Ethics, equality and evidence in health promotion Danish guidelines for municipalities

Abstract

Including reduction of health inequalities and evidence-informed and ethically defendable interventions in health promotion is a challenge, which is not yet fully met by the National Board of Health. When judged from liberal ethical principles, only few of the suggested interventions are acceptable, i.e., those concerning information, but from a paternalistic view, all interventions that may actually benefit the citizens are justified.

Ethical issues in the development and implementation of nutrition-related public health policies and interventions: A scoping review

“…Justice and equity are addressed in a vast majority of these articles, as they constitute one of the core principles in public health ethics and illustrate the strong link that exists between population health and social inequities. Several of these articles stress the lack of integration of ethics and ethical guidance in public health policies and interventions [ 40 , 43 , 44 , 48 , 50 , 55 , 57 , 61 ]. Education and/or the assistance in ethics while developing/implementing public health interventions is also recommended [ 12 , 40 , 44 , 53 , 55 ].…”

“…Although there are broader actions that aim at promoting healthy diets in general, the ethics of public health prevention or treatment of obesity is the most explicitly and frequently discussed subject: 62 articles (36,7%) address this topic (see Table 1 ) [ 1 – 4 , 43 , 56 , 57 , 60 – 114 ]. There is a significant variety in the nature, scope, population targets and types of public health interventions in this field.…”

“…The major challenges described in these articles are to determine what constitutes sound “evidence” in public health programs and the lack of data [ 61 , 71 , 74 ]. Moreover, most authors stress that scientific evidence alone (in particular analyses limited to measuring effects on health and/or cost-effectiveness) cannot guide and determine health policy and decisions for intervention [ 1 , 2 , 43 , 45 , 51 , 61 , 84 , 114 , 124 ]. Ethical aspects, including unexpected consequences–such as stigma, negative impact on autonomy and individual choice, and negative perceptions [ 38 , 47 , 92 ]–must be considered in the monitoring and evaluation of interventions [ 92 ].…”

“…Moreover, evidence about the impact of an intervention on nutrition in one context may not necessarily apply to other contexts [ 24 ]. It is often suggested that in the face of significant public health issues, “doing something is better than doing nothing” (p. 342 in [ 43 ]) and “how could it hurt to try?” (p. 342 in [ 84 ]). This viewpoint implies that interventions could be implemented if they are expected to be effective, without waiting for sufficient evidence [ 1 , 43 ].…”

“…It is often suggested that in the face of significant public health issues, “doing something is better than doing nothing” (p. 342 in [ 43 ]) and “how could it hurt to try?” (p. 342 in [ 84 ]). This viewpoint implies that interventions could be implemented if they are expected to be effective, without waiting for sufficient evidence [ 1 , 43 ]. Yet, this stance is obviously problematic from an ethical standpoint, as such interventions could have no beneficial outcomes or could even be unsafe [ 151 ].…”