文章基本信息

标题：The Implications of Fundamental Cause Theory for Priority Setting
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作者：Daniel S. Goldberg
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2014
卷号：104
期号：10
页码：1839-1843
DOI：10.2105/AJPH.2014.302058
语种：English
出版社：American Public Health Association
摘要：Application of fundamental cause theory to Powers and Faden’s model of social justice highlights the ethical superiority of upstream public health interventions. In this article, I assess the ramifications of fundamental cause theory specifically in context of public health priority setting. Ethically optimal public health policy simultaneously maximizes overall population health and compresses health inequalities. The fundamental cause theory is an important framework in helping to identify which categories of public health interventions are most likely to advance these twin goals. In 1995, medical sociologists Bruce Link and Jo Phelan published an article titled “Social Conditions as Fundamental Causes of Disease.” 1 Therein, the authors articulated a new theory explaining the criteria for a “fundamental” cause and how socioeconomic conditions qualify. In the interim, the literature on fundamental cause theory (FCT) has steadily grown, with at least 30 articles directly addressing the subject and almost 2000 citations of the original article. Despite the accumulating evidence base, to date, few attempts have been made to analyze the ethical implications of FCT. In this article, I aim to help fill that gap, and specifically argue for the significance of FCT in illuminating critical issues of priority setting and social justice in public health policy. 2 It is important to note that I do not offer a theoretical ethical analysis of FCT. Rather, my emphasis is on the practical ethical problem of priority setting in public health. Priority setting is an inherently value-laden inquiry, which is one reason why it is a central topic in public health ethics. It follows that, to evaluate public health priorities, some grounding in ethical theory is required even where the objective is to explore some of the practical ethical implications of FCT.