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Canadian Journal of Public Health

, Volume 104, Issue 5, pp e410–e412 | Cite as

Disadvantaging the Disadvantaged: When Public Health Policies and Practices Negatively Affect Marginalized Populations

  • Diego S. SilvaEmail author
  • Maxwell J. Smith
  • Ross E. G. Upshur
Commentary

Abstract

Public health is intimately related to social justice, which is why practice and research in the field seek to improve the social determinants of health. Despite the best intentions of those working in public health, however, some policies and practices inadvertently further disadvantage pre-existing marginalized populations. In this paper, we provide a diagnosis of possible reasons why this phenomenon might occur. We posit that the challenges associated with further marginalizing certain populations stem from a) not acknowledging the normative aspects of apparently objective data, b) a misunderstanding and an uncritical alignment of public health goals with the ethics theory of utilitarianism, and c) assuming that those working in public health might be able to fully understand the experiences of marginalized populations. It is our view that the trend of public consultation with marginalized persons, the explicit teaching of ethics and philosophy of science in graduate departments of public health, and the increased use of health equity impact assessments might help protect against public health policies and practices that disadvantage marginalized populations.

Key Words

Vulnerable populations social justice homeless persons influenza smoking schizophrenia 

Résumé

La santé publique est intimement liée à la justice sociale, ce qui explique pourquoi la pratique et la recherche sur le terrain visent à améliorer les déterminants sociaux de la santé. Malgré les meilleures intentions des personnes qui travaillent en santé publique toutefois, certaines politiques et pratiques défavorisent encore davantage, sans le vouloir, des populations déjà marginalisées. Dans cet article, nous diagnostiquons les raisons possibles d’un tel phénomène. Nous faisons valoir que les difficultés associées à la marginalisation accrue de certaines populations découlent: a) de la non-reconnaissance des aspects normatifs de données apparemment objectives, b) d’une méconnaissance des objectifs de santé publique et de leur réglage sans discernement sur la théorie éthique de l’utilitarisme et c) de l’hypothèse selon laquelle les personnes qui travaillent en santé publique pourraient être capables de comprendre pleinement les expériences de populations marginalisées. Nous considérons que la tendance à la consultation publique des personnes marginalisées, l’enseignement explicite de l’éthique et de la philosophie de la science dans les départements d’études supérieures en santé publique et l’utilisation accrue des évaluations de l’impact sur l’équité en matière de santé pourraient être des mesures de protection contre les politiques et les pratiques sanitaires qui défavorisent les populations marginalisées.

Mots Clés

populations vulnérables justice sociale personnes sans domicile fixe grippe humaine tabagisme schizophrénie 

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Copyright information

© The Canadian Public Health Association 2013

Authors and Affiliations

  • Diego S. Silva
    • 6
    • 1
    Email author
  • Maxwell J. Smith
    • 2
  • Ross E. G. Upshur
    • 3
    • 4
    • 5
  1. 1.University of Toronto Joint Centre for BioethicsTorontoCanada
  2. 2.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  3. 3.Division of Clinical Public HealthDalla Lana School of Public HealthTorontoCanada
  4. 4.Clinical ResearchBridgepoint HealthTorontoCanada
  5. 5.Department of Family and Community MedicineUniversity of TorontoTorontoCanada
  6. 6.Centre for Research on Inner City HealthSt. Michael’s HospitalTorontoCanada

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