When Ideology Trumps: A Case for Evidence-Based Health Policies

by Bela Fishbeyn

In this issue of The American Journal of Bioethics (AJOB), Adina Preda and Kristin Voigt (2015) investigate the relationship between health policies, social determinants of health, and health inequalities. There is much empirical work demonstrating the correlation between social determinants of health and health outcomes, which establishes a clear relationship between a person’s social and economic status and her health outcomes. What are defined as social determinants of health varies depending on institution or organization, but the World Health Organization (WHO) broadly explains social determinants of health as “the conditions in which people are born, grow, live, work and age” and further, that “these circumstances are shaped by the distribution of money, power and resources at global, national and local levels” (World Health Organization, Social Determinants of Health. n.d.). Preda and Voigt agree that social determinants of health are unavoidably tied to health outcomes but, importantly, they question the resulting normative claims used to inform policy recommendations. Their target article investigates some possible consequences of using a social determinants of health approach as our normative backbone to policy recommendations.

One challenge in dealing with negative health outcomes emerging from social and economic factors is that policies are often driven by ideology and biases rather than evidence. For example, most countries struggle to manage drug addiction though health policies, though drug use rates and treatment options vary from country to country. Many countries have, at one point or another, enacted drug policies that are influenced by ideology instead of evidence, including the depiction of drug use as a character flaw or moral weakness (including our own “Just Say No” campaign circa Nancy Ragan in the early 1980s).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.