D. Robert MacDougall’s Lecture: Chapter 12

For March 5th– In lieu of class, please watch out invited guest lecturer.  Post comments (e.g., what I learned, what I thought was interesting, what it made me think about) and questions for Professor MacDougall below:

D. Robert MacDougall: Ch 12 Guest Lecturer (Philosophy)

He will be visiting this page periodically to respond to more student questions!

The slides used in his presentation are available here:

Powerpoint: health outcomes


38 thoughts on “D. Robert MacDougall’s Lecture: Chapter 12

  1. Chamirah Farley, RN

    I found the lecture with Professor MacDougall to be quite interesting. It was enlightening to listen to his perspective from a philosophical standpoint. I definitely have to agree with him, when one may see data an assumption may be made about what is being presented but fail to think the many other concepts/ideas/reasons that are not being accounted for. It really made me think about the idea of choices and health outcomes.

  2. Isaac D. O

    Professor McDougall’s lecture on Health Policy and its Effects on Health was very educating, interesting and factual from a philosophical approach. Educating in a way that he used three diagrams to explained some inequalities related to race and health base on a research conducted by The Whitehall Study. People perceived to be low on socioeconomic ladder have high mortality rate as compared to the elite , also blacks have high infant mortality rate as compared to other race and lastly women live longer on average of four years than men.
    It is interesting to found out that despite all these racial health inequalities confronting us, we still have ways and means to stay healthy. I learnt that most of these inequalities are base on the choices that we make , our actions and inactions and also our level of exposure to the environment not neccessaritly race.

  3. Jean Schatz

    When I think of philophy, psychology, and sociology, I sometimes get them confused or do not quite know the difference between these fields, so I am happy that D. Robert MacDougall clarified that. Secondly, I liked his approach on explaining his data clearly. At first he was explaining the slides, but when he actually asked the listeners to take a second and write down which study in our opinions was most injust. At that point, I realized that infant mortality in the UK was higher in black racial groups. Why this striked me as an injustice was because I tied 2 of the chart studies together. If blacks had a higher mortality rate, and the lower paid government workers had a higher rate of mortality, that means that black racial groups were not being employed in higher executive positions, for the most part. D. Robert MacDougall explained that justice was treating equals equally. Does this mean that black racial groups are not considered equals?
    D. Robert MacDougall stated that philosophers come up questions from psychologist’s data, then theoretically pass the question along to another field of study that can come up with solutions. My question is which field of study would be most adequate to answer this question of injustice?

  4. Henry M.

    Professor McDougall’s is pretty interesting. I agree with his saying that education, class, income, and job roll cannot guarantee access to health care because nobody had equal access to the health care. What I find interesting is when he mention a study of attitudes of patients by race. I believe that the providers of the health care always pays attention to the patients’ attitude instead of the patients’ race. Was the Infant Mortality chart a lie, especially for the Black/non-Hispanic bar, or was it due to hatred and racism?

    1. Noemi

      Dr. MacDougall was very clear in explaining health care. He point out the differences between psychologists and philosophers. I believe everybody has a choice to their health and there’s no definite definition for it. There’s so many pros and cons to this topic and people might see something healthy when somebody else will not see it the same way. This lecture made me think about not just health but about people and their differences.

  5. Altenor

    Well, I found the education of Dr. Robert MacDougall’s lecture on health outcomes very exciting, and vital. He showed a Whitehall Study, which is an Institutional Chart Data in which there are different categories of health outcomes. The question is : are they unjust? 1. People are born healthy and unhealthy. 2. People regarding their health have life style choices. For example, some may choose to exercise more and eat healthy, some may choose to smoke and eat poorly, whether rich or poor people. Those factors result from the inequality of health. However, hate or the predominance of whites, spanics over blacks in U.S. leads to the health inequality in terms of different educations, icomes or socio-economic, and classes. in my opinion, after watching the video, phylosophically and psychologically, I think health outcomes depicted in the Institutional Chart Data have a variety of factors that make health inequality. Most of all is based on socio-economic status.

  6. thierno

    i found Dr. Robert MacDougall’s lecture quite interesting and well presented. But i have few reservations about relevancy of the graphs presented for a good articulation of justice in those cases. In my understanding, the graphs presented correlation between two different variables such as class and mortality, gender and mortality, infant mortality and race, which i found insufficient to classify the cases by the given definitions of health justice. i thing that other research methods would have been more appropriate to have a clearer picture and a better judgement for the cases. In any case i enjoyed watching the lecture.

  7. Margaret Spence

    I have learned health outcomes, are related to income, your job role and your education. MacDougall looks at the inequalities, that are equate people of color, and the treatment they receive. In the Whitehall study, Professor MacDougall describes what causing the inequalities, people with higher paying jobs have better health outcome then people with lower paying jobs. Which are all related to race. Race is always a factor. When it comes to health care.
    What I though was interesting, that the principals of Justice, which MacDougall describes how we are all treated the same way, with respect equally. “To each person whatever health acquired, without using force or fraud.” For each person, an equal share of health. I also found most interesting was Sociologist looks at the scientific method that are learned. Psychologist, philosopher uses data concept. MacDougall uses both scientific method and data concept, to compare equality and injustice.
    What it made me think about, how females have longer life expectancy at least 5 years longer than men do. MacDougall health outcome terminology explanations are based on the two studies. Which made me think that justice and inequalities we are confronted with, and the choices we make. To me health care is revolving at a rapid pace, and we need to use more scientific method and data, to improve health care outcomes.

  8. shenelle

    Professor MacDougall’s presentation was very interesting and enlightened me on some things. In his presentation he mentioned the Tuskegee experiment, and how that has affected the relationship between white doctors and blacks patients. Therefore, my question is would having more black physicians lower the mortality rate of black people? Also, what is the current (or the most current statistics) ratio of white to black physicians in health care facilities? This also goes in hand with the question of justice and injustice, where whites tend to have a better opportunity to access higher level education than blacks.

  9. Li

    The lecture is very interesting. Dr. Robert MacDougall gave us three examples to show the differences in gender, socioeconomic status, and race will cause different health outcomes. Tons of studies have shown that inequality leads poor health outcome. However it’s really hard to define injustice when we talk about disparities in health outcomes because people see things from different perspectives.

  10. daniel quiles

    Dr.Macdougall takes a very good approach when he uses the UK to show the information on the graph , I think its shows us a different view at country where everyone has healthcare. he makes notice different health inequalities , the variables that effect those disparities.
    when it comes to unjust and justice , its kind of hard to determine because of different variables that come in to play , although he did help me understand the principal of justice using his grading student example.
    im student that learns a lot when you give examples , like when he use family A and B it help me understand how unjust is used in this lecture . without these example I wouldn’t have really understood unjust and justice.

  11. Chander Raj

    Professor MacDougall’s lecture is quite interesting indeed. He showed us not to make any assumptions based on any given data as that data can be incomplete. One thing that I learned from this is that health problems are a big issue when it comes to black people, but race isn’t the factor we should look at, the most important factor for illness is the economic status of the person. As we know blacks have been oppressed and lived as a minority group thus having little to no healthcare or financially set to make the right choices, thus increasing the risk of health problems.

  12. Nawang N. Sherpa

    From the lecture, I got a lot of information that were very vital and kept in mind. I learned that Psychologists and Philosophers are more or less related with only some exceptions. Psychologists focus mainly on scientific research and Philosophers depend on data which are developed by psychologists. Philosophers develop various concepts in order to solve the problems which can’t be solved only by empirical research. However, it is not up to the extent of Philosophers to solve all the problems that may not be resolved by the Psychologists. Philosophers do have some limitations as they might need to refer one or the other part of problem to somebody else.

    From, this I came to know that in order to find the perfect solution, everybody has to work hand in hand as more ideas will be involved in that particular process.

    It was also very interesting to know how justice would mean treating equals equally and unequal unequally. However, it would make more sense when it is justified on what basis equals are treated equally and vice versa followed by two specifications which say every individual needs to be provided whatever they deserve without forcing them or without their knowledge and every individual should be provided equal share of health when it comes to providing justice in health care.

    I also got a clear idea on how inequality and injustice are different. Injustice is something that will go against the principles of justice without following the proper specifications of justice. On the other hand, inequality may be present in any context which may result from an individual’s own choice. However, we must understand that every outcome that leads to inequality may not necessarily be resulted from an individual’s choice. It may be the consequence of how the person is brought up.

    From, the explanation of “The Whitehall Study”, I also understood that health outcome is co-related with one’s occupation, income and education. However, there are several aspects that comes into effect on how a person with high income and good occupation live longer. For example, he or she may gather enough time to exercise after work and spend time for extra activities. After examining the “Infant Mortality by Race” data, I came to know how the outcome was the result of historical injustice done by white doctors to the black patients.

    In conclusion, I got idea that result of health outcome is co-related to injustice, but injustice may not always be the cause of health outcome.

  13. Ashley Golden

    Professor MacDougal brought up some interesting points during the lecture. When he mentioned class of individuals, I wasn’t the least bit surprised when he mentioned those who had less of an education or those who were paid the least are the ones who live shorter than the individuals with higher education and higher paying jobs. The reason I think that happens is because those with higher education want to live longer and some will try to remain in shape and eat healthier because they can afford it. While those who can’t afford it eat what they can. And chances are if your uneducated, eating right and exercising are the last things on your list because you are to busy trying to survive in a world where you’re forced to make a choice on eating an unhealthy $1 burger from mc donalds or eat $8-$10 salad just to get through the day. He also brings up whether it’s unjust or not. In my opinion its hard to answer that question because we as individuals we make choices everyday, sometimes good sometimes bad. And the choices we make ultimately affects ourselves and those around us. Maybe it’s not what we are eating or maybe it is. My point, others maybe more privileged than others but some of us aren’t included in those graphs. Some of us may not have funds like the wealthy, but we are eating right and exercising. Some of us may have the funds to support a healthy lifestyle but may choose not to. We can look at graphs, we can look at science, we can take surveys but we will never have a definite answer. And no I’m not surprised women tend to live longer than men 🙂 .

  14. kareshma

    I found the lecture by Professor MacDougall very informational as he thoroughly addresses some interesting points. One of things he said that I indeed agree but not completely with is the idea of treating equals equally based on how much effort and how affective the results of these efforts are. For example, like he said if two students have the same percentage on an exam they get the same grade, but if one student gets a really lower grade than the other then it wouldn’t be fair to give them the same grade because it would be unfair to the student who probably spent his time studying than to the one who didn’t study. Similarly this does compare to people who receive better health care than others, however the distribution of health is still given at an unfair level to those who are less poorer. Health is a different topic from a class grade, meaning, you cannot deny health care to a person who is unable to pay for it because a person’s life is worth more than a person’s grade. Health Care should be provided throughout the US because the majority of the poor is way more than that of the rich. It takes just a few groups of people to go around to places and teach people who have no knowledge of what it means to be healthy. It’s understandable that the country won’t afford to have health care for everyone in the country and also that not all the rich people will want to give up a part of their paycheck to help the poor but it doesn’t take a lot of money to just educate these people about what health is and what it means to be healthy. This would be a great act of justice and treating equals equal because poor people do try but not everyone is lucky to find a job or to be able to work, but just a little education on how they can make their living conditions better will be a big source of help in a person’s life.

  15. Slangford

    After watching this lecture, it can be said that race will always be a key factor . Race shouldn’t be a factor when it comes to health care but it sadly is. Although some one may have a college degree does not make them smarter than someone without. I feel people look at education just to say Oh well this person must be smart because they have this type of degree. That degree doesn’t mean it’s honestly earned. I know many people with put degrees and college education that are pretty much h geniuses but lack the resources to obtain it due to the color of their skin. I would say race but I don’t like that term. A person’s health should be based on their health. Although their are many perspectives based on health care I feel a common ground should be met when it comes to injustice and equality. Prof. Mac Dougall’s lecture was informative and made me think of many instances where I have seen inequality first hand.

  16. benny

    I really enjoyed Dr Robert’s MacDougall’s lecture and was particularly interested in his definition of justice and whether we would consider any of the graph information he presented as injustice. I really like the definition of justice as treating equals equally. Many at times people define justice as something which is unfair or something they do not agree with, which most at times can be right but does that make it injustice just because one thinks it is unfair ? From the examples that he gave about two guys who both have the same illness but one was born into a rich family so he could afford to buy medication and the other one because he comes from a poor family he could not afford to buy his medication in this situation you can not say that it is injustices because injustice can only occur when the right to get health care has been forcefully taken away from you without your consent. This really gave me an insight to what we can describe as injustice in the heath care system.

  17. Kar Lee

    Professor MacDougall’s lecture mentioned interesting point about the graph on how injustices involve to others. The Whitehall Study slides show injustices because it is something they are disagree with race that will cause different health outcomes. Most of these inequalities are based on the choices that we have to make like for examples some may choose to smoke a lot and eat poorly than rich people. Some people will may choose the right way to exercise more and eat healthy food than others whether than rich or poor people.

  18. matty65

    I like the philosophical approach of Professor MacDougall. His view point help to solidify some of the concept of the video,”Race, The Power of Illusion.” Health, something that most people think of purely in the physical sense is so much more cognitively involved. The Whitehall study really hit that point home. Our health practices, good or bad, are governed by many aspects in our lives but race is not one of them. So I have only one question, if there is so much evidence that race is not a part of the equation, why can’t we just remove it and get some real research done?
    PS. Don’t try to answer this question, you won’t like the answer.

  19. Einstein$13

    Due to the amount of time available, I feel it did a disservice to the amount of information that could have been given. However, the quality of the information was on point. Although, I gained some new knowledge, I am still unclear about a few things. For instance:
    you said the difference in health care itself is not unjust but it is a symptom, what do you think is the remedy for this symptom?
    If you were the health care policy maker, what would you change and would you keep when it comes to the health care system?
    Furthermore, you stated our choice or our freedom to chose is pre determine, I would like to know by what factor?

  20. Keven Deng

    The two view of justice in health inequalities was very interesting since in today’s society the standards by which we follow is the first theory where if the individual makes bad decisions it’s their fault for their poor health and people are free to choose whatever health care that they desire. Concerning the second theory though where society has to contribute to someone’s health care regardless of decisions it is also seen because of the reason that there are countries that have universal health care where everyone can received the same treatment regardless of social status which is paid for by everyone. But the problem with the second theory is that people generally will blame the person for their poor health rather than examine a larger picture as mentioned by Professor MacDougall where the individuals may not have a choice in their decisions and made those poor decisions due to their environment rather than because they had an actual choice in the matter.

  21. ricardo nedd

    Professor MacDougall’s lecture examined and clarified many points, but of particular interest to me was the perceived inequalities are based on the choices. Most health scenarios are all based on habits and choices, non are relevant to race or family history. The simple choice of living a sedentary life style: going home to relax and watch tv after work as opposed to taking a dance class, riding a bicycle or just talking a walk are basic choices that we all can make no matter, race creed, or economic statue that will affect our health.

  22. Dherrera

    After watching the video “Health Outcomes” by Dr. R McDougall on philosophical views towards health care I noticed a couple of interesting points. One point that he mentioned is the issue of just or unjust. This is a very important view because we often see injustice in areas where people have a low economic status and poor health. We might assume that their poor health is due to their economic status, but I believe that the main reason people have poor health is because of their poor personal choices in their lives. For example, a person that holds a steady job is probably in better health than a person that chooses to go on public assistance. I believe that having a job is beneficial to one’s health because it allows you to leave your house on a daily basis and interact with other people; instead of staying at home all day. Some people might see and injustice right away, but in reality theirs is none because these two persons have made personal choices that have a direct impact towards their health.

  23. dorcas

    Professor MacDougall spoke a lot about how our choices affect the outcome of our health, but I believe that inequality has a lot to do with the choices we make. We may have the same health care system available to us like what they have in England, that should not make us to expect that health outcome should be the same for everybody across the board. There are other things that may cause people to make the choices they make. For example comparing poor neighborhood vs rich neighborhood in terms of education, stress of poverty, availability of fresh foods and many other problems affect the choices they make. Many research has shown that supermarkets that carry fresh fruits and other groceries are easily accessible to people in rich neighborhoods, but it is not so in poor neighborhoods. Gyms are not common in poor neighborhoods and the quality of education is different. this means that people living in affluent neighborhoods have it easier even though they make more money, they don’t need to pay for transportation to get to these places. Money for transportation may be an issue for the people in poor neighborhoods to get to the hospital, supermarket, gym and many other important places that can be of help in making the right choices. Many of them are not educated enough to know the outcome of their life style, while some of them may have giving up because of the stressful life they face daily. Even though I strongly believe that the choices we make in life matters, in a situation where we are comparing people’s health based on inequality I don’t think it’s fair to base health outcomes mainly on the choices that people make in life.

  24. donna myriel

    Dr. Robert MacDougall’s lecture was quite interesting, especially the white hall study which pointed out social class but these people had the same health insurance. This has made me realize that a lot of health care disparities are not really caused by lack of insurance, even though the government has made it affordable for everyone to get insurance. A lot of it has to do with our choices we make in our everyday life and also based on our upbringing. Professor MacDougall brings up a lot of factors in his lecture about injustices and his examples made it very easy and clear to understand the different concepts of injustice in our society.

  25. Keila Gordon

    I really enjoyed Dr. Robert Macdougall’s lecture. I loved the way he addressed the topic of whats justice and whats in justice. The examples he gave really helped me understand his ideas and his points. Explaining the different between things that are fair/unfair and things that are just/unjust really cleared up the confusion. I think thats a major controversy on whats just and unjust. Many people may feel because somethings unfair makes it unjust and that is not always the case. He said a person may be born healthy and another may be born with an illness, which is completely unfair, but that doesn’t make it unjust.I couldn’t agree more with that statement from him. Dr Macdougall really helped me understand this topic very well!

  26. klever quinde

    very interesting video, our guest lecturer was very clear in explaining everything and gave great examples. he made the differences between injustices and inequality very clear, also a good explanation on differentiating phycologist and philosophers and how they use data.it was also nice how this tied into the bad blood assignment we did earlier and how it makes certain races fear doctors. very informative video excited to have more guest lectures.

  27. Sadiquah

    It was interesting to listen to Prof. MacDougall’s lecture, he had many relevant examples to help me understand the topics that he was talking about. It was interesting to hear the philosophical standpoint of just/unjust healthcare. He nicely explained the difference between what psychologists are interested in and what philosophers study. So many people have different viewpoints about what is fair and unfair when it comes to health care. I personally feel we will forever have issues in our health care system because we are all at liberty to make choices and due to many different factors such as socio economic status, preconceived notions, etc, a lot of people don’t understand the severity and seriousness that these choices can impact their health. Until we can get everyone to understand the difference between healthy and unhealthy choices we will continue to have health disparities. This was a great lecture. Thank you Prof. MacDougall!

  28. iespinoza

    I encourage everybody to watch the documentary “Stress: portray of a killer” by Robert Sapolsky. It keeps a strong relationship with the Whitehall study the Prof. MacDougall’s made reference in the video. I got a deeper understanding about how the factors or circumstances that surround an individual affect its health. Even when having the same access to healthcare the health behavior of the individual as well as his/her socio-economic position are substantial determinants of health that fall under the individual’s responsibility. I agree with the notion that education is undoubtedly an element that contributes to enhance our health. As educated individuals we are driven not only to make healthier choices but also it moves the individual to a higher hierarchical position in society which as seen in the video means lower morbidity rates.

  29. Rob MacDougall

    Thanks for the interesting comments, students. Just to reiterate a couple of points from the presentation: I wanted to make sure that everyone understood I presented 3 quite different views of “health justice.” I didn’t take a position myself in the video about which one is right. But I did point out that the material principle of health justice you adopt will influence which of the three graphs (presented at the beginning) you think demonstrate an injustice. I am wondering if anybody thought one of the 3 views was better than the others? And also, did anyone change their mind about whether the examples given at the beginning were unjust after hearing the talk? Curious to hear your thoughts….

  30. rssp044

    The Lecture was very interesting. It clearly defines things about “Health Justice” and other issues related to it, which is very important. In my view, all the people do not have same resources and education/knowledge levels, so if anybody needs health assistance or treatment/care, it is the primary responsibility of the nurses and medical doctors to make it clear to the patient about his/her health condition, consequences of the problem, mode of treatment, the expenses and, the outcomes. Being honest with the patients and telling them the right stuff about both problem and treatment would be a fair game. Suppose that you are a doctor and if your patient knows how will you test or treat them that is the best approach both for doctor and for the patient.

    1. AAlmond Post author

      Great job describing ways in which your view of ‘health justice’ can be applied in the clinical setting. I find you recommendations to be well thought out.

  31. Sayma

    I really enjoyed this lecture and the points on the differences between fair/unfair and just/unjust. I do believe part of the problem has a lot to do with the distrust between minorities and white physicians because of the long injustice that has been going on in America, for example the Tuskegee incident. There is a big distrust between minorities and white physicians the same as minorities and police officers. Lot hospitals, physicians, governmental officials still to this day do not see blacks as equal in this country. Also because of many institutional racism blacks have less education and fewer educational opportunities than whites. Also communities of blacks tend to be the target of unhealthy fast food, liquor, and drugs. On the other hand though blacks and minorities period need to take a stand and sometimes step out of the victim spot light, speak up for injustices support and help one another and become independent and not dependent. Education is a big factor also the more education individuals have the more likely they are to make better health related decisions than less educated individuals. Better education also helps lessen the spread of diseases. Often I feel that blacks and minorities in general fall into the idea of accepting things the way they are instead of fighting educational inequality, health inequality, and so on. This is the only way to change things.

  32. IrinaF

    After watching Professors Mc Dougall’s lecture , I found him to be very informative because he used graphs to better inform students that people with highest paying jobs have the better health outcomes. Also, showed a study about infant mortality by race, the graph showed different years and measures deaths that measures by race, and showed blacks had the highest. The life expectancy by birth is similar from the UK and the US. Females live longer, than men. To each person whatever health is acquired
    without using force or fraud . People have the right to have to healthcare and it would be unjust if you were to give that up.

  33. donna myriel

    what i thought was interesting about this lecture was the white hall study. It showed that even as everyone in this country gained access to healthcare, there was a still a difference in mortality rate based on their socio-econimic status. It makes me wonder that if the individuals in lower class are not visiting their doctor regularly because of the amount of hours they work a week or that missing a day of work to see a doctor can affects their pay to keep up in paying for expenses of their everyday needs

  34. Alla P

    Professor McDougall discusses the complex web of circumstances that influence each individual’s healthcare and well-being. Clearly, environment and socioeconomic status would have a huge impact on an individual’s health, but some of the examples used – such as the allergy medication – seemed a little bit silly. Healthcare comes in two forms – that which treats an illness or a problem, and that which merely makes us more comfortable. Taking a Tylenol for a mild headache will not make me “healthier” than somebody who goes without on its own, though an argument could be made that the person without the headache would be more likely to make friends and be in a good mood. He makes a point that some people are simply born sicker than another, and calls it “unjust” – a viewpoint I can understand but cannot bring myself to agree with.


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