title: Health incentive research and social justice: does the risk of long term harms to systematically disadvantaged groups bear consideration?
abstract: The ethics of health incentive research-a form of public health research-are not well developed, and concerns of justice have been least examined. In this paper, we explore what potential long term harms in relation to justice may occur as a result of such research and whether they should be considered as part of its ethical evaluation. 'Long term harms' are defined as harms that contribute to existing systematic patterns of disadvantage for groups. Their effects are experienced on a long term basis, persisting even once an incentive research project ends. We will first establish that three categories of such harms potentially arise as a result of health incentive interventions. We then argue that the risk of these harms also constitutes a morally relevant consideration for health incentive research and suggest who may be responsible for assessing and mitigating these risks. We propose that responsibility should be assigned on the basis of who initiates health incentive research projects. Finally, we briefly describe possible strategies to prevent or mitigate the risk of long term harms to members of disadvantaged groups, which can be employed during the design, conduct and dissemination of research projects.
authors.affiliation: Department of Philosophy, LMU, University of Munich, Germany.|Institute of Biomedical Ethics and History of Medicine, University of Zurich, Switzerland.
authors.forename: Verina
authors.initials: V
authors.lastname: Wild
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, USA.|School of Population and Global Health, University of Melbourne, Australia.
authors.forename: Bridget
authors.initials: B
authors.lastname: Pratt
mesh_terms: D002986:Clinical Trials as Topic / Q000941:ethics*; D003906:Developing Countries; D017408:Guidelines as Topic; D006801:Humans; D033181:Information Dissemination / Q000941:ethics; D009042:Motivation; D011634:Public Health / Q000191:economics / Q000941:ethics; D012052:Reimbursement, Incentive / Q000941:ethics*; D012107:Research Design; D012109:Research Support as Topic; D012935:Social Justice; D012941:Social Responsibility; D035862:Vulnerable Populations
keywords: Behavioural Research; Distributive Justice; Policy Guidelines/Inst. Review Boards/Review Cttes.; Public Health Ethics; Research Ethics