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  • ellenmconsidine

Principled Negotiation and the Ethos of Public Health

I am currently reading a book on negotiation called Getting to Yes, written by members of the Harvard Negotiation Project. One of the opening chapters describes positional bargaining: two sides starting from places of disagreement and inching their way closer by making small concessions in turn. The authors describe how problematic this process is: it is inefficient, commonly leads to unwise outcomes (good for neither side), and can harm relationships between parties. Instead, the book presents a case for principled negotiation, founded on separating the people (negotiators) from the problem, focusing on interests instead of positions, inventing options for mutual gain, and insisting on use of objective criteria. Here is a nice summary, for those interested in learning more.


I bring this book up to motivate presentation of my principles. Nearly everything we do in our professional and personal lives is a negotiation of some kind. It is important to establish what we believe so that we can work with others to identify common ground and develop pragmatic solutions to our problems. The imperative of having a clear set of ideals to guide our thoughts and actions is also articulated in my post Envisioning Utopia.


Listening to the news and having conversations with other people, it is clear that there are foundationally diverse beliefs about how human civilization should look, and how we should get there (if the belief is that we aren't already there). I have come to the unoriginal conclusion that the largest discrepancy in how people think and act is described by the weight an individual mentally assigns to their personal freedoms in comparison with the freedoms of others, and to what extent they believe we should rely on governmental authorities to enforce the balance of individuals' freedoms.

This discrepancy has obvious ties to the arena of public health, where large and complex problems such as infectious diseases and environmental pollution bring tensions between individual freedoms and collective sacrifice to light. In fact, while pondering my beliefs and their implications, I ran across the Public Health Code of Ethics by the American Public Health Association (APHA) and determined this to be the most clear articulation of my principles that I have ever found.


Here is an excerpt from this Code of Ethics [page 3, bolding is mine], defining what it means for humans to flourish:


"Flourishing does not focus so much on biological function as on the social conditions of capability and opportunity upon which health itself and many other goods depend. Flourishing refers to what individuals and communities experience when institutional and cultural structures create the opportunity for people to realize a wide range of potential capabilities inherent in all human beings. Flourishing occurs when capabilities for agency, creativity, intelligence, understanding, emotional engagement, and other positive human potentialities take shape in the form of lives well lived. As such, we take a life course perspective that examines public health issues from maternal and child health into old age while recognizing specific vulnerabilities at the extremes of age. The term human flourishing also underscores the relational interdependence among human beings, which is expressed in virtually all social and cultural activity and fits well with the contemporary understanding of the social determinants of health. The preconditions of everyone’s health are communal and systemic, and the field of public health must address them as such. Human flourishing is thus consonant with a social-relational, rather than an exclusively individualistic, interpretation of key values such as human rights, liberty, equality, and social and environmental justice that play a vital role in contemporary public health.


The opposite of human flourishing is not only disease or ill health but also domination, inequity, discrimination, exploitation, exclusion, suffering, and despair: in a word, the stultification and denial of optimal human self-realization and thriving human communities."


From this definition, it is clear that public health is all about giving people opportunities to live fulfilling lives. In fact, it seems that the goal is to maximize individual freedoms, within the bounds of not denying other individuals their freedoms. Later in this document, there is also an explicit discussion of responsibilities towards future generations and other organisms in our environment.


I recognize that these statements may all seem abstract. However, I think that before moving to more specific examples, we need to identify foundational points of agreement, such as the preciousness of self-realization. Then, we can build upon those foundations and deal with higher-level disagreements (e.g. differences in perspective about how we best allow people to self-realize) as they come. In the midst of extreme political polarization and ever-increasing complexity of societal problems, I believe that this kind of principled negotiation is necessary to develop a modern society that is just and sustainable.


If you too are someone who is interested in helping address large and complex issues in our society, I encourage you to articulate: what are your principles?

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