RESUMO
Policy Points For more than 40 years, most research by epidemiologists, social scientists, and alcohol policy experts found that moderate alcohol consumption was cardioprotective. In the early 2000s, that consensus was shaken by new critics who subjected the previous research to vigorous methodological and empirical analysis, precipitating a bitter controversy, seemingly unresolvable despite numerous observational epidemiological studies. The effort to finally put that debate to rest through a large, multiyear randomized controlled trial under the aegis of the National Institute on Alcohol Abuse and Alcoholism, generated external criticism and adverse newspaper coverage, particularly because the trial was largely funded by the alcohol industry, forcing National Institutes of Health leadership to abruptly terminate the study shortly after it started. In the absence of definitive evidence and given the contentious debate over the risks and benefits of moderate alcohol consumption, those who formulate health policy have a responsibility to clearly acknowledge to the public the existence of evidentiary uncertainty when making recommendations.
Assuntos
Consumo de Bebidas Alcoólicas , Doenças Cardiovasculares/prevenção & controle , Política , Ensaios Clínicos Controlados Aleatórios como Assunto/economia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Projetos de Pesquisa/normas , Apoio à Pesquisa como Assunto , Conflito de Interesses , Humanos , National Institutes of Health (U.S.) , Estados UnidosRESUMO
La vigilancia de las enfermedades ha sido una de las funciones básicas de la salud pública desde fines del siglo XIX: es la base de los programas para promover el bienestar humano a nivel de la población y el cimiento de la respuesta a las epidemias y los brotes de enfermedades. Sin embargo, va mucho más allá de las enfermedades infecciosas. Puede contribuir a reducir las desigualdades, puesto que algunas causas de sufrimiento injusto, injustificado y prevenible no pueden abordarse sin primero hacerlas visibles…
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Vigilância em Desastres , Seguridade Social , Doenças Transmissíveis , Vigilância Sanitária Ambiental , Ética , Saúde Pública , Vigilância em Saúde PúblicaAssuntos
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
Over the past decade, precision medicine (PM) approaches have received significant investment to create new therapies, learn more about disease processes, and potentially prevent diseases before they arise. However, in many ways, PM investments may come at the expense of existing public health measures that could have a greater impact on population health. As we tackle burgeoning public health concerns, such as obesity, and chronic diseases, such as cancer, it is not clear whether PM is aligned with public health or in conflict with its goals. We summarize the areas of promise demonstrated by PM, discuss the limitations of each of these areas from a population health perspective, and discuss how we can approach PM in a manner that is congruent with the core aims of public health.
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Doença Crônica/epidemiologia , Medicina de Precisão/métodos , Saúde Pública/métodos , Alocação de Recursos para a Atenção à Saúde/ética , Alocação de Recursos para a Atenção à Saúde/métodos , Humanos , Medicina de Precisão/economia , Medicina de Precisão/éticaAssuntos
Controle de Doenças Transmissíveis/organização & administração , Política de Saúde , Tuberculose Latente/prevenção & controle , Tuberculose/prevenção & controle , Controle de Doenças Transmissíveis/economia , Saúde Global , Humanos , Tuberculose Latente/diagnóstico , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Tuberculose/epidemiologia , Tuberculose/etnologia , Estados UnidosRESUMO
In 2014, only two states in the United States still mandated specific written informed consent for HIV testing and, after years of controversy, New York ended this requirement, leaving only Nebraska. New York's shift to opt-out testing meant that a singular feature of what had characterized the exceptionalism surrounding HIV testing was eliminated. We trace the history of debates on written informed consent nationally and in New York State. Over the years of dispute from when HIV testing was initiated in 1985 to 2014, the evidence about the benefits and burdens of written informed consent changed. Just as important was the transformation of the political configuration of HIV advocacy and funding, both nationwide and in New York State. What had for years been the subject of furious debate over what a rational and ethical screening policy required came to an end without the slightest public protest. (Am J Public Health. 2017;107:1259-1265. doi:10.2105/AJPH.2017.303819).
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Documentação , Soropositividade para HIV/diagnóstico , Política de Saúde/legislação & jurisprudência , Consentimento Livre e Esclarecido/legislação & jurisprudência , Humanos , Programas de Rastreamento , 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.
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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
We discuss the public and private sponsoring of university research and the issues it raises in a context of diminished federal funding. We consider research funding at schools of public health and why these schools have historically had weaker links to industry than have other academic units. We argue that the possibility of enhanced links with industry at schools of public health may raise specific concerns beyond those facing universities generally. Six issues should be considered before entering into these relationships: (1) the effects on research orientation, (2) unacceptability of some funders, (3) potential threats to objectivity and academic freedom, (4) effects on academic standards, (5) the effects on dissemination of knowledge, and (6) reputational risks.
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Pesquisa Biomédica/economia , Conflito de Interesses/economia , Indústrias/economia , Saúde Pública/educação , Apoio à Pesquisa como Assunto/ética , Escolas para Profissionais de Saúde/economia , Pesquisa Biomédica/ética , Organização do Financiamento/economia , Organização do Financiamento/ética , Humanos , Indústrias/ética , Disseminação de Informação/ética , Relações Interprofissionais/ética , Escolas para Profissionais de Saúde/éticaAssuntos
Doadores de Sangue/legislação & jurisprudência , Infecções por HIV/sangue , Política de Saúde/tendências , Homossexualidade Masculina , Doadores de Sangue/provisão & distribuição , Segurança do Sangue/normas , Segurança do Sangue/tendências , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Masculino , 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.
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Medo , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Promoção da Saúde/organização & administração , Obesidade/epidemiologia , Obesidade/prevenção & controle , Prática de Saúde Pública , Prevenção do Hábito de Fumar , Fumar/epidemiologia , População Urbana , Adolescente , Adulto , Feminino , Estilo de Vida Saudável , Humanos , Masculino , Cidade de Nova Iorque , Avaliação de Processos e Resultados em Cuidados de Saúde , Gravidez , Estigma Social , Estereotipagem , População Urbana/estatística & dados numéricos , Adulto JovemAssuntos
Fármacos Anti-HIV/uso terapêutico , Epidemias/ética , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Alocação de Recursos para a Atenção à Saúde/ética , Prevenção Primária/ética , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Fármacos Anti-HIV/administração & dosagem , Antirretrovirais/uso terapêutico , Países em Desenvolvimento , Epidemias/prevenção & controle , Infecções por HIV/epidemiologia , Infecções por HIV/etiologia , Humanos , Prevenção Primária/métodosRESUMO
Campaigns to limit tobacco use started in the 1970s and have led to bans on public smoking, which have been extended to parks and beaches. A review of state and local statutes shows that during 1993-2011, smoking was banned in 843 parks and on 150 beaches across the United States. Three justifications for these restrictions have been invoked: the risk of passive smoke to nonsmokers, the pollution caused by cigarette butts, and the long-term risks to children from seeing smoking in public. Our analysis of the evidence for these claims found it far from definitive and in some cases weak. What, then, accounts for the efforts to impose such bans? We conclude that the impetus is the imperative to denormalize smoking as part of a broader public health campaign to reduce tobacco-related illness and death. Although invoking limited evidence may prove effective in the short run, it is hazardous for public health policy makers, for whom public trust is essential.