Letter From A Bioethecist


Dear Harlon,

You advocate forming an argument between ethics and the social determinants of health – which is so important. Ethics can be transformed into evidence and there is a growing body of evidence to support its inclusion – it is an uphill battle however. Public health programs can benefit from the contribution that addressing social determinants of health can make to achieving health targets. While developing an economic rationale to work on social determinants of Health is ultimately what will get the powers that be join in and spur on change, there should be a greater ethics voice that guides these rationales, so that existing inequalities in the system are not perpetuated. This is the kind of work that Genome Canada is trying to do with funding of new large scale scientific research. As another example to illustrate my same point, Jeremy Sugarman has often been credited with saying that research ethics includes, but is not limited to the application of research methods in the social sciences (such as anthropology, epidemiology, psychology, and sociology) to the direct examination of issues (treatment of participants for example) in research ethics. As a real world application, one might see a large research institution requiring that trainees funded by training grants should receive instruction in the responsible conduct of research. Responsible training leads to greater research participant protection and empowerment. This kind of initiative could be seen emerging from from many of the atrocities which have occurred in research. In my mind you only need one bad experimental process to ruffle feathers and cause public outrage. While numbers are important for generalization of research findings, it is the qualitative approach to experiment, how it is done, what is underlying what is being observed that are just as important. 
Secondly, the principles of ethics are often broadly listed as:
beneficence – compassion; taking positive action to help others; desire to do good; good patient advocacy.
nonmalificience – avoidance of harms. 
disrtibutive justice – an equal and fair distribution of resources, based on analysis of benefits and burdens of decision. Justice implies that all citizens have an equal right to the goods distributed, regardless of what they have contributed or who they are. Equal access to health care, sanitation clean water for example. 
autonomy- agreement to respect another’s right to self-determine a course of action; support of independent decision making. 
A bit more detail is included in this link I have copied for your convenience. These principles vary in how they are represented in different theories of ethics, but should serve as a general base before delving into theory. 
I am no expert, but just a few thoughts based on your ethics discovery so far. I hope this encourages you to continue to keep that ethics passion alive and help you formulate arguments between ethics and social determinants of health.