Welfare Improvement through Nudging Knowledge (WINK)
The WINK project is a joint project of Utrecht University and Wageningen University and it investigates the merits of nudging as a promising and innovative approach to public health and welfare. Nudging translates insights from behavioral research on decision-making to policy-relevant individual choices in order to gently suggest desired choices without infringing upon autonomy of individuals. It is based on the understanding that individual choices are generally driven by heuristic processes to which the presentation of alternatives can be attuned. Nudging refers to a variety of techniques with which governments and other agents (choice architects) may guide individual choices in order to improve decision outcomes. Nudging is based on libertarian paternalism, which respects individual free choice (libertarian) but suggest the most sensible choices to individuals (paternalistic).
The program focuses on public health and healthy lifestyle choices. Nudging is a highly promising alternative to existing policies, as it may be more effective, less intrusive and less costly. However, systematic research is lacking that investigates the effectiveness of various nudges, their normative acceptability and practical feasibility for public policies. This research program is a systematic empirical investigation of these three issues by a multidisciplinary research team, featuring psychologists and communication, ethics and public administration scholars. We will collaborate in a consortium with six of the most important policy actors in the field of public policy, public health and welfare: Netherlands School for Public Policy, Council for Social Development, Netherlands Centre for Ethics and Health, National Institute for Public Health and the Environment, Netherlands Scientific Council for Government Policy, and Municipal Public Health Service Utrecht.
Justice, and health
People in lower socio-economic classes on average have shorter lives and are less healthy than people in higher socio-economic classes and this raises concerns about justice. Indeed, health policies often aspire to improve the health of worse-off groups, or otherwise reduce (socio-economic) health disparities. But if we are interested in reducing health inequalities for reasons of justice, what indicators of health and/or health-related quality of life should we use? In the Netherlands, the average life-expectancy for people in lowest socio-economic groups is 7 years less than for those in the highest class, but health disparities appear much higher (up to 20 years) if more subjective measures of health or quality of life are included.
The core elements of the philosophical PhD study are (a) to clarify the links between various theories of health and quality of life, and (b) to assess the ethical relevance of concepts and measures of health and quality of life from the perspective of theories of health justice. This work interacts with empirical studies carried out at Amsterdam Medical Centre (Karien Stronks) that aim to clarify how people in different socio-economic classes conceptualise health. The research program will result in proposals how health and quality of life should be conceptualised and measured in policies that aim to reduce health inequalities. The PhD study is carried out by Beatrijs Haverkamp and supervised by Marcel Verweij and Bernice Bovenkerk.
Preventing infections in transfusion blood: An ethical analysis of moral responsibility and fairness in public health
The Philosophy group collaborates with the Netherlands blood services organization, Sanquin, to explore ethical issues in relation to blood safety. Donor blood is screened for infectious agents to protect recipients against harmful infections. However, some screening measures may cost more than 1,000,000 per life year gained. There may be good reasons for aiming at very high safety levels in blood transfusion, but what costs are justified in times where public health care faces clear limits and basic health services are rationed? This question requires a better understanding of the scope of moral responsibility of blood services regarding precautions and prevention of infection via donated blood. This question is the background for several ethical substudies that aim to clarify and critically review the normative assumptions behind and arguments about current blood screening policies. Through review of arguments and concepts, taking into account the specific features of blood donation practice, this study will formulate practical criteria for deciding which tests should be included in blood donor screening. The PhD study is carried out by Koen Kramer and led by philosopher Marcel Verweij and medical microbiologist Hans Zaaijer; it is fully sponsored by Sanquin.
PhD student Koen Kramer published his first paper in the journal Transfusion. It is a review of blood safety policies and procedures in 5 Western countries, exploring what concerns are driving current policies regarding the prevention of transfusion-transmittable infections. The study focuses on general policies and on the introduction of hepatitis B virus nucleic acid testing and selected measures against variant Creutzfeldt-Jakob disease, West Nile virus, and Q-fever. Analysis of policy documents show how blood services take a variety of ethical, scientific and societal considerations into account, but decision making processes are often not as transparent as one would expect in democratic societies. The paper was picket out by the journal editors for a special commentary. A second paper "Donor blood screening and moral responsibility: How safe should blood be?" was recently accepted in the Journal of Medical Ethics and will be published later in 2016.