Public Health Ethics最新文献

How ought scarce health research resources be allocated, where health research spans basic, translational, clinical, health systems and public health research? In this article, I first outline a previously suggested answer to this question: the 'fair-share principle' stipulates that total health research funding ought to be allocated in direct proportion with suffering caused by each disease. Second, I highlight a variety of problems the fair-share principle faces. Like other resource allocation frameworks, the principle needs to address the aggregation and distribution of harms and consider cost-effectiveness. Moreover, to make resource allocation recommendations, the principle has to be used in conjunction with real-world estimates of 'suffering', usually provided by the Global Burden of Disease Study. These estimates are disease-centric and only take 'proximal' causes of health loss into account. Applying the principle based on such estimates disregards 'distal' causes, including social determinants of health, thus skewing resource allocation towards biomedical research and away from public health research. Since public health research aims at improving population health while reducing health inequalities, the principle leads to inequitable priority-setting. The fair-share principle can only become equitable when due consideration is also given to 'distal' causes that are amenable to public health research and interventions.

Information provided to women invited to participate in mammography screening is crucial in supporting informed consent. Expert recommendations remain divided, and the ethical framing of autonomy, especially in shared decision-making, often fails to reflect the realities of clinical practice. This study examines how public-facing documents communicate screening information and explores whether relational autonomy offers a more ethically coherent approach. A document analysis was conducted using the READ method. Documents published between 1999 and 2023, from Quebec, Ontario or Canada, containing the keywords 'breast cancer screening' and 'screening mammography' were included and assessed using a 16-category grid. Fifty-one documents were included (Qc: 16, On: 10, Can: 25) and 11 were excluded. 10 per cent included women from the public, but the majority of contributing experts were women (57 per cent). 96 per cent of documents were considered inaccessible based on the Flesch-Kincaid Grade Level score. Benefits were mentioned more often than risks (90 per cent vs 37 per cent) and 16 per cent confused diagnosis and screening. Women under 50 were overrepresented (37 per cent) and racialized women underrepresented (58 per cent). This analysis reveals biases in how screening information is designed and communicated. Relational autonomy offers a more inclusive framework for evaluating and improving screening communication.

The global spread of highly pathogenic avian influenza (H5N1) clade 2.3.4.4b has evolved into a multispecies panzootic that disrupts conventional boundaries between human, animal and environmental health systems. Using Brazil's response as an illustrative case, this article argues that prevailing containment strategies-particularly mass culling-remain ethically insufficient and practically misaligned with the ecological complexity of H5N1 transmission. To clarify the normative foundations of an alternative approach, we introduce a theoretical framework grounded in zoonoethics and global ecological bioethics, emphasizing multispecies justice, relational vulnerability, intercultural and community engagement and co-responsibility. We then apply this framework to evaluate the limitations of reactive biosecurity paradigms and to outline multispecies-sensitive One Health governance guidelines. The analysis demonstrates that effective and legitimate panzootic response requires moving beyond biomedical and anthropocentric models toward anticipatory, inclusive and ethically grounded governance capable of addressing structural drivers such as biodiversity loss, land-use change and the erosion of Indigenous territorial protections. We conclude by discussing how the H5N1 panzootic represents a 'perfect storm' that demands not only improved preparedness, but a reconceptualization of One Health as an ethical and political project of multispecies cohabitation in an era of planetary instability.

According to the Public Goods Account, proposed by Jonny Anomaly, public health activities should only be concerned with the provision of health-related public goods. In this paper, I argue that the Public Goods Account cannot serve as an adequate account of public health activity. The main reason is that its central concept, that of health-related public goods, is itself implausible. I offer two potential understandings of health-related public goods and argue that, on both understandings, the provision of health-related public goods is neither necessary nor sufficient for a public health activity. First, on both understandings, there are plausible examples of public health activities that do not produce health-related public goods. And second, there are examples of non-public health activities that produce health-related public goods.

Obesity is a complex chronic illness of adiposity, yet body weight and obesity are routinely conflated in public health wording and policy design. This paper examines a recent recommendation from the Australian College of Nursing (ACN) to combat obesity via the routine collection and discussion of weight and height data of all school-aged children in the country. The obesity-specific ethical framework developed by ten Have and colleagues (2013) has been used to critique the ACN proposal, and to propose a shift away from weighing people, particularly young people, in health promotion activities for obesity.

In light of the COVID-19 pandemic, global health organizations have called for the implementation of robust global disease surveillance systems to recognize and respond to emerging pathogens. These active surveillance technologies would have a significant global benefit by preventing the spread of current pandemics and informing future pandemic responses. In this paper, I examine the extent to which we can sacrifice individuals' privacy through global disease surveillance in order to benefit current and future generations. First, I outline disease surveillance technologies and explain how disease surveillance would occur primarily in low-income, rural communities in the Global South. Next, I outline privacy-related harms that these individuals would experience as a result of disease surveillance. I argue that within our current distributional system for global health resources, pandemic surveillance would impose privacy-related burdens on marginalized communities, who would receive inadequate benefits from these programs. This is unfair because it exploits the worst off in order to benefit individuals in wealthy nations. I conclude that to justifiably implement global disease surveillance, we ought to adopt a 'prioritarian' approach to health distribution. To impose privacy-related burdens on the worst off, we must ensure that they benefit significantly.

Public health is commonly regarded as a branch of public policy. While few governments would dispute that public health should be a core responsibility of the state, in practice, it is frequently reduced to a branch of administration, in competition with other branches over annual budget distributions and policy priority. This paper advances the argument that the state should prioritize public health for one crucial reason: public health is a normative principle that constitutes the modern state. As a constitutional principle, it demands the state to promote and preserve public health. The paper examines first what makes public health a normative principle, and then examines why it is a normative principle that makes demands on the state. In so doing, the paper distinguishes public health as a constitutional principle from the constitutional right to health. The paper concludes with a reflection on the urgency to prioritize public health, not merely because of policy needs, but on the ground that it is a foundational normative principle of the modern state.

Mathematical modelling has played an increasingly prominent role in public health responses, for example by offering estimates of how infectious disease incidence over time may be affected by the adoption of certain policies and interventions. In this paper, we call for greater research and reflection into the ethics of mathematical modeling in public health. First, we present some promising ways of framing the ethics of mathematical modeling that have been offered in the very few publications specifically devoted to this subject. Second, to draw out some issues that have not yet been sufficiently considered, we bring in the case of mathematical modeling in voluntary medical male circumcision (VMMC) initiatives for HIV prevention in Africa. We argue that greater attention should be paid to ethical considerations in mathematical modeling, particularly as its use is becoming more widespread and its potential impacts are becoming greater in the 'big data' era, as witnessed during the COVID-19 pandemic.

Normative issues associated with the design and implementation of population-based lung cancer screening policies are underexamined. This study was an exposition of the ethical justification for screening and potential ethical issues and their solutions in Canadian jurisdictions. A qualitative description study was conducted. Key informants, defined as policymakers, scientists and clinicians who develop and implement lung cancer screening policies in Canada, were purposively sampled and interviewed using a semi-structured guide informed by population-based disease screening principles and ethical issues in cancer screening. Interview data were analyzed using qualitative content analysis. Fifteen key informants from seven provinces were interviewed. Virtually all justified screening by beneficence, describing that population benefits outweigh individual harms if high-risk people are screened in organized programs according to disease screening principles. Equity of screening access, stigma and lung cancer primary prevention were other ethical issues identified. Key informants prioritized beneficence over concerns for group-level justice issues when making decisions about whether to implement screening policies. This prioritization, though slight, may impede the implementation of screening policies in a way that effectively addresses justice issues, a goal likely to require justice theory and critical interpretation of disease screening principles.