Definitions and Differences
1. Explain what public health ethics is, how and why it is different from clinical ethics, and the relationship between ethics and evidence.
2. Should obesity screening be introduced in schools as part of an early intervention approach to reducing obesity in the population? Why or why not?
3. What are some of the challenges of applying public health ethics to implementing public health programs in low and middle-income countries and/or global health issues?
1. Public health ethics is defined as the justifications, foundations and actions that are considered ethically and morally fair, for the collective benefit of the public (1). The promotion of health is systematically processed, prioritized and justified with ethical principle, scientific justifications and evaluation of stakeholders keeping intact the liberty of the people and overcoming the barriers (2). Clinical ethics is defined as the discipline in the healthcare industry, which helps healthcare professionals to analyse and resolve ethical conundrums during clinical practice. It encourages the healthcare professionals to consider the individual perspective of the patients and promotes reflective practice, which minimizes patient risk. Clinical ethics is more conformed to the interactions between the healthcare provider and the patient, whereas, the public health ethics is dealt among the an organization and the community (3). Clinical ethics is more concentrated on the individual needs whereas the public health is more generalised for the population. Clinical ethics is more focussed on the sovereignty, non-beneficence, benevolence and justice for the patient but the public health ethics is more bent towards the inter-alliance, inter-community trust, congruity as well as justice for the public. It can be said in a way that clinical ethics is a part of public health ethics. Providing health promotion to reduce the change of exposure to infectious diseases. Creating surveillance, globally to monitor potential risk factors and prevention of health threats. The importance of evidence is support the rationale for the health promoting campaigns. There are two major types of evidence, mainly Normative and Descriptive evidences. The descriptive evidences rely on statistical, qualititative and quantitative data to derive a statement, whereas, normative evidences are generalised opinions or accepted norms about a subject matter. Normative evidence is less preferred than descriptive evidences in the promotion of public health because the aggregation of statistical data and evaluation of the problem is not provided in the former method of evidence. It is important to assess the effect of consequentialism on the promotion of public health. This concept conforms the public health policies keeping the good public health outcome intact. Consequentialism is affected by the overall health and well being of the population and the larger impact it has on the society as a community. Public health is also important to assess the utilitarianism in the society. This utilitarianism concept affects the health and promotion of one affects that of the other. In clinical ethics, this concept is not considered as those policies only regard individual care. Public health community essentially influences the clinical health as a form of community effect, which determines the clinical practices and planning in the healthcare industry (4). Public health programs also structures the policy and safety guidelines in the clinical acre setting and provide equal rights to healthcare among the general population. The CDC has now developed minority health improving strategies whose purpose is to utilise public health ethics to minimise the disparities among the health status, accessibility and benefits among the general population covering minority communities. In summation, the public health is a epidemiological care whereas, clinical health is individualistic.
The Importance of Evidence in Promoting Public Health
2. Obesity is a major problem that is devouring the population slowly. It is estimated by World Health Organization that 340 million children aged from 5-19 years are obese, as of 2016 (5). Obesity induces a lot of health risk factors and causes chronic diseases that might harm the affected person. It is important to assess the potency for obesity in children to prevent the those health risks. Obesity screening is a form of detection method which asses the height, weight, body/mass/index (BMI) to evaluate the correct body weight of an individual. These screening techniques can be commenced at young age, in children that would help prevent obesity and other associated risk factors. This form of practice will reform the mindset of the children to adapt a healthier lifestyle from a very young age (6). This will influence the health of the community in future, prevent susceptibility to diseases, and promote a more constructive, stronger population. According to the Centres for Disease Control and Prevention (CDC), it is supposedly an effective method to reduce the chance of obesity in future (7). The United States Government has already started incorporating physical health screening programs in school like diabetes, hypercholesterolemia, hypertension, asthma, head-lice along with obesity. The programs also included mental health screening like substance abuse in schools to help children from early on. There is not much evidence that supports the improvement of population health when obesity screening programs improves population health, as it is a relatively new concern. But, it has to be kept in mind that this form of practice can have a negative impact on the innocent minds of the children as they might be depressed or demotivated if they were subjected to weight related discrimination. This will affect the mental health of the child. The practice of public health ethics need to be applied in this scenario, where the privacy and discrimination of the participants need to be protected (6). All the participants will be assessed in isolation to prevent public shaming. Detection of a potential or proven obsess participant need to be communicated interpersonally and made sure that the approach is sympathetic, since the majority of the participants are either children or adolescent. They must be given ample information and provided a nutrition and activity regimen, so that eating disorders are not adapted (8). The physical trainers can be advised to practice and incorporate enough time for exercise and encourage reluctant students to be involved in such activities without enforcing temperaments. Parents can also be involved in the screening regimen and educated about the ill effects of obesity in children to ensure that the treatment is all rounded and followed not just in the school but also at home. The school authority can be advised to regularly check for the food provided in the cafeteria is healthy. Communication should be clear to make the children understand the concepts of having a healthy diet and not just some stigma that comes with obesity. School counsellors can also help the children prevent body dissatisfaction and eating disorders.
The Impact of Consequentialism and Utilitarianism
3. Public health programs conducted by health organizations like CDC, National Institute of Health et cetera, against Malaria, malnutrition or other epidemic diseases, provide the participants to recognise the health related issues identify risks and control their lifestyle to influence improved health. Public health programs have the ability to influence the thought processes and the beliefs amongst the community to adapt a healthier choice for their own self (9). The ethical issues regarding the promotion of public health promotion are generally based on the efficacy and autonomy. The efficacies of these programs are determined by the financial expenditure that goes into the programs. The effect of cost of these programs determines the success rate of these programs (10). The autonomy based concerns in the public health programs are determined by the extent of the interventional procedures. People may feel over imposed if the promotion is too much pressing or invasion of privacy as their medical health records and other information is required in such programs. Public health programs can be sometimes, conceived as an invasion of privacy or breach of personal space. Proper education, information and involvement will be required for the public to ensure them that the interventions will promote better health. The problem with low or middle-income countries is that, lack of formal education, financial crisis and other socio-economic determinants of health affect the public health. Financial problems are also prevalent in these conditions, which makes it difficult to promote public programs, since the public cannot invest in proper healthcare expenses (11). There are also religious and ethnic beliefs among the low or middle-income countries. Over the years, several incidents have taken place where the religious leaders have spoken against health practices, like in Netherlands, when after the polio epidemics the then Minister of health spoken against vaccination (12). The dependence of religion might be an ethical barrier among the organizers as well as the public since they are not open to the change of ideas and thoughts and economic output of the population is affected. This hinders the overall development of country as well effects the public health. Another barrier in the promotion of public health programs in low or middle- income countries is that reluctance of participants due to financial, social or economic factors and the participants which makes it difficult to convey the information to improve the public health (13). The stigmas and judgements towards these public health programs also make it difficult for the organizers to maintain the public health ethically. Public health forums can also make the participants feel stigmatized, as they feel exposed in the eye of the public regarding a detected condition. It is important to make sure that the organizers are not manipulating or promoting false hopes in the public, which will reduce its importance in future. The ethical issues will have a global scale impact and determine the health outcome of the community, like in the Australian Government trying to close the gap of healthcare between the Indigenous and the non-Indigenous groups (14).
References
- Marmot M, Bell R. Fair society, healthy lives. Public health. 2012 Sep 1;126:S4-10.
- Faden R, Shebaya S. Public health ethics.
- Beecher MD, Henry K. Ethics and clinical research. InEthics and Medical Decision-Making 2017 Oct 5 (pp. 3-9). Routledge.
- Holland S. Public health ethics. John Wiley & Sons; 2015 Jan 20.
- Obesity and overweight [Internet]. World Health Organization. 2016 [cited 23 April 2018]. Available from: https://www.who.int/mediacentre/factsheets/fs311/en/
- US Preventive Services Task Force. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. Pediatrics. 2010 Jan 12:peds-2009.
- Body Mass Index (BMI) Measurement in Schools [Internet]. Cdc.gov. 2017 [cited 23 April 2018]. Available from: https://www.cdc.gov/healthyschools/obesity/bmi/bmi_measurement_schools.html
- Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, Zitman FG. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Archives of general psychiatry. 2010 Mar 1;67(3):220-9.
- Glanz K, Bishop DB. The role of behavioral science theory in development and implementation of public health interventions. Annual review of public health. 2010 Apr 21;31:399-418.
- Ali MK, Echouffo-Tcheugui JB, Williamson DF. How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program?. Health affairs. 2012 Jan 1;31(1):67-75.
- Kruk ME, Porignon D, Rockers PC, Van Lerberghe W. The contribution of primary care to health and health systems in low-and middle-income countries: a critical review of major primary care initiatives. Social Science & Medicine. 2010 Mar 1;70(6):904-11.
- Ruijs WL, Hautvast JL, Kerrar S, Van der Velden K, Hulscher ME. The role of religious leaders in promoting acceptance of vaccination within a minority group: a qualitative study. BMC public health. 2013 Dec;13(1):511.
- Rainey JJ, Watkins M, Ryman TK, Sandhu P, Bo A, Banerjee K. Reasons related to non-vaccination and under-vaccination of children in low and middle income countries: findings from a systematic review of the published literature, 1999–2009. Vaccine. 2011 Oct 26;29(46):8215-21.
Close the Gap: Indigenous Health Campaign | Australian Human Rights Commission [Internet]. Humanrights.gov.au. 2018 [cited 26 April 2018]. Available from: https://www.humanrights.gov.au/our-work/aboriginal-and-torres-strait-islander-social-justice/projects/close-gap-indigenous-health
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