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Philosophy, Public Health, and Liberal Education
The discipline of philosophy is among the oldest and most “traditional” liberal arts fields. Philosophy has changed in fundamental ways, however, and has reinvented itself often in different sociocultural contexts—“Western” and non-“Western”. In this article, I want to suggest some ways that the field can reinvent itself again to contribute productively to the goal of teaching public health to undergraduates. In attending to public health issues, the field can, in turn, strengthen itself as an engaged and compelling liberal arts field that teaches students broadly transferable skills and knowledge. The reinvention of philosophy needed for this transformation can draw on its own approaches in normative, often “applied” ethics, and “social epistemology,”—the latter as represented by such philosophers as Alvin Goldman or Philip Kitcher—as well as by forging enhanced collaborations with the social and biomedical sciences, and other medical humanities.
The feasibility of such efforts depends on many considerations, including overall institutional mission, resources, openness to curricular innovation, faculty and student interest, the nature of an institution’s general education program, and its receptivity to interdisciplinarity. These efforts, I believe, are worthwhile, especially in the area of values and ethics; the field of philosophy offers an approach to understanding public health distinct from approaches provided by other fields, including those in the social sciences.
Conceptions of Philosophy
Philosophy as it functions in contemporary U.S. higher education institutions cannot entirely be confined to its typical philosophy department homeland. Nonetheless, I wish for some institutional definiteness to frame this discussion mainly in terms of how the philosophy department in a contemporary U.S. university might, with extensive collaboration across disciplinary boundaries, contribute to integrative education about public health in undergraduate liberal education. I want to argue that the philosophy department in some U.S. higher education institutions can and should contribute to undergraduate public health education while simultaneously and partly through these contributions continue to pursue a departmental mission as part of liberal education.
Just what philosophy is is itself a matter for controversy. Often, philosophy is identified with a canon of great works and auxiliary writings, but this conception is an oversimplification, and makes philosophy and public health work more difficult than problems-oriented conceptions of the discipline.
How Can Philosophy Departments Advance Public Health Outcomes?
A philosophy department could contribute to public health studies in its own degree programs for its majors and minors, and in philosophy courses for the general education of nonmajors, as well as in more specifically dedicated philosophy courses chiefly intended for nonphilosophy specialists in areas such as the biomedical sciences.
I think it is quite realistic, though not obviously feasible everywhere, for some philosophy departments to offer a philosophy major or minor with a philosophy and public health emphasis, or more modestly, some electives, alongside a more traditionally conceived major or minor. For reasons of limited resources and personnel, the courses might initially —or possibly for a long time —be expected to do double duty as courses for majors/minors and for the general undergraduate student population.
A philosophy department major/minor with a public health emphasis would include at least one course in epistemology or philosophy of science with a focus on general issues about public health, or with a focus on more specific topics, such as case studies of public health problems in the United States or abroad, including AIDS, influenza, obesity, infant mortality, and sex education. While it is often difficult to keep factual and normative issues apart, such topics can be discussed with a greater emphasis on one or the other area. A required normative ethics or politics of public health course could also consider similar issues from the point of view of normative policy positions and their justification. One example of the latter might be a course about the often-asserted right to health care in a U.S. or global context, a course or segment of a course about the normative politics of international and national governmental responses to AIDS, a course or segment about the ethics of biomedical research in less-developed countries, or a course or segment about moral obligations concerning assistance from richer countries about health care in poorer countries. Such a major/minor option should also preferably include auxiliary requirements in statistics and epidemiology, as well as a capstone course with a public health emphasis for the major option.
Philosophy departments could also collaborate with interdisciplinary programs devoted to education of undergraduates about public health; for example, in team-taught courses, philosophy faculty could coteach with public health-related faculty about the sciences, or the normative ethics or legal policy, or the politics of public health areas. Such courses could include study of topics such as health insurance coverage, reproductive health, global health, epidemics, substance abuse, disaster responses, accidents, the pharmaceutical industry, medical informatics applied to populations, societal mental health, and environmental health issues. The academic discipline of philosophy could do all this without compromising its nature.
Philosophy: A Pragmatic Vision
Philosophy can be seen as an activity that includes, besides other areas, the philosophical part of any discipline. Still more generally, philosophy can be thought of as a discipline or interdisciplinary and multidisciplinary activity that examines, evaluates, and helps guide the theory and practice of fundamental features of any human pursuit —public health-related activities, as well as science, medicine, the arts, religion, ethics, law, etc. This pragmatic conception of philosophy does not sharply distinguish philosophy from the activities it helps coordinate. In this way, a reflective public health practitioner, in thinking over fundamental concepts or theories in the field, may be “doing philosophy,” without having a degree in the academic subject of philosophy. Someone with an academic degree in philosophy may also collaborate in such work—including the teaching of undergraduates—with academics in colleges of public health, or as coauthors or members of teams devoted to research or interventions about public health. Thus, if public health as an academic area is thought of as interdisciplinary or multidisciplinary, any of the disciplines involved in it have philosophical aspects that the philosophy department could work on advancing across departmental lines.
Philosophy can also contribute to research in public health and even interventions about public health, though it is currently exceptional for it to do so. Undergraduate research, as well as undergraduate participation in “community engagement” activities, as encouraged by the Carnegie Foundation for the Advancement of Teaching, can be at once philosophically oriented, liberal-arts oriented, and directed at the improvement of public health. The philosophy department in its more traditional forms has not made much use of undergraduate internships or fieldwork-oriented or interventionist research as part of undergraduate liberal education. This is a regrettable limitation of several humanities disciplines. Philosophy could profitably do more to further field experiences, internships, and community engagement by encouraging philosophy majors and minors to do research on environmental health issues, health-care disparities in urban areas, etc., in their immediate community or in more far-flung locales, or through other philosophy department involvement in interdisciplinary program study and community-engagement activities.
One Example: A Philosophical Course about AIDS
An advanced philosophically oriented undergraduate course about AIDS might be useful as a departmental elective for philosophy majors, for a wide range of general education students, and for biomedical sciences majors; it could also serve as a capstone course for some majors.
A course about the social facts as well as the normative ethics and politics of responses to AIDS might include the history of the pandemic, comparative discussions of governmental responses in the United States and South Africa, as well as other countries; the Thabo Mbeki denial of a causal connection between HIV and AIDS; Mbeki’s academic supporters in denial of an HIV/AIDS causal link, such as the biomedical scientist Peter Duesberg of the University of California-Berkeley; discussions of academic research efforts such as NIH-supported studies of the role of circumcision of males in decreasing incidence of infection in certain African countries; the pharmaceutical industry response to the crisis; evaluation of U.S. government assistance to Africa through the President’s Emergency Plan for AIDS Relief (PEPFAR), etc.
There is a question of what philosophy has to add to such a topic. There are a variety of possible answers to this. Arguably, and it is a “philosophical” argument, the AIDS epidemic and other public health-related crises of comparable seriousness raise questions about the moral and political legitimacy of both domestic governments and the global system of international relations, incorporating as it does entities such as the National Institutes of Health; organizations such as the United Nations; subdivisions of the UN, such as the World Health Organization; universities; nonprofits, such as the Gates Foundation and the Clinton Foundation; and so forth. Politicians and philanthropists also seem to understand that public acknowledgment of their rights to command the power and resources they do is furthered by their addressing huge public health problems such as the AIDS pandemic. There would be a “philosophical” dimension to the issues addressed in the course, partly because of the fundamental nature of some of the questions.
Liberal education takes seriously preparation for a student’s social prospects as a free person. Among other things, this preparation can include the student’s prospects as a free citizen, hopefully of a democracy; the student’s role not only as a potentially free citizen in his or her own country, but a free person in global society. Problems about public health are constantly presenting themselves as if they may be purely or almost entirely factual, scientific, technical matters for experts to address, but at their core, many of these problems have a substantial dimension of citizenly or cosmopolitan choice in accordance with critically examined values. Liberal education may, indeed should, have technical, scientific, factual aspects, but it is ultimately more about enabling the student to choose freely, reasonably, and ethically about matters of values.
A big part of both philosophy and liberal education, then, is furthering citizenly and cosmopolitan free choice by clarifying and guiding individual and collective decisions about society. That is why the topic of how society should respond to AIDS or public health crises of similar magnitude cannot be purely or mainly technical or scientific, but must be philosophical and can be central to all students’ liberal education.
Edward Sankowski is a professor of philosophy at the University of Oklahoma–Norman.