What money can't buy

Since writing about Michael Sandel earlier this month, his new book, “What Money Can’t Buy” has been published.  In suggesting that we have become a market society (instead of just being a market economy), he argues that the ‘market triumphalism’ that marks politics in western democracies coincides with a ‘moral vacancy’ in public debate and ideas. In short, we have lost the plot in terms of having a moral compass by which to make decisions. This is due to money (or the market) distorting the direction of public life. He warns of what type of society we will become if we allow all decisions to be made by monetary value and economics rather than relying on social norms or civic values.  However, he also gives examples where people do want their society to be governed by what is right rather than what is profitable – hospitals or schools for example are not viewed by the populace as fulfilling their purpose if they are primarily for profit. His enquiry questions how economics has been able to position itself as a value-neutral science, which itself has contributed to a sense of the infallibility of ‘market logic’.

The concern with the idea that everything is for sale and that everything has a monetary value comes at the same time as a new WHO report on the illegal trade in kidneys.  An estimated 10,000 black market operations happen annually in human organs, 75% of which are kidneys. The report shows the huge profits that can be made, and whilst the illegal trade in human organs was falling in 2006-7, it is now increasing again. The Treaty of Istanbul was meant to have put a stop to this illegal trade but there are still people advertising for donors, such as in China. Poor people can earn up to £2,500 for donating a kidney, whilst the wealthy can afford the many more thousands of pounds charged for a transplant. There is a huge unmet demand for kidneys – something that healthier lifestyles and more upstream interventions might prevent.  Where health is bought, someone has to pay!

Some of these trends make it even more imperative that the movement within health promotion to work with civic associations is speeding up, so that civic values can predominate and counter the triumph of the market. There is a huge interest at present on how to engage with civil society for the betterment of public health, and on what makes a ‘good citizen’. According to Kubow et al (2000:134), “effective citizenship first requires the internalisation of a set of civic ethics or values”; the difference between a good person and a good citizen is due to the latter’s engagement with civic society, contributing in some way to the public good.  It’s virtuous to be involved in community action, and it transcends self-interest or monetary reward.  This participative citizenship, according to Kymlicka and Norman (1995:293), holds the “intrinsic value of political participation for the participants themselves”.

What motivates some people to engage with others for the public good, whilst others do not, is worthy of investigation. We were reminded of this during this week as we held an expert symposium as part of our Peers in Prison Settings Project (see www.leedsmet.ac.uk.pips). Our research centres on a systematic review to assess the efficacy of peer approaches in prison, and it raises the question of why some offenders volunteer to become peers, either as part of Listener schemes, or in other capacities as mentors and educators. They may be motivated by gaining rewards and more privileges, but many are motivated simply by a wish to contribute.  As such, we are also assessing the effect on these volunteers, as they may gain as much as those they are mentoring or otherwise helping. The project runs for a year, from February 2012 to February 2013, and should contribute to policy within prison settings.

Topically, the question of whether prisoners should have the right to vote, a basic right of any citizen, came into the news this week.  The UK government’s view is that prisoners have lost their right to vote by virtue of their conviction. It would seem that an opportunity has been lost here for education on citizenship within prison.

References:

Kubow, P., Grossman, D., & Ninomiya, S (2000) Multidimensional citizenship: Educational policy for the 21^st century, in Cogan, J. & Derricot, R. (eds.) Citizenship for the 21rt century: An international perspective on education, Kogan Page, London, 131-150

Kymlicka, W., & Norman, W., (1995) Return of the Citizen: A survey of recent work on citizenship theory, in Beiner, R. (ed.) Theorizing Citizenship, State University of New York Press, Albany, NY, 283-322

Ethical thinking in health promotion

This week I taught a session Ethics in health promotion practice, on our MSc Public Health – Health Promotion.  Ethics, of course permeates the course – ethics is at the heart of deciding what kind of society we want to create, and health promotion is all about creating the kind of society in which health justice is available for all.  Previously, we have considered ‘big picture’ ethics, with issues of inequity, justice and so on, and also the practical issues facing health promoters in designing their programmes, such as use of coercion, fear appeals, how to work ethically with communities and so on. This session focused more on the processes of ethical reasoning. We therefore started by considering the link between critical thinking and ethical reasoning with a useful guide being:

› http://www.criticalthinking.org/files/SAM-EthicalReasoning2005.pdf

We also took a look at the work of one of the most prominent ethical thinkers, Peter Singer, who in this video ponders why some people but not others feel that the level of wealth enjoyed by the super rich is a moral outrage:

› http://www.youtube.com/watch?v=gVViICWs4dM&feature=related

Most of the session though focused on the work of Michael Sandel, whose series of public ethical debates are currently being aired on BBC Radio 4:

› http://www.bbc.co.uk/podcasts/series/r4sandel

He feels that the philosophy behind current issues is not explicit, and he has tried to develop the lines of reasoning that it would be useful to take to arrive at decisions.

The reason that this broadcast as useful for us, apart from exposing the principles of ethical reasoning, was that it took the issue of whether we should bribe people to be healthy. The discussion started by considering whether people who are obese and overweight should be given money to lose weight.

He used a variety of means – dialogue, using evidence, listing objections and the case for, giving similar but different cases and really defining terms – to arrive at a series of principles. The discussion ranged over the fact that we do in effect use incentives – e.g. taxing cigarettes – although giving people money to lose weight is in effect rewarding previous ‘bad’ behavior. What about all the people who do promote their own health without being given any inducements? There was moral repugnance at paying female drug addicts if they agreed to be sterilized, on the basis that they were not in a ‘proper place’ to make free decisions. But opinion was divided about whether giving money to the overweight was ethicaly acceptable - for one in the audience, it had worked. 

Some felt that a bribe was a more honest word that an incentive, though one participant felt that a bribe is something that goes against a moral code, whereas an incentive doesn’t.

Summing up, Sandel argued that paying people implicitly goes against other values, such as freedom of choice, and also crowds out other learning, such as the intrinsic value of carrying out an activity. 

The podcast is well worth listening to.

As it happens, this week our new external examiner, Dr.  Peter Duncan came to Leeds Met for our exam board. He is also a leading writer on ethics in health promotion, having published a lot with Alan Cribb. Peter works at King’s College London:

http://www.kcl.ac.uk/sspp/departments/education/people/academic/duncanp.aspx

His publications can be seen at:

http://rg.kcl.ac.uk/staffprofiles/staffprofile.php?pid=1813

Peter joins a distinguished list from the epistemic health promotion community who have acted as external examiners in the past.  (For those unfamiliar with higher education, an external examiner scrutinises the marking of student work, and looks at student assignments to make sure they are of a similar standard to that in other Universities). For the last five years, our external was Angela Scriven, an academic working at Brunel University, and a prolific writer and editor of key health promotion books: 

http://www.brunel.ac.uk/shssc/people/health-studies-community-nursing/angela-scriven

Before that, Jane Wills occupied the post of external examiner. She is perhaps most well known for her introductory book on health promotion, written with Jennie Naidoo, but she has written many other papers and books too. She works at the University of the South Bank in London:

http://www.lsbu.ac.uk/hsc/research/ipcph.shtml

This linking of academic health promotion experts brings added dimensions to the course.  For the last five years I have acted as external at the University of the West of England in Bristol and other colleagues play this role elsewhere. It remains to be seen whether  having a particular person as external affects students’ reading.  Maybe we will see more students reading Peter’s work on ethics and health promotion!