Dr. Eckenwiler describes an eco-structural approach (ESA) to health ethics, suggesting that it should advance ethical ideals in many domains, especially health justice. With a conception of people as ecological subjects, an ESA privileges place, seeing people as dwelling in particular health ecosystems. How do conditions support or undermine health? Simultaneously, an ESA situates us in social norms and processes. Do these enhance the capability to be healthy? Do they generate structural health injustice? We operationalize an ESA in patient care by attending to conditions in the sites where birthing, healing, 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, and also critiques the “sourcing” of its workforce from low-income countries for contributing to global health inequities. With public health, an ESA sutures sundered relations with health care and with sectors significant to health, like urban planning. Relationships between people, animals, land, the built environment, and climate demand attention, as do racist norms and global economic processes that thwart health justice in long-ensconced ways. An ESA might envision a revolution in health governance that challenges nationalism, where health systems serve (some) citizens, yet are dependent on human resources supplied via colonial ties, global economic structures, and labor policies. An ESA might have us design around shared investment in and global coordination of health worker education and deployment, tailored to specific health ecosystems to help ensure equity.
Learning Objectives: After this webinar, attendees will:
- Be able to define social determinant of health
- Be able to define structural injustice and structural health injustice
- Be able to explain why "place" is important for health
This was an Office of Academic Clinical Affairs (OACA) event, hosted by the Center for Bioethics, and co-sponsored by the following U of MN units: Center for Global Health and Social Responsibility, Office of Academic Clinical Affairs; Medical School; School of Nursing; and School of Public Health.
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 the 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.