June 7-8, 2018, Lisbon, ISCTE-University Institute of Lisbon, Portugal
Health policies have become more aligned with the needs of different social groups (e.g. migrants, ethnic minorities, women, LGBT) and of specific medical conditions (e.g. HIV, mental and age-related diseases). Regulators interfere more and more in professional work models and decisions to better control health systems performance and to enhance transparency, but so do empowered citizens in the defence of their rights as patients. Scientific knowledge is often called upon to improve the governance of health systems by providing clinical protocols and guidelines with evidence on effectiveness and efficiency. Nevertheless, the tensions involving rights, knowledge, and trust in health have been widely acknowledged.
Moreover, events such as the ongoing global warming, the latest financial and economic crisis, or the increasing number of refugees not only highlight that old tensions in health have persisted over time but also testify to the rise of new paradoxes linking rights, knowledge and trust. Health inequalities increased in the 21st century, the expected functioning of health systems often do not meet users´ and professionals´ needs, and the strengthened political and civil rights are constantly under challenge.
Health professionals continue to play a key mediation role between evidence and users despite professional values, commitment and ethics are under growing criticism, hence a seemingly contradictory link between distrust of and dependence on expert knowledge. This paradox coexists with market-driven dynamics in which users are turned into consumers and, together with professionals, they are made accountable for individual decisions. The diversity of scientific and lay rationalities makes the different knowledge rather difficult to reconcile, and the expectation of certainty in evidence-based truth is virtually unattainable. More established health care professions and emerging actors including the so-named complementary and alternative practitioners compete for their own place in the production of truths, while empowered citizens claim the right to decide freely on important events concerning their lives regardless of experts´ evidence (e.g. death and birth). The role of private investors in R&D is also still not entirely clear with regard to public regulation and science agenda setting.
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