Department of Physical Therapy, Dalla Lana School of Public Health, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada.
Glob Public Health. 2011;6(7):777-93. doi: 10.1080/17441692.2011.553627. Epub 2011 May 24.
As interconnections between health, ideology and politics become increasingly acknowledged, gaps in the literature also become visible in terms of analytic frameworks to engage these issues and empirical studies to understand the complexities. 'Critical public-health ethics' provides such an analytic lens. This article presents the results of a critical public-health ethics analysis of the government of Canada's international response to HIV. This qualitative study involved in-depth, semi-structured interviews with 23 experts on Canada's international response over time. Descriptive, thematic and theoretical analyses revealed an underlying dilemma between Canada's philanthropic desire to 'do the right thing' for the broader public good and Canada's commitment to its own economic growth and other forms of self-interest. Related to this tension were four conspicuous areas of silence in the data: (1) The relative absence of moral vocabulary for discussing Canada's duty to respond to the global HIV pandemic. (2) Scant reference to solutions based on poverty reduction. (3) Little awareness about the dominance of neoliberal economic rationality and its impact on HIV. (4) Limited understanding of Canada's function within the international economic order in terms of its role in poverty creation. Our study has implications for Canada and other rich nations through its empirical contribution to the chorus of calls challenging the legitimised, institutionalised and normative practice of considering the economic growth of wealthy countries as the primary objective of global economic policy.
随着健康、意识形态和政治之间的联系日益得到承认，在分析框架方面也出现了文献空白，无法用这些框架来处理这些问题，也缺乏实证研究来理解其中的复杂性。“批判公共卫生伦理学”为此提供了一种分析视角。本文介绍了对加拿大政府应对艾滋病毒的国际反应进行批判公共卫生伦理学分析的结果。这项定性研究涉及对 23 名加拿大国际应对艾滋病问题的专家进行深入的半结构式访谈。描述性、主题性和理论性分析揭示了加拿大在慈善方面的愿望与加拿大对自身经济增长和其他形式的自身利益的承诺之间存在的根本困境。与这种紧张关系相关的是数据中四个明显的沉默领域：（1）在讨论加拿大回应全球艾滋病毒大流行的责任方面，道德词汇相对缺乏。（2）几乎没有提到基于减贫的解决办法。（3）对新自由主义经济理性主义的主导地位及其对艾滋病毒的影响认识不足。（4）对加拿大在国际经济秩序中的作用，即其在创造贫困方面的作用，理解有限。通过对呼吁挑战将富裕国家的经济增长视为全球经济政策首要目标的合法化、制度化和规范性做法的合唱做出的实证贡献，本研究对加拿大和其他富裕国家具有启示意义。
