Bulletin of the World Health Organizationhttps://www.scielosp.org/feed/bwho/2008.v86n8/2016-01-01T00:02:00ZUnknown authorVol. 86 No. 8 - 2008WerkzeugWHO 60th anniversary commemorative volumeS0042-968620080008000012016-01-01T00:02:00Z2001-01-28T00:08:00ZThe contribution of ethics to public healthS0042-968620080008000022016-01-01T00:02:00Z2001-01-28T00:08:00ZColeman, Carl HBouësseau, Marie-CharlotteReis, Andreas
<em>Coleman, Carl H</em>;
<em>Bouësseau, Marie-Charlotte</em>;
<em>Reis, Andreas</em>;
<br/><br/>
The importance of public-health ethicsS0042-968620080008000032016-01-01T00:02:00Z2001-01-28T00:08:00ZKrebs, John
<em>Krebs, John</em>;
<br/><br/>
Drug donations: what lies beneathS0042-968620080008000042016-01-01T00:02:00Z2001-01-28T00:08:00ZPinheiro, Cristina P
<em>Pinheiro, Cristina P</em>;
<br/><br/>
Clinical trials in India: ethical concernsS0042-968620080008000052016-01-01T00:02:00Z2001-01-28T00:08:00ZOvercoming migrants' barriers to healthS0042-968620080008000062016-01-01T00:02:00Z2001-01-28T00:08:00ZIranian health houses open the door to primary careS0042-968620080008000072016-01-01T00:02:00Z2001-01-28T00:08:00ZFrom rhetoric to realityS0042-968620080008000082016-01-01T00:02:00Z2001-01-28T00:08:00ZRecent news from WHOS0042-968620080008000092016-01-01T00:02:00Z2001-01-28T00:08:00ZUsing human rights to improve maternal and neonatal health: history, connections and a proposed practical approachS0042-968620080008000102016-01-01T00:02:00Z2001-01-28T00:08:00ZGruskin, SofiaCottingham, JaneHilber, Adriane MartinKismodi, EszterLincetto, OrnellaRoseman, Mindy Jane
<em>Gruskin, Sofia</em>;
<em>Cottingham, Jane</em>;
<em>Hilber, Adriane Martin</em>;
<em>Kismodi, Eszter</em>;
<em>Lincetto, Ornella</em>;
<em>Roseman, Mindy Jane</em>;
<br/><br/>
We describe the historical development of how maternal and neonatal mortality in the developing world came to be seen as a public-health concern, a human rights concern, and ultimately as both, leading to the development of approaches using human rights concepts and methods to advance maternal and neonatal health. We describe the different contributions of the international community, women's health advocates and human rights activists. We briefly present a recent effort, developed by WHO with the Harvard Program on International Health and Human Rights, that applies a human rights framework to reinforce current efforts to reduce maternal and neonatal mortality.Herbal medicine research and global health: an ethical analysisS0042-968620080008000112016-01-01T00:02:00Z2001-01-28T00:08:00ZTilburt, Jon CKaptchuk, Ted J
<em>Tilburt, Jon C</em>;
<em>Kaptchuk, Ted J</em>;
<br/><br/>
Governments, international agencies and corporations are increasingly investing in traditional herbal medicine research. Yet little literature addresses ethical challenges in this research. In this paper, we apply concepts in a comprehensive ethical framework for clinical research to international traditional herbal medicine research. We examine in detail three key, underappreciated dimensions of the ethical framework in which particularly difficult questions arise for international herbal medicine research: social value, scientific validity and favourable risk-benefit ratio. Significant challenges exist in determining shared concepts of social value, scientific validity and favourable risk-benefit ratio across international research collaborations. However, we argue that collaborative partnership, including democratic deliberation, offers the context and process by which many of the ethical challenges in international herbal medicine research can, and should be, resolved. By "cross-training" investigators, and investing in safety-monitoring infrastructure, the issues identified by this comprehensive framework can promote ethically sound international herbal medicine research that contributes to global health.Denaturalizing scarcity: a strategy of enquiry for public- health ethicsS0042-968620080008000122016-01-01T00:02:00Z2001-01-28T00:08:00ZSchrecker, Ted
<em>Schrecker, Ted</em>;
<br/><br/>
Most scarcities that underpin health disparities within and among countries are not natural; rather, they result from policy choices and the operation of social institutions. Using examples from the United States of America: the Chicago heat wave and hurricane Katrina, this paper develops "denaturalizing scarcity" as a strategy for enquiry to inform public-health ethics in an interconnected world. It first describes some of the resource scarcities that are of greatest concern from a public-health perspective, and then outlines two (not mutually exclusive) lines of ethical reasoning that demonstrate their importance. One of these involves the multiple relationships that link rich and poor across national borders in today's interconnected world. The paper then briefly describes ways in which globalization and the associated institutions are linked to health-threatening scarcities. The paper concludes that denaturalizing scarcity represents a valuable alternative to mainstream health ethics, directing our attention instead to why some settings are "resource poor" and others are not.Integrating ethics, health policy and health systems in low- and middle-income countries: case studies from Malaysia and PakistanS0042-968620080008000132016-01-01T00:02:00Z2001-01-28T00:08:00ZHyder, Adnan AMerritt, MariaAli, JosephTran, Nhan TSubramaniam, KulanthayanAkhtar, Tasleem
<em>Hyder, Adnan A</em>;
<em>Merritt, Maria</em>;
<em>Ali, Joseph</em>;
<em>Tran, Nhan T</em>;
<em>Subramaniam, Kulanthayan</em>;
<em>Akhtar, Tasleem</em>;
<br/><br/>
Scientific progress is a significant basis for change in public-health policy and practice, but the field also invests in value-laden concepts and responds daily to sociopolitical, cultural and evaluative concerns. The concepts that drive much of public-health practice are shaped by the collective and individual mores that define social systems. This paper seeks to describe the ethics processes in play when public-health mechanisms are established in low- and middle-income countries, by focusing on two cases where ethics played a crucial role in producing positive institutional change in public-health policy. First, we introduce an overview of the relationship between ethics and public health; second, we provide a conceptual framework for the ethical analysis of health system events, noting how this approach might enhance the power of existing frameworks; and third, we demonstrate the interplay of these frameworks through the analysis of a programme to enhance road safety in Malaysia and an initiative to establish a national ethics committee in Pakistan. We conclude that, while ethics are gradually being integrated into public-health policy decisions in many developing health systems, ethical analysis is often implicit and undervalued. This paper highlights the need to analyse public-health decision-making from an ethical perspective.Demographic and health surveillance: longitudinal ethical considerationsS0042-968620080008000142016-01-01T00:02:00Z2001-01-28T00:08:00ZCarrel, MargaretRennie, Stuart
<em>Carrel, Margaret</em>;
<em>Rennie, Stuart</em>;
<br/><br/>
Longitudinal data gathered from health surveillance, when combined with detailed demographic information, can provide invaluable insight into disease outcomes. Many such surveillance sites exist in the developing world, particularly in Asia and sub-Saharan Africa, and focus on diseases such as HIV/AIDS, cholera, malaria and tuberculosis. The indistinct positions of such surveillance systems, often inhabiting an area between research, treatment and population health monitoring, means that the necessity of and responsibility for ethical oversight is unclear. This regulatory vacuum is further compounded by a lack of attention to longitudinal surveillance systems in ethics literature. In this paper, we explore some key ethical questions that arise during demographic and health surveillance in relation to ethical principles of beneficence, respect for persons and justice: health-care provision, informed consent and study sustainability.Ethical analysis to improve decision-making on health technologiesS0042-968620080008000152016-01-01T00:02:00Z2001-01-28T00:08:00ZSaarni, Samuli IHofmann, BjørnLampe, KristianLühmann, DagmarMäkelä, MarjukkaVelasco-Garrido, MarcialAutti-Rämö, Ilona
<em>Saarni, Samuli I</em>;
<em>Hofmann, Bjørn</em>;
<em>Lampe, Kristian</em>;
<em>Lühmann, Dagmar</em>;
<em>Mäkelä, Marjukka</em>;
<em>Velasco-Garrido, Marcial</em>;
<em>Autti-Rämö, Ilona</em>;
<br/><br/>
Health technology assessment (HTA) is the multidisciplinary study of the implications of the development, diffusion and use of health technologies. It supports health-policy decisions by providing a joint knowledge base for decision-makers. To increase its policy relevance, HTA tries to extend beyond effectiveness and costs to also considering the social, organizational and ethical implications of technologies. However, a commonly accepted method for analysing the ethical aspects of health technologies is lacking. This paper describes a model for ethical analysis of health technology that is easy and flexible to use in different organizational settings and cultures. The model is part of the EUnetHTA project, which focuses on the transferability of HTAs between countries. The EUnetHTA ethics model is based on the insight that the whole HTA process is value laden. It is not sufficient to only analyse the ethical consequences of a technology, but also the ethical issues of the whole HTA process must be considered. Selection of assessment topics, methods and outcomes is essentially a value-laden decision. Health technologies may challenge moral or cultural values and beliefs, and their implementation may also have significant impact on people other than the patient. These are essential considerations for health policy. The ethics model is structured around key ethical questions rather than philosophical theories, to be applicable to different cultures and usable by non-philosophers. Integrating ethical considerations into HTA can improve the relevance of technology assessments for health care and health policy in both developed and developing countries.A personalist approach to public-health ethicsS0042-968620080008000162016-01-01T00:02:00Z2001-01-28T00:08:00ZPetrini, CarloGainotti, Sabina
<em>Petrini, Carlo</em>;
<em>Gainotti, Sabina</em>;
<br/><br/>
First we give an overview of the historical development of public health. Then we present some public-health deontology codes and some ethical principles. We highlight difficulties in defining ethics for public health, with specific reference to three of them that concern: (i) the adaptability to public health of the classical principles of bioethics; (ii) the duty to respect and safeguard the individual while acting within the community perspective that is typical of public health; and (iii) the application-oriented nature of public health and the general lack of attention towards the ethical implications of collective interventions (compared with research). We then mention some proposals drafted from North American bioethics "principles" and utilitarian, liberal and communitarian views. Drawing from other approaches, personalism is outlined as being the theory that offers a consistent set of values and alternative principles that are relevant for public health.National bioethical legislation and guidelines for biomedical research in the Islamic Republic of IranS0042-968620080008000172016-01-01T00:02:00Z2001-01-28T00:08:00ZZahedi, FarzanehLarijani, Bagher
<em>Zahedi, Farzaneh</em>;
<em>Larijani, Bagher</em>;
<br/><br/>
Rapid advances in biomedical science and technology, which have revolutionized medicine and health-care services in different societies, have been associated with inevitable ethical challenges. Undoubtedly, these innovations could lead to irreversible disasters if they are not limited by appropriate regulations. Substantial attempts have been made in the Islamic Republic of Iran to establish a structured approach for identifying, analysing and resolving ethical issues in clinical practice. Given the consensus of religious and scientific scholars, some laws recently approved by the parliament include the Deceased and Brain-Dead Patients Organ Transplantation Act (2000), Embryo Donation to Infertile Spouses Act (2003) and the Therapeutic Abortion Act (2005). National guidelines for ethical assessment and supervision of research proposals have also been compiled by the authorities. This paper reviews the main endeavours made in bioethics legislation in the Islamic Republic of Iran.Health-sector responses to intimate partner violence in low- and middle-income settings: a review of current models, challenges and opportunitiesS0042-968620080008000182016-01-01T00:02:00Z2001-01-28T00:08:00ZColombini, ManuelaMayhew, SusannahWatts, Charlotte
<em>Colombini, Manuela</em>;
<em>Mayhew, Susannah</em>;
<em>Watts, Charlotte</em>;
<br/><br/>
There is growing recognition of the public-health burden of intimate partner violence (IPV) and the potential for the health sector to identify and support abused women. Drawing upon models of health-sector integration, this paper reviews current initiatives to integrate responses to IPV into the health sector in low- and middle-income settings. We present a broad framework for the opportunities for integration and associated service and referral needs, and then summarize current promising initiatives. The findings suggest that a few models of integration are being replicated in many settings. These often focus on service provision at a secondary or tertiary level through accident and emergency or women's health services, or at a primary level through reproductive or family-planning health services. Challenges to integration still exist at all levels, from individual service providers' attitudes and lack of knowledge about violence to managerial and health systems' challenges such as insufficient staff training, no clear policies on IPV, and lack of coordination among various actors and departments involved in planning integrated services. Furthermore, given the variety of locations where women may present and the range and potential severity of presenting health problems, there is an urgent need for coherent, effective referral within the health sector, and the need for strong local partnership to facilitate effective referral to external, non-health services.Emerging norms for the control of emerging epidemicsS0042-968620080008000192016-01-01T00:02:00Z2001-01-28T00:08:00ZMcDougall, Christopher WUpshur, Ross EGWilson, Kumanan
<em>Mcdougall, Christopher W</em>;
<em>Upshur, Ross Eg</em>;
<em>Wilson, Kumanan</em>;
<br/><br/>
The burden of surgical conditions and access to surgical care in low- and middle-income countriesS0042-968620080008000202016-01-01T00:02:00Z2001-01-28T00:08:00ZOzgediz, DorukJamison, DeanCherian, MeenaMcQueen, Kelly
<em>Ozgediz, Doruk</em>;
<em>Jamison, Dean</em>;
<em>Cherian, Meena</em>;
<em>Mcqueen, Kelly</em>;
<br/><br/>
Access to medicines versus access to treatment: the case of type 1 diabetesS0042-968620080008000212016-01-01T00:02:00Z2001-01-28T00:08:00ZBeran, DavidMcCabe, ArianeYudkin, John S
<em>Beran, David</em>;
<em>Mccabe, Ariane</em>;
<em>Yudkin, John S</em>;
<br/><br/>
The Declaration of Helsinki and public healthS0042-968620080008000222016-01-01T00:02:00Z2001-01-28T00:08:00ZWilliams, John R
<em>Williams, John R</em>;
<br/><br/>
Just health: meeting health needs fairlyS0042-968620080008000232016-01-01T00:02:00Z2001-01-28T00:08:00ZRid, Annette
<em>Rid, Annette</em>;
<br/><br/>
Ethics and infectious diseaseS0042-968620080008000242016-01-01T00:02:00Z2001-01-28T00:08:00ZUpshur, Ross
<em>Upshur, Ross</em>;
<br/><br/>
Cambridge textbook of bioethicsS0042-968620080008000252016-01-01T00:02:00Z2001-01-28T00:08:00ZDingwall, Robert
<em>Dingwall, Robert</em>;
<br/><br/>
Accessible public-health education: a potential growth area?S0042-968620080008000262016-01-01T00:02:00Z2001-01-28T00:08:00ZSanders, DavidGuwatudde, DavidAlexander, Lucy
<em>Sanders, David</em>;
<em>Guwatudde, David</em>;
<em>Alexander, Lucy</em>;
<br/><br/>
Estimation of global visual impairment due to uncorrected refractive errorS0042-968620080008000272016-01-01T00:02:00Z2001-01-28T00:08:00ZDandona, LalitDandona, Rakhi
<em>Dandona, Lalit</em>;
<em>Dandona, Rakhi</em>;
<br/><br/>
Author reply to: estimation of global visual impairment due to uncorrected refractive errorS0042-968620080008000282016-01-01T00:02:00Z2001-01-28T00:08:00ZMariotti, SilvioResnikoff, SergePascolini, Donatella
<em>Mariotti, Silvio</em>;
<em>Resnikoff, Serge</em>;
<em>Pascolini, Donatella</em>;
<br/><br/>
Country ownership and vertical programmes in health, health information and health researchS0042-968620080008000292016-01-01T00:02:00Z2001-01-28T00:08:00ZKennedy, AndrewIJsselmuiden, Carel
<em>Kennedy, Andrew</em>;
<em>Ijsselmuiden, Carel</em>;
<br/><br/>
Integrating cervical cancer prevention in HIV/AIDS treatment and care programmesS0042-968620080008000302016-01-01T00:02:00Z2001-01-28T00:08:00ZMwanahamuntu, Mulindi HSahasrabuddhe, Vikrant VStringer, Jeffrey SAParham, Groesbeck P
<em>Mwanahamuntu, Mulindi H</em>;
<em>Sahasrabuddhe, Vikrant V</em>;
<em>Stringer, Jeffrey Sa</em>;
<em>Parham, Groesbeck P</em>;
<br/><br/>
Evaluation of the WHO Assessment Instrument for Mental Health SystemsS0042-968620080008000312016-01-01T00:02:00Z2001-01-28T00:08:00ZSaxena, ShekharLora, Antoniovan Ommeren, MarkBarrett, ThomasMorris, JodiSaraceno, Benedetto
<em>Saxena, Shekhar</em>;
<em>Lora, Antonio</em>;
<em>Van Ommeren, Mark</em>;
<em>Barrett, Thomas</em>;
<em>Morris, Jodi</em>;
<em>Saraceno, Benedetto</em>;
<br/><br/>
CorrigendumS0042-968620080008000322016-01-01T00:02:00Z2001-01-28T00:08:00Z