Dilemmas of nudging in public health: an ethical analysis of a Danish pamphlet

2020 ◽  
Author(s):  
Jacob Busch ◽  
Emilie Kirstine Madsen ◽  
Antoinette Mary Fage-Butler ◽  
Marianne Kjær ◽  
Loni Ledderer
Keyword(s):  
Public Health ◽  
Ethical Issues ◽  
Screening Programme ◽  
Screening Program ◽  
Ethical Analysis ◽  
Choice Making ◽  
The Face ◽  
Information Materials ◽  
The Individual ◽  
To Receive

Summary Nudging has been discussed in the context of public health, and ethical issues raised by nudging in public health contexts have been highlighted. In this article, we first identify types of nudging approaches and techniques that have been used in screening programmes, and ethical issues that have been associated with nudging: paternalism, limited autonomy and manipulation. We then identify nudging techniques used in a pamphlet developed for the Danish National Screening Program for Colorectal Cancer. These include framing, default nudge, use of hassle bias, authority nudge and priming. The pamphlet and the very offering of a screening programme can in themselves be considered nudges. Whether nudging strategies are ethically problematic depend on whether they are categorized as educative- or non-educative nudges. Educative nudges seek to affect people’s choice making by engaging their reflective capabilities. Non-educative nudges work by circumventing people’s reflective capabilities. Information materials are, on the face of it, meant to engage citizens’ reflective capacities. Recipients are likely to receive information materials with this expectation, and thus not expect to be affected in other ways. Non-educative nudges may therefore be particularly problematic in the context of information on screening, also as participating in screening does not always benefit the individual.

Pandemic Disease, Public Health, and Ethics

2019 ◽  
pp. 796-811 ◽  
Author(s):  
Maxwell Smith ◽  
Ross Upshur
Keyword(s):  
Public Health ◽  
Ethical Issues ◽  
Ethical Challenges ◽  
Pandemic Preparedness ◽  
Scarce Resources ◽  
Ethical Frameworks ◽  
Health Measures ◽  
Care Workers ◽  
The Face ◽  
Conducting Research

Infectious disease pandemics raise significant and novel ethical challenges to the organization and practice of public health. This chapter provides an overview of the salient ethical issues involved in preparing for and responding to pandemic disease, including those arising from deploying restrictive public health measures to contain and curb the spread of disease (e.g., isolation and quarantine), setting priorities for the allocation of scarce resources, health care workers’ duty to care in the face of heightened risk of infection, conducting research during pandemics, and the global governance of preventing and responding to pandemic disease. It also outlines ethical guidance from prominent ethical frameworks that have been developed to address these ethical issues and concludes by discussing some pressing challenges that must be addressed if ethical reflection is to make a meaningful difference in pandemic preparedness and response.

Recalibrating healthcare to create a more equitable post-pandemic work environment

2021 ◽  
pp. 084047042110541
Author(s):  
W. Glen Pyle ◽  
Frances C. Roesch
Keyword(s):  
Public Health ◽  
Work Environment ◽  
Ethical Issues ◽  
Working Hours ◽  
Team Dynamics ◽  
Organizational Goals ◽  
Team Members ◽  
Diversity And Inclusion ◽  
The Individual ◽  
Employee Needs

The COVID-19 pandemic has accelerated the need for flexible arrangements, including asynchronous work and working from home. These arrangements may be necessary to comply with public health directives and are manageable when few other options exist. It can be difficult to lead in an environment when team members have divergent core working hours and are not available for collaboration. This can be compounded by the perception of inequitable treatment of employee needs or preferences by management, which can further strain team dynamics. As the pandemic eases, it may be difficult for all employees to revert to a fully on-site arrangement; some may be unable and others unwilling. Leaders will need to consider ethical issues in reaching organizational goals in this new reality. Equity, diversity, and inclusion principles will be critical when balancing the needs of the individual and the team. Supportive arrangements and a culture of inclusion will be key to retaining top talent.

scholarly journals When work kills

2016 ◽  
Vol 15 (4) ◽  
pp. 229-234 ◽  
Author(s):  
Sarah Waters ◽  
Marina Karanikolos ◽  
Martin McKee
Keyword(s):  
Public Health ◽  
Comparative Approach ◽  
Content Type ◽  
Workplace Conditions ◽  
Contractual Relationship ◽  
The Face ◽  
Human Costs ◽  
Multidisciplinary Perspective ◽  
The Individual ◽  
The Uk

Purpose The purpose of this paper is to examine the rising public health phenomenon of workplace suicide drawing on comparative insights from the French and UK contexts. France has experienced what the media describes as a “suicide epidemic” in the workplace, with rising numbers of employees choosing to kill themselves in the face of extreme pressures at work. Design/methodology/approach The paper uses a comparative approach drawing on insights from the French context, in which workplace suicide is legally and officially recognised, to shed critical light on the UK context where workplace suicide remains a hidden phenomenon. Findings Whilst in France, workplace suicide is treated as an urgent public health phenomenon and data on suicides are collected centrally, in the UK, despite a deterioration in working conditions, suicide is not recognised in legislation and data are not collected centrally. Unless society recognises and document rising workplace suicides, we will be unable to deal with their profound human consequences for suicidal individuals, their families and society more widely. Research limitations/implications Research on workplace suicides in the UK and many other national contexts is hampered by fragmentary statistical data on this phenomenon. Practical implications The paper calls for greater recognition, analysis and monitoring of workplace suicide in the UK. Suicide should be included in the list of workplace accidents that are reported to the authorities for further investigation. In a context where workplace conditions are deteriorating, society need to recognises the profound human costs of these conditions for the individual employee. Social implications The paper has important implications for the contemporary workplace in terms of the contractual relationship between employer and employee. Originality/value Workplace suicide is an urgent, yet under-researched phenomenon. The paper brings a comparative and multidisciplinary perspective to bear on this phenomenon.

scholarly journals How evolutionary behavioural sciences can help us understand behaviour in a pandemic

2020 ◽  
Vol 2020 (1) ◽  
pp. 264-278
Author(s):  
Megan Arnot ◽  
Eva Brandl ◽  
O L K Campbell ◽  
Yuan Chen ◽  
Juan Du ◽  
...  
Keyword(s):  
Public Health ◽  
Behaviour Change ◽  
Evolutionary Dynamics ◽  
Inclusive Fitness ◽  
Behavioural Change ◽  
Best Interests ◽  
The Public ◽  
The Face ◽  
The Individual ◽  
Behavioural Sciences

Abstract The COVID-19 pandemic has brought science into the public eye and to the attention of governments more than ever before. Much of this attention is on work in epidemiology, virology and public health, with most behavioural advice in public health focusing squarely on ‘proximate’ determinants of behaviour. While epidemiological models are powerful tools to predict the spread of disease when human behaviour is stable, most do not incorporate behavioural change. The evolutionary basis of our preferences and the cultural evolutionary dynamics of our beliefs drive behavioural change, so understanding these evolutionary processes can help inform individual and government decision-making in the face of a pandemic. Lay summary: The COVID-19 pandemic has brought behavioural sciences into the public eye: Without vaccinations, stopping the spread of the virus must rely on behaviour change by limiting contact between people. On the face of it, “stop seeing people” sounds simple. In practice, this is hard. Here we outline how an evolutionary perspective on behaviour change can provide additional insights. Evolutionary theory postulates that our psychology and behaviour did not evolve to maximize our health or that of others. Instead, individuals are expected to act to maximise their inclusive fitness (i.e, spreading our genes) – which can lead to a conflict between behaviours that are in the best interests for the individual, and behaviours that stop the spread of the virus. By examining the ultimate explanations of behaviour related to pandemic-management (such as behavioural compliance and social distancing), we conclude that “good of the group” arguments and “one size fits all” policies are unlikely to encourage behaviour change over the long-term. Sustained behaviour change to keep pandemics at bay is much more likely to emerge from environmental change, so governments and policy makers may need to facilitate significant social change – such as improving life experiences for disadvantaged groups.

scholarly journals International surveillance networks and principles of collaboration

2001 ◽  
Vol 6 (2) ◽  
pp. 17-21 ◽  
Author(s):  
I. S.T. Fisher ◽  
O N Gill ◽  
Keyword(s):  
Public Health ◽  
Personal Data ◽  
Individual Responsibility ◽  
Surveillance Networks ◽  
Shared Data ◽  
Transmission Of Information ◽  
Potential Sources ◽  
The Face ◽  
Foodborne Outbreaks ◽  
The Individual

(on behalf of the Enter-net participants) In the face of the multiplication and the development of international surveillance networks for communicable diseases, many questions on the transmission of personal data and information arise. The confidential nature of shared data and their disclosure internationally within and outside the network are therefore potential sources for conflicts. To resolve these problems, Enter-net developed its 'Collaboration Principles' intended to apply to all the participants of the network and to all others potentially involved. These principles propose solutions to questions related to the access to databases created within the framework of the network, to the quality and confidentiality of circulating data, to the individual responsibility in the identification of an incriminated product in case of an outbreak, and even to the transmission of information outside the network. These principles, which are to be regularly reviewed, are primarily aimed at optimising early detection and management of foodborne outbreaks, and at taking the necessary measures for public health. Considering the nature of the problems, however, some of these principles are also of relevance to other surveillance networks. (on behalf of the Enter-net participants)

scholarly journals Nutrigenomics, individualism and public health

2004 ◽  
Vol 63 (1) ◽  
pp. 161-166 ◽  
Author(s):  
Ruth Chadwick
Keyword(s):  
Public Health ◽  
Genetic Variation ◽  
Functional Foods ◽  
Ethical Issues ◽  
Public Confidence ◽  
Nucleotide Polymorphisms ◽  
Dietary Recommendations ◽  
Single Nucleotide ◽  
The Individual ◽  
The Relationship

Issues arising in connection with genes and nutrition policy include both nutrigenomics and nutrigenetics. Nutrigenomics considers the relationship between specifc nutrients or diet and gene expression and, it is envisaged, will facilitate prevention of diet-related common diseases. Nutrigenetics is concerned with the effects of individual genetic variation (single nucleotide polymorphisms) on response to diet, and in the longer term may lead to personalised dietary recommendations. It is important also to consider the surrounding context of other issues such as novel and functional foods in so far as they are related to genetic modification. Ethical issues fall into a number of categories: (1) why nutrigenomics? Will it have important public health benefits? (2) questions about research, e.g. concerning the acquisition of information about individual genetic variation; (3) questions about who has access to this information, and its possible misuse; (4) the applications of this information in terms of public health policy, and the negotiation of the potential tension between the interests of the individual in relation to, for example, prevention of conditions such as obesity and allergy; (5) the appropriate ethical approach to the issues, e.g. the moral difference, if any, between therapy and enhancement in relation to individualised diets; whether the 'technological fix' is always appropriate, especially in the wider context of the purported lack of public confidence in science, which has special resonance in the sphere of nutrition.

scholarly journals Asymptomatic Employee Screening for SARS-CoV-2: Implementation of and Reactions to an Employer-Based Testing Program

2020 ◽  
Author(s):  
Laura H. Goetz ◽  
Tyler L. DeLaughder ◽  
Kathleen L. Kennedy ◽  
Nicholas J. Schork ◽  
Timothy K. McDaniel ◽  
...  
Keyword(s):  
Public Health ◽  
Statistical Analysis ◽  
Healthcare Workers ◽  
Screening Program ◽  
Working Environment ◽  
Chi Square ◽  
Employee Survey ◽  
Testing Program ◽  
Health Measures ◽  
The Face

ABSTRACTIntroductionAsymptomatic testing for SARS-CoV-2 among healthcare workers or other essential personnel could remove infected carriers from the workforce, decreasing chances for transmission and workplace outbreaks. Results from one-time testing programs have been reported but data regarding longitudinal testing, including information about employee’s reactions to such programs, is not readily available.MethodsTo identify asymptomatic carriers of SARS-CoV-2, we implemented a longitudinal screening program for critical on-site employees within our research institute in early April 2020. We conducted a survey of both on-site employees and those working from home in order to measure their reactions to the testing program. Statistical analysis of the survey was conducted with general linear regression and Pearson’s Chi-Square tests.ResultsDespite an ongoing high community prevalence rate of COVID-19, to date only two asymptomatic employees tested positive out of 1050 tests run during 7 months of the program. However, 12 symptomatic employees not participating in the program have tested positive. The employee survey was completed by 132/306 (43%) employees, with 93% agreeing that asymptomatic employee screening led to a better and safer working environment and 75% agreeing with on-site public health measures to help contain the virus, but only 58% feeling COVID-19 was a serious threat to their health.ConclusionOur results suggest that a longitudinal asymptomatic employee screening program for SARS-CoV-2 can be accepted by employees and can be used to maintain the health of the workforce, potentially keeping positivity rates below community levels in the face of the ongoing COVID-19 pandemic.

scholarly journals Do healthcare professionals and young adults know about the National Chlamydia Screening Programme? Findings from two cross-sectional surveys

2018 ◽  
Vol 30 (1) ◽  
pp. 72-78 ◽  
Author(s):  
Susanna Currie ◽  
Catherine H Mercer ◽  
Kevin J Dunbar ◽  
John Saunders ◽  
Sarah C Woodhall
Keyword(s):  
Public Health ◽  
Healthcare Professionals ◽  
Screening Programme ◽  
The Other ◽  
Chlamydia Screening ◽  
Cross Sectional ◽  
Testing Frequency ◽  
Genitourinary Medicine ◽  
The Individual ◽  
Testing Patterns

The extent to which healthcare professionals (HCPs) and young people (YP) are aware of, and adhere to, National Chlamydia Screening Programme (NCSP) recommendations on testing frequency is unclear. To address this two cross-sectional surveys in 2015–2016: one among genitourinary medicine (GUM) and non-GUM HCPs (n = 109) and the other among YP attending a GUM clinic in England (n = 195). For both, questions were designed to measure awareness of NCSP guidance and whether respondents acted on that knowledge. This included questions about YP’s most recent test(s) (if ever) and the time since first and last sex with their most recent partners. Knowledge of NCSP testing guidelines varied among both GUM and non-GUM HCP respondents. However, lack of knowledge of the guidelines did not preclude HCPs from recommending testing in line with NCSP recommendations in practice. While most YP were not aware of NCSP recommendations, around two-thirds had tested for Chlamydia at least once in the last year. However, testing seldom appeared to coincide with partnership change. There is a knowledge gap and a discord between testing recommendations and practice. Interventions are needed to encourage appropriate testing patterns to maximise the individual and public health benefits of testing.

scholarly journals MANEJO DE PACIENTES COM HALITOSE ATENDIDOS NO SERVIÇO PÚBLICO DE SAÚDE

2016 ◽  
Vol 7 (3) ◽  
Author(s):  
Luciana Mara Peixôto Araujo ◽  
Ariane De Oliveira Santana ◽  
Iasmin De Sousa Moura ◽  
Jefferson David Melo De-Matos ◽  
Marignês Theotonio dos Santos Dutra ◽  
...  
Keyword(s):  
Public Health ◽  
Health Service ◽  
Health Professionals ◽  
Social Impact ◽  
Public Health Service ◽  
Medical Doctors ◽  
The Public ◽  
The Face ◽  
Foul Odor ◽  
The Individual

Halitosis is characterized by a foul odor emanating from the oral cavity. This condition is considered an embarrassing symptom with a significant social impact for the individual. The aim of this study was to evaluate the knowledge of professionals working on public health service about halitosis and to examine the criteria for referrals of suspected cases. This study had the participation of 37 health professionals including medical doctors and dentists. All participants answered a questionnaire about the etiology, management and treatment of halitosis. Among all the professionals analyzed 92% (n = 34) reported receiving patients complaining of halitosis. 88% (n = 22) of dentists and 50% (n = 06) of medical doctors believe that the main cause of halitosis has an oral origin. 89.1% (n = 33) of samples reported performing the treatment of halitosis. In addition, the complementary exam most requested for the diagnosis of halitosis was the radiograph of the face. The results suggest that there is a mistake in the management of patients with halitosis attended in the public health service. This study brings to light the need to educate and train medical doctors and dentists about the etiological factors, forms of diagnosis and treatment of halitosis.

Socio-demographic and Clinical Characteristics of Patient with Thyroid Cancer

2020 ◽  
Vol 11 (1) ◽  
pp. 54-58
Author(s):  
AKM Farhad Hossain ◽  
Md Mahmudur Rahman Siddiqui ◽  
Sayada Fatema Khatun
Keyword(s):  
Public Health ◽  
Thyroid Cancer ◽  
Clinical Characteristics ◽  
Family Income ◽  
Ethical Issues ◽  
Endocrine System ◽  
Public Health Problem ◽  
Follicular Carcinoma ◽  
Public Health Issue ◽  
Cross Sectional

Background: Thyroid cancer is the most common malignant disease in endocrine system. It is an emerging public health issue associated with burden on the family, community and the nation. The aim of this study is to determine the socio-demographic and clinical characteristics of patient with thyroid cancer attending in tertiary hospital. Methods: This cross sectional study was conducted among 246 thyroid cancer patients in two tertiary hospitals of Dhaka city from 01 July 2018 to 30 June 2019. The subjects were selected purposively following specific selection criteria and maintaining ethical issues. Data were collected by face to face interview using a semi-structured questionnaire and checklist. Data were analyzed by the statistical package for the social science (SPSS) version 23. Results: This study revealed that majority (74.4%) of respondents was female, married (72%), housewife (61.4%), rural respondent (41.1%) and had primary education (69%). Mean (± SD) age of the respondent was 37.85(±12.20) years (Range 14-70 years) and mean (± SD) monthly family income was Tk. 17681(±10602). Out of 246 cases, 204 (82.9%) was papillary and 42 (17.1%) was follicular carcinoma. Various clinical presentations included visible neck swelling in 225 (91.5%), swollen lymph node in 103 (41.9%), pain 90 (36.6%), Difficulties in swallowing 87 (35.4%), Hoarseness of voice in 141 (57.3%), cough along with swelling 47(19.1%), Difficulties in breathing due to swelling in 13(5.3%) of the patients. Conclusion: Incidence of thyroid cancer has increased worldwide specially in female patients in 3rd and 4th decades of life. As thyroid cancer is a growing public health problem in Bangladesh, proper screening and early diagnostic facilities at all level should be available to measure its actual burden in the country. Anwer Khan Modern Medical College Journal Vol. 11, No. 1: Jan 2020, P 54-58

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