Journal of public health (Oxford, England)最新文献

Background: Public health is tasked with preventing harm, promoting health and ensuring equitable access to care. Yet, increasing sociopolitical and economic turmoil is creating barriers to public health delivering its core roles. Whilst moral dilemmas are inherent in public health polycrises and their resultant ongoing impacts has thrust consideration of the moral harms that may be experienced when we are prevented in the delivery of care into discourses about the future priorities of public health. Experiencing moral harms can result in profound impacts for the individual and the delivery and outcomes of care and are emerging as a public health concern. At a time when public health and healthcare are facing interconnected challenges in funding, workforce attrition, erosions in public trust and quality, it is critical we identify the pertinent drivers of moral harms.

Methods: This commentary explores five different perspectives representing varied geographical locations and health infrastructures.

Results: Specifically, we explore the critical roles of economic status, social anthropological considerations, fiscal, organisational and individual factors to outline key drivers to formulate public health policy responses, going forward.

Conclusions: Addressing the moral harms is a public health imperative and associated solutions have a critical role to play in dampening the flames of current turmoil.

Internationally there are significant challenges to improving and protecting population health through effective prevention. In this novel analysis, we integrate public health evidence, ethics, and economics to argue that current health resourcing strategies neglect prevention, underestimate the social determinants of health, and fail to engage with the ethical dimensions of economic decision-making. We highlight the risk that overreliance on economic evidence may marginalize underserved populations, where data are limited, thereby deepening health inequalities. We conclude that improving population health and reducing disparities requires reframing prevention through both ethical and economic lenses. Investing in community-based, equity-oriented interventions can deliver sustained health and economic gains and support a more inclusive and resilient health system.

Global/public health policy and security historically relied on alignment of values to the Western value system to achieve public health security, environmental protection, emergencies, and disaster-risk management and public health governance. This alignment was facilitated by globalization. As geopolitical landscapes shift, a clash of values is eroding the dominance of once-uniform systems. This is paving the way for a multipolar world, where diverse value systems increasingly influence public health policies and discourse. Whereas evidence informs policy decisions, values motivate public health implementation integrity and fidelity. Ethical values and law are indispensable pillars of good public health policy, implementation and practice. The African Ubuntu ethical value system recognizes that being human is to be interrelated, interdependent and interconnected with all for all. It accommodates diversity in unity through harmonization, reciprocity, solidarity and the common good. It is in line with the One Health concept. This commentary proposes shared ethical values as a tool for implementation integrity and fidelity of global/public health policy. It recommends value- and evidence-based public health decision-making and practice that recognizes the paradigm shift from value alignment based on uniformity to harmonization of values based on unified diversity and moral reasoning.

The practice of public health within military settings presents distinct ethical challenges that differ from those encountered in civilian public health practice. This article explores the unique ethical considerations faced by military public health professionals, focusing on the tensions between individual rights and the health needs of the collective, which is amplified by the military's relative control over the lives of service personnel. The paper applies Upshur's (2002) 'Principles for the Justification of Public Health Intervention'-harm, least restrictive means, reciprocity, and transparency-to the military context, including in combat operations. It examines the 'dual loyalty' dilemma faced by military public health professionals, who hold professional commitments to both their patient population and, as military officers, to the chain of command. Further ethical considerations around defining the 'public' in military settings, access to healthcare, and the risk of moral injury are explored, including examples from previous military operations. The article provides a novel contribution to public health ethics practice by offering an overview from the perspective of public health professionals working within the armed forces which could guide training, policy development, and practice.

Background: The One Health approach encourages the normative consideration of human, animal and environmental health as a balance where these three interfaces are presented as interdependent. Thus, its ethical contribution may complement the scope of Public Health to address emerging threats that come into play non-human nature.

Methods: A philosophical methodology is combined with a scoping review aimed at identifying and discussing the relationship between One Health and Public Health ethics related to non-human health.

Results: After searching and screening, 65 studies were included for data extraction. My research finds, from a non-anthropocentric view, three ethical pitfalls to be consistent with the moral mandate of One Health and to address emerging Public Health threats: health disparities between human and non-human animals; health disparities between animal and non-animals; and health disparities between individuals and ecological wholes.

Conclusions: These pitfalls lead to consider, first, whether in research and practice One Health ethics is not so different from Public Health ethics. Second, whether there is a gap between the moral mandates of One Health and its practical commitment to the non-anthropocentric care for non-human health. This research can be helpful to highlight the contributions of One Health and warrant attention to its limitations.

Background: Public health ethics provides a framework for navigating ethical dilemmas, distinguished from clinical bioethics by its focus on population health, prevention, and explicit acknowledgement of political context. While public health ethical frameworks have been developed, concerns are raised about lack of utility or integration of equity and Indigenous perspectives (First Nations, Inuit, Métis). This study aimed to engage groups impacted by public health decisions to identify ethical values and develop recommendations for public health ethics practice in British Columbia.

Methods: A two-phase, community-engaged qualitative study was conducted from March 2024 to January 2025. 40 public health professionals and members of equity-deserving groups (people with disabilities, Indigenous Peoples, newcomer, seniors), were recruited for interviews or focus groups in phase one. Phase two involved follow-up surveys or interviews with 18 participants. Directed content analysis was utilized to identify themes.

Results: Participants emphasized the importance of equity, humanization, Indigenous Cultural Safety, and wholistic wellbeing, as well as relational values of trust and transparency. Recommendations included increasing equity through addressing social determinants of health and developing accessible practice tools.

Conclusions: Engaging equity-deserving groups generated insights and actionable recommendations to improve equity, strengthen public health ethics practice and build trust in public health.