Carleigh Krubiner

Is it good public policy to pay people to change their unhealthy behaviors? What is the fairest way to allocate limited resources? What are researchers’ obligations to study-participants living in low-income settings? Carleigh Krubiner likes to ponder the issues that exist at the crossroads of public health research, policy and practice. “Ethics serves as another policy tool,” she says, “a framework to examine how to improve health practices and policies to better align with ethical principles and values.”

Her proposed doctoral thesis is an examination of the ethical considerations in designing conditional cash transfer programs (CCTs), which pay participants to adopt healthy behaviors such as antenatal care, preventive health visits and continued education. The idea behind CCTs, which exist in about 30 low-income countries, is that incentives will promote healthy actions in the short term and improve prospects for well-being in the long run. As part of her research, Krubiner plans to develop a guiding framework for CCT program design that will help policymakers set appropriate conditions for payment, addressing concerns about individual liberty and protecting against potential negative consequences. “The idea is to break the cycle of poverty,” she says. “These programs have great potential to improve the health and well-being of the poor, but there are also real concerns at stake when intervening in personal decision making, and these approaches need to be justified with due consideration and respect for the people they intend to help.”

In the future, Krubiner plans to split her time between academic interests and policy guidance. In addition to continuing her research on the ethics of social safety nets and public health programs in the developing world, she hopes to serve on domestic and international ethics advisory committees.

“There are so many exciting innovations to improve public health,” Krubiner says. “But it’s important to think about the ethical questions at stake before getting on board with the next big thing.”