Tobacco as a Matter of Public Health: Ethical Issues

Author(s):  
Kristin Voigt

This chapter considers normative issues that tobacco raises at the population level, particularly with respect to the anti-smoking strategies policymakers might pursue and the reasons and justifications underlying these strategies. After setting out several background factors that shape the debate, the chapter discusses different grounds on which state and public health actors might seek to restrict tobacco use, considering in turn those justifications that focus on protecting smokers and those that seek to protect third parties. The chapter then considers normative problems arising in relation to specific anti-smoking strategies, such as restrictions on the sale, use, and marketing of cigarettes; taxation; incentives for cessation; and denormalization strategies. Issues of paternalism and the stigma associated with smoking are also discussed.

Author(s):  
Jennifer McGowan ◽  
Lion Shahab

Worldwide, tobacco use is a leading cause of morbidity and mortality. However, the health effects of smoking are reversible, making smoking cessation an important target for public health policy. Tobacco control is a field of public health science dedicated to reducing tobacco use and, thereby, to reducing cigarette-related morbidity and mortality. For tobacco control to be effective, it is necessary for policy makers to understand the personal and interpersonal factors which encourage people to smoke, factors which motivate smokers to quit (e.g., health, social pressure, cost), and the personal and population-level methods that are most effective at encouraging and prolonging attempts to quit. Research has identified that social norms, mental health, and individual personality factors are most associated with smoking uptake, so interventions which reduce social smoking (e.g., smoking bans, plain packaging) would be most effective at preventing uptake. Conversely, the use of cigarettes is maintained by nicotine addiction and attempts to quit are often motivated by health concerns, social pressure and the cost of tobacco products. As such, interventions that address physiological and behavioral addiction inherent in tobacco product use (e.g., nicotine replacement therapy combined with counselling), that create social pressure to stop (e.g., mass media campaigns), or that increase the cost of tobacco products are most likely to be effective at encouraging attempts to quit.


Author(s):  
Kirsten Wiens ◽  
Barbara Jauregui ◽  
Benjamin Arnold ◽  
Kathryn Banke ◽  
Djibril Wade ◽  
...  

The use of biomarkers to measure immune responses in serum is crucial for understanding population-level exposure and susceptibility to human pathogens. Advances in sample collection, multiplex testing, and computational modeling are transforming serosurveillance into a powerful tool for public health program design and response to infectious threats. In July 2018, 70 scientists from 20 countries met to perform a landscape analysis of approaches that support an integrated serosurveillance platform, including the consideration of issues for successful implementation. Here, we summarize the group’s insights and proposed roadmap for implementation, including objectives, technical requirements, ethical issues, logistical considerations, and monitoring and evaluation.


2019 ◽  
Vol 9 (1) ◽  
pp. 1-13
Author(s):  
Michael Robert Nicholson

Learning outcomes This case focuses on ethics issues arising from the tobacco trade. Government as regulator of that trade and guardian of public health faced complex political, financial and ethical issues in discharge of its responsibilities. The harms resulting from tobacco use were well-known and had generally attracted adverse decisions from governments everywhere. The company offering tobacco products for sale, Carreras Ltd., had generally continued to do well financially despite those adverse decisions. Government, in the present case, had introduced legislation to penalize tobacco use in public places, and in so doing, raised several ethical issues such as punishing smokers for using a legal, widely distributed product; classifying cigarettes as harmful to health yet allowing its wide distribution and sale; continuing to derive substantial tax revenue from sale of a harmful product; enabling Carreras to profit from sale of said harmful product; offering little help to smokers to break their nicotine addiction. Students should be asked to identify and recommend solutions to the ethical issues faced by: the government and its “point man”, the Minister of Health as they sought to reduce the public’s use of a harmful product. The smoker who may be even addicted to a product is known to cause or contribute to a host of serious diseases. Students were to identify and recommend solutions to ethical issues faced by the players in the case. One of these players was Carreras whose operations were facing severe regulatory and public relations headwinds. Another was the nonsmoking public whose health was put at risk even though they did not use the product. The sentences could be reworded to read; Carreras, in its continued efforts to justify selling a harmful product. Nonsmokers who, despite not using the product, suffered adverse health consequences because of its use by others. Case overview/synopsis Cigarette smoking has been linked to a long list of serious diseases including several cancers, cardio-vascular disease, pulmonary ailments and stroke. Despite several government actions over the years to reduce cigarette smoking, it remained widespread and continued to take a heavy toll on public health. The government’s latest gambit, the Public Health (Tobacco Control) Regulations introduced in 2013, represented the first legislation specifically designed to restrain smoking in “public places”. Carreras Ltd., a subsidiary of British American Tobacco (BAT), had been the only significant provider of cigarettes in Jamaica for several decades and in the period allocated for public feedback, mounted a fierce assault on the Regulations, and galvanized other private sector interests to join in that effort. The case addresses the interaction between government’s roles as guardian and financier of public health, the public’s right of choice, and a company’s right to sell a legal product, albeit one deemed harmful to public health. That government derived substantial tax receipts from trade in that product added another layer of complexity to the matter. The Minister of Health, Dr Fenton Ferguson, was the government’s point man and our protagonist. Complexity academic level Final year University students of Management would have been exposed to ethics theories. Many management courses do not devote enough effort to the study of the interplay between the ethical, financial, and legal and the issues that can arise therefrom to complicate decision-making. The case was structured to invite exploration of this interplay. Supplementary materials Teaching Notes are available for educators only. Please contact your library to gain login details or email [email protected] to request teaching notes. Subject code CSS 11: Strategy


2020 ◽  
Vol 11 (1) ◽  
pp. 54-58
Author(s):  
AKM Farhad Hossain ◽  
Md Mahmudur Rahman Siddiqui ◽  
Sayada Fatema Khatun

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


Author(s):  
Nurul Rofiqo ◽  
Agus Perdana Windarto ◽  
Dedy Hartama

This study aims to utilize Clushtering Algorithm in grouping the number of people who have health complaints with the K-means algorithm in Indonesia. The source of this research data was collected based on the documents of the provincial population which had health complaints produced by the National Statistics Agency. The data used in this study are data from 2013-2017 consisting of 34 provinces. The method used in this research is K-means Algorithm. Data will be processed by clushtering in 3 clushter, namely clusther high health complaints, clusther moderate and low health complaints. Centroid data for high population level clusters 37.48, Centroid data for moderate population level clusters 27.08, and Centroid data for low population level clusters 14.89. So that obtained an assessment based on the population index that has health complaints with 7 provinces of high health complaints, namely Central Java, Yogyakarta, Bali, West Nusa Tenggara, East Nusa Tenggara, South Kalimantan, Gorontalo, 18 provinces of moderate health complaints, and 9 other provinces including low health complaints. This can be an input to the government to give more attention to residents in each region who have high health complaints through improving public health services so that the Indonesian population becomes healthier without health complaints.Keywords: data mining, health complaints, clustering, K-means, Indonesian residents


Author(s):  
Jennifer D. Allen ◽  
Rachel C. Shelton ◽  
Karen M. Emmons ◽  
Laura A. Linnan

There is substantial variability in the implementation of evidence-based interventions across the United States, which leads to inconsistent access to evidence-based prevention and treatment strategies at a population level. Increased dissemination and implementation of evidence-based interventions could result in significant public health gains. While the availability of evidence-based interventions is increasing, study of implementation, adaptation, and dissemination has only recently gained attention in public health. To date, insufficient attention has been given to the issue of fidelity. Consideration of fidelity is necessary to balance the need for internal and external validity across the research continuum. There is also a need for a more robust literature to increase knowledge about factors that influence fidelity, strategies for maximizing fidelity, methods for measuring and analyzing fidelity, and examining sources of variability in implementation fidelity.


Author(s):  
Maxwell Smith ◽  
Ross Upshur

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.


Author(s):  
Nicholas Evans ◽  
Thomas Inglesby

This chapter introduces ethical issues that arise in the context of biosecurity: policies and actions intended to prevent the development or emergence, or mitigate the consequences, of serious biological threats. These threats could include deliberate biological weapon attacks (bioterrorism), pandemics, emerging infectious diseases, or major laboratory accidents. The basic values that underpin these public health concerns are first introduced. Ethical issues that arise before, during, and following a biosecurity crisis are then examined, including issues of resource allocation, dual-use research, and the possibility of quarantine. Their resolution requires trade-offs among different ethical values, including utility, fairness, and liberty.


Author(s):  
David B. Resnik

This chapter provides an overview of the ethics of environmental health, and it introduces five chapters in the related section of The Oxford Handbook of Public Health Ethics. A wide range of ethical issues arises in managing the relationship between human health and the environment, including regulation of toxic substances, air and water pollution, waste management, agriculture, the built environment, occupational health, energy production and use, environmental justice, population control, and climate change. The values at stake in environmental health ethics include those usually mentioned in ethical debates in biomedicine and public health, such as autonomy, social utility, and justice, as well as values that address environmental concerns, such as animal welfare, stewardship of biological resources, and sustainability. Environmental health ethics, therefore, stands at the crossroads of several disciplines, including public health ethics, environmental ethics, biomedical ethics, and business ethics.


Author(s):  
Monika Mitra ◽  
Linda Long-Bellil ◽  
Robyn Powell

This chapter draws on medical, social, and legal perspectives to identify and highlight ethical issues pertaining to the treatment, representation, and inclusion of persons with disabilities in public health policy and practice. A brief history of disability in the United States is provided as a context for examining the key ethical issues related to public health policy and practice. Conceptual frameworks and approaches to disability are then described and applied. The chapter then discusses the imperativeness of expanding access to public health programs by persons with disabilities, the need to address implicit and structural biases, and the importance of including persons with disabilities in public health decision-making.


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