Merritt Maria W, Sutherland C Simone, Tediosi Fabrizio
Johns Hopkins Berman Institute of Bioethics and Department of International Health, Johns Hopkins Bloomberg School of Public Health.
Swiss Tropical and Public Health Institute and Universität Basel.
Public Health Ethics. 2018 Jul 18;11(3):275-292. doi: 10.1093/phe/phy013. eCollection 2018 Nov.
We sought to assess formally the extent to which different control and elimination strategies for human African trypanosomiasis (Gambiense HAT) would exacerbate or alleviate experiences of societal disadvantage that traditional economic evaluation does not take into account. Justice-enhanced cost-effectiveness analysis (JE-CEA) is a normative approach under development to address social justice considerations in public health decision-making alongside other types of analyses. It aims to assess how public health interventions under analysis in comparative evaluation would be expected to influence the clustering of disadvantage across three core dimensions of well-being: agency, association and respect. As a case study to test the approach, we applied it to five strategies for Gambiense HAT control and elimination, in combination with two different other evaluations: a cost-effectiveness analysis and a probability of elimination analysis. We have demonstrated how JE-CEA highlights the ethical importance of adverse social justice impacts of otherwise attractive options and how it indicates specific modifications to policy options to mitigate such impacts. JE-CEA holds promise as an approach to help decision makers and other stakeholders consider social justice more fully, explicitly and systematically in evaluating public health programs.
我们试图正式评估针对人类非洲锥虫病（冈比亚型昏睡病）的不同控制和消除策略在何种程度上会加剧或减轻传统经济评估未考虑的社会劣势情况。强化正义的成本效益分析（JE - CEA）是一种正在发展的规范性方法，旨在与其他类型的分析一起，在公共卫生决策中考虑社会正义因素。它旨在评估在比较评估中所分析的公共卫生干预措施预计将如何影响福祉三个核心维度（能动性、关联性和尊重）上劣势的聚集情况。作为测试该方法的案例研究，我们将其应用于冈比亚型昏睡病控制和消除的五种策略，并结合另外两种不同的评估：成本效益分析和消除概率分析。我们已经证明了JE - CEA如何突出了原本有吸引力的选项对社会正义产生不利影响的伦理重要性，以及它如何指出对政策选项进行具体修改以减轻此类影响。JE - CEA有望成为一种帮助决策者和其他利益相关者在评估公共卫生项目时更全面、明确和系统地考虑社会正义的方法。
