RESUMO
Education for public health is at a critical inflection point, and either transforms for success or fails to remain relevant. In 2020, the Association for Schools and Programs of Public Health launched an initiative, Framing the Future 2030: Education for Public Health (FTF 2030) to develop a resilient educational system for public health that promotes scientific inquiry, connects research, education, and practice, eliminates inequities, incorporates anti-racism principles, creates and sustains diverse and inclusive teaching and learning communities, and optimizes systems and resources to prepare graduates who are clearly recognizable for their population health perspectives, knowledge, skills, attitudes, and practices. Three expert panels: (1) Inclusive excellence through an anti-racism lens; (2) Transformative approaches to teaching and learning; and (3) Expanding the reach, visibility, and impact of the field of academic public health are engaged in ongoing deliberations to generate recommendations to implement the necessary change. The article describes the panels' work completed thus far, a "Creating an Inclusive Workspace" guide, and work planned, including questions for self-evaluation, deliberation, and reflection toward actions that support academe in developing a resilient education system for public health, whether beginning or advancing through a process of change. The FTF 2030 steering committee asserts its strong commitment to structural and substantial change that strengthens academic public health as an essential component of a complex socio-political system. Lastly, all are called to join the effort as collaboration is essential to co-develop an educational system for public health that ensures health equity for all people, everywhere.
Assuntos
Saúde Pública , Instituições Acadêmicas , Humanos , Escolaridade , AprendizagemRESUMO
The release of the American Heart Association's 2030 Impact Goal and associated metrics for success underscores the importance of cardiovascular health and cardiovascular disease surveillance systems for the acquisition of information sufficient to support implementation and evaluation. The aim of this policy statement is to review and comment on existing recommendations for and current approaches to cardiovascular surveillance, identify gaps, and formulate policy implications and pragmatic recommendations for transforming surveillance of cardiovascular disease and cardiovascular health in the United States. The development of community platforms coupled with widespread use of digital technologies, electronic health records, and mobile health has created new opportunities that could greatly modernize surveillance if coordinated in a pragmatic matter. However, technology and public health and scientific mandates must be merged into action. We describe the action and components necessary to create the cardiovascular health and cardiovascular disease surveillance system of the future, steps in development, and challenges that federal, state, and local governments will need to address. Development of robust policies and commitment to collaboration among professional organizations, community partners, and policy makers are critical to ultimately reduce the burden of cardiovascular disease and improve cardiovascular health and to evaluate whether national health goals are achieved.
Assuntos
American Heart Association , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Saúde Global , Formulação de Políticas , Vigilância da População , Serviços Preventivos de Saúde/normas , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Nível de Saúde , Humanos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologiaRESUMO
Clinical trials and public health surveillance of bednet use for malaria prevention involve the ongoing collection of sensitive data from private settings. This article discusses risks to bystanders, who have not consented to participating in surveillance or research, but whose behavior may nevertheless be recorded. In the case of clinical trials, community consultation and consent processes are one well-accepted way to address potential risk to bystanders. I argue that the intrusive monitoring required by some bednet trials may render this type of consent insufficient. In these cases, either bystanders should be enrolled as participants and give consent or less intrusive monitoring methods should be used. Validated monitoring methods should also have relevance for practice beyond use in a clinical trial. Considering the global impact of malaria, applying these methods to public health surveillance would be a practical use. Existing justifications for surveillance without consent, which sometimes result in coercive public health measures, could apply to the case of bednets. Particularly in cases where there is the potential for harm to others, individuals who were not the original subjects of disease reporting are often caught in the surveillance net. Although an argument can be made that malaria meets this bar, considerations of feasibility, sustainability, and trust make intrusive surveillance unsustainable in the case of a daily, lifelong behavior such as bednet use.
Assuntos
Malária , Mosquiteiros , Animais , Análise Ética , Humanos , Privacidade , Saúde PúblicaAssuntos
Assédio Sexual , Mulheres Trabalhadoras , Engenharia , Feminino , Humanos , Medicina , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Disciplinas das Ciências Naturais , Cultura Organizacional , Relatório de Pesquisa , Assédio Sexual/classificação , Assédio Sexual/prevenção & controle , Assédio Sexual/estatística & dados numéricos , Estados UnidosAssuntos
Sistemas Eletrônicos de Liberação de Nicotina , Regulamentação Governamental , Redução do Dano , United States Food and Drug Administration , Sistemas Eletrônicos de Liberação de Nicotina/economia , Sistemas Eletrônicos de Liberação de Nicotina/normas , Humanos , Abandono do Hábito de Fumar , Governo Estadual , Impostos , Produtos do Tabaco/economia , Estados UnidosRESUMO
Controversy has swirled over the past three decades about the ethics of fear-based public health campaigns. The HIV/AIDS epidemic provided a context in which advocacy groups were almost uniformly hostile to any use of fear, arguing that it was inherently stigmatising and always backfired. Although this argument was often accepted within public health circles, surprisingly, the bioethicists who first grappled with this issue in terms of autonomy and coercion in the 1980s were not single-minded: fear could be autonomy-enhancing. But by the turn of the 21st century, as opponents of fear-based appeals linked them to stigmatisation, ethicists typically rejected fear as inherently unethical. The evidence has increasingly suggested that fear-based campaigns 'work.' Emotionally charged public health messages have, as a consequence, become more commonplace. We conclude that an ethics of public health, which prioritises population well-being, as contrasted with the contemporary focus of bioethics on autonomy, provides a moral warrant for ensuring that populations understand health risk 'in their guts.' This, we argue, does not relieve public health authorities from considering the burdens their efforts may impose on vulnerable populations.
Assuntos
Temas Bioéticos , Coerção , Medo , Comportamentos Relacionados com a Saúde , Promoção da Saúde/ética , Autonomia Pessoal , Saúde Pública/ética , Atitude Frente a Saúde , Beneficência , Dissidências e Disputas , Infecções por HIV/prevenção & controle , Promoção da Saúde/métodos , Humanos , Assunção de Riscos , Justiça SocialAssuntos
Sistemas Eletrônicos de Liberação de Nicotina , Política de Saúde , Abandono do Hábito de Fumar/métodos , Fumar/legislação & jurisprudência , Tabagismo/terapia , Conflito de Interesses , Comparação Transcultural , Sistemas Eletrônicos de Liberação de Nicotina/efeitos adversos , Órgãos Governamentais , Redução do Dano , Política de Saúde/história , História do Século XX , História do Século XXI , Humanos , Nicotina/efeitos adversos , Administração em Saúde Pública , Fumar/efeitos adversos , Tabagismo/história , Reino Unido , Estados UnidosRESUMO
POLICY POINTS: In situations of scientific uncertainty, public health interventions, such as counseling for HIV infection, sometimes must be implemented before obtaining evidence of efficacy. The history of HIV counseling and testing, which served as the cornerstone of HIV prevention efforts at the US Centers for Disease Control and Prevention (CDC) for a quarter of a century, illustrates the influence of institutional resistance on public health decision making and the challenge of de-implementing well-established programs. CONTEXT: In 1985, amid uncertainty about the accuracy of the new test for HIV, public health officials at the Centers for Disease Control and Prevention (CDC) and AIDS activists agreed that counseling should always be provided both before and after testing to ensure that patients were tested voluntarily and understood the meaning of their results. As the "exceptionalist" perspective that framed HIV in the early years began to recede, the purpose of HIV test counseling shifted over the next 30 years from emphasizing consent, to providing information, to encouraging behavioral change. With this increasing emphasis on prevention, HIV test counseling faced mounting doubts about whether it "worked." The CDC finally discontinued its preferred test counseling approach in October 2014. METHODS: Drawing on key informant interviews with current and former CDC officials, behavioral scientists, AIDS activists, and others, along with archival material, news reports, and scientific and governmental publications, we examined the origins, development, and decline of the CDC's "counseling and testing" paradigm for HIV prevention. FINDINGS: Disagreements within the CDC emerged by the 1990s over whether test counseling could be justified on the basis of efficacy and cost. Resistance to the prospect of policy change by supporters of test counseling in the CDC, gay activists for whom counseling carried important ethical and symbolic meanings, and community organizations dependent on federal funding made it difficult for the CDC to de-implement the practice. CONCLUSIONS: Analyses of changes in public health policy that emphasize the impact of research evidence produced in experimental or epidemiological inquiries may overlook key social and political factors involving resistance to deimplementation that powerfully shape the relationship between science and policy.
Assuntos
Sorodiagnóstico da AIDS , Segurança do Sangue/normas , Centers for Disease Control and Prevention, U.S./normas , Aconselhamento/normas , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Prática de Saúde Pública/normas , Estigma Social , Atitude do Pessoal de Saúde , Segurança do Sangue/métodos , Aconselhamento/métodos , Aconselhamento/tendências , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Redução do Dano , Humanos , Entrevistas como Assunto , Masculino , Política , Estados UnidosRESUMO
Surveillance is the radar of public health. Without tracking, often by name, the incidence and prevalence of both infectious and chronic disease, health officials would be unable to understand where and how to potentially intervene or what resources might be required to protect populations. Surveillance without individual informed consent has been challenged in the name of both bioethics and human rights. In this article we contend that a robust conception of public health not only justifies surveillance but, without disregarding the need to respect individuals, provides an affirmative duty to engage in surveillance. There may be social and political circumstances in which the names of those reported cannot be protected from unwarranted disclosure and misuse for ends that have little to do with protecting the public's health. But while the potential for misuse requires an ongoing, searching scrutiny of disease surveillance, remote or hypothetical threats should not serve to undermine this vital public health activity.
Assuntos
Direitos Humanos , Vigilância em Saúde Pública , Confidencialidade/ética , Notificação de Doenças , Humanos , PolíticaRESUMO
Fear-based public health campaigns have been the subject of an intense moral and empirical debate. We examined how New York City, under Mayor Michael Bloomberg, used fear-based appeals to confront three challenges to public health: high rates of tobacco use, obesity, and HIV infection. New York City's use of this type of messaging may have set a precedent. Other state and local health departments will have to navigate how and whether to use fear in a context where it is possible to assert that it can serve the interests of public health. But this will not reduce the need to carefully balance efficacy, uncertainty, stigma, marginalization, emotional burdens, justice, community participation, and scientific credibility.