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On Relative Priorities in African Bioethics

Posted: 21 Mar 2011 11:04 AM PDT

Jacquineau Azetsop (Faculté de Médécine, Teilhard de Chardin), whose work we have noted here on MH Blog in the past, has an excellent new article out in Developing World Bioethics entitled New Directions in African Bioethics: Ways of Including Public Health Concerns in the Bioethics Agenda. Here is the Abstract:

Research ethics is the most developed aspect of bioethics in Africa.

Most African countries have set up Institutional Review Boards (IRBs) to provide guidelines for research and to comply with international norms. However, bioethics has not been responsive to local needs and values in the rest of the continent. A new direction is needed in African bioethics. This new direction promotes the development of a locally-grounded bioethics, shaped by a dynamic understanding of local cultures and informed by structural and institutional problems that impact the public's health, as well as cognisant of the salient contribution of social sciences and social epidemiology which can bring a lasting impact on African local communities. In today's post-Structural Adjustment Africa, where healthcare has been liberalized and its cost increased, a bioethics agenda that focuses essentially on disease management and clinical work remains blind in the face of a structural marginalization of the masses of poor. Instead, the multidimensional public health crisis, with which most African countries are confronted, calls for a bioethics agenda that focuses primarily, but not exclusively, on health promotion and advocacy. Such an approach to bioethics reckons with the macro-determinants of health and well-being and places clinical and research ethics in the broader context of population's health. The same approach underscores the need to become political, not only by addressing health policymaking processes and procedures, but also by becoming an advocacy forum that includes other constituencies equipped with the potentialities to impact the population's health.

Readers of MH Blog can probably guess that I am cheering all the way through this abstract. Research ethics and clinical bioethics have their place in developing world bioethics, but the evidence is robust suggesting that attention to the macrosocial determinants of health -- rather than research or clinical care -- is likely to have the greatest impact on ameliorating disease and human suffering in the developing world. Azetsop is at the vanguard of scholars urging the turn to population-level and public health ethics.

The article is (obviously) highly recommended.