By Colten Maertens-Pizzo

On May 3, Archbishop Paglia, president of the Pontifical Academy for Life, spoke to the 17th World Congress of Public Health on the necessity of justice in public health. The congress is hosted by the World Federation of Public Health Associations every two to three years, this year focusing on the role of interdisciplinarity for health equity. Paglia contributed significantly by calling the congress to recognize that public health cannot achieve equity if it lacks an awareness of the need for justice in public health policy.

Paglia began his address by claiming that public health exists in the context of polycrisis, which he defines as “an era in which the balance of the human family to which we were accustomed is breaking up due to a combination of factors concerning ecology, energy, war and all their consequences.” Although some might argue that his tone is alarmist, the message warrants serious reflection. It simply is a fact that human endeavors in many fields today are expanding faster than our ethical considerations. This happens in public health when policies are made without understanding the health situation of the communities they will affect. Paglia identifies three aspects of primary importance regarding the ethics of public health and the justice necessary for ensuring the public’s well-being.

First, there is an inalienable link between the health of the individual and the health of the community, a “reciprocity and interdependence” among persons “that our societies, especially in the West, have tended to forget” because of strong currents of individualism. Such individualism inclines everyone to forget that “every life is a common life, it is life of one another.” The justice of public health, contrary to individualistic inclination, must balance the needs of the individual and the needs of the community, without favoring one side disproportionately. Elements of this problem have shown up in the debates about masking and vaccination.

Second, public health is a composite discipline by nature. As a mosaic of various types of knowledge, public health cannot be properly understood without insights from “biology and hygiene, epidemiology and statistics, … economics and sociology, cultural anthropology and ecology.” Policies and politics surrounding public health, for this reason, must listen carefully to the expertise of these fields to determine the right balance of individual and collective needs.

Third, health and disease are not only natural phenomena. They are, to some extent, “socially constructed and produced.” That is, lifestyles factor heavily into health and disease and need to be taken into account when evaluating the health of a community in a particular region. But more interestingly, Paglia recognizes that the tools used to gauge health and diagnose disease are influenced by culture. These tools are then used to evaluate such essential variables as life expectancy, which then influence the allocation of medicines and treatments for individuals and communities. Any flaw in the initial measurement, then, leads to inequities for individuals and communities, which in turn, may worsen public health.

According to Paglia, justice demands we recognize the social determinants of health, including “variables such as the salary level, the educational qualification, the neighborhood of residence,” and account for their effect on public health. As it stands, “not all lives are equal and health is not protected for everyone in the same way.” For example, he criticized the current regulation of vaccine patents for maintaining health inequality by burdening those who are effectively unable to pay for vaccination. This observation can be taken further and applied to situations where paying for one treatment causes people to forgo other needed preventative measures, which keeps them at the margins of good health, if not in outright poor health.

Thankfully, Paglia ends his message with a hopeful note: “Life expectancy” has a “spiritual meaning [that] also resonates for me.” Although it is a useful term for statistics about death and disease, there is more to the concept of life than objective measures: “What matters is what actually nourishes hope for our lives, both on a personal and community level,” not least of which is an “attitude of mutual care which expresses God’s style in meeting the men and women who (all) are close to his heart, since here is rooted the hope of our living.”

Colten Maertens-Pizzo works for the Archdiocese of Chicago Catholic School System.

Justice Must Inform Public Health