Daniel Goldberg (JD/PhD) is Asstant Professor in the Department of Bioethics and Interdisciplinary Studies at the Brody School of Medicine, East Carolina University. His current work concerns issues regarding the social determinants of health, public health policy and chronic illness, and health inequities. In addition, he maintains an active research program in the history of medicine, and focuses primarily on two topics in 19th century America: the history of medical imaging (especially X-rays) and the history of pain without lesion. His doctoral dissertation addressed the undertreatment of pain in the U.S., and he has been actively writing, teaching, and speaking on the subject of pain since 2004.
"Food Policy, the Social Determinants of Health, and the General Insignificance of Individual Responsibility: A Population-Level Bioethics Approach"
Public Lecture Thursday, Nov. 13, 2:00-3:15, Winningham 107
Free and Open to the Public
Abstract: The central claim of this paper is that normative priorities in public health policy can and should be set without considering the extent to which individuals are responsible for their health behaviors. The paper begins by surveying the applied ethics literature on individual responsibility for health, and argues that, while much of this scholarship is helpful in illuminating theoretical analysis on responsibility, it is far less helpful in context of priority-setting in public health policy. There are two central flaws in relying too heavily on a framework of individual responsibility in setting public health policy for risky health behaviors. First, such an approach tends to be insensitive to the social epidemiologic evidence base that shows marked inequalities in the distribution of risk factors in general and of risky health behaviors in particular. Second, such a framework is methodologically individualist. The paper draws on Powers and Faden’s health sufficiency model of social justice to argue that regardless of how we might cash out individual responsibility for health, food policy priorities are clear: collective action on the social determinants of health. Application of the epidemiologic evidence to Powers and Faden’s ethical model justifies such prioritization while avoiding many of the empirical and ethical problems plaguing frameworks that instead focus on individual behavior. These deficiencies can be grouped under the rubric of “methodological individualism,” and the paper examines some of these pitfalls, focusing especially on the devastating (and unequally distributed) consequences of fat stigma. The paper concludes by noting that even a high degree of conceptual confusion as to the concept of individual responsibility does not alter the normative case for prioritizing action on the social determinants of health as to food policy.