title: Disadvantaging the disadvantaged: When public health policies and practices negatively affect marginalized populations.
abstract: Public health is intimately related to social justice, which is why practice and research in the field seek to improve the social determinants of health. Despite the best intentions of those working in public health, however, some policies and practices inadvertently further disadvantage pre-existing marginalized populations. In this paper, we provide a diagnosis of possible reasons why this phenomenon might occur. We posit that the challenges associated with further marginalizing certain populations stem from a) not acknowledging the normative aspects of apparently objective data, b) a misunderstanding and an uncritical alignment of public health goals with the ethics theory of utilitarianism, and c) assuming that those working in public health might be able to fully understand the experiences of marginalized populations. It is our view that the trend of public consultation with marginalized persons, the explicit teaching of ethics and philosophy of science in graduate departments of public health, and the increased use of health equity impact assessments might help protect against public health policies and practices that disadvantage marginalized populations.
authors.affiliation: Dalla Lana School of Public Health Joint Centre for Bioethics University of Toronto. diego.silva@utoronto.ca.
authors.forename: Diego S
authors.initials: DS
authors.lastname: Silva
authors.forename: Maxwell J
authors.initials: MJ
authors.lastname: Smith
authors.forename: Ross E G
authors.initials: RE
authors.lastname: Upshur
mesh_terms: D002170:Canada; D006291:Health Policy; D006703:Ill-Housed Persons; D006801:Humans; D019982:Organizational Case Studies; D015397:Program Evaluation; D015980:Public Health Practice; D012559:Schizophrenia; D012907:Smoking; D062487:Social Marginalization; D035862:Vulnerable Populations
keywords: Vulnerable populations; homeless persons; influenza; schizophrenia; smoking; social justice