PLAN DE COMUNICACIÓN, CAPACITACIÓN Y EDUCACIÓN AMBIENTAL.

In this review of KantÕs philosophy and its potential for an ethics of public health, we have seen how Kant disposes with the command and control structure society, which typically featured in 18th century authoritarian Prussian society. Instead he asks for recognition of the morality of any top down politics and policy and the role of public officials in society. Although many public health professionals and experts would consider themselves at far distance of politics and bureaucracy Ð arenÕt they serving the public? Ð Kant is precisely addressing the issue how reasonable and just policies serving the public should be enacted. The underlying impetus canÕt be the principle of doing good, it should be accompanied by the judgment of justness. Just in KantÕs term is quite different than notions of equity or fairness presuppose. It is about (indirect) consequences of actions outside the domain of control and care by communities and other forms of association. In this respect KantÕs view on three points have been attempted to made clear:

1. his view on instrumental rationality: the setting of ends and correlatively the selection of preferable methods

xvii

This is taken from the philosopher Meir Dan-Cohen, who takes up on the one hand the Kantian view but on the other hand (what he claims) the social view; my point is that the crucial philosophical lesson of Meir-Cohen is perfectly in line with what Kant was aiming at.

2. his view on public and private (experts and officials) transcending the distinction between the individual and the social

3. his view on responsibility hereby constituting identities of individuals and communities The bottom line of KantÕs thought is to reject the top down, command and control structure of societal regulation. Instead he is avant la lettre proposing concepts of governance, voice and citizenship which are now quite important issues in contemporary political philosophy. In this sense the point of this paper is quite provocative: claiming that the rigid, principle based and duty freak kind of reading of KantÕs philosophy should be reclaimed by a reading which focuses much more on the virtue based, anthropological and pragmatic side of KantÕs philosophy, as well as on the importance of Kant as a political philosopher (reading his moral philosophy and philosophy of right in terms of his political philosophy rather than the other way around which is the received view, but which is commentated and has been substituted by the new reading following critics such as Allison, Wood, OÕNeill, Herman, and many others.

Thus, Kant is putting emphasis here on the morality of political power. It is remarkable to see how KantÕs work parallels HirschmanÕs work, who also puts much emphasis on the producing forces of knowledge, products and power. The issue for Hirschman is that many goods, private but certainly public goods, are complex goods. In most institutional domains such as health care, education, childcare, and labour arrangements, the quality of public products is not easy to determine. This applies the more so, when services are developing. In those cases it is unclear what is actually offered; there is no clear yardstick to determine good care, good education, etc. Participants do not know what they want, and in fact, producers of such services do neither. In such situations it is much more adequate to improve the functioning of these institutions: ÒThe reality of the situation is that demand for a service has arisen in advance of real knowledge of how to satisfy it É the institutional question is here not of protecting the consumer, but of educating the producer and providing him with as much information as possible about his performanceÓ.55 So, we need to enact learning processes, but the focus is on the producers of social and political life and the institutional mechanisms to provoke voice.56 In Kantian terms, it is about the power circles of social, economic and political life.

The other intriguing insight of KantÕs philosophy is his presuppositions on the notion agency and responsibility. In a revolutionary way Kant forecasts already some of the extreme consequences of our notions on deed, risk, and moral worth developing now in our society and culture of risk, responsibility and social management. Kant was deeply involved in this area of concern, which seems to be highly relevant to the public health community and to current public health practice.

To finalize this point, already elaborated in this chapter, we may capture the famous case as presented by Augustinus, the Church Father, concerning committing adultery and marriage misconduct. He presents the case of the man versus his woman, but in our present world language it could also be a woman versus her husband, in which case the reasoning runs the other way, or it could also be two women or men. Probably not accidentally, Augustinus did not consider these situations. Here is the case Augustinus presents: A man in a hotel enters a room searching for the nice lady he saw in the lobby and ending up in bed with her. Another man enters a room looking for the same woman, but mistakenly he enters his own room and he ends up in bed with his own wife. The third man enters a room intending to go to bed with

his wife, but by accident enters the wrong room confronted with that same good looking woman of the lobby. Who is responsible for what in these three consecutive cases?

Similarly: I could meet an Italian, clearly visible pregnant woman and out of my anger with the Italian law, I light up my cigarette; I meet the same Italian woman but she is a happy smoker and responds to my lighting up the cigarette by smoking her own cigarette; and thirdly, I meet the same Italian woman, she smokes and asks me to light her cigarette, but I am penalized. Again, who is responsible for what?

The answer according to Kant has to be sought with reference to the social background for constituting and regulating individual and social behaviour. Indeed, smoking (or other forms of bad behaviour) can be considered a public affair, if enacted as a public issue: as external costs of (indirect) consequences of acts to others: this is the business of politics on his view. It is not the kinds of measures, by law or other enforcing regulations which form the centre of politics according to Kant. His emphasis is on the process through which we struggle to sort out what are public and private affairs with respect to the freedom of autonomous persons and communities. But we cannot discuss such issues without acknowledging the fact that in this process identities and responsibilities of selves and communities are created, shaped and reshaped.

Here comes the Kantian gist. As always Kant is putting upside down our self-evident,

common sense, and intuitive feelings and notions: All our collective measures to reinforce peopleÕs sense of responsibility by making explicit public announcements on the various issues of responsibility Ð do not smoke, do not eat fat, do exercise, refrain from stress, and so on Ð are supposed to strengthen our identification with the appropriate sources of subject and object responsibility. However, while trying to reinforce our notions of responsibility, public health measures as representative of other collective, coercive measures, may in fact weaken it. If we learn that coercive measures apply to the operations of our free will, we may respond progressively contracting the latterÕs domain. The paradoxical effect here is that in many instances behaviour has to be moralized and blamed for: the person is an addict, the person has no control over his or her body and mind, the person has to be corrected. Increasingly we have to describe actions in a deterministic vocabulary designed to place our free will, our selves, and our communal life at the periphery of self and communal life, that is outside the boundaries of social life. This in fact leads to minimalist forms of constitution of selves and communities. Instead of accusing liberalism, as Kant actually already conceptualized in the 1790s (donÕt forget that there was a strong communitarian and communist as well as a libertarian countermovement against Enlightenment in the late 18th century, a period which we now consider as the Golden Age of Enlightenment) of creating atomistic individuals, liberalism should be seen on KantÕs view as constituting selves, both individually and collectively. There is no other way. For, in some cases, we really need to restrict behaviour and to enforce legal sanctions as in the case of becoming murderers or terrorists Ð in which case there is a direct link between subject and object responsibility, at least a link which should be created according to Kant. However, in most cases, similar approaches may be unintended and unwelcome. If the mishaps associated with driving, smoking, eating fat, exercising too little, living too ambitious lives and other kinds of behaviours considered to be unresponsive to societyÕs needs and goals, carry with them severe social and legal repercussions, we may decide to give up all sorts of social behaviour which are vital and creative to individuals and communities. By cutting down responsibilities, individuals and communities may draw the boundaries of their selves and their identities more narrowly than they otherwise would have done.

Then we end up in the paradoxical in which in the Anglo-American approach we would be astonished to learn that the person who deliberately refrains from pulling the drowning child out of the pond is not legally responsible for the childÕs death Ð which is in fact the legal case in the USA57 Ð versus the situation in Italy where the person who lights up a cigarette in front of a pregnant women will be penalized.