Abstract
Over the last 12 years the United Kingdom (UK) has seen the introduction of an austerity programme—a fiscal policy—with the primary goal to reduce the government's budget deficit and the role of the welfare system. Between 2010 and 2015 there was an estimated reduction of £14.5 billion in spending, attributable to decreasing the value of benefits and restricting entitlement to benefit claimants. By 2020, there had been an estimated unprecedented £27 billion less spent on welfare compared with spending in 2010. Whilst fiscally-successful at reducing spending, some implemented welfare policies have had direct consequences for people's health, increasing inequalities which have been heavily criticized. Moreover, there is growing concern that this has an intergenerational effect. In this paper, we describe the ethical principles in human research, how these have been considered in public health policy, and the existing evidence of the direct and intergenerational health and welfare consequences of some recent, nationally-implemented welfare policies. We argue that ethical principles, specifically the ethical principle of safety that is applied in all research, should be applied to all public welfare policies to stop the rising inequalities in health we are seeing across generations. We highlight that initial changes implemented to welfare policies as a response to COVID-19 demonstrate that there can be a political and societal perceived value in going further to support individuals and their families during times of adversity, and consider the ethical implications of this.
Highlights
Ethical Principles in Medical Research and PolicySince 1964 when the World Medical Association published the Declaration of Helsinki, specific ethical principles for all medical researchers and research studies involving human participants have been in place
If we look beyond welfare policies to consider interventions from other sectors, the scientific evidence is littered with examples of well-meaning interventions that caused unintentional harm
The focus on ethical practices are largely on developing countries, and whilst welfare policy implementation may learn from methodologies used in other policy areas, it remains an absent factor
Summary
Since 1964 when the World Medical Association published the Declaration of Helsinki, specific ethical principles for all medical researchers and research studies involving human participants have been in place. The Declaration of Helsinki requires physicians to make the health of the patient “their first consideration” and to act “only in the patient’s interest” (quoting the Declaration of Geneva) It requires that those leading research “promote and safeguard the health, well-being and rights of patients,” ensuring their “respect.” It highlights the need to continually check and challenge treatments and tools “through research for their effectiveness, efficiency, accessibility and quality.”. Compensation “for subjects who are harmed as a result of participating in research must be ensured,” and “appropriate arrangements for post-trial provisions” must be made These principles are checked and approved by research ethics committees before any study begins, and these committees have the right to monitor ongoing studies, receiving updates on any serious adverse events. There have been active concerns that health and social care policies which are designed to support people in low-paid employment, unemployment, and disability, to promote inclusion, health, and well-being during times of adversity, in particular, have been ignoring ethical evidence [6]
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