact of worries on mental health. Only worries concerned with self and close others (micro worries) are expected to be related to poor mental health, whereas worries about society or the entire world (macro worries) are expected to be positively related to mental health. An instrument is introduced to study worries in accordance with the proposed structure. Its validity is tested by two confirmatory techniques (similarity structure analysis and confirmatory factor analysis) in samples from Israel, West Germany, and (the former) East Germany. Worry scores are also related to five mental health indicators. Results show that across samples micro and macro worries can validly be distinguished. Micro worries are strongly related to poor mental health, whereas macro worries are unrelated to mental health or relate marginally to positive well-being.     

Psychology and health. Research, practice, and policy

Since World War II, American psychology's role in health care has significantly expanded. This was formally recognized in 2001 when the membership of the American Psychological Association (APA) approved a bylaw change in its mission statement to include the word health. An accumulating body of research demonstrates and recent reviews conclude that psychological factors are primary in health and in illnesses. This article proposes a vision of psychology that endorses a bio-psycho-socio-cultural model of health research and interventions. The author provides 4 definitions of health, reviews selected psychology health research and interventions, summarizes APA's recent health-related activities, and presents 5 policy recommendations for consideration and debate.     

Health Promotion,Health Locus of Control,and Health Behavior: Two Field Experiments1

In spite of a sizable body of research on the effects of information promotions on health knowledge and health behavior, relatively little is known about how such efforts affect change (or why they do not). This paper addresses that problem by exploring the particular role that health locus of control (HLC) beliefs play in individual responses to health promotion efforts aimed at encouraging preventive health behaviors. Two field experiments are presented. The first experiment examined the extent to which HLC beliefs are related to differences in individual levels of health knowledge following the distribution of an informational booklet on health. Internals high on health value who received the information booklet demonstrated greater health knowledge three months later than did other subjects, although this difference was greater among men than among women. The second experiment explored how HLC beliefs interact with differently framed “control” messages to promote behavior change in breast self-examination (BSE). HLC beliefs interacted with the control language of the BSE promotional message and a neutral reminder to affect subsequent BSE practice. Together, these studies suggest a more influential role for health locus of control beliefs in shaping responses to health messages than has previously been documented in field settings.     

Relationships between locus of control,health value,and preventive health behaviors among women

This study examines the relationships between locus of control expectancies, rated health value, and reported participation in preventive health behaviors among a healthy sample of undergraduate women. The prediction that participation in preventive health behaviors would be a joint function of an internal health-related locus of control belief and holding health in high value was not supported. Instead, individuals who valued their health reported participating in a greater number of health-enhancing behaviors compared to those who valued their health less. Respondents' scores on a health value scale in combination with their rated health status proved to be better predictors of health behaviors than their locus of control beliefs. Limitations of locus of control research with young, healthy individuals are discussed and further investigation into the utility and validity of health value scales is recommended.     

Human Rights,Cultural Pluralism,and International Health Research

In the field of bioethics, scholars have begun to consider carefully the impact of structural issues on global population health, including socioeconomic and political factors influencing the disproportionate burden of disease throughout the world. Human rights and social justice are key considerations for both population health and biomedical research. In this paper, I will briefly explore approaches to human rights in bioethics and review guidelines for ethical conduct in international health research, focusing specifically on health research conducted in resource-poor settings. I will demonstrate the potential for addressing human rights considerations in international health research with special attention to the importance of collaborative partnerships, capacity building, and respect for cultural traditions. Strengthening professional knowledge about international research ethics increases awareness of ethical concerns associated with study design and informed consent among researchers working in resource-poor settings. But this is not enough. Technological and financial resources are also necessary to build capacity for local communities to ensure that research results are integrated into existing health systems. Problematic issues surrounding the application of ethical guidelines in resource-poor settings are embedded in social history, cultural context, and the global political economy. Resolving the moral complexities requires a commitment to engaged dialogue and action among investigators, funding agencies, policy makers, governmental institutions, and private industry.     

健康公平--概念、影响因素与政策

长期以来健康不平等和不公平一直是卫生改革与发展所关注的重点,并已经成为了国际卫生政策的主要方向.在国家之间健康不平等和不公平也存在不同的理解.发达国家主要集中在产生疾病和导致死亡率差异的社会经济阶层的形成机制,将健康不平等作为疾病病原学的一个函数,关键措施是加强初级卫生保健;在中低收入国家,人们却趋向于通过提供基本的医疗保健服务来解决这一问题.