Dowdy David W, Zwerling Alice A, Stennett Andrea, Searle Alexandra, Dukhanin Vadim, Taylor Holly A, Merritt Maria W
Departments of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada.
MDM Policy Pract. 2020 Apr 26;5(1):2381468320915239. doi: 10.1177/2381468320915239. eCollection 2020 Jan-Jun.
In making policy decisions with constrained resources, an important consideration is the impact of alternative policy options on social justice. Social justice considers interactions between individuals and society and can be conceptualized across domains of agency, association, and respect. Despite its importance, social justice is rarely considered formally in health policy decision making, partially reflecting challenges in its measurement. We define three criteria for considering social justice in health-related policy decisions: 1) linkage of social justice to a measurable construct; 2) ability to reproducibly and feasibly estimate the impacts of a policy decision on the selected construct; and 3) appropriate presentation to decision makers of the expected social justice implications using that construct. We use preliminary data from qualitative interviews from three groups of respondents in South Africa and Uganda to demonstrate that stigma meets the first of these criteria. We then use the example of policy addressing novel treatment regimens for multidrug-resistant tuberculosis and a validated tuberculosis stigma scale to illustrate how policy effects on stigma could be estimated (criterion 2) and presented to decision makers in the form of justice-enhanced cost-effectiveness analysis (criterion 3). Finally, we provide a point-by-point guide for conducting similar assessments to facilitate consideration of social justice in health-related policy decisions. Our case study and guide for how to make social justice impacts more apparent to decision makers also illustrates the importance of local data and local capacity. Performing social justice assessments alongside more traditional evaluations of cost-effectiveness, budget impact, and burden of disease could help represent data-informed considerations of social justice in health care decision making more broadly.
在资源有限的情况下做出政策决策时，一个重要的考虑因素是替代政策选项对社会正义的影响。社会正义考虑个人与社会之间的互动，可以在能动性、关联性和尊重等领域进行概念化。尽管其很重要，但社会正义在卫生政策决策中很少被正式考虑，部分原因是其衡量存在挑战。我们定义了在与健康相关的政策决策中考虑社会正义的三个标准：1）将社会正义与可衡量的结构联系起来；2）能够以可重复和可行的方式估计政策决策对所选结构的影响；3）使用该结构向决策者适当地呈现预期的社会正义影响。我们使用来自南非和乌干达三组受访者的定性访谈的初步数据来证明耻辱感符合这些标准中的第一条。然后，我们以针对耐多药结核病新治疗方案的政策为例，并使用经过验证的结核病耻辱感量表来说明如何估计政策对耻辱感的影响（标准2），并以增强正义的成本效益分析的形式呈现给决策者（标准3）。最后，我们提供了一份逐点指南，用于进行类似评估，以促进在与健康相关的政策决策中考虑社会正义。我们的案例研究以及关于如何使社会正义影响对决策者更明显的指南也说明了本地数据和本地能力的重要性。在对成本效益、预算影响和疾病负担进行更传统评估的同时进行社会正义评估，有助于在更广泛的医疗保健决策中体现基于数据的社会正义考量。
