In primary prevention, they focus on preventing ill health in the first place and on promoting good health. For these and other reasons, many in the public health community are skeptical of the relative utility of secondary prevention in a clinical context. Here, the goal is first and foremost to avoid poor health by empowering people with different ways of living healthy.
Yet many variables associated with chronic disease are primarily related to legitimizing governments. While a positive impact of such policies on chronic disease incidence and mortality would certainly be plausible, a wide range of less radical and more politically viable options exist on the menu of different levels of government action.
Corporate Entities
In many cases this is achieved through voluntary corporate social commitments, such as charters or formal partnerships with charities or community organisations. Although many companies generate profits through healthy products, many others benefit from bringing products to market that are likely to cause harm. What makes this prospect all the more dire is the industry's refusal to take seriously the standards it agrees to uphold.
Case Studies
The authors describe empirical research findings and conceptual arguments that suggest that stigma is always associated with negative health outcomes—especially in otherwise disadvantaged populations, and certainly in the case of obesity. The case then shifts focus to another situation frequently encountered in public health practice: the applicability of the evidence base to multiple settings. The county health department director, drawn to the program because of its potential cost-effectiveness, readily embraces the program.
Later, however, during a program meeting, one of the department's public health nurses expresses concern about an overly strong focus on personal responsibility, which she feels makes the program unfair. Based on her knowledge of the target population, she also thinks the program will be rejected. While the first three cases are set in the United States, the case by Aspradaki et al.
The case description puts the reader in the position of Greece's central oral health director providing a consultation to the head of public health programs in the Ministry of Health. The case provides context for smoking in Europe and nearby regions before summarizing the legislative framework that led Bulgaria to consider the ban. The case then raises the question of whether you, as director of the regional health inspection, can guarantee the implementation of the new law.
The cases illustrate only a fraction of the ethical issues that arise in chronic disease prevention and health promotion.
- Background
- Case Description
- Discussion Questions
Evidence has shown that food and drink marketing to children contributes negatively to health, affecting food knowledge, attitudes, dietary habits, consumption practices and health status. However, recently, numerous non-governmental and international organizations and all levels of government have expressed their concern about food and beverage marketing and advertising to children as a public health issue. The Institute of Medicine conducted a systematic review of the influence of food and beverage marketing on diet and diet-related health in children and adolescents (McGinnis et al. 2006.
Marketing influences children's food and beverage preferences, purchase requests and short-term consumption, even among young children (ages 2-5); and. As part of its Global Strategy for the Prevention and Control of Noncommunicable Diseases (WHO 2004), WHO subsequently endorsed policy recommendations for governments to take action on the marketing of food and drink to children. The chain recently offered to increase its annual cash donation to cover all food and equipment costs in exchange for renaming the program "The Big Boss Burger Community Kitchen" and for placing the chain's logo on all signs and promotional materials.
On the one hand, a few years ago your Healthy Public Policy team launched a study on the impact of food and drink advertising on children. Last year's update to the Board of Health study included a recommendation that city-operated venues and programs avoid commercial food and beverage advertising aimed at children younger than 13. In an ideal world, how much do you think food and beverage marketing should be exposed?
The extent, nature and effects of food promotion to children: A review of the evidence to December 2008.
- Background
- Case Description
- Discussion Questions
However, society can legitimately intervene to prohibit behavior that exposes others to serious harm, and this "harm principle" is invoked as a basis for removing children from homes where parenting practices are judged to contribute to severe childhood obesity and its accompanying comorbidities ( Murtagh and Ludwig 2011. As the state's new health commissioner, the governor has charged you with making obesity prevention a public health priority. More than 50% of the state's children and about 20% of adults are enrolled in Medicaid (a federal-state program that provides health care services for low-income Americans), making it the largest line item in the state budget.
The governor has requested that you convene and lead a 12-member task force to make recommendations for a statewide obesity prevention strategy. For months, task force members debated measures that eliminate or limit adults' choices through government action, such as taxes and bans on unhealthy foods and beverages. However, task force members agreed to tackle childhood obesity prevention on the grounds that the state has a role in protecting them.
Members of the task force also wanted to invest in a nationwide media campaign about the causes and harms of childhood obesity because they believed it would raise awareness and promote informed choices. But proponents of the tougher approach say it is honest about the facts and emphasizes the essential role of parents in regulating children's behavior. Stigma, ethics and policy: A commentary on Bayer's "Stigma and the ethics of public health: Not can we but should we".
United Health Foundation in samenwerking met de American Public Health Association en Partnership for Prevention.
- Background
- Case Description
- Discussion Questions
2013), stigma in a public health context consists of two central components: (1) an in-group marks an out-group as different based on some common demographic characteristic, and (2) the in- group knows a negative evaluation of the characteristic. The prospect of compounded disadvantage and inequalities makes stigma a critical issue for public health ethics, one that strongly implicates the concerns of distributive and social justice (Powers and Faden 2006; Courtwright 2009. Recent data show that the prevalence of obesity is 35.7% in the United States (Ogden et al.
This debate has roots in the nineteenth century, but is ongoing (Leichter 2003) and influences public perceptions of whether collective action in the name of public health is warranted. The fact that socioeconomic conditions have a tremendous impact on determining obesity patterns among and within populations suggests reason to suspect that public health interventions aimed at changing individual lifestyles will be particularly effective in combating obesity (MacLean et al., 2009. Some commentators argue that the denormalization and stigmatization of smoking has produced positive public health consequences.
While the evidence for the effectiveness of stigma as a means of improving public health in general remains debatable, the evidence regarding obesity overwhelmingly suggests that stigma is more likely to exacerbate rather than reduce obesity (Puhl et al. 2013; Puhl and Heuer 2010. While efforts to curb obesity are critical, it is ultimately all too easy to implement public health interventions that reinforce the stigma of obesity, increase health inequalities, and neglect the role social conditions play in structuring patterns of obesity and limiting obesity At a recent BCHD meeting, Pauline, a public health nurse employed by the health department, expressed concern about the implementation of the program.
To what extent should public health interventions aimed at combating obesity address the upstream social determinants of obesity and obesity-related diseases?
- Background
- Case Description
- Discussion Questions
Water fluoridation adjusts the fluoride concentration in the public water supply to an optimal level for the prevention of dental caries (WHO 2002. Despite the proven effectiveness of fluorides in the prevention of dental caries, public debates about the effectiveness of water fluoridation continue (Awofeso 2012). ; Rugg-Gunn and Do 2012. Several publications discuss the benefits and harms of water fluoridation (McDonagh et al.
Despite the controversy, water fluoridation is “the most celebrated example” of “collective action/efficiency” to justify public health programs and policies (Faden and Shebaya 2010). Although the government mandated water fluoridation in 1974, this has been the case since 2013. The program had not been implemented due to diffuse public opposition to such interventions. In 2008, a special committee proposed to the Ministry of Health and Social Solidarity to include water fluoridation in the national public health strategy (Ministry of Health and Social Solidarity 2008). .
It also included a systematic content analysis of all mentions of water fluoridation by the relevant actors (eg dental professionals, policy makers) reported in the Journal of the Hellenic Dental Association for 1983 to 2011. Significant concerns were about a lack of technical infrastructure and organizational problems in the institutions that will implement water fluoridation. Papadakis is considering implementing mandatory water fluoridation, but is concerned about the many problems it may face (i.e. ethical, legal, political and social challenges).
Papadakis asks for input on what to consider before mandatory water fluoridation is implemented in Greece.
- Background
- Case Description
- Discussion Questions
As a member of the EU, Bulgaria has had to harmonize its legislation with European legislation. Bulgarian society was also divided into groups of supporters of changes and opponents of smoking restrictions. In November 2012, two independent members of the Bulgarian parliament raised the issue of business losses from the smoking ban.
They claimed that 10,000 people lost their jobs due to fewer visitors to food and beverage outlets and called for the law to be revised (Todorova 2012). The Minister of Economy, Energy and Tourism favored a more flexible application of the law. Despite the controversy and public debates, the law banning smoking in public places has remained unchanged since May 2013.
What will you, as director of the regional health inspection, do to ensure the implementation of the law in the region. When is it acceptable to limit personal autonomy for the benefit of the health of others. Open Access This chapter is distributed under the terms of the Creative Commons Attribution-Noncommercial 2.5 License (http://creativecommons.org/licenses/by-nc/2.5/), which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
Smoking ban confronted two ministers—The Minister of Economy Dobrev and the Minister of Health Atanasova.
