Cancer prevention in people experiencing homelessness: ethical considerations and experiences from the CANCERLESS project.

The incidence of cancer in Europe has been increasing in recent years. Despite this, cancer prevention has remained a low priority in health policies. Cancer is one of the main causes of mortality among people experiencing homelessness, who continue to have difficulties accessing prevention programs. A strategy that has been tested to favor cancer prevention is the health navigator figure. The objective of CANCERLESS project is to implement this model among populations experiencing homelessness in four European countries to foster the prevention and early detection of cancer. In this perspective, a presentation of CANCERLESS project is made, and its ethical aspects are discussed according to the ethics of public health, the ethics of care, solidarity, relational autonomy, and the social recognition of the virtue of just generosity. The ethical foundations of CANCERLESS project are rooted in social justice and in equity in access to health systems in general and cancer screening programs in particular. The ethics of public health guided by utilitarianism are insufficient in serving the interests of the most disadvantaged groups of the population. Hence, it is necessary to resort to relational bioethics that includes the ethics of care and solidarity and that recognizes the moral identity of socially excluded persons, reaffirming their position of equality in society. Relational autonomy therefore provides a broader conception by including the influence of living conditions in decisions. For this reason, the CANCERLESS project opts for a dialogue with those affected to incorporate their preferences and values into decisions about cancer prevention.

Ethical considerations and methodological uses of Facebook data in public health research: A systematic review.

OBJECTIVE: Since 2016, around seven in 10 adults in the United States (U.S.) actively use Facebook. While much Facebook data is publicly available for research, many users may not understand how their data are being used. We sought to examine to what extent research ethical practices were employed and the research methods being used with Facebook data in public health research. METHODS: We conducted a systematic review (PROSPERO registration CRD42020148170) of social media-based public health research focused on Facebook published in peer-reviewed journals in English between January 1, 2006 and October 31, 2019. We extracted data on ethical practices, methodology, and data analytic approaches. For studies that included verbatim user content, we attempted to locate users/posts within a timed 10-min period. RESULTS: Sixty-one studies met eligibility criteria. Just under half (48%, n = 29) sought IRB approval and six (10%) sought and obtained informed consent from Facebook users. Users' written content appeared in 39 (64%) papers, of which 36 presented verbatim quotes. We were able to locate users/posts within 10 min for half (50%, n = 18) of the 36 studies containing verbatim content. Identifiable posts included content about sensitive health topics. We identified six categories of analytic approaches to using these data: network analysis, utility (i.e., usefulness of Facebook as a tool for surveillance, public health dissemination, or attitudes), associational studies of users' behavior and health outcomes, predictive model development, and two types of content analysis (thematic analysis and sentiment analysis). Associational studies were the most likely to seek IRB review (5/6, 83%), while those of utility (0/4, 0%) and prediction (1/4, 25%) were the least likely to do so. CONCLUSIONS: Stronger guidance on research ethics for using Facebook data, especially the use of personal identifiers, is needed.

Chapitre 3. Perturbateurs endocriniens : un enjeu sanitaire, environnemental et scientifique, éthique et juridique.

Endocrine disruptors are substances capable of interfering with our hormonal system, leading to deleterious effects. Given the many sources of exposure, the challenge is to understand the role played by these substances in the development of certain pathologies. Assessing their effects on health is therefore a scientific challenge and an important public health issue.

Navigating complex trade-offs in public health interventions.

Public health, just as any policy-related field, faces the evergreen problem of turning knowledge into action. Among other problems, there is a clash between the inherent complexity of public health problems and the inevitable push, by decision-makers and the public, to simplify them. The Covid-19 pandemic has shown the insufficiencies of our current epistemological, methodological and normative apparatus to handle such crises in a timely manner. Despite this, several authors have been arguing for the importance of engaging global crises such as Covid-19 in ways that do not oversimplify key dimensions of the issues involved. In this paper, we contribute to this emerging scholarship. Building on existing work in the field of environmental problem-solving, we propose an integrative approach to navigating complex trade-offs in public health interventions. Briefly put, we propose that decision making should be informed by an analysis of any given problem from four distinct, but interrelated, lenses: (i) values and valuation, (ii) process and governance, (iii) power and inequalities and (iv) scientific evidence, methods and concepts. This normative framework, we argue, can help with spelling out the complexity of public health problems and with spelling out the rationale behind public health decision making to non-specialists and the general public. We illustrate our approach using the controversy over wearing face masks in the Covid-19 pandemic.

Herd Immunity: History, Concepts, and Ethical Rationale.

Public health emergencies are fraught by epistemic uncertainty, which raises policy issues of how to handle that uncertainty and devise sustainable public health responses. Among such responses, a herd immunity policy might be an option. Particularly before the development of vaccines, the current COVID-19 pandemic has highlighted the polarized nature of the political debate concerning the ethical feasibility of herd immunity strategies. This article provides a conceptual framework tailored to uncover the ethical rationale behind such strategies. Clarity on this issue is important in order to facilitate the terms of the political debate when tackling future health emergencies.

A theoretical framework for ethical decision-making during public health emergencies / Un marco teórico para la toma de decisiones éticas durante emergencias de salud pública / Um referencial teórico para tomada de decisão ética durante emergências de saúde pública

Abstract: The new theoretical ethical framework is a general frame or tool for ethical agents, developed to guide ethical reasoning during public health emergency preparedness and response. The TEF is based on the assumption that no existing ethical discourse in medical ethics alone is sufficient to address ethical issues of a PHE. The solutions suggested by existing approaches are limited in practicability and effectiveness, because they cannot address root problems and interplay among ethical problems. The reason for this insufficiency rests on the argument that ethical problems of PHEs have causal and reciprocal relationships, and any ethical decision-making framework should provide a wide enough perspective to consider relevant ethical norms and theories to suggest practical, implementable, coherent solutions compatible with the communal values and cultural norms. The TEF we suggest for PHEs embraces a holistic and integrated ethical perspective that enables us to comprehend that ethical problems that arise in various settings caused by PHE phenomena are in relationship with each other instead of addressing them as a standalone problem. The TEF provides decision-makers to achieve a coherent web of considered judgements compatible with ethical values and principles in various settings. This type of conceptualization offers a wide perspective to see causal and relational relationships among problems and produce outcomes that would not be possible by eclectic approaches.

Resumen: El nuevo Marco Ético Teórico (MET) es una estructura general o herramienta para eticistas, desarrollada para guiar el razonamiento ético durante la preparación y respuesta a emergencias de salud pública (ESP). Supone que no existe un discurso ético en la ética médica que por sí solo sea suficiente para abordar temas éticos de ESP. Las soluciones sugeridas de aproximaciones existentes son limitadas en la práctica y en la efectividad, debido a que no pueden abordar problemas de raíz sin considerar las interacciones entre los problemas éticos. Esta insuficiencia es porque los problemas éticos de ESP tiene relaciones causales y recíprocas, y cualquier estructura de toma de decisiones éticas debería proporcionar una perspectiva suficientemente amplia como para considerar normas éticas y teorías relevantes, y sugerir soluciones prácticas que sean coherentes y compatibles con valores comunes y normas culturales. El MET que sugerimos para ESP abarca una perspectiva ética integral e integrada, que posibilita la comprensión de que los problemas éticos que surgen en varías situaciones causadas por fenómenos ESP se hallan en relación entre ellos, en vez de abordarlos como un problema aislado. El MET proporciona a los que toman decisiones el lograr una red coherente de juicios compatibles con los valores y principios éticos en varias situaciones. Este tipo de conceptualización ofrece una amplia perspectiva para ver relaciones causales y relacionales entre problemas y producir resultados que no serían posibles mediante aproximaciones eclécticas.

Resumo: O novo referencial ético teórico (NT: TEF, sigla em inglês) é um referencial geral ou instrumento para agentes éticos, desenvolvido para guiar o raciocínio ético durante o preparo e resposta a emergências de saúde pública (NT: PHE, sigla em inglês). O TEF é baseado na suposição de que nenhum discurso ético existente em ética médica sozinho é suficiente para abordar aspectos éticos de uma PHE. As soluções sugeridas pelas abordagens existentes são limitadas em praticabilidade e efetividade, porque elas não podem abordar problemas fundamentais e inter-relacionar problemas éticos. A razão para essa insuficiência repousa no argumento de que problemas éticos de PHEs têm relações causais e recíprocas, e qualquer referencial para tomada de decisão ética deve propiciar uma perspectiva ampla o suficiente para considerar normas e teorias éticas relevantes para sugerir soluções práticas, implementáveis e coerentes, compatíveis com valores comunitários e normas culturais. A TEF que sugerimos para PHEs abarca uma perspectiva ética holística e integrada que nos permite compreender que os problemas éticos que surgem em diversos ambientes causados pelo fenômeno da PHE estão em relação entre si, ao invés de abordá-los como um problema isolado. O TFE propicia a tomadores de decisões alcançar uma rede de julgamentos considerados compatíveis com valores e princípios éticos em ambientes diversos. Esse tipo de conceitualização oferece uma perspectiva ampla para observar relações causais e relacionais entre problemas e produzir desfechos que não seriam possíveis por abordagens ecléticas.

The ephemeral effects of fact-checks on COVID-19 misperceptions in the United States, Great Britain and Canada.

Widespread misperceptions about COVID-19 and the novel coronavirus threaten to exacerbate the severity of the pandemic. We conducted preregistered survey experiments in the United States, Great Britain and Canada examining the effectiveness of fact-checks that seek to correct these false or unsupported beliefs. Across three countries with differing levels of political conflict over the pandemic response, we demonstrate that fact-checks reduce targeted misperceptions, especially among the groups who are most vulnerable to these claims, and have minimal spillover effects on the accuracy of related beliefs. However, these reductions in COVID-19 misperception beliefs do not persist over time in panel data even after repeated exposure. These results suggest that fact-checks can successfully change the COVID-19 beliefs of the people who would benefit from them most but that their effects are ephemeral.

'Us-Versus-Them': Othering in COVID-19 public health behavior compliance.

OBJECTIVE: We explored public perceptions about the COVID-19 pandemic to learn how those attitudes may affect compliance with health behaviors. METHODS: Participants were Central Pennsylvania adults from diverse backgrounds purposively sampled (based on race, gender, educational attainment, and healthcare worker status) who responded to a mixed methods survey, completed between March 25-31, 2020. Four open-ended questions were analyzed, including: "What worries you most about the COVID-19 pandemic?" We applied a pragmatic, inductive coding process to conduct a qualitative, descriptive content analysis of responses. RESULTS: Of the 5,948 respondents, 538 were sampled for this qualitative analysis. Participants were 58% female, 56% with ≥ bachelor's degree, and 50% from minority racial backgrounds. Qualitative descriptive analysis revealed four themes related to respondents' health and societal concerns: lack of faith in others; fears of illness or death; frustration at perceived slow societal response; and a desire for transparency in communicating local COVID-19 information. An "us-versus-them" subtext emerged; participants attributed non-compliance with COVID-19 behaviors to other groups, setting themselves apart from those Others. CONCLUSION: Our study uncovered Othering undertones in the context of the COVID-19 pandemic, occurring between groups of like-minded individuals with behavioral differences in 'compliance' versus 'non-compliance' with public health recommendations. Addressing the 'us-versus-them' mentality may be important for boosting compliance with recommended health behaviors.

Solidarity in Pandemics, Mandatory Vaccination, and Public Health Ethics.

Mandatory vaccination has been a highly disputed policy for tackling infectious diseases. Here I argue that a universal mandatory vaccination policy for the general public against the COVID-19 pandemic is ethically preferable when grounded in the concept of solidarity, which is defined by Barbara Prainsack and Alena Buyx as an enacted commitment to a relevant respect recognized by a group of individuals with equal moral status. This approach is complementary to utilitarian accounts and could better address other reasonable oppositions to mandatory vaccination. From a solidaristic account, the recognized relevant respect is to end the COVID-19 pandemic as soon as possible. This group of individuals would be willing to carry costs to assist each other in this respect, and a mandatory vaccination policy could be their institutionalized mutual assistance. The costs to be carried include both the financial costs of vaccination and the health costs stemming from potential adverse events and scientific uncertainties. The proposed social health insurance similarity test suggests the degree of coercion the mandatory vaccination policy could undertake within each state's specific legal and judicial context. (Am J Public Health. 2022;112(2):255-261. https://doi.org/10.2105/AJPH.2021.306578).

Genética, Genómica y COVID-19: implicaciones éticas / Genetics, Genomic and COVID-19: ethical implications

Introducción: La genética y la genómica contribuyen al desarrollo de enfoques personalizados y más efectivos para la prevención y el tratamiento de enfermedades infecciosas. Durante la actual pandemia se realizan estudios genómicos a pacientes con COVID-19 o expuestos no afectados, para delinear los factores del huésped asociados con la variabilidad en la susceptibilidad, la infectividad y gravedad de la enfermedad. Objetivo: Describir las implicaciones éticas de la genética y genómica en la práctica clínica y la salud pública durante la pandemia de la COVID-19. Métodos: Se consultan las bases bibliográficas de PubMed/Medline y Google académico. Se describen las implicaciones éticas, beneficios y perjuicios relacionados con los estudios genéticos y genómicos, en la práctica clínica y la salud pública en la COVID-19. Conclusiones: Los estudios genéticos y genómicos desarrollados durante la pandemia de COVID-19 representan un logro de la coordinación y cooperación global(AU)

Introduction: Genetics and Genomic contribute to the development of personalized approaches and more effective for prevention and treatment of infectious diseases. During the current pandemics, genomic studies have been performed to patients with COVID-19 or expossed, non affected, to trace the factors of the associated host with the variability in the susceptibility, the infectivity and critical condition of the disease. Objective: To describe the ethical implications genetics and genomic in the clinical practice and public health during COVID-19 pandemic. Methods: Bibliographic bases such as PubMed/Medline and Google Scholar were consulted. The ethical implications, benefits and damages related to the genetics and genomic studies are described, in the clinical practice and public health in COVID-19. Conclusions: The genetics and genomic studies developed during COVID-19 pandemic represent an achievement of the global coordination and cooperation (AU)

Public health ethics and the COVID-19 pandemic.

Health is a human right anchored in values as a basic necessity of life. It promotes the well-being of persons, communities, economic prosperity, and national development. The coronavirus disease-2019 (COVID-19) pandemic caught the world unaware and unprepared. It presented a huge challenge to the health and economic systems of every country. Across the spectrum of human endeavor and liberty, several ethical questions have been raised with regard to its management, particularly the public health control measures. Decisions for pandemic control measures are made under difficult circumstances driven by urgency and panic, with uncertainties and complexities for public goods over individual rights. Global solidarity in controlling the pandemic is being tested. National governments have the responsibility to protect public health on the grounds of common good. Political considerations should not be the basis for decision-making against the best available epidemiological data from pandemic disease dynamics. Hence, the need to adhere to the values of honesty, trust, human dignity, solidarity, reciprocity, accountability, transparency, and justice are major considerations. A literature search was conducted for the publications from academic databases and websites of health-relevant organizations. I discuss the ethical questions and challenges of the COVID-19 pandemic in the context of public health control measures using the standard ethical principles of respect for autonomy, beneficence, nonmaleficence, and social (distributive) justice. It is observed that, at the country level, the World Health Organization (WHO) guidelines are used to control the pandemic. As WHO through the COVAX strategy distributes the vaccines to less developed countries, a lot still needs to be done to address the complex bottlenecks of allocation and distribution. There is a need to ensure acceptable and transparent system that promotes cooperation, equitable access, and fair distribution of vaccines on a global scale.

Résumé La santé est un droit humain ancré dans des valeurs en tant que nécessité fondamentale de la vie. Elle favorise le bien-être des personnes, des collectivités, la prospérité économique et le développement national. La pandémie de COVID-19 a pris le monde au dépourvu et au dépourvu. Cela représente un énorme défi pour les systèmes de santé et économiques de chaque pays. Dans tout le spectre de l'activité humaine et de la liberté, plusieurs questions éthiques ont été soulevées concernant sa gestion, en particulier les mesures de contrôle de la santé publique. Les décisions concernant les mesures de lutte contre la pandémie sont prises dans des circonstances difficiles motivées par l'urgence et la panique, avec des incertitudes et des complexités pour les biens publics plutôt que les droits individuels. La solidarité mondiale dans la lutte contre la pandémie est mise à l'épreuve. Les gouvernements nationaux ont la responsabilité de protéger la santé publique au nom du bien commun. Les considérations politiques ne devraient pas être la base de la prise de décision par rapport aux meilleures données épidémiologiques disponibles sur la dynamique des maladies pandémiques. Ainsi, la nécessité d'adhérer aux valeurs d'honnêteté, de confiance, de dignité humaine, de solidarité, de réciprocité, de responsabilité, de transparence et de justice sont des considérations majeures. Une recherche documentaire a été menée pour les publications des bases de données universitaires et des sites Web d'organisations liées à la santé. Je discute des questions éthiques et des défis de la pandémie de COVID-19 dans le contexte des mesures de contrôle de la santé publique en utilisant les principes éthiques standard de respect de l'autonomie, de la bienfaisance, de la non-malfaisance et de la justice sociale (distributive). On constate qu'au niveau des pays, les directives de l'OMS sont utilisées pour contrôler la pandémie. Alors que l'OMS, via la stratégie COVAX, distribue les vaccins aux pays moins développés, il reste encore beaucoup à faire pour remédier aux goulots d'étranglement complexes de l'allocation et de la distribution. Il est nécessaire de garantir un système acceptable et transparent qui favorise la coopération, l'accès équitable et la distribution équitable des vaccins à l'échelle mondiale. critères d'attribution des vaccins COVID-19 dès qu'ils deviennent disponibles.

Now Is Our Time to Act: Why Academic Medicine Must Embrace Community Collaboration as Its Fourth Mission.

In his Leadership Plenary at the Association of American Medical Colleges (AAMC) annual meeting, "Learn Serve Lead 2020: The Virtual Experience," president and CEO David Skorton emphasized that the traditional tripartite mission of academic medicine-medical education, clinical care, and research-is no longer enough to achieve health justice for all. Today, collaborating with diverse communities deserves equal weight among academic medicine's missions. This means going beyond "delivering care" to establishing and expanding ongoing, two-way community dialogues that push the envelope of what is possible in service to what is needed. It means appreciating community assets and creating ongoing pathways for listening to and learning from the needs, lived experiences, perspectives, and wisdom of patients, families, and communities. It means working with community-based organizations in true partnership to identify and address needs, and jointly develop, test, and implement solutions. This requires bringing medical care and public/population health concepts together and addressing upstream fundamental causes of health inequities. The authors call on academic medical institutions to do more to build a strong network of collaborators across public and population health, government, community groups, and the private sector. We in academic medicine must hold ourselves accountable for weaving community collaborations consistently throughout research, medical education, and clinical care. The authors recognize the AAMC can do better to support its member institutions in doing so and discuss new initiatives that signify a shift in emphasis through the association's new strategic plan and AAMC Center for Health Justice. The authors believe every area of academic medicine could grow and better serve communities by listening and engaging more and bringing medical care, public health, and other sectors closer together.