Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Public Health. Show all posts
Showing posts with label Public Health. Show all posts

Sunday, January 28, 2024

Americans are lonely and it’s killing them. How the US can combat this new epidemic.

Adrianna Rodriguez
USA Today
Originally posted 24 Dec 23

America has a new epidemic. It can’t be treated using traditional therapies even though it has debilitating and even deadly consequences.

The problem seeping in at the corners of our communities is loneliness and U.S. Surgeon General Dr. Vivek Murthy is hoping to generate awareness and offer remedies before it claims more lives.

“Most of us probably think of loneliness as just a bad feeling,” he told USA TODAY. “It turns out that loneliness has far greater implications for our health when we struggle with a sense of social disconnection, being lonely or isolated.”

Loneliness is detrimental to mental and physical health, experts say, leading to an increased risk of heart disease, dementia, stroke and premature death. As researchers track record levels of self-reported loneliness, public health leaders are banding together to develop a public health framework to address the epidemic.

“The world is becoming lonelier and there’s some very, very worrisome consequences,” said Dr. Jeremy Nobel, founder of The Foundation for Art and Healing, a nonprofit that addresses public health concerns through creative expression, which launched an initiative called Project Unlonely.

“It won’t just make you miserable, but loneliness will kill you," he said. "And that’s why it’s a crisis."

Key points:
  • Loneliness Crisis: America faces a growing epidemic of loneliness impacting mental and physical health, leading to increased risks of heart disease, dementia, stroke, and premature death.
  • Diverse and Widespread: Loneliness affects various demographics, from young adults to older populations, and isn't limited by social media interaction.
  • Health Risks: The Surgeon General reports loneliness raises risk of premature death by 26%, equivalent to smoking 15 cigarettes daily. Heart disease and stroke risks also increase significantly.
  • Causes: Numerous factors contribute, including societal changes, technology overuse, remote work, and lack of genuine social connection.
  • Solutions: Individual actions like reaching out and mindful interactions help. Additionally, public health strategies like "social prescribing" and community initiatives are crucial.
  • Collective Effort Needed: Overcoming the epidemic requires collaboration across sectors, fostering stronger social connections within communities and digital spaces.

Sunday, September 17, 2023

The Plunging Number of Primary Care Physicians Reaches a Tipping Point.

Elisabeth Rosenthal
KFF Health News
Originally posted 8 September 23

Here are two excerpts:

The percentage of U.S. doctors in adult primary care has been declining for years and is now about 25% — a tipping point beyond which many Americans won’t be able to find a family doctor at all.

Already, more than 100 million Americans don’t have usual access to primary care, a number that has nearly doubled since 2014. One reason our coronavirus vaccination rates were low compared with those in countries such as China, France, and Japan could be because so many of us no longer regularly see a familiar doctor we trust.

Another telling statistic: In 1980, 62% of doctor’s visits for adults 65 and older were for primary care and 38% were for specialists, according to Michael L. Barnett, a health systems researcher and primary care doctor in the Harvard Medical School system. By 2013, that ratio had exactly flipped and has likely “only gotten worse,” he said, noting sadly: “We have a specialty-driven system. Primary care is seen as a thankless, undesirable backwater.” That’s “tragic,” in his words — studies show that a strong foundation of primary care yields better health outcomes overall, greater equity in health care access, and lower per capita health costs.

One explanation for the disappearing primary care doctor is financial. The payment structure in the U.S. health system has long rewarded surgeries and procedures while shortchanging the diagnostic, prescriptive, and preventive work that is the province of primary care. Furthermore, the traditionally independent doctors in this field have little power to negotiate sustainable payments with the mammoth insurers in the U.S. market.

Faced with this situation, many independent primary care doctors have sold their practices to health systems or commercial management chains (some private equity-owned) so that, today, three-quarters of doctors are now employees of those outfits.


Some relatively simple solutions are available, if we care enough about supporting this foundational part of a good medical system. Hospitals and commercial groups could invest some of the money they earn by replacing hips and knees to support primary care staffing; giving these doctors more face time with their patients would be good for their customers’ health and loyalty if not (always) the bottom line.

Reimbursement for primary care visits could be increased to reflect their value — perhaps by enacting a national primary care fee schedule, so these doctors won’t have to butt heads with insurers. And policymakers could consider forgiving the medical school debt of doctors who choose primary care as a profession.

They deserve support that allows them to do what they were trained to do: diagnosing, treating, and getting to know their patients.

Here is my warning:

The number of primary care physicians in the US is declining, and this trend is reaching a tipping point. More than 100 million Americans don't have usual access to primary care, and this number has nearly doubled since 2014. This shortage of primary care physicians could have a negative impact on public health, as people without access to primary care are more likely to delay or forgo needed care.

Tuesday, February 21, 2023

Motornomativity: How Social Norms Hide a Major Public Health Hazard

Walker, I., Tapp, A., & Davis, A.
(2022, December 14).


Decisions about motor transport, by individuals and policy-makers, show unconscious biases due to cultural assumptions about the role of private cars - a phenomenon we term motonormativity. To explore this claim, a national sample of 2157 UK adults rated, at random, a set of statements about driving (“People shouldn't drive in highly populated areas where other people have to breathe in the car fumes”) or a parallel set of statements with key words changed to shift context ("People shouldn't smoke in highly populated areas where other people have to breathe in the cigarette fumes"). Such context changes could radically alter responses (75% agreed with "People shouldn't smoke... " but only 17% agreed with "People shouldn't drive... "). We discuss how these biases systematically distort medical and policy decisions and give recommendations for how public policy and health professionals might begin to recognise and address these unconscious biases in their work.


Our survey showed that people can go from agreeing with a health or risk-related proposition to disagreeing with it simply depending on whether it is couched as a driving or non-driving issue. In the most dramatic case, survey respondents felt that obliging people to breathe toxic fumes went from being unacceptable to acceptable depending on whether the fumes came from cigarettes or motor vehicles. It is, objectively, nonsensical that the ethical and public health issues involved in forcing non-consenting people to inhale air-borne toxins should be judged differently depending on their source, but that is what happened here. It seems that normal judgement criteria can indeed be suspended in the specific context of motoring, as we suggested.

Obviously, we used questions in this study that we felt would stand a good chance of demonstrating a difference between how motoring and non-motoring issues were viewed. But choosing questions likely to reveal differences is not the same thing as stacking the deck. We gave the social bias every chance to reveal itself, but that could only happen because it was out there to be revealed. Prentice and Miller (1992) argue that the ease with which a behavioural phenomenon can be triggered is an index of its true magnitude. The ease with which effects appeared in this study was striking: in the final question the UK public went from 17% agreement to 75% agreement just by changing two words in the question whilst leaving its underlying principle unchanged.

Another example of a culturally acceptable (or ingrained) bias for harm. Call it "car blindness" or "motornormativity."

Sunday, June 12, 2022

You Were Right About COVID, and Then You Weren’t

Olga Khazan
The Atlantic
Originally posted 3 MAY 22

Here are two excerpts:

Tenelle Porter, a psychologist at UC Davis, studies so-called intellectual humility, or the recognition that we have imperfect information and thus our beliefs might be wrong. Practicing intellectual humility, she says, is harder when you’re very active on the internet, or when you’re operating in a cutthroat culture. That might be why it pains me—a very online person working in the very competitive culture of journalism—to say that I was incredibly wrong about COVID at first. In late February 2020, when Smith was sounding the alarm among his co-workers, I had drinks with a colleague who asked me if I was worried about “this new coronavirus thing.”

“No!” I said. After all, I had covered swine flu, which blew over quickly and wasn’t very deadly.

A few days later, my mom called and asked me the same question. “People in Italy are staying inside their houses,” she pointed out.

“Yeah,” I said. “But SARS and MERS both stayed pretty localized to the regions they originally struck.”

Then, a few weeks later, when we were already working from home and buying dried beans, a friend asked me if she should be worried about her wedding, which was scheduled for October 2020.

“Are you kidding?” I said. “They will have figured out a vaccine or something by then.” Her wedding finally took place this month.


Thinking like a scientist, or a scout, means “recognizing that every single one of your opinions is a hypothesis waiting to be tested. And every decision you make is an experiment where you forgot to have a control group,” Grant said. The best way to hold opinions or make predictions is to determine what you think given the state of the evidence—and then decide what it would take for you to change your mind. Not only are you committing to staying open-minded; you’re committing to the possibility that you might be wrong.

Because the coronavirus has proved volatile and unpredictable, we should evaluate it as a scientist would. We can’t hold so tightly to prior beliefs that we allow them to guide our behavior when the facts on the ground change. This might mean that we lose our masks one month and don them again the next, or reschedule an indoor party until after case numbers decrease. It might mean supporting strict lockdowns in the spring of 2020 but not in the spring of 2022. It might even mean closing schools again, if a new variant seems to attack children. We should think of masks and other COVID precautions not as shibboleths but like rain boots and umbrellas, as Ashish Jha, the White House coronavirus-response coordinator, has put it. There’s no sense in being pro- or anti-umbrella. You just take it out when it’s raining.

Sunday, September 20, 2020

Financial Conflicts of Interest are of Higher Ethical Priority than “Intellectual” Conflicts of Interest

Goldberg, D.S.
Bioethical Inquiry 17, 217–227 (2020).


The primary claim of this paper is that intellectual conflicts of interest (COIs) exist but are of lower ethical priority than COIs flowing from relationships between health professionals and commercial industry characterized by financial exchange. The paper begins by defining intellectual COIs and framing them in the context of scholarship on non-financial COIs. However, the paper explains that the crucial distinction is not between financial and non-financial COIs but is rather between motivations for bias that flow from relationships and those that do not. While commitments to particular ideas or perspectives can cause all manner of cognitive bias, that fact does not justify denying the enormous power that relationships featuring pecuniary gain have on professional behaviour in term of care, policy, or both. Sufficient reason exists to take both intellectual COIs and financial COIs seriously, but this paper demonstrates why the latter is of higher ethical priority. Multiple reasons will be provided, but the primary rationale grounding the claim is that intellectual COIs may provide reasons to suspect cognitive bias but they do not typically involve a loss of trust in a social role. The same cannot be said for COIs flowing from relationships between health professionals and commercial industries involving financial exchange. The paper then assumes arguendo that the primary rationale is mistaken and proceeds to show why the claims that intellectual COIs are more significant than relationship-based COIs are dubious on their own merits. The final section of the paper summarizes and concludes.


iCOIs exist and they should be taken seriously. Nevertheless, fCOIs are of greater ethical priority. The latter diminish trust in a social role to a much greater extent than do the former, at least in the broad run of cases. Moreover, it is not clear how providers could avoid developing intellectual commitments and preferences regarding particular therapeutic modalities or interventions—and even if we could prevent this from occurring, it is far from evident that we should. We can easily imagine cases where a studied determination to remain neutral regarding interventions would be an abdication of moral responsibility, would be decidedly unvirtuous, and would likely result in harm to care- and service-seekers. While we also have evidence that some intellectual commitments can motivate bias in ways that likely result in harm to care- or service-seekers, this premise only justifies taking iCOIs seriously—it is literally no argument for deprioritizing fCOIs. Although the fact that iCOIs are in many cases unavoidable is a weak justification for ignoring iCOIs, the comparable avoidability of the vast majority of fCOIs is indeed a reason for prioritizing the latter over the former.

A pdf is here.

Tuesday, September 1, 2020

Systemic racism and U.S. health care

J. Feagin & Z. Bennefield
Social Science & Medicine
Volume 103, February 2014, Pages 7-14


This article draws upon a major social science theoretical approach–systemic racism theory–to assess decades of empirical research on racial dimensions of U.S. health care and public health institutions. From the 1600s, the oppression of Americans of color has been systemic and rationalized using a white racial framing–with its constituent racist stereotypes, ideologies, images, narratives, and emotions. We review historical literature on racially exploitative medical and public health practices that helped generate and sustain this racial framing and related structural discrimination targeting Americans of color. We examine contemporary research on racial differentials in medical practices, white clinicians' racial framing, and views of patients and physicians of color to demonstrate the continuing reality of systemic racism throughout health care and public health institutions. We conclude from research that institutionalized white socioeconomic resources, discrimination, and racialized framing from centuries of slavery, segregation, and contemporary white oppression severely limit and restrict access of many Americans of color to adequate socioeconomic resources–and to adequate health care and health outcomes. Dealing justly with continuing racial “disparities” in health and health care requires a conceptual paradigm that realistically assesses U.S. society's white-racist roots and contemporary racist realities. We conclude briefly with examples of successful public policies that have brought structural changes in racial and class differentials in health care and public health in the U.S. and other countries.


• A full-fledged theory of structural (systemic) racism for interpreting health care data.

• A full-fledged developed theory of structural (systemic) racism for interpreting public health data.

• Focus on powerful white decision makers central to health-related institutions.

• Importance of listening to patients and physicians of color on health issues.

• Implications of systemic racism theory and data for public policies regarding medical care and public health.

The info is here.

Friday, August 7, 2020

Your Ancestors Knew Death in Ways You Never Will

Donald McNeil, Jr.
The New York Times
Originally posted 15 July 20

Here is the end:

As a result, New Yorkers took certain steps — sometimes very expensive and contentious, but all based on science: They dug sewers to pipe filth into the Hudson and East Rivers instead of letting it pool in the streets. In 1842, they built the Croton Aqueduct to carry fresh water to Manhattan. In 1910, they chlorinated its water to kill more germs. In 1912, they began requiring dairies to heat their milk because a Frenchman named Louis Pasteur had shown that doing so spared children from tuberculosis. Over time, they made smallpox vaccination mandatory.

Libertarians battled almost every step. Some fought sewers and water mains being dug through their properties, arguing that they owned perfectly good wells and cesspools. Some refused smallpox vaccines until the Supreme Court put an end to that in 1905, in Jacobson v. Massachusetts.

In the Spanish flu epidemic of 1918, many New Yorkers donned masks but 4,000 San Franciscans formed an Anti-Mask League. (The city’s mayor, James Rolph, was fined $50 for flouting his own health department’s mask order.) Slowly, science prevailed, and death rates went down.

Today, Americans are facing the same choice our ancestors did: We can listen to scientists and spend money to save lives, or we can watch our neighbors die.

“The people who say ‘Let her rip, let’s go for herd immunity’ — that’s just public-health nihilism,” said Dr. Joia S. Mukherjee, the chief medical office of Partners in Health, a medical charity fighting the virus. “How many deaths do we have to accept to get there?”

A vaccine may be close at hand, and so may treatments like monoclonal antibodies that will cut our losses.

Till then, we need not accept death as our overlord — we can simply hang on and outlast him.

The info is here.

Monday, August 3, 2020

The Role of Cognitive Dissonance in the Pandemic

Elliot Aronson and Carol Tavris
The Atlantic
Originally published 12 July 20

Here is an excerpt:

Because of the intense polarization in our country, a great many Americans now see the life-and-death decisions of the coronavirus as political choices rather than medical ones. In the absence of a unifying narrative and competent national leadership, Americans have to choose whom to believe as they make decisions about how to live: the scientists and the public-health experts, whose advice will necessarily change as they learn more about the virus, treatment, and risks? Or President Donald Trump and his acolytes, who suggest that masks and social distancing are unnecessary or “optional”?

The cognition I want to go back to work or I want to go to my favorite bar to hang out with my friends is dissonant with any information that suggests these actions might be dangerous—if not to individuals themselves, then to others with whom they interact.

How to resolve this dissonance? People could avoid the crowds, parties, and bars and wear a mask. Or they could jump back into their former ways. But to preserve their belief that they are smart and competent and would never do anything foolish to risk their lives, they will need some self-justifications: Claim that masks impair their breathing, deny that the pandemic is serious, or protest that their “freedom” to do what they want is paramount. “You’re removing our freedoms and stomping on our constitutional rights by these Communist-dictatorship orders,” a woman at a Palm Beach County commissioners’ hearing said. “Masks are literally killing people,” said another. South Dakota Governor Kristi Noem, referring to masks and any other government interventions, said, “More freedom, not more government, is the answer.” Vice President Mike Pence added his own justification for encouraging people to gather in unsafe crowds for a Trump rally: “The right to peacefully assemble is enshrined in the First Amendment of the Constitution.”

The info is here.

Tuesday, July 21, 2020

Collective narcissism predicts the belief and dissemination of conspiracy theories during the COVID-19 pandemic.

Sternisko, A., Cichocka, A., Cislak, A.,
& Van Bavel, J. J. (2020, May 21).


While COVID-19 was quietly spreading across the globe, conspiracy theories were finding loud voices on the internet. What contributes to the spread of these theories? In two national surveys (NTotal = 950) conducted in the United States and the United Kingdom, we identified national narcissism – a belief in the greatness of one’s nation that others do not appreciate – as a risk factor for the spread of conspiracy theories during the COVID-19 pandemic. We found that national narcissism was strongly associated with the proneness to believe and disseminate conspiracy theories related to COVID-19, accounting for up to 22% of the variance. Further, we found preliminary evidence that belief in COVID-19 conspiracy theories and national narcissism was linked to health-related behaviors and attitudes towards public policies to mitigate the spread of COVID-19. Our study expands previous work by illustrating the importance of identity processes in the spread of conspiracy theories during pandemics.


Ultimately, we hope that our studies are not only relevant for researchers but also for practitioners.Yet, little is known about how to increase or decrease the link between collective narcissism and conspiracy theories. Therefore, we urge future research to examine if focusing on the protection of the national image influences the spread of COVID-19 conspiracy theories, and the implications of these associations for public-health communication. For instance, underscoring that the national in-group is in some way disadvantaged in fighting the pandemic might increase the need to assert the image of the group and further fuel conspiracy theories.  Conversely, public-health messages might benefit from stressing that the adherence to health guidelines and policies also helps protect the nation’s image. Exploring such and other interventions could help limit the current ‘infodemic'.

Tuesday, July 14, 2020

The Pandemic Experts Are Not Okay

Ed Yong
The Atlantic
Originally posted 7 July 20

Here is an excerpt:

The field of public health demands a particular way of thinking. Unlike medicine, which is about saving individual patients, public health is about protecting the well-being of entire communities. Its problems, from malnutrition to addiction to epidemics, are broader in scope. Its successes come incrementally, slowly, and through the sustained efforts of large groups of people. As Natalie Dean, a biostatistician at the University of Florida, told me, “The pandemic is a huge problem, but I’m not afraid of huge problems.”

The more successful public health is, however, the more people take it for granted. Funding has dwindled since the 2008 recession. Many jobs have disappeared. Now that the entire country needs public-health advice, there aren’t enough people qualified to offer it. The number of epidemiologists who specialize in pandemic-level infectious threats is small enough that “I think I know them all,” says Caitlin Rivers, who studies outbreaks at the Johns Hopkins Center for Health Security.

The people doing this work have had to recalibrate their lives. From March to May, Colin Carlson, a research professor at Georgetown University who specializes in infectious diseases, spent most of his time traversing the short gap between his bed and his desk. He worked relentlessly and knocked back coffee, even though it exacerbates his severe anxiety: The cost was worth it, he felt, when the United States still seemed to have a chance of controlling COVID-19.

The info is here.

Sunday, June 21, 2020

Downloading COVID-19 contact tracing apps is a moral obligation

G. Owen Schaefer and Angela Ballantyne
BMJ Blogs
Originally posted 4 May 20

Should you download an app that could notify you if you had been in contact with someone who contracted COVID-19? Such apps are already available in countries such as Israel, Singapore, and Australia, with other countries like the UK and US soon to follow. Here, we explain why you might have an ethical obligation to use a tracing app during the COVID-19 pandemic, even in the face of privacy concerns.


Vulnerability and unequal distribution of risk

Marginalized populations are both hardest hit by pandemics and often have the greatest reason to be sceptical of supposedly benign State surveillance. COVID-19 is a jarring reminder of global inequality, structural racism, gender inequity, entrenched ableism, and many other social divisions. During the SARS outbreak, Toronto struggled to adequately respond to the distinctive vulnerabilities of people who were homeless. In America, people of colour are at greatest risk in several dimensions – less able to act on public health advice such as social distancing, more likely to contract the virus, and more likely to die from severe COVID if they do get infected. When public health advice switched to recommending (or in some cases requiring) masks, some African Americans argued it was unsafe for them to cover their faces in public. People of colour in the US are at increased risk of state surveillance and police violence, in part because they are perceived to be threatening and violent. In New York City, black and Latino patients are dying from COVID-19 at twice the rate of non-Hispanic white people.

Marginalized populations have historically been harmed by State health surveillance. For example, indigenous populations have been the victims of State data collection to inform and implement segregation, dispossession of land, forced migration, as well as removal and ‘re‐education’ of their children. Stigma and discrimination have impeded the public health response to HIV/AIDS, as many countries still have HIV-specific laws that prosecute people living with HIV for a range of offences.  Surveillance is an important tool for implementing these laws. Marginalized populations therefore have good reasons to be sceptical of health related surveillance.

Wednesday, June 3, 2020

Justice without Retribution: An Epistemic Argument against Retributive Criminal Punishment

Gregg D. Caruso (2020)
Neuroethics ​13(1): 13-28.


Within the United States, the most prominent justification for criminal punishment is retributivism. This retributivist justification for punishment maintains that punishment of a wrongdoer is justified for the reason that she deserves something bad to happen to her just because she has knowingly done wrong—this could include pain, deprivation, or death. For the retributivist, it is the basic desert attached to the criminal’s immoral action alone that provides the justification for punishment. This means that the retributivist position is not reducible to consequentialist considerations nor in justifying punishment does it appeal to wider goods such as the safety of society or the moral improvement of those being punished. A number of sentencing guidelines in the U.S. have adopted desert as their distributive principle, and it is increasingly given deference in the “purposes” section of state criminal codes, where it can be the guiding principle in the interpretation and application of the code’s provisions. Indeed, the American Law Institute recently revised the Model Penal Code so as to set desert as the official dominate principle for sentencing. And courts have identified desert as the guiding principle in a variety of contexts, as with the Supreme Court’s enthroning retributivism as the “primary justification for the death penalty.” While retributivism provides one of the main sources of justification for punishment within the criminal justice system, there are good philosophical and practical reasons for rejecting it. One such reason is that it is unclear that agents truly deserve to suffer for the wrongs they have done in the sense required by retributivism. In the first section, I explore the retributivist justification of punishment and explain why it is inconsistent with free will skepticism. In the second section, I then argue that even if one is not convinced by the arguments for free will skepticism, there remains a strong epistemic argument against causing harm on retributivist grounds that undermines both libertarian and compatibilist attempts to justify it. I maintain that this argument provides sufficient reason for rejecting the retributive justification of criminal punishment. I conclude in the third section by briefly sketching my public health-quarantine model, a non-retributive alternative for addressing criminal behavior that draws on the public health framework and prioritizes prevention and social justice. I argue that the model is not only consistent with free will skepticism and the epistemic argument against retributivism, it also provides the most justified, humane, and effective way of dealing with criminal behavior.

The info is here.

Thursday, May 28, 2020

Global health without justice or ethics

S Venkatapuram
Journal of Public Health

The great promise at the start of the twenty-first century that Anglo-American philosophers would produce transformative theories and practical guidance for realizing global health equity and justice has largely gone unfulfilled. The publication of The Law of Peoples by John Rawls in 1999 formally inaugurated the emerging academic field of global justice philosophy.1 After 2000, numerous monographs, journal articles and conferences discussed global justice. And new academic associations, journals and research centres were established.

One remarkable aspect of the new field was that the stark inequalities in health across societies were often the starting concern. Despite our diverse philosophical and ethical views, reasonable people are likely to be morally troubled about the large inequalities in life expectancies between some sub-Saharan country X and the USA or another rich country. This initially shared moral intuition or indignation, then, motivated diverse arguments about what precisely is morally bad about global health inequalities and global poverty and the possible demands of justice. Some philosophers described what ‘our’ duties are or, indeed, are not, to help ‘those people over there’. Others minimized the distinction between us and them by arguing for theories of radical global equality, the arbitrariness of political borders and duties that follow from our complicity in transnational harms experienced in other countries.

Progress in global justice philosophy seemingly promised real-world progress in global health equity and justice, because health inequality was the foremost issue in philosophical debates on global inequality, poverty and claims of the ‘global poor’. At the same time, largely driven by HIV research, bioethics went global as it was exported alongside medical research to resource poor settings. Bioethicists also began to go beyond clinical and research settings to examine public health ethics, social inequalities in health and social determinants—from local conditions all the way to global institutions and processes. Nevertheless, as of 2020, it is difficult to identify any compelling conceptions of global justice or global health justice or to identify any significant philosophical contributions to the practical improvement of global health and inequalities. What happened?

The rest of the article is linked above.

Tuesday, May 5, 2020

Measuring Two Distinct Psychological Threats of COVID-19 and their Unique Impacts on Wellbeing and Adherence to Public Health Behaviors

Kachanoff, F., Bigman, Y., Kapsaskis, K., &
Gray, K.  (2020, April 2).


COVID-19 threatens lives, livelihoods, and civic institutions. Although public health initiatives (i.e., social distancing) help manage its impact, these initiatives can further sever our connections to people and institutions that affirm our identities. Three studies (N=1,195) validated a brief 10-item COVID-19 threat scale that assesses 1) realistic threats to physical or financial safety, and 2) symbolic threats to one’s sociocultural identity. Studies reveal that both realistic and symbolic threat predict higher anxiety and lower wellbeing, and demonstrate convergent validity with other measures of threat sensitivity. Importantly, the two kinds of threat diverge in their relationship to public health behaviors (e.g., social distancing): Realistic threat predicted greater self-reported compliance, whereas symbolic threat predicted less self-reported compliance to these social-disconnection initiatives. Symbolic threat also predicted using creative ways to affirm identity even in isolation. Our findings highlight how social psychological theory can be leveraged to understand and predict people’s behavior in pandemics.

From the General Discussion:

Symbolic and realistic threats also had significant yet different consequences for self-reported adherence to and support of public health initiatives essential to stopping the spread of the virus (i.e., social distancing, hand washing). People who perceived high levels of realistic threat to their (and their group’s) physical and financial security reported greater adherence and support for such practices. In direct contrast, people who perceived more symbolic threat to what it means to be an American, reported less support for and adherence to public health guidelines. However, if people do engage in social distancing, symbolic threat is positively associated with finding creative ways to enact and express their social (e.g., national) identity even in isolation.

Thursday, March 26, 2020

Respirators, our rights, right and wrong: Medical ethics in an age of coronavirus

Dan Sulmasy
Being human in helping others.nydailynews.com
Originally posted 22 March 20

The coronavirus pandemic is upon us. This novel virus has disrupted lives, killed people, and wreaked havoc with our economy. COVID-19 has also raised novel ethical questions and generated ethical duties for the public, health professionals and the government. Just as our health system has been caught off guard, so have our ethics.

The general principles that guide care for individual patients are the duty to help the sick and respect their autonomy. The general principles that guide public health ethics are concern for the common good and justice. In the current crisis, these principles all come into play. We are in this together. Even if the personal risk for an individual is not great, the risk to the common good is immense. But the measures taken to mitigate the effects of the virus must be just and fair.

The duties for the general public are not arbitrary. They might seem mundane, but they are important and ought to be considered truly ethical duties. Obey the rules: We owe this to each other. Wash your hands. Keep six feet away from strangers. Don’t shake hands with, kiss or hug strangers or acquaintances. Disinfect surfaces where the coronavirus might linger. Self-quarantine if you become sick. Call or email your doctor through an encrypted system or telemedicine connection.

Unless you are experiencing life-threatening distress, don’t rush to the emergency room where you could infect people having heart attacks or complications of cancer. Don’t hoard food, disinfectant wipes, or toilet paper. Don’t spread false and alarming rumors on social media.

Thursday, February 6, 2020

Whither Bioethics Now?: The Promise of Relational Theory

Susan Sherwin and Katie Stockdale
International Journal of Feminist 
Approaches to Bioethics 10 (1): 7-29. 2017.


This article reflects on the work of feminist bioethicists over the past ten years, reviewing how effective feminists have been in using relational theory to reorient bioethics and where we hope it will go from here. Feminist bioethicists have made significant achievements using relational theory to shape the notion of autonomy, bringing to light the relevance of patients' social circumstances and where they are situated within systems of privilege and oppression. But there is much work to be done to reorient bioethics so that it is capable of addressing some current public health challenges. We argue that relational theory holds promise for beginning this work.

Here is an excerpt:

One reason to think that it is important to see feminist relational theory as the shaping sensibility through which other normative concepts and ideals can be understood is that a relational lens enables us to see the ways in which the very possibility of solidarity can depend on whether social, political, and economic circumstances make possible the choices and actions that are constitutive of solidarity. For example, drawing upon feminist conceptions of relational personhood and autonomy, author Susan Sherwin (2012) points out that the choices and actions available to individuals are bound up with the choices and actions of agents at other levels of human organization, such as international bodies, corporations, social groups, and governments. Since moral responsibility is limited to what agents actually can choose and do, moral responsibilities across all levels of human organization are intertwined and thus also relational.

The article is here.

Thursday, December 5, 2019

How Misinformation Spreads--and Why We Trust It

Cailin O'Connor and James Owen Weatherall
Scientific American
Originally posted September 2019

Here is an excerpt:

Many communication theorists and social scientists have tried to understand how false beliefs persist by modeling the spread of ideas as a contagion. Employing mathematical models involves simulating a simplified representation of human social interactions using a computer algorithm and then studying these simulations to learn something about the real world. In a contagion model, ideas are like viruses that go from mind to mind.

You start with a network, which consists of nodes, representing individuals, and edges, which represent social connections.  You seed an idea in one “mind” and see how it spreads under various assumptions about when transmission will occur.

Contagion models are extremely simple but have been used to explain surprising patterns of behavior, such as the epidemic of suicide that reportedly swept through Europe after publication of Goethe's The Sorrows of Young Werther in 1774 or when dozens of U.S. textile workers in 1962 reported suffering from nausea and numbness after being bitten by an imaginary insect. They can also explain how some false beliefs propagate on the Internet.

Before the last U.S. presidential election, an image of a young Donald Trump appeared on Facebook. It included a quote, attributed to a 1998 interview in People magazine, saying that if Trump ever ran for president, it would be as a Republican because the party is made up of “the dumbest group of voters.” Although it is unclear who “patient zero” was, we know that this meme passed rapidly from profile to profile.

The meme's veracity was quickly evaluated and debunked. The fact-checking Web site Snopes reported that the quote was fabricated as early as October 2015. But as with the tomato hornworm, these efforts to disseminate truth did not change how the rumors spread. One copy of the meme alone was shared more than half a million times. As new individuals shared it over the next several years, their false beliefs infected friends who observed the meme, and they, in turn, passed the false belief on to new areas of the network.

This is why many widely shared memes seem to be immune to fact-checking and debunking. Each person who shared the Trump meme simply trusted the friend who had shared it rather than checking for themselves.

Putting the facts out there does not help if no one bothers to look them up. It might seem like the problem here is laziness or gullibility—and thus that the solution is merely more education or better critical thinking skills. But that is not entirely right.

Sometimes false beliefs persist and spread even in communities where everyone works very hard to learn the truth by gathering and sharing evidence. In these cases, the problem is not unthinking trust. It goes far deeper than that.

The info is here.

Saturday, November 3, 2018

Just deserts

A Conversation Between Dan Dennett and Gregg Caruso
Originally published October 4, 2018

Here is an excerpt:

There are additional concerns as well. As I argue in my Public Health and Safety (2017), the social determinants of criminal behaviour are broadly similar to the social determinants of health. In that work, and elsewhere, I advocate adopting a broad public-health approach for identifying and taking action on these shared social determinants. I focus on how social inequities and systemic injustices affect health outcomes and criminal behaviour, how poverty affects brain development, how offenders often have pre-existing medical conditions (especially mental-health issues), how homelessness and education affects health and safety outcomes, how environmental health is important to both public health and safety, how involvement in the criminal justice system itself can lead to or worsen health and cognitive problems, and how a public-health approach can be successfully applied within the criminal justice system. I argue that, just as it is important to identify and take action on the social determinants of health if we want to improve health outcomes, it is equally important to identify and address the social determinants of criminal behaviour. My fear is that the system of desert you want to preserve leads us to myopically focus on individual responsibility and ultimately prevents us from addressing the systemic causes of criminal behaviour.

Consider, for example, the crazed reaction to [the then US president Barack] Obama’s claim that, ‘if you’ve got a [successful] business, you didn’t build that’ alone. The Republicans were so incensed by this claim that they dedicated the second day of the 2012 Republican National Convention to the theme ‘We Built it!’ Obama’s point, though, was simple, innocuous, and factually correct. To quote him directly: ‘If you’ve been successful, you didn’t get there on your own.’ So, what’s so threatening about this? The answer, I believe, lies in the notion of just deserts. The system of desert keeps alive the belief that if you end up in poverty or prison, this is ‘just’ because you deserve it. Likewise, if you end up succeeding in life, you and you alone are responsible for that success. This way of thinking keeps us locked in the system of blame and shame, and prevents us from addressing the systemic causes of poverty, wealth-inequality, racism, sexism, educational inequity and the like. My suggestion is that we move beyond this, and acknowledge that the lottery of life is not always fair, that luck does not average out in the long run, and that who we are and what we do is ultimately the result of factors beyond our control.

The info is here.

I clipped out the more social-psychological aspect of the conversation.  There is a much broader, philosophical component regarding free will earlier in the conversation.