Hello and welcome to the She research podcast. I'm your host Diego Silva. Before introducing our guests, I want to acknowledge that we're recording on the unceeded country of the Gadigal people of the Eora Nation this is and will continue to be Aboriginal land and I pay my respects to those who have and continue to care for country. And without further ado, I'm really happy to welcome today. Dr. Kathryn McKay, Kate McKay a voice that you'll recognise on this podcast. Although today she's here as a guest. She's going to be speaking to us about her recently published paper, Public Health, Virtue Ethics. Welcome, Kate.
Thanks, Diego.
Really excited to have you with us. I've been sort of following you in this paper along for a few years now. So it's really great to see it up and running. And I know that you're working on new stuff kind of growing from this, we'll touch on that at some point as well. But to begin, I was wondering if you could just tell us a little bit about the paper. What's the summary of the paper about?
Yeah, so the summary of the paper is, that I'm interested in developing a virtue ethics for public health. And there's been a little bit of work in this area. So this paper takes a couple of recent approaches to incorporating virtue ethics into public health ethics, and sort of gives friendly critiques of them sort of says, what's good about them, what can be improved upon, and then I provide my own account. And essentially, I think that because public health is the sort of thing that operates at the whole community level, either entire groups or entire populations, that if we're going to do virtue ethics for public health, it has to also be at the population, level community level. And so that kind of means bringing virtue up one level, not focusing on the individual, but focusing on the institution and the structures of social life.
Right. Why should we care about virtues at all in public health?
Yeah, I think that's a very good question, because you might just think, well, the reason why virtue hasn't been done in public health ethics is because it's not relevant here. I think that's a mistake. I think that public health ethics is a really important part of how we think about public health and agencies that are working at the broader governmental level. They're talking about what impacts our health, beyond just the physician patient relationship, or the context of medicine. And mostly, public health ethics is focused on things like coming up with good consequences, or improving health equity. So justice concerns, and consequential concerns are utilitarian sometimes especially. And I think that both of those are important. Of course, we do want good consequences and of course, we do want justice. And those are important, and human rights are an important part of this, too. So all of that's true. What I think that virtue adds and why I think it's important is because it can help us to think about how these things are achieved, not just that we achieve them, it can help us to think about what kind of justice we want. And it can also help us to think in more rich, richer terms, I guess, about what public health is doing, when it's engaging in its different kinds of campaigns or initiatives or laws or whatever it's doing. Because public health has a really significant role in structuring social or political life. It's doing a ton of stuff in the background that sometimes we notice and sometimes we don't. Sometimes we notice ok in the context of COVID. But sometimes we don't in the context of food hygiene, and surveillance and important sanitation measures, routine vaccination programs. And I think that it can really help us have a richer understanding of what public health is doing when we can think about these using virtue terms, which have a lot to do with, like, what kind of life do we want to live? What kind of collective life would we like to live?
So you mentioned the fact that your paper is focusing on not the individual level virtues, but sort of this collective virtues? Can you explain a little bit about what that difference is and what that actually looks like?
Yeah, the normal way to think about virtues so far has been thinking about individual character traits. So, a person would become a virtuous person, by habituating themselves towards the virtues and gaining the right kind of disposition towards them. So a person would become generous by practicing acts of generosity but also cultivating within themselves a certain disposition towards being generous. And because this way of thinking about virtues goes all the way back to Plato and Aristotle. The focus has really has been on individuals having better characters becoming virtuous agents. And in bioethics, where virtue has appeared, it's been very much focused on either roles, so what's the role of a virtuous physician, for example, or character traits of sort of individual practitioners. And what I want to try to do what I'm starting to do in this paper, and what I'm still working on, is leveling up, I guess, the idea of virtue. So Plato and Aristotle also both had this idea that you could have political or collective virtues. Plato had this idea of the city soul, which was analogous to the personal soul. And so the city soul was actually the the soul of the political community. And it's not just an aggregation of the good virtues of all the individuals, but it's actually the character of the polis itself in in Plato's words. So I'm, I'm sort of thinking about that I'm thinking about how well institutions have certain characters, institutions are a collective agents. And there's some work in this around organisations or agencies, or a lot of work around this and corporations. But these are collective agents, they operate in the world, they make significant changes. And it's already kind of normal for us to talk about them using virtue terms. So it's not uncommon to hear somebody talk about, say, an honest government or a dishonest government. Or maybe you'd say something like, it's a very trustworthy bank, or something like that. And you're basically ascribing this virtuous thing to a collective agent. So that's what I'm trying to do with public health. I'm trying to say, well, public health is a collective agent, it's a very powerful collective agent, actually. And public health could is the sort of thing that sets the groundwork in many ways for what our life looks like together. So when it's doing that, it should be focused on what kind of virtues it's enabling in society. So is it making it easier for us to be compassionate toward each other? Is it making it easier for us to do things that are conducive to justice? Or is it supporting injustice in certain ways? An example could be that it's supporting oppression of different communities in different ways. And I don't think that public health means to so I don't want to sound like I'm being too harsh on public health here. But I actually think that not paying enough attention to the virtues, has, has allowed public health ethics, not to ask certain kinds of questions like this, that might be helpful.
One of the things that you discussed in the paper that I think is well worth picking up on and builds off some of the response that you just gave was this idea of responsibility and agency of the individual versus kind of what we expect at us more societal level. I was wondering if you could sort of build on that a little bit and explain to the listeners, I guess, you know, part of that motivation in terms of focusing on that institutional level virtue and what that does or doesn't do when we're thinking about sort of behavior change, or other sorts of things that are sort of bread and butter of Public Health at the individual level?
And I think, to go slightly off track for a second, but to bring it back around, someone whose work I really respect is Iris Marian Young, and she wrote about the structures of justice, I think there's a whole field in political philosophy that's really accustomed to thinking about justice as structural. And justice is then not just a matter of personal responsibility, because it couldn't be, justice actually, is something that's achieved or undermined via the collection of a bunch of individual choices, which in themselves are kind of like not problematic, you know, you just you can't really find anything unjust about like a person making a mistake or making a particular decision in their world. Rather, you have to look at the sum of all of the decisions. So Iris Marion Jung has this view on justice where she says, You know, it's just injustice can be the product of a bunch of people doing their best, which is perhaps paradoxical a bunch of people doing their best trying to be moral trying to treat people well, but living within a system of rules, and customs, that may themselves not be good. So they may be racist. And when we talk about structural racism, we're talking about racism that's baked in to the laws and the customs and the policies, and then the strategies that people use to move around them. So just like we talked about structural injustice, or structural racism, I want us to talk about structural virtues where we could try to address some of those things.
Can you give us an example of what this would look like in practice? Because I think the structural racism one is a really sort of apt one. So in the context of public health, what would be your kind of go to example?
Well, I would call it an example from COVID-19. There were a couple of instances during COVID-19 in Australia, where certain areas were put under harsh lockdowns, purportedly to stem an outbreak. So this happened in Sydney in the neighborhood, or the council, rather, of Canterbury Bankstown. And it also happened in Melbourne around some council towers. And I'm connecting this to structural racism, because those neighborhoods and those towers are places where migrants and sort of non-Anglo white Australians live. And those actions cause sort of immediate outrage caused feelings in those communities of being scapegoated really of something bad happening to them. And the Mayor's from Canterbury and Bankstown have said things about how it really undermined their feeling that they were part of the Sydney community. So this is a time when public health did something that the way that I would sort of diagnose this, I would say that they undermined civic friendship. They undermined a feeling of togetherness, exactly when we needed it. We needed cooperation, we needed forms of solidarity. And rather they enforced a feeling of contempt, of blame casting of, in some cases, stigmatisation of these locales, because they were allegedly, the centers of outbreaks. And then I guess the thing to say about that is like, not only did that undermine collective feelings, not only that undermine friendship between neighborhoods between people and kind of fray the social fabric, it also didn't work.
I hope I laughed away from the microphone enough, but yes, absolutely. Yes. I agree with your conclusion. Yeah.
Yeah. So I think that if public health, you know, in this example, it's a bit of a strange one because it was quarantined, and I'm not going to claim that decisions were not being made in the best circumstances under the pandemic conditions. However, if public health was more accustomed, like if it was more accustomed in public health ethics and in public health practice to think about things like this, to think about what, how is this going to impact civic friendship? How is this going to impact compassion between groups? Then I don't think they would have been so quick to do those things.
Yeah, I actually think it's a great example, for your purposes, because because I think there's a tendency to think in terms of virtues. And I think of some of the examples in your paper or NCD. They're not that they're the non communicable disease kind. But you hit the nail on the head just there at the end, which I think is this idea of what's the pattern and behavior of practice prior to the onset of the pandemic itself? And it wasn't one of compassion. It wasn't one of civic friendship. Is that in so it's, we talked, I talked about this with like, policymakers in the context of trust, we need to build why would communities trust us when we're going in Well, it's, you know, well, it's an emergency. So people are kind of scared. But be Have you done anything to build trust prior to the onset of the pandemic itself? And the answer is not really. So I think this kind of builds on a little bit of the these are the virtues that we need to build, even during peacetime, as it were, during non pandemic times for the sake of pandemic preparedness. So whoever is listening to this, and is going to be part of royal commissions in Australia and abroad, I think there's a role for virtue here.
I think that's right. And can I just build on that for a sec, because I think you've mentioned something that's really important about virtue. And I mentioned this in relation to individuals. But the point behind virtue is that it's something that you work on for a long time, and you develop a disposition, right? So the institution would need to develop this kind of disposition. And that's exactly what you were just mentioning, you do it during peace times. And then, when a crisis hits or something like that, you've already developed the disposition, it's already a well formed part of how public health does its practice. Yeah.
It's so funny, because we see this in, I love sports, we see this in sports, right? The idea of how does somebody calm their nerves, when they're hitting a foul shot at the end of the game, and you know, game seven of the championship? Well, because they've practiced, practiced, practiced. And yet we don't actually kind of move this to other fields of inquiry. Anyways, I digress. I want to go back to a couple of things that you mentioned. So one was I really like this idea of the city soul that you talked about? What is the relationship, in your mind, between public health in the rest of the city soul, as it were? In other words, where does public health sit in virtue to the relative to the other myriad of things that a state does and that its citizens do?
This gets into work that I'm developing right now. And I think I could go on about it at length, so I'll try to keep it brief. I am quite attracted to a Nobel winning economists, taxonomy. His name is Oliver Williamson, he's got this great taxonomy of institutions and their structures. And so it's a four part four part taxonomy. At level one, you have socially embedded norms, customs, religion, things like this. At level two, you have the operations of formal structures, government, constitutions, laws, formal policies. At the third level, you have gameplay governance, you have strategy, negotiation. And at level four, you have interactions between people market level interactions between people. So on this kind of taxonomy, public health is a level three public bureau. That means that it's involved in strategy, how to get something done within the formal rules that are set by the Constitution or the laws. Public health is interesting because it has a couple of features that it only shares with one or two other level three institutions like public health can trigger police power. Public health also has a more direct feedback to government for policymaking and stuff like that. But nonetheless, it's at that kind of level three spot where it's putting a lot of downward force on the individual level, transactions sort of person to person. So it exerts a lot of force over, for example, the kind of choices that people make day to day. When public health wants to do something like a particular initiative. It often has a campaign component. It wants to change behavior, as you said at the outset, so through the campaign, the mechanism of the campaign is trying to change, negotiate the sort of formal structures and make people do something different. So public health is interacting in a really big web of different institutions, some of them are very, very slow to change, like our customs and traditions and religions. And then some of them change all the time really fast. And those are market level, you know, person to person transactions, those change constantly. Level three institutions like public health can change quickly, one to 10 years, Williamson says, so we can actually have change happening somewhat rapidly there. And they can exert a lot of pressure, I think, on formal rules, like those sorts of laws and policies that the government puts in place. But it's always going to be working within the boundaries of the Constitution, for example, things like that.
So what about you mentioned compassion, at length in your essay? In what you just sort of described this sort of four part, sort of heuristic? How do we think about compassion? Does it does it permeate these four levels? Is it something that exists just at level three? Is it something that exists just at public health level? Like, where does compassion sit as a virtue?
Great question. I think that compassion and the other virtues that I mentioned, in this podcast in this paper, civic friendship, justice, even temperance, which Rosier talks about honesty, these are already things of value in our level, one social embedded level. These are things that we already think matter and we already think are good. So public health doesn't have to sort of invent them or invent their value, the value is already there. But, I don't think that the government level of the sort of formal constitution, that's not really a place where virtues have come in, and maybe it's not the right place, I haven't really thought that through yet. But maybe it's not the case that a constitution would contain certain kinds of virtues, although, of course, it contains lots of values. At level three, I think that is a place where structural virtues have an important role to play coming back from level one. So the virtues are already already there. They're just sort of loosely structuring, very informal, we think they matter. But it's just up to basically your moral code. When you're talking about level one. At level three, that's kind of where public health and other institutions like it, could start reinforcing those, essentially, and saying, these are virtues that will lead to a better society. And that's ultimately, the goal, the goal of virtue, political virtue, is to have a better communal life together. So in the interests of having a better communal life, AKA a more just, communal life, we would put structures in place that would actually reinforce the justice that we already think matters and try to exert the downward pressure really, to try to shape how interpersonal relations, interpersonal transactions will go. But then, like I said, I'm not so interested in whether or not those individuals become more just rather, I would like for public health to be thinking about how their actions, their initiatives, their campaigns, all of those level three structures that they're involved in, how those things are communicating, and enforcing either justice or injustice. And if it's injustice, then to really reflect on how they could change that and how to better structure justice.
So then, this is a really good segue to a question that has been sort of in the back of my mind when I was reading your paper. And as, as you sort of been discussing your paper in your in your project, how does this differ from the pre existing literature that applies the capabilities and functioning approach to bioethics and explicitly to public health ethics? A lot of the language seems similar to a non virtue theorists ear. So I was hoping that you can sort of speak a little bit to how you're differentiating what you're doing from from the work that others have done applying Sen and Nussbaum, for example.
Yeah. Well, I would guess that it would probably just be complimentary because the so the focus on of the capabilities for folks who might not be familiar is that instead of focusing, focusing our questions around justice on what people have, which is a sort of typical way of thinking about distributive or social justice, like how much of X resources does each group have, instead of thinking about what we have, the capabilities approach encourages us think about what people are able to do. So what are different groups in society, able to do with whatever resources they have, actually.
And Sen talks about this as converting resources into functionings. So the idea is that, you know, giving somebody a packet of resources is kind of kind of good, but kind of meaningless unless they can actually do something with it. So what can they do? I think that's a really important question and talking about the capabilities, especially around, you know, improving fundamental capabilities like literacy, or the basics, like, do people have housing? Can people feel safe in their neighborhood? Those are all really important. But it's not the same kind of question is asking about virtues, which would rather think about how do we encourage so these groups can do these sort of fundamental things that we think are important? How do we then encourage compassion between those groups so that we don't have something like, extreme polarisation, which is something that we're seeing in society at the moment? How do we prevent them from social fragmentation and contempt, or indifference? How do we build up civic friendship? And so it's kind of like, so it's certainly not to say, at all, that the capabilities wouldn't be welcome.
Yeah, right.
It's kind of project. I think that it's I actually think that this virtue ethics project is not in competition with the other ways of thinking about public health ethics. I think that it's complimentary. And in some ways, it's just asking a question. That's one step back from the other questions that people have been asking?
What, what's motivated you to get to this point in the first place? Like how have you gotten here?
I got here, because I was studying health promotion campaigns. And I studied health promotion campaigns through my PhD after working in health promotion for four years. And I started to notice that the campaign's lacked compassion. And I didn't really have any way to make sense of that. And so I didn't talk about it in my PhD. But it's been bothering me ever since. And I finished my PhD five years ago, but I'm still struggling actually, with how to make sense of this feeling like these campaigns are, yeah, they're not compassionate, rather, they're stigmatising and mean. Yeah. And sometimes I think they've gotten better, actually, since I finished that research. But they often commit something that I mentioned in the paper, which is lifestyle drift, which is where they've got a sort of structural problem in front of them. It could be something to do with food availability, or it could be something to do with lack of infrastructure for physical activity or workplace risks. And they pass the buck down to the individual. And they say, you should make a different choice here. They say, parents, you should pack a different lunch for your children, or you should try to walk to school more, even if there are no sidewalks in your community. So it passes the buck from the government to the the individual. And a lot of health promotion does that, I think. And we can talk at length about why that's unjust, and maybe even why that's an ineffective. There's lots of different analyses out there, of those kinds. And I think those are all true. But I also think that we're that there's something that's not compassionate about them, there's something that's disrespectful, but in a deep way, about them. And that that's the kind of thing that I'm really trying to grasp and to be able to get into words with the virtue work. And that's how I ended up on this path.
So where are you going from here? I kind of feel like you're gonna feel like you're, you're we're back in grad school. And it's like, so what are you going to do with your PhD?
Exactly. So I am working on that paper that I mentioned, where I'm talking about these kinds of levels and where public health fits in these other institutions. So that's something that's under development now. But I'm trying to write a book on this topic, because it's big and unwieldy.
Oh, it's huge. Yeah, yeah.
And there's so many questions, including, like, what does it even mean to say that something is a collective agent, which I said earlier on, you know, and that other people have worked on that idea, but sort of like, what does it mean for public health to be conceptualised that way? And, and then I think there are big questions to answer about like, well, what difference does this make? And I do think that it makes a difference. Like I think all ethical analysis ought to make a difference. It ought to make what we do better, more ethical, but sort of explaining where virtue will complement the other analyses that we have. And basically just trying to flesh out also what it means to have compassion as a collective virtue or to have civic friendship as a collective virtue. So there's a ton of work that I still need to do on this. And that's the program of work for the next couple of years.
Well, I'm looking forward to seeing what comes of it. You're touching on stuff that hasn't been touched before, which I think is really exciting. So I'm really looking forward to how things progress. Yeah, I'm bias but I genuinely am. Thanks very much for joining us, Kate.
I want to thank you for listening to this episode of The she research podcast you can find the paper, Kate's paper that we discussed linked in the Episode Notes along with the transcript. I really encourage you to read it's a great paper. The She pod is produced by sheet network and edited by Regina Botros. You can find our other episodes on Spotify, radio, public anchor or wherever you get your podcasts of quality. Thanks again for listening and see you guys next time.