Abstract
In health promotion discourses, access to medical care is presented as a universal remedy. As a result, ethical considerations are often limited to the issue of equitable access. Yet focusing on access to healthcare hides the issue of access to data needed for scientific development. Putting into place a system for saving lives involves population health monitoring and is founded on scientific rationality. This chapter refocuses political attention from medical intervention to what makes it possible. In doing so, the underlying ethical issue shifts from a concern with universal access to healthcare—considered a right from an equity standpoint—to a discussion of the options and consequences of a type of government based on science. The author puts forward the idea that it is not because it is technically and scientifically possible to do something that it should be done. To illustrate this argument, the chapter discusses the example of The Lancet's project on stillbirths (2011-2030) taken up by the WHO.
TopBackground
In 1942, William Henry Beveridge published Social Insurance and Allied Services in which he developed the idea of universal state-covered social protection for the whole population and for all social risks. Better known as the Beveridge Plan, it proposed a guarantee not only to life, but to a healthy life, associated with the right to health. This model was implemented in England after the Labour Party was elected in 1945, and was thereafter exported throughout the world (Foucault, 2001a). The Beveridge Plan directly influenced the organization of health services in many countries. However, the creation of the World Health Organization (signed in 1946 and taking effect in 1948) under the United Nations charter (ratified in 1945) took the project of universal social protection to a worldwide scale, stating that “The health of all peoples is fundamental to the attainment of peace and security” (WHO, 1948, p. 1) and “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” (WHO, 1948, p. 1). The goal of the WHO is “the attainment by all peoples of the highest possible level of health” (WHO, 1948, p. 2). To achieve this, the WHO considers as a matter of principle that “Unequal development in different countries in the promotion of health and control of disease […] is a common danger” (WHO, 1948, p. 1) and that “The health of all peoples […] is dependent upon the fullest co-operation of individuals and States” (WHO, 1948, p. 1). Henceforth, no political party could disregard health issues and expenses, since the WHO Constitution states that “Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures” (WHO, 1948, p. 1). On this basis, since the end of the Second World War, there has been a shared vision of what population health and individual well-being should be (Rose, 2006).
Key Terms in this Chapter
Form of Scientific Rationality: Forms of reasoning and operations that underpin scientific practice, and which come to be viewed as natural and self-evident. For example, the forms of reasoning in statistical analyses ad taxonomical classification as well as defining, counting, agreeing on equivalences, and creating standards for measuring.
Government: A way to manage people, to shape them so that their thoughts and actions, present, and future can be influenced and guided, including the conduct of oneself.
Quantifying Mechanisms: Mechanisms aimed to establish what exists in the form of numbers; to count, calculate and measure by constituting people (or things) as research objects and based on equivalence conventions.
Promoters: Experts who use discursive strategies and argumentative techniques in order to trigger mechanisms for government based on science, thus perpetuating the form of rationality.
Government Based on Science: A type of government in which power is exerted through science.
Monitoring Mechanisms: Mechanisms that enable researchers to access data, which in turn triggers examination and management procedures, as well as techniques for encouraging and discouraging certain types of conduct.
Intervention Mechanisms: Target mechanisms that identify what must be aimed for and what must be avoided through techniques that direct people’s choices towards standards based on scientific evidence.
Prevention Mechanisms: Mechanisms intended to have an upstream effect on what must be stopped or adjusted by creating standards.
Benevolence: A way of thinking and acting that involves not only caring for, protecting, and fighting to save and improve lives through access to medical care, but also counting life events, population monitoring, and risk-benefit calculations using data needed for scientific development.