William Sherlaw

Teaching seven principles for public health ethics: towards a curriculum for a short course on ethics in public health programmes

BackgroundTeaching ethics in public health programmes is not routine everywhere – at least not in most schools of public health in the European region. Yet empirical evidence shows that schools of public health are more and more interested in the integration of ethics in their curricula, since public health professionals often have to face difficult ethical decisions.DiscussionThe authors have developed and practiced an approach to how ethics can be taught even in crowded curricula, requiring five to eight hours of teaching and learning contact time. In this way, if programme curricula do not allow more time for ethics, students of public health can at least be sensitised to ethics and ethical argumentation. This approach – focusing on the application of seven mid-level principles to cases (non-maleficence, beneficence, health maximisation, efficiency, respect for autonomy, justice, proportionality) – is presented in this paper. Easy to use ‘tools’ applying ethics to public health are presented.SummaryThe crowded nature of the public health curriculum, and the nature of students participating in it, required us to devise and develop a short course, and to use techniques that were likely to provide a relatively efficient introduction to the processes, content and methods involved in the field of ethics.

Why the French did not choose to panic: a dynamic analysis of the public response to the influenza pandemic

To understand the French publics response to the 2009 pandemic A/H1N1 influenza health threat a sequence analysis framework has been employed mobilising different theoretical strands such as innovations diffusion theory, surprise theory and social representation theory. These tend to suggest that disease episodes, public health policy and the publics response should be considered within a larger socio-cognitive frame incorporating representations anchored by prior disease episodes and campaigns. It is suggested in this article that the publics response was greatly influenced by the pervasive anchoring of the social representations of the pandemic threat to the 1918 Spanish flu in the lay and scientific media. These representations were eventually seen not to match the reality of the disease and consequently the French public did not panic during the 2009 pandemic. This hypothesis has been tested empirically by examining retrospective media, bibliographical data and an analysis of risk perception carried out through three cross-sectional studies prior to and during the pandemic episode and one month after the launch of the vaccination campaign. These findings suggest that alarmist framings of health threats may be counterproductive since they may reduce the capacity of public health organisations to mobilise the public in the case of more serious emerging disease.

Disabled people, inclusion and policy: better outcomes through a public health approach?

The social model of disability has implications for evaluation of disability policy. Public health analyses suggest that a population and environmental approach to enablement is more likely to impact positively on disabled people than person-centred action. The capacity of people living with disabilities to participate in a range of social activities and the attitudes of others to such participation are, along with environments, important factors contributing to disability situations and therefore the restriction of our promotion of personhood. These are areas where metrics could be used to evaluate the impact of disability policy.

English for public health teaching within the context of internationalisation in France

book chapter: William Sherlaw, Kasia Czabanowska, Mark Thompson: English for public health teaching within the context of internationalisation in France in Wilkinson, Robert / Walsh, Mary Louise (eds.) Integrating Content and Language in Higher Education From Theory to Practice. Selected papers from the 2013 ICLHE Conference. Peter Lang GmbH Frankfurt am Main, Berlin, Bern, Bruxelles, New York, Oxford, Warszawa, Wien, 2015. 341 pp., 1 ISBN 978-3-631-65726-3. Doi: 10.3726/978-3-653-05109-4

Seeking mental health care from private health practitioners among individuals with alcohol dependence/abuse; results from a study in the French general population

INTRODUCTION Better knowledge of the factors that have an impact on pathways to mental health care may contribute greatly to organizing optimum health-care delivery. However, surveillance systems concerning alcohol problems in the French general population are suboptimal. The objectives of this study were to investigate: 1) the prevalence of mental health-care seeking in individuals with alcohol abuse/dependence in France, 2) which category of medical practitioner was consulted, and 3) psychological and socio-environmental factors associated with mental health-care seeking. METHODS A total sample of 22,138 individuals was interviewed in a telephone survey. Individual data on alcohol dependence/abuse and other mental health disorders were collected using the Composite International Diagnosis Interview - short form. Mental health-care seeking was assessed, together with data on living conditions, deprivation, and self-reported drinking problems. Only respondents meeting criteria for alcohol dependence/abuse were included in analyses. RESULTS Less than half of the 722 respondents with alcohol abuse/dependence had sought mental health care in the preceding 12 months, of whom 90.5% consulted their general practitioner (GP) (56.1%), or both a general practitioner and a psychiatrist (34.4%). Mental health-care seeking was associated with female sex, previous alcohol discussion with a doctor, and the presence of psychiatric comorbidities arising in the preceding 12 months. Living environment, socio-economic status, or self-reported drinking problems had no influence. DISCUSSION A minority of people with alcohol abuse/dependence sought mental health care, mainly in relation to psychiatric comorbidities. In addition, most people consulting a GP were not referred to a psychiatrist. However, social deprivation and living in rural areas did not hinder mental health-care seeking among respondents. Adequate protocols to treat alcohol disorders could be implemented among private health-care providers to improve management of alcohol problems in France.

Penser la programmation en santé publique dans une perspective de capabilités

As a theory of distributive justice, Amartya Sens theory of capabilities questions the choices and decisions associated with the development and planning of public health programs. In this paper, the authors describe Sens approach and explore its implications for public health by applying it to the case of tobacco control programs. Based on the tobacco control objectives set by the WHO and on the MPOWER package of measures, they notice that the translation of the objectives in capabilities call for a greater attention to the conditions of living of the different population groups. It also put into doubt the measures restricting access to tobacco products that do not account for their differing impacts on adults. The authors conclude that this ethical perspective is likely to be controversial as it may rank freedom as a value that overrides health.

Improving Health and Tackling Health Inequities Through the Non-health Sector

To improve population health and reduce health inequities, it will be necessary to orient policy toward the non-health sector such as housing, taking into account the environment, and especially the built environment, in which people live, work, and play. Seven principles for the analysis of health inequities and a model framing the impact of the non-health sector on health are put forward. Numerous illustrations are given to show how non-health sector policies may influence health. These include the economy, employment, inclusion of disabled people, education, and environment. Non-health sector determinants of health are identified, and the importance of discrimination, neighborhoods, housing, urban policy, and intersectoral and participatory action is stressed. Reference is made to Health in All Policies and health impact assessment. Scientific and political challenges are outlined, and different approaches to tackling health inequities are reviewed. In conclusion, reorienting policy toward the non-health sector taking into account widening inequality is supported by substantial evidence and is a matter of elementary social justice.