Looking Ahead: Addressing Ethical Challenges in Public Health Practice

Ethical challenges in public health can have a significant impact on the health of communities if they impede efficiencies and best practices. Competing needs for resources and a plurality of values can challenge public health policymakers and practitioners to make fair and effective decisions for their communities. In this paper, the authors offer an analytic framework designed to assist policymakers and practitioners in managing the ethical tensions they face in daily practice. Their framework is built upon the following set of six considerations: determining population-level utility of the proposed action; demonstrating evidence of need and effectiveness of actions; establishing fairness of goals and proposed implementation strategies; ensuring accountability; and, assessing expected efficiencies and costs associated with the proposed action. Together, these considerations create a structured guide to assist decision-makers in identifying potential ethical challenges and in assessing the moral considerations that underlie public health practice - and possibly even, if the conditions are met, reduce the creation of ethical tension. Although the authors'empirical experiences provide the basis for the framework advanced here, their approach remains to be tested and evaluated by public health practitioners.     

Regulating genetically modified crops and foods in Canada and the United Kingdom: Democratizing risk regulation

Abstract: This article examines the alternate use of models of representative, functional and citizen‐centred participatory democracy in the formulation of policies to regulate the risks of genetically modified crops and foods in the United Kingdom and Canada. It demonstrates that representative, functional and participatory democracy have all played a role in the United Kingdom; functional democracy has been ascendant in Canada, with representative democracy playing a secondary role. These cross‐national differences derive from the greater imperative for regulatory legitimacy in the U.K., and the Canadian pre‐occupation with regulatory effectiveness. The result is a more transparent U.K. regulatory framework that provides representation of a broader range of public values and concerns than in Canada. Sommaire: Cet article examine les différentes utilisations de modèles de démocratie représentative, fonctionnelle et axée sur les citoyens dans la formulation de politiques destinées à réglementer les risques associés aux cultures et aliments génétiquement modifiés au Royaume‐Uni et au Canada. Il démontre que les démocraties représentatives, fonctionnelles et participatives ont toutes joué un rôle au Royaume‐Uni; la démocratie fonctionnelle a dominé au Canada, tandis que la démocratie représentative y a joué un rôle secondaire. Ces différences transnationales proviennent du plus grand impératif de légitimité de la réglementation au R.‐U., et de la préoccupation canadienne de l'efficacité de la réglementation. Le résultat est un cadre de réglementation plus transparent au R.‐U. qui représente un plus vaste éventail de valeurs et de préoccupations publiques qu'au Canada.