Health.Holism.Cosmopolitanism
– building ethical competence for human health –
This text is a contribution for the next issue of the magazine Centerpoint Now published by the World Council of Peoples for the United Nations (issue to be published later this year)
Health is the basic human capacity that makes everything else in life possible. It has physical and psychological aspects, and one’s overall health condition is influenced both by external factors, as well as individual behavior. Thinking in terms of ethics and values with respect to human health thus requires a dual approach.
First, health can be threatened by external manmade phenomena and situations over which individuals have little or no control. Well-known collective health risks typical of industrialized societies are climate change, pollution, industrial use of toxic chemicals, unsustainable food production and consumption, and loss of biodiversity. Deplorable examples of a more timeless nature include miserable living conditions due to a lack of basic logistics for food, drinkable water, shelter and medicine. People living in such settings are also more vulnerable to communicable diseases such as HIV, tuberculosis, malaria and viral hepatitis. However, the Covid-19 virus that spread across the world since early 2020 shows that everyone on earth can be affected (although of course impoverished environments make protection and treatment more difficult). Finally, yet importantly, war and terror do not only harm civilian populations physically and psychologically, they also have devastating long-term effects on health, given their detrimental impact on basic infrastructure.
On the other hand, it seems typical for humans to voluntarily put ourselves in danger. High-risk activities, such as mountaineering, continuously attract people eager to take on the challenge, despite numerous examples of fatalities. The millennia-old enjoyment of drinking alcohol and smoking remains part of modern social life, notwithstanding widespread knowledge of scientifically proven, harmful consequences. In modern times, trans fats and sugar have been added to these seductions, rendering unhealthy diet a major contributor to noncommunicable diseases such as diabetes, cancer and heart disease.
Considering these two dangerous paths for human health – manmade collective health risks that limit individual autonomy, on the one hand, and self-chosen potential self-destructions, on the other – provides a useful point of departure to talk about “ethical competence” as an essential component of fairness in relation to human health governance. Both scenarios present potential harms that can be neither fully known, nor controlled. However, common sense suggests that people will accept a risk they cannot completely know or control so long as they trust that its justification is ‘fair’. Fairness in this context implies the possibility of self-determination in the face of that risk. The New Humanism Project proposes to reformulate this possibility in the form of a human right: ‘the right to be responsible’.
As an enabling right, for collective health risks such as those of climate change or toxic chemicals, ‘the right to be responsible’ essentially means ‘the right to co-decide’ in political decision making for health governance related to these risks. For practices such as alcohol consumption, smoking or mountaineering, ‘the right to be responsible’ means nothing else than ‘the freedom to hurt yourself’. For the Covid-19 virus threat, ‘the right to be responsible’ refers to both possibilities and therefore essentially to the enabling right for all of us: in our social behavior, with the risk of infection, we might not be too much concerned about our own health if we don’t respect the rules of social distancing and hygiene, but we will always put others in danger too.
Fairness with respect to the evaluation and justification of health risks involves a different set ethics and values for the two paths envisaged. For a risk that is taken personally and voluntarily, what matters is that one is correctly informed about what is, and is not yet known about its possible health effects (as for example in the case of alcohol consumption). Access to accurate information enables a deliberation about whether or not to engage in the risky behavior. For collective health risks, fairness is more complex. In the first place, there must be a recognition of the uncertainties that limit an accurate understanding of the risk. Secondly, the various interpretations of all stakeholders should also be taken into consideration. For example, regarding climate change, although there is now scientific evidence of the link between human activity and climate change, fairness demands the recognition of uncertainty regarding how this issue will manifest in the future (making the precautionary principle still the most important policy principle for climate change governance). Indeed, in current governance of climate change, political and economic actors tend to overlook the ‘right to be responsible’ of potentially affected communities. For a collective health risk, deliberation and decision-making should involve society at large, with roles and responsibilities for policy makers, experts, private sector players, civil society representatives, and the general public.
In the New Humanism Project, we state that, to ensure fairness in relation to collective health risks, the focus should be on articulating and enabling the ‘right to be responsible’ of the potentially affected in the governance of those risks. In conclusion:
- Collective health risks such as climate change, pollution, unsustainable food production and consumption and loss of biodiversity are complex social problems underpinned by multiple uncertainties and often incommensurable value judgements. A characteristic of these complex social problems is that they are all interconnected, which means they need to be tackled together, in a holistic perspective. Humans are connected with one another ‘in complexity’. Fairness therefore implies dealing fairly with the complexity that binds us, which, in turn, comes down to adopting reflexivity as an ethical attitude, taking into account one’s own position, interests, hopes, hypotheses, beliefs and concerns.
- With globalization and the interconnectedness of current socio-economic practices, it is clear that collective health risks now have global dimensions. Therefore, collective health risk governance would benefit not only from a holistic, but also from a global perspective in both interpretation and approach. The examples of climate change and unsustainable food production and consumption illustrate that not only politicians, experts or entrepreneurs, but actually all of us, as citizens, have the responsibility to apply a global perspective in evaluating our visions and acts, when we make choices that have an impact on health. As individuals enjoying an acceptable standard of living in our contemporary society, all of our choices with respect to the food we eat, the clothes we wear, the consumer products we buy, the energy we consume, the means of transport we use, and so on, have some effect somewhere else on earth. As a consequence, ethical reasoning with respect to those choices requires that we look beyond our familiar local ‘comfort zones’ and think as ‘citizens of the world’ or cosmopolitans who try to evaluate the consequences of our choices, and are motivated to understand our specific place, role, responsibilities and rights in the bigger picture.
- Our responsibility to adopt reflexivity as an ethical attitude and to reason and act as cosmopolitans essentially leans on our capacity to do so. Understanding the bigger picture, the complexity of collective health risks and the consequences of our acts, roles, rights and responsibilities in relation to them therefore requires ethical competence. Therefore, ‘the right to be responsible’ translates as ‘the right to develop reflexivity as an ethical attitude’ and ‘the right to become a cosmopolitan’. It may be clear these ethical stances require developing reflexivity as an intellectual skill, the ability to see ‘the bigger picture and one’s self in it’ along with one’s interests, hopes, hypotheses, beliefs and concerns. In the New Humanism Project, we argue that ethical competence for reflexivity can be fostered by reforming politics, research and education into interaction methods that are inclusive, pluralistic, transdisciplinary and deliberative. We believe these interactive methods will not only enable more effective governance of collective health risks, they may also be perceived as fair across different sectors of society.
(authors: Gaston Meskens & Silke Van Cleuvenbergen, for the New Humanism Project; with thanks to Shamina de Gonzaga (Centerpoint Now) for reviewing the text and for making useful and valid suggestions)