Valeurs et principes éthiques en santé publique : une revue systématique.

CONTEXT: “Analytical frameworks” and “practical tools” referring extensively to values and principles have been developed since the 1990’s to provide guidance for public health decision makers and practitioners in ethical reasoning. OBJECTIVE: This study aimed at identifying the values and principles in public health ethics “frameworks” and “tools”, at classifying them by theme, and at characterizing them by questioning their meanings and articulations. METHOD: We conducted a systematic review according to PRISMA-S guidelines. It used 3 databases and gathered documents published during the last thirty years. This corpus was analyzed following a multidisciplinarily defined interpretive framework. RESULTS: We included 51 publications. More than a half was issued by North American organizations and 7 by European organizations. We identified 110 values and 153 principles referring to the themes of justice, autonomy, beneficence and non-maleficence, governance and evaluation of actions. LIMITATIONS: There are likely other unpublished frameworks and tools used by public health actors and decision makers. CONCLUSION: Although the most cited values and principles appear to correspond to several fundamental characteristics of public health, it is still early to talk about an ethics specific to public health.

[Elaboration of prevention norms: Need for ethical reflection]. / Élaboration des normes de prévention : une réflexion éthique nécessaire.

INTRODUCTION: Public health tries to modify existing social norms by setting up strategies to promote the emergence of norms that are more adapted to the objectives of good health and well-being. Prevention policies and the corresponding interventions concern health behaviours and are designed to modify the individual's habits, and contribute to defining new ways of being, acting and living. Prevention therefore involves numerous personal, cultural, social and collective values. An ethical reflection concerning the meaning, rationale and justice of these actions is therefore essential. The objective of this study is to characterize the ethical reflection at the time of creation of public health norms. METHODS: A narrative review, based on the Web of Science database covering journals of the various disciplines concerned, was conducted to address this issue. RESULTS: Thirty-four publications were selected, illustrating the numerous definitions and types of norms used in public health intervention strategies. Many stakeholders are involved in the creation of public health norms specialists, opinion leaders, and social stakeholders. Finally, although some publications stress that the use of prevention norms raises a number of ethical issues, no publication refers to the presence of a structured ethical reflection as part of this process. CONCLUSION: Ethical reflection is an essential part of prevention interventions and tools. What is the best way of achieving the best results? How to resolve conflicts of interests? These issues must be addressed when developing policies or programmes and can more effectively guide public health strategies and help to improve their acceptability and efficacy in populations.

[Complexity: concept and challenges for public health interventions]. / La complexité : concept et enjeux pour les interventions de santé publique.

Introduction: Since 2000, the notion of "complex interventions" has been emerging in the health research field. "Complex interventions" and "complexity" are commonly used terms, but they are generally not defined. Conceptual ambiguities persist concerning the notion of complexity. The objective of this exploratory review is to characterize the notion of complexity: What is complexity? Where does this notion come from and what does it cover? What are the consequences of complexity in the health field?Methods: To clarify the concept of complexity, a narrative review was conducted in the fields of humanities and social science, managerial economics, psychology and healthcare.Results: The concept of complexity, that can be attributed to Edgar Morin, has been the subject of appropriations, adaptations, and operations in multiple areas. Complexity consists of understanding the factors influencing individual decisions. In the field of healthcare, the concept of complexity is used more pragmatically and is defined by objective characteristics of interventions (defined as complex) or their contexts for the practical purposes of evaluation.Discussion: The notions of complexity and complex interventions have implications for researchers and users of the results of research. In particular, the notion of complexity is designed to provide a better understanding of the mechanism of effectiveness of interventions, support transferability and use by actors and decision-makers.