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

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: 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.

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.

Public health measures intended to address collective health problems can be harmful or inconvenient for certain population groups. This hinders the effective enforcement of these measures, even when they are legal norms. In such cases, appealing to culturally accepted moral values can be an effective persuasion strategy to increase public support. This is an example of the usefulness of ethics for public health.

Background: Artificial intelligence (AI) has many different potential applications for healthcare system delivery, from imagery testing, triage, to the early detection of infectious patterns in large populations. Scientific literature shows that policies, legislation, and quasi-legislation on the question of AI are rapidly emerging and use one of four main regulatory strategies. Each strategy has limitations and can contribute to the creation of ethical and medico-legal risk, which our research contributes to identify.

Methods: We undertook a double-method literature review, first with a scoping literature review. We identified over 1200 documents from ~71 countries (from every continent), as well as international organizations that had adopted a form of regulatory strategy toward AI. We then proceeded to a narrative literature review where we highlighted both the taxonomy of regulatory strategies in use, and their respective risks and challenges to public health objectives.

Findings: The legal or quasi-legal framework surrounding the use of AI follows one of four possible strategies: trustworthiness, risk-reduction, ethical/principled, or indirect. The vast majority of the documents surveyed reveal that values and principles of public health are not sufficiently, or even explicitly, built-in the normative framework for health applications of AI (Health AI), and creates a wide array of challenges and risks, which our research helps to identify.

Conclusions: This leads to a detrimental situation and leads to two main consequences: the creation of a "regulatory gap" for Health AI, and also a potential mismatch with already existing medico-legal duties of public health actors and health professionals.

Background: The ethical practice of public health is guided by the articulation of ethical principles in a code and competencies to be demonstrated by individuals or embodied by institutions.

Methods: To update competencies listed since the first full list published by the American Public Health Leadership Society in 2004, we search the published literature with terms related to ethics, competencies, education, and public health.

Results: We identified 84 articles meeting the search criteria. Only five presented specific competencies for public health ethics. Several of these were overly general. The most specific competencies related to particular areas of public health.

Discussion: There has been little progress in describing public health ethics competencies since 2004, with the exception of particular areas of public health. To be meaningful, competency frameworks must be specific and measurable. But to be useful, they must not be overly specific and burdensome in number. The authors recommend that institutions and countries promoting the ethical practice of public health through codes and competencies share their questions and solutions informally and transparently in a community of learning.

In the wake of widespread public skepticism toward health authorities, this paper introduces a stewardship model of communication to guide public health officials in restoring trust. In critically examining the broader ethical concept of stewardship as developed by the World Health Organization and the Nuffield Council on Bioethics, the paper argues that public health officials-as stewards of the population's health and well-being-have an ethical duty to convey scientific knowledge truthfully. Rather than promoting excessive transparency or manipulating public perception through noble lies, the proposed stewardship model insists on honesty tempered by discretion. This entails conveying information that is accessible, assessable, and accountable. Through conceptual analysis and practical examples, the paper outlines how public health officials can fulfill their ethical duty of care by reclaiming their role as trustworthy stewards.