Causal Pluralism and Public Health Ethics Trade‐Offs: A Toolkit for Acting on Social Determinants of Health

This paper aims to specify causal pluralism through considerations from public health ethics for causal analyses featuring social determinants of health. We will argue that choosing approaches to causality within a pluralistic framework can be informed by ethical considerations. More specifically, we will show how different conceptions of justice set different explanatory demands and how those demands constrain which causal concepts are appropriate to use. We will particularly illustrate this by examining how these causal concepts differentially support competing theories of justice, namely distributive and relational conceptions of justice, in the context of understanding and addressing health inequalities linked to social determinants like income inequality. We will further argue that this strategy can be employed more broadly to different causal concepts and ethical priorities.