Ethics Grand Rounds Dec. 9, 2022 | 12:15 - 1:30 PM CST Zoom | Free | Open to the Public

An Eco-Structural Approach to Health Ethics

Zoom | Free | Open to the public

Drawing on work from social epidemiologists and health justice philosophers, in this talk I'll describe an eco-structural approach (ESA) to health ethics, and suggest that it has rich potential to advance ethical ideals and practices in many domains within bio-, public, and global health ethics. An ESA, most importantly, can promote health justice, i.e., the capability to be healthy. With a conception of people as ecological subjects, an ESA privileges place, conceiving of people as dwelling in particular and at-the-same-time intersecting, health ecosystems. How do conditions, thinking intersectionally, support or undermine inhabitants’ health, considered generally or as a particular group? Simultaneously, an ESA situates us in social norms and processes, scrutinizing our positioning within social structures. Do these enhance the capability to be healthy for patients, communities, people with a symptom cluster or in a certain socio-economic situation? Do they generate structural health injustice?  We can operationalize an ESA in patient and long-term care by ensuring attendance to conditions in the sites where birthing, healing, liminality, and dying take place, their lights, sounds, smells, material provisions, and physical design. In long-term care, an ESA recognizes design and other place-related features that can be important to health and well-being of residents and workers. It also critiques the “sourcing” of its workforce from low- and middle-income countries for contributing to global health inequities, along with the deprived living conditions of many migrant caregivers. With public health, an ESA sutures sundered relations with health care but also with sectors significant to health, like urban planning, illuminating, for instance, the fact that many minority urban neighborhoods are -- and not accidentally -- treeless heat islands whose inhabitants lack the resources for air conditioning. Relationships between people, animals, land, the built environment, and climate demand our urgent attention, as do racist norms and structures and global economic processes that thwart health justice in highly-patterned, long-ensconced ways. An ESA might envision a revolution in health governance that challenges nationalism, where health systems serve the citizenry, yet also are dependent on human resources seasoned and supplied from legacies of colonial ties, neoliberal economic structures, and labor policies. We might, for instance, design around shared investment in and global coordination of health worker education and deployment, tailored to specific health ecosystems (with priorities set by principles of epistemic justice) to help ensure equity.

Objectives: After this seminar, participants will:

  1. Be able to define social determinant of health
  2. Be able to define structural injustice and structural health injustice
  3. Be able to explain why "place" is important for health


Headshot of Lisa Eckenwiler PhD

Lisa Eckenwiler, PhD is Professor and Chair of the Department of Philosophy at George Mason University, where she teaches courses in bioethics and global health ethics. Her research centers broadly on vulnerability and structural health injustice, with special interests in migration, humanitarian health ethics, and placemaking. She is at work on a book entitled Placemaking for Health Justice, for Routledge Press, and lead editor for Forced Migration and Health Justice, for Oxford University Press. Her previous books include Long-term Care, Globalization and Justice (Johns Hopkins University Press, 2012) and The Ethics of Bioethics: Mapping the Moral Landscape, co-edited with Felicia Cohn (Johns Hopkins University Press, 2007). Her research collaborations are currently focused on trauma and placemaking for humanitarian health ethics; the ethics of closing humanitarian projects; and the integration of refugees and other migrants in destination countries. Professor Eckenwiler is a Fellow of the Hastings Center, and recently served as Vice President of the International Association of Bioethics. She is also founder and current chair of the Migrant Health and Ethics Network (within the International Association of Bioethics) and a founding member of the Independent Resource Group for Global Health Justice.