MacKay Kathryn, Quigley Muireann
Politics, Philosophy, and Religion Department, Lancaster University, Lancaster, UK.
Birmingham Law School, University of Birmingham, Birmingham, UK.
Health Care Anal. 2018 Dec;26(4):380-397. doi: 10.1007/s10728-018-0357-y.
There have been calls for some time for a new approach to public health in the United Kingdom and beyond. This is consequent on the recognition and acceptance that health problems often have a complex and multi-faceted aetiology. At the same time, policies which utilise insights from research in behavioural economics and psychology ('behavioural science') have gained prominence on the political agenda. The relationship between the social determinants of health (SDoH) and behavioural science in health policy has not hitherto been explored. Given the on-going presence of strategies based on findings from behavioural science in policy-making on the political agenda, an examination of this is warranted. This paper begins by looking at the place of the SDoH within public health, before outlining, in brief, the recent drive towards utilising behavioural science to formulate law and public policy. We then examine the relationship between this and the SDoH. We argue that behavioural public health policy is, to a certain extent, blind to the social and other determinants of health. In section three, we examine ways in which such policies may perpetuate and/or exacerbate health inequities and social injustices. We argue that problems in this respect may be compounded by assumptions and practices which are built into some behavioural science methodologies. We also argue that incremental individual gains may not be enough. As such, population-level measures are sometimes necessary. In section four we defend this contention, arguing that an equitable and justifiable public health requires such measures.
一段时间以来，英国及其他地区一直有人呼吁采用新的公共卫生方法。这是因为人们认识到并承认健康问题往往具有复杂和多方面的病因。与此同时，利用行为经济学和心理学（“行为科学”）研究见解的政策在政治议程上日益突出。健康的社会决定因素（SDoH）与行为科学在卫生政策中的关系迄今尚未得到探讨。鉴于基于行为科学研究结果的策略在政治议程的决策中持续存在，对此进行审视是有必要的。本文首先探讨SDoH在公共卫生中的地位，然后简要概述最近利用行为科学制定法律和公共政策的趋势。接着，我们考察这与SDoH之间的关系。我们认为，行为公共卫生政策在一定程度上忽视了健康的社会和其他决定因素。在第三节中，我们研究这些政策可能使健康不平等和社会不公正长期存在和/或加剧的方式。我们认为，这方面的问题可能因一些行为科学方法中固有的假设和做法而更加复杂。我们还认为，个体层面的渐进收益可能不够。因此，有时需要采取针对人群的措施。在第四节中，我们为这一论点辩护，认为公平合理的公共卫生需要这些措施。
