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Health incentive research and social justice: does the risk of long term harms to systematically disadvantaged groups bear consideration?
  1. Verina Wild1,2,
  2. Bridget Pratt3,4
  1. 1Department of Philosophy, LMU, University of Munich, Germany
  2. 2Institute of Biomedical Ethics and History of Medicine, University of Zurich, Switzerland
  3. 3Department of International Health, Johns Hopkins Bloomberg School of Public Health, USA
  4. 4School of Population and Global Health, University of Melbourne, Australia
  1. Correspondence to Dr V Wild, Faculty of Philosophy, Ludwig-Maximilians-University Munich, Geschwister-Scholl-Platz 1, Munich 80539, Germany; v.wild{at}


The ethics of health incentive research—a form of public health research—are not well developed, and concerns of justice have been least examined. In this paper, we explore what potential long term harms in relation to justice may occur as a result of such research and whether they should be considered as part of its ethical evaluation. ‘Long term harms’ are defined as harms that contribute to existing systematic patterns of disadvantage for groups. Their effects are experienced on a long term basis, persisting even once an incentive research project ends. We will first establish that three categories of such harms potentially arise as a result of health incentive interventions. We then argue that the risk of these harms also constitutes a morally relevant consideration for health incentive research and suggest who may be responsible for assessing and mitigating these risks. We propose that responsibility should be assigned on the basis of who initiates health incentive research projects. Finally, we briefly describe possible strategies to prevent or mitigate the risk of long term harms to members of disadvantaged groups, which can be employed during the design, conduct and dissemination of research projects.

  • Behavioural Research
  • Distributive Justice
  • Policy Guidelines/Inst. Review Boards/Review Cttes.
  • Public Health Ethics
  • Research Ethics

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  • Contributors Both authors meet all four required criteria: substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; and drafting the work or revising it critically for important intellectual content; and final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. VW had the idea for the paper and wrote the first draft.

  • Funding Australian National Health and Medical Research Council (NHMRC) Early Career Sidney Sax Public Health Overseas Fellowship, 1052346. The research leading to this paper has received funding from the European Union's Seventh Framework Programme FP7/2007-2013 under Grant Agreement no. 602386 Credits4Health.

  • Disclaimer The contents of this article are solely the responsibility of the authors and do not reflect the views of the NHMRC.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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