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

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.

One of the ethical conflicts facing public health is that which pits utilitarian ethics against egalitarian ethics, that is, the principle of maximizing aggregate health against the principle of moral equality. Public health codes and guidelines usually incorporate both of these principles because the ethical objectives of public health pursue the greatest health for the population and respect for the equality of all people and greater equity in health. The conflict between the two is particularly evident in contexts of health care rationing. In such contexts, the utilitarian ethic is the winner, contrasting with equality and equity in public health. The thesis I defend here is that this conflict stems from a deficient interpretation of both ethics, which should be corrected as follows: on the one hand, utilitarianism should be interpreted on the basis of the principle of equality and not against it, and, on the other, egalitarianism should include utilitarian decisions when these are the best way to interpret the principle of equality. By way of conclusion, public health codes and guidelines should incorporate this reconciliation between utility and equality in order to better guide ethical decisions in public health, including tragic choices in contexts of rationing and disasters.

Geopolitical forces significantly challenge public health ethical principles and require deeper attention from public health experts. We have lacked awareness of geopolitical trends, particularly how neoliberalism fuels wealth inequality (fostering the super-rich and oligarchy), which in turn drives populism, culture wars, and performative cruelty, escalating toward conflict and autocracy. This has left us poorly prepared to respond effectively to health threats. The negative impacts of the information revolution have accelerated neoliberalism and populism, particularly through the control of social media platforms and industrial scale disinformation. All of these harm public physical and mental health, and create division and insecurity in societies. The second Trump presidency is bringing all these aspects of the neoliberal agenda into stark relief. Global and domestic health is being undermined through cuts to health services, wealth transfer, politicized aid, erosion of international order, and the dismantling of scientific and democratic institutions. To remain relevant and effective, public health professionals must reaffirm their commitment to ethical principles like solidarity, responsibility to act, and evidence-based practice. We must show courage and speak out, advocating for the health of the public and a healthy state. The protection of people and planet, and indeed human survival, depends on it.

Background: Since the original publication of the Seven Principles of Public Health Ethics, the world has gone through a global pandemic. Rising nationalism, and political tensions have become increasingly heated. In other words, we are in a state of turmoil. This paper aims to restate the principles for the current context and introduces a practical tool for public health professionals to apply to guide ethical reflection.

Methods: The seven-principle approach is reviewed in light of feedback received personally, at academic events and from the literature over the last more than ten years. Two revised original tools specifying the principles are integrated into one.

Results: The case for explicit and transparent public health ethics is made, followed by an overview of important philosophical ethical theories. Then, each revised principle is explained and one practical tool for ethical decision-making is presented.

Conclusions: The authors suggest that this tool can contribute to improving public health decision making by laying out a clear and simple framework for ethical decision-making, which is helpful to contribute to public trust and reasonable public health practice in a world of turmoil.

Two Executive Orders signed by USA's President Trump on 20 January 2025: one, USA's exit from World Health Organization (WHO) and other, a 90 days' freeze on USAID's funds and activities globally with immediate effect, have far reaching impact on global public health and development. Zero fund contribution from USA (currently, largest fund contributor to WHO), means decreased resources which would negatively impact WHO developmental initiatives globally. The impact of USAID fund freeze is yet to be ascertained. DOGE and Trump administration appear to have based their decision on their 'America First' to critically assess US aid to global communities, vis-à-vis the requirement and needs to their own people. However, the modus operandi and modalities of executing these orders overnight, without consulting or appraising the stakeholders was not the best way. It erodes the ethos of commitment to Global Health, International Health and Development. While World Leaders and Global-Public-Health-Community could consider diplomacy and advocacy channels, urging President Trump to reconsider his decisions, some immediate risk-mitigation and damage-control strategies could be put in place. This could include strengthening and expansion of geopolitical realignments, emergence of new leadership, newer models of programme implementation, technology enabled monitoring and evaluation that can reduce costs of programme implementation and management.

Objective: This study examined the incidence and predictors of post-acute sequelae of COVID-19 (PASC) and Long COVID in adults and children with confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. Associations assessed included demographic factors, comorbidities, lab markers, and patient clinical complications.

Method: A retrospective cohort of 13,940 patients with confirmed SARS-CoV-2 infection (7836 adults and 6104 children) from the Optum® COVID-19 Electronic Health Record dataset was analyzed (1 June 2020-30 June 2021). PASC was defined as symptoms lasting <3 months postinfection and Long COVID as symptoms ≥3 months. Inclusion criteria were patients of all ages with a confirmed SARS-CoV-2 infection. Excluded from the study were patients in the Texas Department of Criminal Justice system and patients with active HIV, malignancy, or respiratory viral/bacterial infection. Statistical analyses (chi-square, Mann-Whitney U, multivariable logistic regression) were performed using Microsoft Excel and IBM Statistical Package for the Social Sciences statistics V.25.

Results: Symptoms consistent with PASC were reported by 21.5% of adult patients, with 8.8% reporting Long COVID; 10.5% of pediatric patients reported PASC, with 9% reporting Long COVID (P < .05). In adults, predictors of PASC included age ≥54, female sex, non-Caucasian race, smoking, obesity, pneumonia, and multiple comorbidities; higher red blood cell count was protective. Predictors of Long COVID in adults was associated with female sex, obesity, and heart disease. In children, predictors of PASC included female sex and comorbidities. Younger age (≤10 years) was a significant predictor of Long COVID in children.

Conclusions and public health implications: Protocols that include targeted follow-up and early intervention are needed for post-COVID conditions in high-risk individuals across age groups. Integrating predictive markers into routine care could enhance preparedness and resilience against future waves of post-viral syndromes.

Background: The Nuffield's Intervention Ladder (NIL) framework casts public acceptability of health interventions based on their level of intrusiveness- how much they restrict personal autonomy and freedom of choice. This scoping review explores the application of the NIL framework in assessing public acceptability of diet and physical activity interventions, identifying key trends, gaps, and alignment with the framework's conceptual underpinnings.

Methods: We searched six databases (PubMed, Scopus, Medline, Embase, Science Direct, and Web of Science) and included 15 eligible studies. Data were charted and synthesized thematically and narratively.

Results: The NIL framework was applied across different study designs, primarily post hoc, to categorize interventions based on their intrusiveness. Consistent with the framework, less intrusive interventions (information provision, enabling choice) were widely accepted. Moderately intrusive interventions (changing defaults, incentives, and disincentives) received mixed public acceptance, whereas highly intrusive interventions (restrict and eliminate choice) generally garnered lower public acceptability. Highly intrusive interventions were publicly acceptable when they are directed at children, or at industries. Across all intervention types, demographic and behavioural factors significantly influenced public acceptance.

Conclusion: The NIL framework offers useful insights into how intrusiveness affects public acceptability of interventions. However, the review highlights that various factors influence acceptability in ways that extend the framework's initial propositions.

Background: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. This study aimed to investigate the dose-response relationship between leisure-time physical activity (LTPA) and cardiovascular health, assessed by heart age and predicted 10-year CVD risk, and explore the mediating role of inflammatory regulation.

Methods: This cross-sectional study included 6658 individuals aged 30-74 years from National Health and Nutrition Examination Survey 2015-2018. Heatmap visualization assessed variable distributions, while generalized linear regression models (GLMs) and restricted cubic splines quantitatively examined the LTPA-cardiovascular health associations.

Results: Heatmap visualization revealed that, among the 26 variables evaluated, LTPA was inversely associated with heart age, predicted 10-year CVD risk, and odds ratio for high CVD risk. GLM analyses indicated that each additional hour per week of LTPA was associated with a 0.17-year reduction in heart age, a 0.07% decrease in predicted 10-year CVD risk, and a 5% lower odds for having high CVD risk. Vigorous-intensity LTPA showed stronger benefits than moderate activity. Systemic inflammation biomarkers significantly mediated the associations between LTPA and cardiovascular health.

Conclusions: The findings support a dose-dependent cardioprotective effect of LTPA, partially mediated through anti-inflammatory pathways. These results highlight the importance of promoting LTPA, particularly vigorous-intensity activity, for cardiovascular health promotion.