METI International, known simply as METI, is a non-profit research organization founded in July 2015 by Douglas Vakoch that creates and transmits interstellar messages to attempt to communicate with extraterrestrialcivilizations. It is based in San Francisco, California.
Overview
METI targets nearby stars and researches the nature of the messages to send. On October 16, 17, and 18, 2017, it sent a message consisting of a scientific and mathematical tutorial to the red dwarfLuyten's Star, just over 12 light years from Earth. The message was sent from a radio transmitter at the EISCAT research facility in Tromsø, Norway.
METI's aim is to build an interdisciplinary community to design
interstellar messages, within the context of the evolution of
intelligence and language.
In May 2016, it convened the meeting “The Intelligence Of SETI:
Cognition And Communication In Extraterrestrial Intelligence” in Puerto
Rico. In May 2018 in Los Angeles, it held “Language in the Cosmos” in conjunction with the International Space Development Conference. to examine the connection between astrobiology and linguistics. On March 22, 2017, it held a workshop in Paris examining the question "What is life?" from an extraterrestrial perspective.
METI also conducts an optical search of extraterrestrial intelligence (SETI).
Its optical observatory in Panama looks for laser pulses from advanced
civilizations. It has examined anomalous stars like the nearby red dwarf
star Ross 128, as well as HD 164595, 94 light years from Earth. None of the searches has yielded evidence of artificial signals.
Criticism
American scientist and science-fiction author David Brin
has questioned "whether small groups of zealots should bypass all
institutions, peer critique, risk appraisal or public opinion, to shout
‘yoohoo’ into a potentially hazardous cosmos" and so force a fait
accompli on humanity.
The zoo hypothesisspeculates on the assumed behavior and existence of technologically advanced extraterrestrial life and the reasons they refrain from contacting Earth. It is one of many theoretical explanations for the Fermi paradox. The hypothesis states that extraterrestrial life intentionally avoids communication with Earth to allow for natural evolution and sociocultural development, and avoiding interplanetary contamination,
similar to people observing animals at a zoo. The hypothesis seeks to
explain the apparent absence of extraterrestrial life despite its
generally accepted plausibility and hence the reasonable expectation of
its existence.
Extraterrestrial life forms might, for example, choose to allow
contact once the human species has passed certain technological,
political, and/or ethical standards. Alternatively, they may withhold
contact until humans force contact upon them, possibly by sending a spacecraft
to an extraterrestrial-inhabited planet. In this regard, reluctance to
initiate contact could reflect a sensible desire to minimize risk. An
extraterrestrial society with advanced remote-sensing technologies may
conclude that direct contact with neighbors confers added risks to
itself without an added benefit. A variant on the zoo hypothesis
suggested by former MIT Haystack Observatory scientist John Allen Ball
is the "laboratory" hypothesis, in which humanity is being subjected to
experiments, with Earth serving as a giant laboratory.Ball describes this hypothesis as "morbid" and "grotesque", simultaneously overlooking the possibility that such experiments may be altruistic, i.e., designed to accelerate the pace of civilization to overcome a tendency for intelligent life to destroy itself, until a species is sufficiently developed to establish contact.
Assumptions
The
zoo hypothesis assumes, first, that whenever the conditions are such
that life can exist and evolve, it will, and secondly, there are many
places where life can exist and a large number of extraterrestrial
cultures in existence.
It also assumes that these extraterrestrials have great reverence for
independent, natural evolution and development. In particular, assuming
that intelligence is a physical process that acts to maximize the
diversity of a system's accessible futures,
a fundamental motivation for the zoo hypothesis would be that premature
contact would "unintelligently" reduce the overall diversity of paths
the universe itself could take.
These ideas are perhaps most plausible if there is a relatively
universal cultural or legal policy among a plurality of extraterrestrial
civilizations necessitating isolation with respect to civilizations at
Earth-like stages of development. In a universe without a hegemonic
power, random single civilizations with independent principles would
make contact. This makes a crowded universe with clearly defined rules
seem more plausible.
If there is a plurality of extraterrestrial cultures, however,
this theory may break down under the uniformity of motive concept
because it would take just a single extraterrestrial civilization, or
simply a small group within any given civilisation, to decide to act
contrary to the imperative within human range of detection for it to be
undone, and the probability of such a violation of hegemony increases
with the number of civilizations. This idea, however, becomes more plausible if all civilizations tend to
evolve similar cultural standards and values with regard to contact
much like convergent evolution on Earth has independently evolved eyes on numerous occasions, or all civilizations follow the lead of some particularly distinguished civilization, such as the first civilization among them.
In this hypothesis, the problem of universal ethical homogeneity
is solved because the acquisition of a persistent advanced level of
civilization requires overcoming many problems, such as
self-destruction, war, overpopulation, pollution, and scarcity. Managing
to solve these problems could guide a civilization to adopt a
responsible and wise behavior, otherwise they would disappear (involving
other solutions to the Fermi paradox). In the zoo hypothesis, no
contact would be possible until humanity had acquired a certain level of
civilization and maturity (responsibility and wisdom), otherwise it
would become a potential threat.
One estimate for when humanity might be able to test the zoo
hypothesis, essentially by eliminating ways technological
extraterrestrials within the Galaxy may be able to hide, is some time
within the next half century.
A modified zoo hypothesis is a possible solution to the Fermi paradox. The time between the emergence of the first civilization within the Milky Way and all subsequent civilizations could be enormous. Monte Carlo simulation shows the first few inter-arrival times between emergent civilizations would be similar in length to geologic epochs
on Earth. The zoo hypothesis assumes a civilization may have a
ten-million, one-hundred-million, or half-billion-year head start on
humanity, i.e., it may have the capability to completely negate our best attempts to detect it.
The zoo hypothesis relies in part on applying the concept of hegemonic power to the Fermi paradox. Even if a first hegemonic non-interventionist grand civilization (first civilization)
is long gone, their initial legacy could persist in the form of a
passed-down tradition, or perhaps in an artificial lifeform (artificial superintelligence)
dedicated to a non-interventionist hegemonic goal without the risk of
death. Thus, the hegemonic power does not even have to be the first
civilization, but simply the first to spread its non-interventionist
doctrine and control over a large volume of the galaxy. If just one
civilization acquired hegemony in the distant past, it could form an
unbroken chain of taboo against rapacious colonization in favour of
non-interference in any civilizations that follow. The uniformity of
motive concept previously mentioned would become moot in such a
situation. The main problem would be how a galaxy-wide civilization
would block Earth from receiving all intentional or unintentional
communications.
Nonetheless, if the oldest civilization still present in the
Milky Way has, for example, a 100-million-year time advantage over the
next oldest civilization, then it is conceivable that they could be in
the singular position of being able to control, monitor, influence or
isolate the emergence of every civilization that follows within their
sphere of influence. This is analogous to what happens on Earth within
our own civilization on a daily basis, in that everyone born on this
planet is born into a pre-existing system of familial associations,
customs, traditions and laws that were already long established before
our birth and which we have little or no control over.
Overcoming the zoo hypothesis is one of the goals of METI, an organization created in 2015 to communicate with extraterrestrials, an active form of the search for extraterrestrials (SETI). METI, however, has been criticized for not representing humanity's collective will and for potentially endangering humanity.
Criticism
Some
critics of the hypothesis say that only a single dissident group in an
extraterrestrial civilization, or alternatively the existence of
galactic cliques instead of a unified galactic club, would be enough to
break the pact of no contact.
To Stephen Webb and others, it seems unlikely, taking humans and human
intercivilizational politics as reference, that such prohibition would
be in effect for millions of years or at least human existence without a
single breach thereof. Others say that the zoo hypothesis, along with its planetarium variation, is highly speculative and more aligned with theological theories. One possible counterargument to the dissident (rogue) group argument is that extraterrestrial artificial superintelligences
dominate space, including space occupied by biological intelligences;
moreoever, separate artificial superintelligences are assumed to tend
towards a network of merged superintelligencies, thereby dissuading
rogue behaviour.
Appearance in fiction
The zoo hypothesis is a common theme in science fiction.
1930s
1937: In Olaf Stapledon's 1937 novel Star Maker,
great care is taken by the Symbiont race to keep its existence hidden
from "pre-utopian" primitives, "lest they should lose their independence
of mind.” It is only when such worlds become utopian-level space
travellers that the Symbionts make contact and bring the young utopia to
an equal footing.
1950s
1951: Arthur C. Clarke's The Sentinel (first published in 1951) and its later novel adaptation 2001: A Space Odyssey (1968) feature a beacon which is activated when the human race discovers it on the moon.
1953: In Childhood's End, a novel by Arthur C. Clarke
published in 1953, the alien cultures had been observing and
registering Earth's evolution and human history for thousands (perhaps
millions) of years. At the beginning of the book, when mankind is about
to achieve spaceflight, the aliens reveal their existence and quickly end the arms race, colonialism, racial segregation and the Cold War.
1960s
In Star Trek, the Federation (including humans) has a strict Prime Directive
policy of nonintervention with less technologically advanced cultures
which the Federation encounters. The threshold of inclusion is the
independent technological development of faster-than-light propulsion. In the show's canon, the Vulcan race limited their encounters to observation until Humans made their first warp flight, after which they initiated first contact, indicating the practice predated the Human race's advance of this threshold. Additionally, in the episode "The Chase (TNG)", a message from a first (or early) civilization is discovered, hidden in the DNA of sentient
species spread across many worlds, something that could only have been
fully discovered after a race had become sufficiently advanced.
In Hard to Be a God by Arkady and Boris Strugatsky,
the (unnamed) medieval-esque planet where the novel takes action is
protected by the advanced civilization of Earth, and the observers from
Earth present on the planet are forbidden to intervene and make overt
contact. One of the major themes of the novel is the ethical dilemma
presented by such a stance to the observers.
1980s
1986: In Speaker for the Dead by Orson Scott Card,
the human xenobiologists and xenologers, biologists and anthropologists
observing alien life are forbidden from giving the native species, the
Pequeninos, any technology or information. When one of the
xenobiologists is killed in an alien ceremony, they are forbidden to
mention it. This happens again until Ender Wiggin, the main character of
Ender's Game,
explains to the Pequeninos that humans cannot partake in the ceremony
because it kills them. While this is not exactly an example of the zoo
hypothesis, since humanity makes contact, it is very similar and the
humans seek to keep the Pequeninos ignorant of technology.
1987: In Julian May's 1987 novel Intervention,
the five alien races of the Galactic Milieu keep Earth under
surveillance, but do not intervene until humans demonstrate mental and
ethical maturity through a paranormal prayer of peace.
1989: Iain M. Banks' The State of the Art depicts the Culture secretly visiting Earth and then deciding to leave it uncontacted, watching its development as a control group,
to confirm whether their manipulations of other civilizations are
ultimately for the best (the laboratory hypothesis). Other works by
Banks depict the Culture (or a Culture equivalent) routinely
manipulating less advanced civilizations, including pre-industrial ones
(e.g., Inversions), both covertly and overtly, for philosophical or foreign policy purposes.
1989: Bill Watterson's Calvin and Hobbes
comic strip for 8 November 1989 alludes to the possibility of an
ethical threshold for first contact (or at least for the prudence of
first contact) in Calvin's remark "Sometimes I think the surest sign
that intelligent life exists elsewhere in the universe is that none of
it has tried to contact us."
2000s
2000: In Robert J. Sawyer's SF novel Calculating God
(2000), Hollus, a scientist from an advanced alien civilization, denies
that her government is operating under the prime directive.
2003: In South Park's inaugural episode of season seven, "Cancelled",
aliens refrain from contacting Earth because the planet is the subject
and setting of a reality television show. Unlike most variations of the
zoo hypothesis where contact is not initiated in order to allow organic
socioeconomic, cultural, and technological development, the aliens in
this episode refrain from contact for the sole purpose of entertainment.
In essence, the aliens treat all of Earth like the titular character in
The Truman Show in order to maintain the show's integrity.
2008: In the video game Spore, which simulates
the evolution and life of species on a fictional galaxy, intelligent
species in the "Space Stage" cannot contact those in previous stages,
which did not unify their planets, nor develop spaceflight yet. However, they are allowed to abduct their citizens/members, to create crop circles in their terrain and to place in their planets a tool called "monolith", which accelerates their technological evolution.
2010s
2012: In the sci-fi video game Star Citizen,
the zoo hypothesis is vaguely referenced in a lore point and is
referred to as the Fair Chance Act. In the document, humans are
generally forbidden from terraforming, mining, and inhabiting planets if the world is found to harbor lifeforms capable of developing intelligence. Multiple planetary systems
are planned to be implemented as the game's active development
continues that will feature planets protected under the Fair Chance Act.
2016: In the video game Stellaris,
players control an interstellar empire that can encounter less
technologically advanced, non-space faring civilizations. Depending on
player choices and their empire's organization, they can observe such
"pre faster-than-light"
planets in a manner similar to the zoo hypothesis, using science
stations with missions that can include passive observation,
technological enlightenment, covert infiltration and indoctrination. Players can also discover "pre-sapient" species, which can be uplifted to sentience using scientific research projects.
In epistemology, criteria of truth (or tests of truth) are standards and rules used to judge the accuracy of statements and claims. They are tools of verification, and as in the problem of the criterion, the reliability of these tools is disputed. Understanding a philosophy's criteria of truth
is fundamental to a clear evaluation of that philosophy. This necessity
is driven by the varying, and conflicting, claims of different
philosophies. The rules of logic have no ability to distinguish truth on their own. An individual must determine what standards distinguish truth from falsehood. Not all criteria are equally valid. Some standards are sufficient, while others are questionable.
The criteria listed represent those most commonly used by scholars and the general public.
The opinions of those with significant experience, highly trained or
possessing an advanced degree are often considered a form of proof. Their knowledge
and familiarity within a given field or area of knowledge command
respect and allow their statements to be criteria of truth. A person may
not simply declare themselves an authority, but rather must be properly
qualified. Despite the wide respect given to expert testimony, it is not an infallible criterion. For example, multiple authorities may conflict in their claims and conclusions.
Coherence refers to a consistent and overarching explanation for all
facts. To be coherent, all pertinent facts must be arranged in a
consistent and cohesive fashion as an integrated whole. The theory that
most effectively reconciles all facts in this fashion may be considered
most likely to be true. Coherence is the most potentially effective test
of truth because it most adequately addresses all elements. The main
limitation lies not in the standard, but in the human inability to acquire all facts of an experience. Only an omniscient
mind could be aware of all of the relevant information. A scholar must
accept this limitation and accept as true the most coherent explanation
for the available facts. Coherence is difficult to dispute as a
criterion of truth, since arguing against coherence is validating
incoherence, which is inherently illogical.
Some view opinions held by all people to be valid criteria of truth. According to consensus gentium,
the universal consent of all mankind (all humans holding a distinct
belief), proves it is true. There is some value in the criterion if it
means innate truth, such as the laws of logic and mathematics.
If it merely means agreement, as in a unanimous vote, its value is
questionable. For example, general assent once held that the sun revolved about the flat earth.
Consistency (mere)
Mere consistency
is when correct statements do not contradict, but are not necessarily
related. Accordingly, an individual is consistent if he does not
contradict himself. It is inadequate as a criterion because it treats
facts in an isolated fashion without true cohesion and integration;
nevertheless it remains a necessary condition for the truth of any argument, owing to the law of noncontradiction. The value of a proof largely lies in its ability to reconcile individual facts into a coherent whole.
Consistency (strict)
Strict consistency is when claims are connected in such a fashion that one statement follows from another. Formal logic and mathematical rules are examples of rigorous consistency. An example would be: if all As are Bs and all Bs are Cs, then all As are Cs. While this standard is of high value, it is limited. For example, the premises are a priori
(or self-apparent), requiring another test of truth to employ this
criterion. Additionally, strict consistency may produce results lacking
coherence and completeness. While a philosophical system may demonstrate
rigorous consistency with the facts it considers, all facts must be
taken into consideration for an adequate criterion of truth, regardless
of their detriment to any given system.
Correspondence is quite simply when a claim corresponds with its
object. For example, the claim that the White House is in Washington,
D.C. is true, if the White House is actually located in Washington.
Correspondence is held by many philosophers to be the most valid of the
criteria of truth. An idea that corresponds to its object is indeed
true, but determining if the correspondence is perfect requires
additional tests of truth. This indicates that correspondence is a
perfectly valid definition of truth, but is not of itself a valid
criterion of truth. An additional test beyond this "definition" is
required to determine the precise degree of similarity between what is
posited and what exists in objective reality. Establishing correspondence between what is posited and what exists is fraught with its own difficulties, see Map–territory relation.
Custom
Most people consciously or unknowingly employ custom
as a criterion of truth, based on the assumption that doing what is
customary will prevent error. It is particularly applied in the
determination of moral truth and reflected in the statement "when in
Rome, do as the Romans do". People stick closely to the principle of
custom when they use common vernacular, wear common fashions and so
forth; essentially, when they do what is popular. Custom is not
considered a serious, or valid, test of truth. For example, public
opinion polls do not determine truth.
Emotions
Many
people allow feelings to determine judgment, often in the face of
contrary evidence or without even attempting to collect evidence and
facts. They are implicitly accepting emotions
as a criterion of truth. Most people will admit that feelings are not
an adequate test for truth. For example, a seasoned businessman will put
aside his emotions and search for the best available facts when making
an investment. Similarly, scholars are trained to put aside such subjective judgments when evaluating knowledge. Emotions are real, however, and thus must be considered within any social scientific system of coherence.
Instinct
The existence of distinct instincts
has long been debated. Proponents of instinct argue that we eat because
of hunger, drink because of thirst, and so forth. Some have even argued
for the existence of God based on this criterion, arguing that the
object of every instinct has a referent in reality. The counterpoint of
hunger is food; for thirst it is liquid; for the sex drive it is a mate.
Instincts are not accepted as a reliable test because they are most
often indistinct, variant and difficult to define. Additionally,
universal instincts are so few that they offer little to the greater
body of philosophy as a criterion.
Intuition
Intuition is an assumed truth with an unknown, or possibly unexamined, source. It is a judgment that is not dependent on a rational
examination of the facts. It is usually experienced as a sudden
sensation and/or rush of thoughts that feel "right". Many persons
experience intuitive epiphanies which later prove to be true. Scholars
have sometimes come upon valid theories and proofs while daydreaming or
otherwise mentally occupied with something bearing no apparent
relationship to the truth they seek to reveal. Intuition is at best a
source for truths, rather than a criterion with which to evaluate them.
Intuitive knowledge requires testing by means of other criteria of truth
in order to confirm its accuracy.
Majority rule
Majority rule is a statistical method of accepting assertions and proposals. In democratic systems, majority rule is used to determine group decisions, particularly those relating to personal morality and social behavior. Some systems divided into several oppositional factions may depend on mere plurality.
While majority rule may make for a good democratic system, it is a poor
determinant of truth, subject to the criticisms of the broad version of
consensus gentium.
Naïve realism
Naïve realism posits that only that which is directly observable by the human senses
is true. First-hand observation determines the truth or falsity of a
given statement. Naïve Realism is an insufficient criterion of truth. A
host of natural phenomena are demonstrably true, but not observable by
the unaided sense. For example, Naïve Realism would deny the existence
of sounds beyond the range of human hearing and the existence of x-rays.
Similarly, there are a number of sense experiments which show a
disconnect between the perceived sensation and the reality of its cause.
If an idea works then it must be true, to the Pragmatist. The consequences of applying a concept reveal its truth value
upon examination of the results. The full meaning of an idea is
self-apparent in its application. For example, the therapeutic value and
effect of penicillin in relation to infections is proven in its
administration. Although pragmatism
is considered a valuable criterion, it must be used with caution and
reservation, due to its potential for false positives. For example, a
doctor may prescribe a patient medication for an illness, but it could
later turn out that a placebo is equally effective. Thus, untrue
concepts could appear to be working contrary to the purpose of the
pragmatic test. However, it has validity as a test, particularly in the
form William Ernest Hocking
called "negative pragmatism". In essence, it states that ideas that do
not work cannot possibly be true, though ideas which do work may or may
not be true.
Revelation
The principal distinction between intuition and revelation is that revelation has an assumed source: God (or another higher power). Revelation may be defined as truth emanating from God. Many religions
fundamentally rely on revelation as a test of truth. This criterion is
subject to the same criticisms as intuition. It may be a valid reference
of truth for an individual, but it is inadequate for providing a
coherent proof of the knowledge to others.
Time
Time is a criterion commonly appealed to in debate, often referred to as "the test of time".
This criterion posits that over time erroneous beliefs and logical
errors will be revealed, while if the belief is true, the mere passage
of time cannot adversely affect its validity.
Time is an inadequate test for truth, since it is subject to similar
flaws as custom and tradition (which are simply specific variations of
the time factor). Many demonstrably false beliefs have endured for
centuries and even millennia (e.g. vitalism).
It is commonly rejected as a valid criterion. For example, most people
will not convert to another faith simply because the other religion is
centuries (or even millennia) older than their current beliefs.
Tradition
Tradition,
closely related to custom, is the standard stating that which is held
for generations is true. Those accepting tradition argue that ideas
gaining the loyalty multiple generations possesses a measure of
credibility. Tradition possesses many of the same failings as custom. It
is possible for falsehoods to be passed down from generation to
generation, since tradition generally emphasizes repetition over critical evaluation.
Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society". According to the World Health Organization,
an explicit health policy can achieve several things: it defines a
vision for the future; it outlines priorities and the expected roles of
different groups; and it builds consensus and informs people.
Different approaches
Health
policy often refers to the health-related content of a policy.
Understood in this sense, there are many categories of health policies,
including global health policy, public health policy, mental health
policy, health care services policy, insurance policy, personal healthcare policy, pharmaceutical policy, and policies related to public health such as vaccination policy, tobacco control policy or breastfeeding promotion
policy. Health policy may also cover topics related to healthcare
delivery, for example of financing and provision, access to care, quality of care, and health equity.
Health policy also includes the governance and implementation of
health-related policy, sometimes referred to as health governance, health systems governance or healthcare governance.
Conceptual models can help show the flow from health-related policy
development to health-related policy and program implementation and to health systems
and health outcomes. Policy should be understood as more than a
national law or health policy that supports a program or intervention.
Operational policies are the rules, regulations, guidelines, and
administrative norms that governments use to translate national laws and
policies into programs and services.
The policy process encompasses decisions made at a national or
decentralized level (including funding decisions) that affect whether
and how services are delivered. Thus, attention must be paid to policies
at multiple levels of the health system and over time to ensure
sustainable scale-up. A supportive policy environment will facilitate
the scale-up of health interventions.
There are many aspects of politics and evidence that can influence the decision of a government, private sector business or other group to adopt a specific policy. Evidence-based policy relies on the use of science and rigorous studies such as randomized controlled trials
to identify programs and practices capable of improving policy relevant
outcomes. Most political debates surround personal health care
policies, especially those that seek to reform healthcare delivery, and can typically be categorized as either philosophical or economic. Philosophical debates center around questions about individual rights,
ethics and government authority, while economic topics include how to
maximize the efficiency of health care delivery and minimize costs.
In many countries it is left to the individual to gain access to healthcare goods and services by paying for them directly as out-of-pocket expenses, and to private sector players in the medical and pharmaceutical industries to develop research. Planning and production of health human resources is distributed among labour market participants.
Other countries have an explicit policy to ensure and support
access for all of its citizens, to fund health research, and to plan for
adequate numbers, distribution and quality of health workers to meet
healthcare goals. Many governments around the world have established universal health care,
which takes the burden of healthcare expenses off of private businesses
or individuals through pooling of financial risk. There are a variety
of arguments for and against universal healthcare and related health
policies. Healthcare is an important part of health systems and therefore it often accounts for one of the largest areas of spending for both governments and individuals all over the world.
Many countries and jurisdictions integrate a human rights philosophy in directing their healthcare policies. The World Health Organization reports that every country in the world is party to at least one human rights treaty that addresses health-related rights, including the right to health as well as other rights that relate to conditions necessary for good health. The United Nations' Universal Declaration of Human Rights (UDHR) asserts that medical care is a right of all people:
UDHR Article 25:
"Everyone has the right to a standard of living adequate for the health
and well-being of himself and of his family, including food, clothing,
housing and medical care and necessary social services, and the right to
security in the event of unemployment, illness, disability, widowhood,
old age or other lack of livelihood in circumstances beyond his
control."
In some jurisdictions and among different faith-based organizations,
health policies are influenced by the perceived obligation shaped by
religious beliefs to care for those in less favorable circumstances,
including the sick. Other jurisdictions and non-governmental organizations draw on the principles of humanism in defining their health policies, asserting the same perceived obligation and enshrined right to health. In recent years, the worldwide human rights organization Amnesty International has focused on health as a human right, addressing inadequate access to HIV drugs and women's sexual and reproductive rights including wide disparities in maternal mortality
within and across countries. Such increasing attention to health as a
basic human right has been welcomed by the leading medical journal The Lancet.
There remains considerable controversy regarding policies on who
would be paying the costs of medical care for all people and under what
circumstances. For example, government spending on healthcare is
sometimes used as a global indicator of a government's commitment to the
health of its people.
On the other hand, one school of thought emerging from the United
States rejects the notion of health care financing through taxpayer
funding as incompatible with the (considered no less important) right of
the physician's professional judgment, and the related concerns that
government involvement in overseeing the health of its citizens could
erode the right to privacy
between doctors and patients. The argument furthers that universal
health insurance denies the right of individual patients to dispose of
their own income as per their own will.
Another issue in the rights debate is governments' use of
legislation to control competition among private medical insurance
providers against national social insurance systems, such as the case in Canada's national health insurance program. Laissez-faire supporters argue that this erodes the cost-effectiveness
of the health system, as even those who can afford to pay for private
healthcare services drain resources from the public system. The issue here is whether investor-owned medical insurance companies or health maintenance organizations
are in a better position to act in the best interests of their
customers compared to government regulation and oversight. Another claim
in the United States perceives government over-regulation of the
healthcare and insurance industries as the effective end of charitable
home visits from doctors among the poor and elderly.
Economics: healthcare financing
Public and private health expenditure by country
Many types of health policies exist focusing on the financing of
healthcare services to spread the economic risks of ill health. These
include publicly funded health care (through taxation or insurance, also known as single-payer systems), mandatory or voluntary private health insurance, and complete capitalization of personal health care services through private companies, and medical savings accounts, among others.
The debate is ongoing on which type of health financing policy results
in better or worse quality of healthcare services provided, and how to
ensure allocated funds are used effectively, efficiently and equitably.
There are many arguments on both sides of the issue of public versus private health financing policies:
Claims that publicly funded healthcare improves the quality and efficiency of personal health care delivery:
Government spending on health is essential for the accessibility and sustainability of healthcare services and programmes.
For those people who would otherwise go without care due to lack of financial means, any quality care is an improvement.
Since people perceive universal healthcare as free (if there is no insurance premium or co-payment), they are more likely to seek preventive care which may reduce the disease burden and overall healthcare costs in the long run.
Single-payer systems reduce wastefulness by removing the middle man,
i.e. private insurance companies, thus reducing the amount of
bureaucracy.
In particular, reducing the amount of paperwork that medical
professionals have to deal with for insurance claims processing allows
them to concentrate more on treating patients.
Claims that privately funded healthcare leads to greater quality and efficiencies in personal health care:
Perceptions that publicly funded healthcare is free can lead to overuse of medical services, and hence raise overall costs compared to private health financing.
Privately funded medicine leads to greater quality and efficiencies
through increased access to and reduced waiting times for specialized
health care services and technologies.
Limiting the allocation of public funds for personal healthcare does
not curtail the ability of uninsured citizens to pay for their
healthcare as out-of-pocket expenses. Public funds can be better rationalized to provide emergency care services regardless of insured status or ability to pay, such as with the Emergency Medical Treatment and Active Labor Act in the United States.
Privately funded and operated healthcare reduces the requirement for
governments to increase taxes to cover healthcare costs, which may be
compounded by the inefficiencies among government agencies due to their
greater bureaucracy.
Other health policy areas
Health policy options extend beyond the financing and delivery of personal health care, to domains such as medical research and health workforce planning, both domestically and internationally.
Medical research policy
Medical research
can be both the basis for defining evidence-based health policy, and
the subject of health policy itself, particularly in terms of its
sources of funding. Those in favor of government policies for publicly
funded medical research posit that removing profit as a motive will
increase the rate of medical innovation.
Those opposed argue that it will do the opposite, because removing the
incentive of profit removes incentives to innovate and inhibits new
technologies from being developed and utilized.
The existence of sound medical research does not necessarily lead
to evidence-based policymaking. For example, in South Africa, whose
population sets the record for HIV infections,
previous government policy limiting funding and access for AIDS
treatments met with strong controversy given its basis on a refusal to
accept scientific evidence on the means of transmission.
A change of government eventually led to a change in policy, with new
policies implemented for widespread access to HIV services. Another issue relates to intellectual property,
as illustrated by the case of Brazil, where debates have arisen over
government policy authorizing the domestic manufacture of antiretroviral drugs used in the treatment of HIV/AIDS in violation of drug patents.
Some countries and jurisdictions have an explicit policy or strategy to plan for adequate numbers, distribution and quality of health workers to meet healthcare goals, such as to address physician and nursing shortages. Elsewhere, workforce planning is distributed among labour market participants as a laissez-faire approach to health policy. Evidence-based policies for workforce development are typically based on findings from health services research.
Health in foreign policy
Many governments and agencies include a health dimension in their foreign policy in order to achieve global health
goals. Promoting health in lower income countries has been seen as
instrumental to achieve other goals on the global agenda, including:
Promoting global security – linked to fears of global pandemics, the intentional spread of pathogens, and a potential increase in humanitarian conflicts, natural disasters, and emergencies;
Promoting economic development
– including addressing the economic effect of poor health on
development, of pandemic outbreaks on the global market place, and also
the gain from the growing global market in health goods and services;
Global
health policy encompasses the global governance structures that create
the policies underlying public health throughout the world. In
addressing global health, global health policy "implies consideration of
the health needs of the people of the whole planet above the concerns
of particular nations."
Distinguished from both international health policy (agreements among
sovereign states) and comparative health policy (analysis of health
policy across states), global health policy institutions consist of the
actors and norms that frame the global health response.
EU health policy
The EU
contributes to the improvement of public health through financing and
laws addressing medications, patient rights in cross-border healthcare,
illness prevention, and the promotion of good health. EU countries hold primary responsibility for organizing and delivering health services
and medical care. Therefore, EU health policy works to supplement
national policies, assure health protection in all EU measures and to
strengthen the Health Union.
The goals of EU public health policies and initiatives are to protect and improve the health of EU residents, promote the modernization and digitalization of health systems and infrastructure, increase the resilience of Europe's health systems, and improve the ability of EU member states to prevent and respond to pandemics in the future.
In a senior-level working group on public health, representatives from the European Commission and national governments
debate strategic health concerns. The EU's health policy and yearly
work programmes are implemented with the assistance of member states,
institutions, and other interest groups.
European Commission's role
The
European Commission's Directorate for Health and Food Safety assists
member states in their efforts to protect and improve the health of
their people and to guarantee the accessibility, efficiency, and
resilience of their healthcare structures. This is accomplished in a
number of ways, such as by proposing legislation, providing financial support,
coordinating and facilitating the exchange of best practices between EU
countries and health experts and by health promotion activities.
Legislation
The Treaty on the Functioning of the European Union
grants the EU the authority to enact health legislation in accordance
with Article 168 (protection of public health), Article 114 (single
market), and Article 153 (social policy). The EU has adopted legislation in following areas: Patient's rights in cross-border healthcare, Pharmaceuticals and medical devices (pharmacovigilance, falsified medicines, clinical trials), Health security and infectious diseases, Digital health and care, Tobacco, organs, blood, tissues and cells. The Council of the EU can also send recommendations on public health to member states.
Patients' rights in cross-border healthcare
EU citizens are entitled, by law, to receive healthcare in any member state of the EU and to have their home nation compensate them for care received elsewhere.
The European Health Insurance Card (EHIC) guarantees that essential
medical care is given under the same conditions and at the same cost as
people insured in that country.
Medicines and medical devices
The EU regulates the authorisation of medicines at EU level by the European Medicines Agency or at the national level by the appropriate authorities in the EU member states.
Cross-border health threats
To
guarantee a high degree of health protection in the European Union,
monitoring, early warning, preparedness, and reaction measures to
counter major cross-border threats to health are crucial. The European
Centre for Disease Prevention and Control (ECDC) offers EU member states
independent scientific advice, support, and knowledge on public health
risks, including infectious diseases.
Promoting health and tackling diseases
Cancer - In addition to its direct effects on people's health and well-being, cancer also affects public finances, healthcare and social systems, productivity, and economic growth, all of which depend on having a healthy labor force. A cancer screening
recommendation was endorsed by the Council in 2003, and it encouraged
EU nations to put in place population-based, quality-assured screening
programs. Cancer screening was limited to breast, cervical and colorectal cancer, so in 2022 member states decided to expand the focus to include prostate, lung and gastric cancer. The EU has also passed a number of measures to shield workers from hazardous substances and chemicals, such as lead and substances that cause cancer and mutagenesis.
Tobacco
- With over 700 000 deaths annually, tobacco use is the single biggest
preventable health risk and the leading contributor to premature mortality in the European Union
(Approximately 50% of smokers pass away too soon, on average, 14 years
before non-smokers). The tobacco products directive establishes
guidelines for the production, labeling, and retailing of tobacco and
associated goods. High tariffs on tobacco products were implemented by another directive on the structure and rates of excise duty
applied to manufactured tobacco, with the goal of reducing tobacco
consumption, particularly among youth. The 2009 Council recommendation
on smoke-free environments requires all EU member states to take precautions against tobacco smoke exposure for individuals at public places and work.
Vaccination - Vaccination policy
is a competence of member states. The EU helps its member states
coordinate their policies and initiatives. In December 2018 the Council
approved a recommendation to enhance EU cooperation on diseases that can
be prevented by vaccination. This project sets out guidance on
addressing vaccine hesitancy, increasing vaccination rates, encouraging procurement coordination for vaccines, and supporting research and innovation.
In December 2022, EU ministers of health approved Council conclusions
on vaccination as one of the best methods for preventing illness
and improving public health. The conclusions focus on two areas of
action: fighting vaccine reluctance and preparing for upcoming
challenges through EU cooperation.
Investing in health
The
EU4Health program provides funds to tackle cross-border health
concerns, improve the availability and cost of medical equipment,
pharmaceuticals, other crisis-relevant items, and strengthen the
resilience of health systems. Other EU programmes further finance
healthcare systems, health research, infrastructure and other broader health-related issues, in particular:
Horizon Europe health cluster - supports innovation and research
to create a resilient EU ready to face new challenges, for high-quality
digital services that are available to everyone, and accessible,
high-quality healthcare.
EU cohesion funds - invest in health in EU countries and regions.
