Founded on a commitment to social justice and health equity, community health centers in the United States provide high‐quality primary care to underserved populations and address social drivers of health disparities. Through an examination of two books on the history of community health centers, Peace & Health: How a Group of Small‐Town Activists and College Students Set Out to Change Healthcare, by Charles Barber, and Community Health Centers: A (...) Movement and the People Who Made It Happen, by Bonnie Lefkowitz, this essay provides insight into what it takes to center social justice in community‐based health care organizations. As bioethics reorganizes itself around an emphasis on justice, scholars in bioethics have much to learn from colleagues in community health. (shrink)

In “Think Pragmatically: Investigators’ Obligations to Patient-Subjects When Research is Embedded in Care,” Morain and Largent 2023 persuasively argue that the prevailing ways of conceptualizing in...

Architecture, like ethics, concerns actual rather than ideal choices. William James's remarks on ethics, at a meeting of the Yale Philosophical Club in 1890, could apply equally well to the built environment:The actual possible in this world is vastly narrower than all that is demanded; and there is always a pinch between the ideal and the actual which can only be got through by leaving part of the ideal behind. There is hardly a good which we can imagine except as (...) competing for the possession of the same bit of space and time with some other imagined good.1Health care facilities are spaces in which certain imagined goods—the care of the sick, the treatment or prevention of disease—meet the actual possible of .. (shrink)

In an earlier edition of CambridgeQuarterly, in the section (CQ Vol 9, No 4), Larry Gottlieb sought advice on ethics committee assembly and policy implementation for a community mental health center. One concern mentioned is that staff members frequently encounter ethical issuesregarding the care of clients whose decisionmaking abilities are impaired by chronic mental illness and/or substance abuse. My response offers a suggestion for policy development and implementation, which may be integrated into guiding staff members of community (...) mental health centers toward a model of care planning that is centered on clients' experiences of their treatments and on relationship-building among clients, community members, and mental health professionals. (shrink)

PrécisFederally Qualified Health Centers (FQHCs) proved to be critical points of access for people of color and other underserved populations during the COVID-19 pandemic, administering 61% of their COVID-19 vaccinations to people of color, compared to the 40% rate for the overall United States’ vaccination effort. To better understand the approaches and outcomes of FQHCs in pandemic response, we conducted semi-structured interviews with FQHC health care providers and outreach workers and analyzed them using an inductive qualitative methodology.

This article examines the regulation of Latina youth sexualities in the context of sexual and reproductive health care provision. In-depth interviews with health care providers working in two Latino-serving community health centers are analyzed for how they interpret and respond to the sexual and reproductive practices of their low-income Latina teen patients. The author finds that providers emphasize teenage pregnancy as a social problem among this population to the exclusion of other dimensions of youth sexualities (...) and encourage Latina girls’ adherence to a life course trajectory that conforms to middle-class, heteronormative ideals as a solution to this problem. By relying on such understandings, providers construct meanings of sexual citizenship that require participation in bourgeois heteronormativity. These findings suggest that Latino-serving community health centers, their providers, and their teen patients could benefit from questioning the assumptions that inform providers’ appraisals of Latina youth and developing a more inclusive approach to Latina youth sexualities beyond a discourse of pregnancy prevention. Such efforts could allow community health centers to actively participate in disrupting the structural inequalities that shape their young patients’ lives. (shrink)

This study examines truthfulness through eight dimensions to explicate truth in health communication and explores the relationships between message truthfulness and message attributes and audience characteristics. A content analysis of 974 television antismoking ads from the Centers for Disease Control (CDC) reveals a high degree of truthfulness. Message truthfulness is related to thematic frames, emotion appeals, source, age, social role and smoking status, and positive framing of consequences. Ads targeted at teens/youth and smokers tend to have lower message (...) truthfulness than ads targeting older age groups and non-smokers. Ads with humor and fear appeals are found to be less truthful. (shrink)

The impact of recent changes in public health insurance on community‐based health‐care in the USARecent changes in US government‐funded healthcare insurance are having profound impacts on all types of community‐based health‐care, reducing access to care by vulnerable populations. This article traces the impacts of recent policies on a range of community institutions in which nurses play a critical role, such as health centers, highlighting the effects on access to care and the survival (...) of non‐profit services in less‐advantaged communities. In general, the new policies shifted revenues into fixed payment per client contracts (capitation) paid to for‐profit managed care organizations and away from non‐profit community services. The full impact of this competitive, market‐oriented system of health services has just begun to be felt. The uncertainties and dissatisfactions assure continued activity to change current conditions, including efforts by groups that seek greater access to health services for all populations and security for committed providers and personnel, including nurses. (shrink)

Community Engagement (CE) has been presented by bio-ethicists and scientists as a straightforward and unequivocal good which can minimize the risks of exploitation and ensure a fair distribution of research benefits in developing countries. By means of ethnographic fieldwork undertaken in Kenya between 2007 and 2009 we explored how CE is understood and enacted in paediatric vaccine trials conducted by the Kenyan Medical Research Institute and the US Centers for Disease Control (KEMRI/CDC). In this paper we focus on (...) the role of paid volunteers who act as an interface between villagers KEMRI/CDC. Village Reporters’ (VRs) position of being both with the community and with KEMRI/CDC is advantageous for the conduct of trials. However it is also problematic in terms of exercising trust, balancing allegiances and representing community views. VRs role is shaped by ambiguities related to their employment status and their dual accountability to researchers and their villages. VRs are understandably careful to stress their commitment to self-less community service since it augments their respectability at community level and opens up opportunities for financial gain and self-development. Simultaneously VRs association with KEMRI/CDC and proximity to trial participants requires them to negotiate implicit and explicit expectations for material and medical assistance in a cultural setting in which much importance is placed on sharing and mutuality. To ensure continuity of productive interactions between VRs, and similar community intermediaries, and researchers, open discussion is needed about the problematic aspects of relational ethics, issues concerning undue influence, power relations and negotiating expectations. (shrink)

It is still remarkably difficult for public health officials charged with developing and implementing pandemic influenza preparedness plans at the community levelto obtain clear, concrete, and consistent guidance on how to construct plans that are both ethical and actionable. As of mid-2007, most of the federal and state pandemic plans filed with the Centers for Disease Control and Prevention, describing how public health officials will coordinate public agencies and private entities in the event of an outbreak, (...) failed to include ethical guidance for first responders responsible for providing essential services and making fair decisions during a public health emergency. (shrink)

As this nation embarks on new efforts to reform the U.S. health system, we face a critical unfinished agenda from the mid- 1960s: persistent racial, ethnic, and socioeconomic disparities in health and health care. Medicaid, Medicare, and Community Health Centers — public programs with very different legislative histories and financing mechanisms — were the first federally funded, nationwide efforts to improve health care access for low-income and elderly Americans. Members of racial and ethnic (...) minority groups also greatly benefited from these efforts because recipients of federal funds, such as Medicare, were required to comply with the newly passed Civil Rights Act of 1964, which barred racial discrimination. Unquestionably, government played a major role in the gains in health care access that have occurred in the last half century. Yet today all Americans do not have the same opportunities for health, access to care, or quality of care when they receive it. (shrink)

Two major safety net providers – community health centers and public hospitals – continue to play a key role in the health care system even in the wake of coverage reform. This article examines the gains and threats they face under the Affordable Care Act.

ObjectiveThe psychological condition of healthcare workers since the COVID-19 pandemic has attracted the attention of many studies. However, few have reported on psychosocial problems of primary healthcare workers in the COVID-19 pandemic. This study aimed to examine the mediating roles of social support and resilience in COVID-19-related work stress and symptoms of anxiety and depression.MethodsA total of 840 primary healthcare workers in 17 community health centers in Guangzhou, China, were recruited from May to July 2021. Data on (...) demographic characteristics, COVID-19-related work stress, social support, resilience, anxiety and depression were collected. A structural equation model was used for mediation analysis.ResultsMore than half of participants reported mild or more severe symptoms of anxiety and depression. Social support and resilience mediate the association between COVID-19-related work stress and symptoms of anxiety and depression, respectively. Furthermore, the association between work stress and symptoms of anxiety and depression was also mediated by an accumulation of social support and resilience. The indirect effect of COVID-19-related work stress on anxiety and depression through resilience was much greater than other indirect effects.ConclusionAnxiety and depression were prevalent among primary healthcare workers. This study highlights the psychological impact of the COVID-19-related psychosocial work environment on primary healthcare workers. There is an urgent need to improve working conditions for primary healthcare workers in the COVID-19 and to implement intervention strategies aimed at increasing individual resilience alongside the establishment of external supportive work environments. (shrink)

This article explores how structural failures in major federal environmental regulations —which set a foundation for environmental protections nationwide— have helped create many of the environmental injustices that people of color and low-income communities experience. It continues by examining how local governments have reinforced and compounded the failures in the federal environmental regulatory framework, particularly through local land use decisions. Although states play an important role in environmental policymaking, we propose that local governments are uniquely positioned to utilize a (...) class='Hi'>health justice approach to address environmental health inequities. This approach centers partnerships between frontline communities and local governments to develop just solutions that fill gaps within the federal environmental regulatory system and anticipate and mitigate the compounding effects of environmental health inequities. (shrink)

Introducción: los accidentes son de las primeras causas de muerte a nivel mundial, por lo que la prevención de los mismos es una emergencia. Objetivo: valorar la repercusión de una intervención comunitaria en la disminución de peligros potenciales de accidentes en familias con niños de 0 a 18 meses. Métodos: se realizó un estudio cuasi experimental multietápico, con enfoques cuantitativo y cualitativo, entre enero de 2009 a junio de 2012. Se trabajó con 39 familias entre las que se produjeron nacimientos (...) en el periodo enero de 2008 a enero de 2010 de los Consultorios Médicos del Consejo Popular 26 de julio del Municipio Santo Domingo. Se efectuó una intervención por un grupo de trabajo comunitario conformado por integrantes del Círculo de interés "Prevención es Salud" y brigadistas de la Cruz Roja, liderados por la enfermera de la familia, se empleó para ello la Guía para Análisis de vulnerabilidades y capacidades de la Cruz Roja, modificada en su etapa I. Resultados: Post intervención se logró la reversión de vulnerabilidades en cuanto a capacidades, se manifestaron cambios favorables en los conocimientos y disminuyó significativamente el número de peligros potenciales en cada hogar. Conclusiones: Cuando se trabaja con familias con instrumentos sencillos y accesibles, y con el grupo de trabajo comunitario, se favorece la toma de conciencia sobre el problema en el entorno donde se generó. Introduction: accidents are one of the first causes of death worldwide, so their prevention is an urgency. Objective: assess the effect of a community intervention in the reduction of potential dangers of accidents in family with children aged from zero to 18 months. Methods: a multiage cuasi experimental study was carried out, with quantitative and qualitative approaches, from January 2009 to June 2012. The sample was taken from thirty-nine families who had children in the period ranging from January 2008 to January 2010 belonging to the family doctor´s house of the community called "26 de Julio" from Santo Domingo municipality. An intervention was carried out by a community group work composed by members of centers of interests called ¨Prevention is health¨ and members of the Red Cross led by the family nurse. It was necessary to ask a guide to analyze the vulnerabilities and capabilities of the Red Cross, modified in the first stage. Results: During the post intervention, it was possible to change the vulnerabilities in terms of capacities, favorable changes were present in the knowledge and the number of potential risks significantly decreased in each house. Conclusions: when families are approached with simple and accessible instruments, and with a community group work it is possible to make favorable changes in terms of awareness of the problem in the same place where it emerged. (shrink)

The Management of Scientific Integrity within Academic Medical Centers discusses the impact scientific misconduct has in eight complex case studies. Authors look at multifaceted mixtures of improper behavior, poor communication, cultural issues, adverse medical/health issues, interpersonal problems and misunderstandings to illustrate the challenge of identifying and managing what went wrong and how current policies have led to the establishment of quasi legal processes within academic institutions. The book reviews the current global regulations and concludes with a section authored (...) by a US federal court judge who provides his perspective on the adequacy of current regulations and policies. (shrink)

A romance with the concept of community has long characterized activist healthcare movements and has more recently been taken up by academic medical centers as a sign of virtuous civic engagement. During the late 1960s, the word community, as deployed by administrators at prestigious AMCs, became increasingly politicized, commodified and racialized. Here, we analyze how the concept of community was initially framed in the 1963 Community Mental Health Centers Act, the first legislation to (...) establish community mental health centers in America. We then examine the Health Policy Advisory Center’s analysis of the proposed Washington Heights Community Mental Health Center to be run by Columbia University’s College of Physicians and Surgeons, an institution that had historically neglected residents’ health needs. Community pushback against Columbia’s plan to build a multi-block center, amplified by medical students and residents critical of the professionalized community mental health movement, escalated in the late 1960s, leading the city’s planning board to reject Columbia and approve a community council’s plan for preventive and rehabilitative local services. These conflicting overtones of “community” still inform understandings of the word in medicine today; thus, a critical historical analysis of “community” is warranted. (shrink)

The study aims to investigate indigenous communities’ socio-economic impacts as a result of the COVID-19 pandemic and to explore coping strategies to aid in the socio-economic recovery of indigenous communities. -/- The COVID-19 pandemic has had a negative impact on indigenous people's livelihoods, including employment and income, education, the migration of people, health, and natural resources. As a result of COVID-19, the indigenous people have lost their employment and income. The price of fish has decreased, which has lowered their (...) ability to make money from selling fish. Migrant workers returned home because they were concerned about their health security and many lost their jobs. Schools were closed because of COVID-19 and this increased education inequality. Health was impacted because it was difficult to access health services due to restrictions on travel. Returning migrants have pressured forest and fishery resources through increases in the number of fishers, which include the migrants who have returned to their own village. -/- The RGC, rural communities and indigenous communities have taken a number of measures to cope with the issues stemming from COVID-19. Migrant workers tried to look for local employment, used fishing to supplement household consumption and income needs, and often borrowed money from neighbors. Students attempted to use e-learning that was facilitated by the government; teachers visited some students’ homes, and older students supported younger students in their school lessons. In terms of health, home visits were facilitated for pregnant women, and people sought permission to travel to health centers. After giving birth, families were visited and offered a small amount of money to support their basic needs. To deal with natural resources, some coping strategies included smaller groups of patrolling teams, support grants from CSOs for forest and fishery resource patrolling, drone delivery to community fishery committees, and requesting community members to report illegal fishing or logging. And to minimize the spread of COVID-19, a mandatory 14-day quarantine at home was imposed on all people returning to the village. (shrink)

Ethical reality is coextensive with human dignity. Therefore, one essential way to understand ethics is as the systematic effort to discern the imperatives of human dignity. Seeing ethics in this way highlights the fact that health care institutions have many centers of ethical responsibility (CERs) — the Chief Executive Officer, Board of Trustees, senior management team, etc. The Ethics Committee is only one such CER and not the most important one. These other CERs will benefit from identifying: (1) (...) the fact that they are consistently dealing with ethical reality and making ethical decisions; (2) some critical elements of good ethical decision-making: (i) having the appropriate community; (ii) making the guiding value priorities explicit and specific; (iii) gaining skill in using the needed intellectual tools; and (iv) fashioning appropriate process and structure for discernment. (shrink)

A single defining question perennially intrigues scholars and practitioners interested in public heath: To what extent should human rights be limited to protect the community’s health and safety? The question achieved prominence in the aftermath of the attacks on the World Trade Center and Pentagon on September 11, 2001 and with the intentional dispersal of anthrax spores through the U.S. Postal Systein. The conflict between security and public health intensified with the development of the Model State Emergency (...) Health Powers Act, drafted by the Center for Law and the Public’s Health at the request of the Centers for Disease Control and Prevention. The Model Act grants states consiclernble powers to control persons and property in response to a public health emergency, defined to inclucle bioterrorism or the appearance of novel or previously controlled or eradicated infectious agents or biological toxins. (shrink)

Background: This article describes the overall attitudes of children, their parents, and attending physicians toward including or excluding pediatric patients in medical communication and health care decision-making processes. Methods: Fifty-two interviews were carried out with pediatric patients (n = 17), their parents (n = 19), and attending oncologists (n = 16) in eight Swiss pediatric oncology centers. The interviews were analyzed using thematic coding. Results: Parenting styles, the child's personality, and maturity are factors that have a great impact (...) upon the inclusion of children in their health care processes. Children reported the desire to be heard and involved, but they did not want to dominate the decision-making process. Ensuring trust in the parent–child and physician–patient relationships and respecting the child as the affected person were important values determining children's involvement. These two considerations were closely connected with the concern that fantasies are often worse than reality. Seeking children's compliance with treatment was a practical but critical reason for informing them about their health care. The urge to protect them from upsetting news sometimes resulted in their (partial) exclusion. Conclusions: The ethical imperative for inclusion of children in their health care choices was not so much determined by the right for self-determination, but by the need to include them. If children are excluded, they imagine things, become more isolated, and are left alone with their fears. Nevertheless, the urge to protect children is innate, as adults often underestimate children's coping capacities. (shrink)

Drinking water is an important health behavior to support overall child health. Research indicates that children are consuming too little water and too many sugary drinks. Overconsumption of sugary drinks increases child risk for the epidemics of obesity and diet-related chronic diseases like type-II diabetes, stroke, and heart disease. Increasing access to appealing, low-cost drinking water in schools and childcare where children spend much of their time supports efforts to reduce sugary drink consumption. Drinking water infrastructure is key (...) to water access in childcare and schools. In 2012-2013, almost one-third of permanent U.S. school buildings had plumbing systems in fair or poor condition, and almost 40 percent had major renovations or repairs planned.3 Basic plumbing standards for new construction and major renovations or repairs are contained in state and local plumbing codes, and many of these codes are derived from model codes established by private organizations. This article describes the model code process and intervention points where the public health community can work to improve plumbing standards in school buildings and childcare centers. (shrink)

Human rights protect the conditions of a minimally decent life of which mental health is an indispensable element. Adequate care for mental health is thus recognized as part of the human right to health. However, for populations living far from urban centers, adequate in-person (mental) health care is often extremely costly and thus not provided. Digital mental health care options have become an effective alternative to in-person treatment. Benefitting from these new digital opportunities, though, (...) requires sufficient access to the internet. Because everyone has a human right to adequate health care, and digital mental health care is now an effective option for progressively realizing this human right for people who live in remote regions, these people also have to be understood to have a right to access to the internet. This right to internet access creates duties for public authorities and the international community to create the required digital infrastructure and (where needed) to cover the costs of internet access where this is the only feasible way of delivering, or progressively realizing, the mental health care that is indispensable for having the opportunity to lead minimally decent lives. (shrink)

The aim of this study is to develop a valid and reliable measurement tool for determining students' spiritual health and life orientation. For this purpose, the Spiritual Health and Life-Orientation Measure (SHALOM) inventory developed by Fisher (2010) is adapted to Turkish. The adaptation study was carried out on 1591 high school students in three study groups studying in Ankara and Muş. The original English measure consisting of four dimensions and twenty items was translated into Turkish, factor analysis, validity (...) and reliability tests were conducted on the sampling data. As a result of the study, the Turkish-adapted inventory consists of four dimensions (personal, social, environmental and transcendental) which resemble the original inventory. In addition, internal consistency coefficients of the inventory dimensions were in perfect harmony with the original inventory and served the purpose of the scale. In Conclusion The Turkish adaptation of the SHALOM Inventory can be used in different disciplines of psychology, educational sciences, and social sciences. Summary: The concept of religion, which is an important dynamic and carrier of the social field, has gone into a double distinction since the second half of the 18th century; the concept of spirituality has begun to be refined from the concept of religion. The concepts of religion and spirituality are very difficult to define; While the concept of religion focuses ideology and rules of belief, spirituality centers on individual experiences and interrelationships that extend religion. For this reason, different spirituality and religion definitions are made from different perspectives and different spirituality scales were developed within this framework. However, the results of these studies differ significantly from each other; this means that spirituality was defined and conceptualized based on the scale that was used. Early period studies on spirituality mostly focus on religion, health, psychology and work life. In these studies, after defining the concept of spirituality; the relationship between the concept and health, religion, psychology and business life or necessity for human life is discussed. In the West, until the 1950s, the concepts of religion and spirituality were used interrelated. However, today these two concepts are almost completely separated from each other.Literature consists of numerous inventory development studies to measure spirituality. The fact that the inventory works based on different conceptual foundations makes it difficult to draw a general, meaningful and consistent conclusion about spiritual health and life orientation. Furthermore, spirituality measurements reflecting the religion and values ​​of a particular culture cannot be comprehensive or universal. At this point, Fisher criticizes the measurement tools developed for the purpose of measuring spirituality: in terms of "mixing religion and spirituality", "relying on the world of values", "not taking into account cultural differences", "and questioning only the mystical/spiritual experience". As a result, it can be said that no measurement developed in the conceptual structure of the West does not take into account the cultural flexibility and accept its spiritual values as universal or prevalent.The SHALOM inventory developed by Fisher, which adapted to the Turkish culture in present study, is based on four basic (individual, social, environmental and transcendent) areas that constitute the world of interpersonal relationship. In this study, spirituality, as in Fisher's work, emphasizes the interaction with certain concepts of different intensities that are considered as independent from religion and above religions. In this context, the concept of spirituality communicates with one's personal space, social position, nature, and transcendental power. This adaptation study will provide useful information and comments on the students' spiritual health levels. This is the most important motive behind the idea of adapting the SHALOM inventory developed by Fisher to the Turkish culture. In addition, by adapting the SHALOM inventory, which is emphasized to have cultural flexibility and adapted to different languages, a new and different measurement tool will be available to understand the nature of the concept of spirituality.This research was carried out to adapt the inventory of Spiritual Health and Life Orientation scale developed for students to Turkish culture. This inventory adaptation study was performed with the data collected from three working groups in Ankara and Muş provinces and 1591 high school students. The first study group was carried out with 414, the second study group with 788, and the third group with 389 high school students. While the data collected from 414 students were used for Exploratory Factor Analysis (AFA) analysis, data collected from 788 students were used for Confirmatory Factor Analysis (CFA). In addition, 389 students were used to determine the criterion validity of the inventory. The original language of the SHALOM inventory, which is intended to be adapted into Turkish, is English, and translation studies are conducted separately by three linguistic experts who know the grammar and semantic characteristics of both languages. After the translation studies, the scale was applied to the sampling group and AFA was performed on the sample data. The AFA results showed that a factor roof resembling the original inventory was formed. Determining factors are given appropriate names (personal, enviromental, social and transcendental) by taking into consideration the theoretical names and the dimension names in the original form of the SHALOM. The structure was confirmed by DFA, and as a result of the DFA, X2/sd (1.72) ratio and IFI (0.96) fit indicator was found to be the appropiate fit for the model tested. As a result, it is understood that the Spiritual Health and Life Orientation Inventory consists of four dimensions as in the original inventory, the internal consistency coefficients of the inventory dimensions are in harmony with the original inventory and serve the purpose of the scale. In conclusion the Turkish adaptation of the SHALOM Inventory can be used in different disciplines of psychology, educational sciences, and social sciences. Spirituality should not only be defined within the framework of Western theories, but the nature and likelihood of the spirituality predicted by Islam should be discussed. Moreover, the types and dimensions of Islamic spirituality should be determined by taking into account the cultural subjectivity of an Islamic character. In the study of spirituality, the human model which modernity presents universally should not be accepted as the only truth. It should be tried to develop human models that come from Islamic culture and history and which are specific to us and define us. This should be taken into account not only in mental health / religious studies, but also in psychology of religion in general. In addition, culture-specificity should be given importance, and the experience gained from the cultural accumulation developed by the Turkish civilization with the Islamic doctrine should lead to the studies of spirituality. In this respect, this study aims to adapt the value and spiritual orientation of a different culture to Turkish culture, but it is problematic to construct the concept with Western values. Although Western values are similar to Islamic values and principles, it is envisaged that it may be difficult to measure the concept of spirituality in practice. (shrink)

The Centers for Disease Control and Prevention has focused its obesity prevention and control efforts on improving population-level health. A recent Institute of Medicine report identified systems that affect population health, to include health care delivery systems, schools, businesses and employers, communities, and governmental public health infrastructure. CDC uses the public health model to engage these systems, and this process coordinates multiple settings, sectors, and jurisdictions to develop an integrated approach to identify, prevent, and (...) control obesity. The public health approach goes beyond medical care to prioritize policy and environmental strategies that can be implemented across jurisdictional levels, in collaboration with traditional and nontraditional partners. The process ultimately produces tools, guidelines, and interventions that can be used to prevent and control obesity. In this manuscript, we provide an overview of the public health perspective on obesity, outline the public health framework for addressing obesity, and discuss the rationale for leveraging law-based efforts as a tool to accomplish the public health mission. (shrink)

The Centers for Disease Control and Prevention has focused its obesity prevention and control efforts on improving population-level health. A recent Institute of Medicine report identified systems that affect population health, to include health care delivery systems, schools, businesses and employers, communities, and governmental public health infrastructure. CDC uses the public health model to engage these systems, and this process coordinates multiple settings, sectors, and jurisdictions to develop an integrated approach to identify, prevent, and (...) control obesity. The public health approach goes beyond medical care to prioritize policy and environmental strategies that can be implemented across jurisdictional levels, in collaboration with traditional and nontraditional partners. The process ultimately produces tools, guidelines, and interventions that can be used to prevent and control obesity. In this manuscript, we provide an overview of the public health perspective on obesity, outline the public health framework for addressing obesity, and discuss the rationale for leveraging law-based efforts as a tool to accomplish the public health mission. (shrink)

Professor Gostin is a leading authority on health law, whose writing and teaching are among the most authoritative in the United States, as exemplified by his recent work, Public Health Law: Power, Duty, Restraint. Gostin's article in this issue of the Journal of Law, Medicine & Ethics pays homage to Jonathan Mann by expressing the debt he feels toward this extraordinary doctor and public health official with whom he had collaborated on several projects.As many will remember, Mann (...) held high-level positions at the Centers for Disease Control and worked on AIDS research in Central Africa before setting up the World Health Organization's Global Programme on AIDS, which he ran from 1986 to 1990. Thanks to his profound commitment and consummate communication skills, he achieved the unprecedented feat of raising the budget within two years to almost $100 million from the initial set-up of “himself, a secretary, and one typewriter,” as described by Daniel Tarantola. (shrink)

The National Institutes of Health is the largest biomedical research institution in the world. It has become one of the world's most highly respected research centers in part because of its efforts over the years to provide the research community with leadership in both the ethical and scientific parameters of research involving humans. As its 113th birthday approaches at the turn of the century, its great legacy is providing an environment to stimulate and nourish the diversity and (...) creativity of ideas, and thereby enable science to progress. This research must continue to be guided and tempered by consistent and critical federally-supported ethical analyses. (shrink)

RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth (...) semistructured interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

This paper is one of the four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and multi-disciplinary partners. Each of the action agenda papers deals with one of the four core elements of public health legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper (...) are for consideration by policy makers and practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.Advancing and protecting the public's health depends upon the coordination of actions by many, diverse partners. For effective public health preparedness, there must be effective coordination of legal tools and law-based strategies across local, state, tribal, and federal jurisdictions, and also across sectors such as public health, health care, emergency management, education, law enforcement, community design, and academia. (shrink)

In the fall of 2001, the need for a vigorous and effective public health system became more apparent than it had been for many decades. With the advent of the first widescale bioterrorist attack on the United States, the government's obligation to respond and take steps to protect the public health became self-evident.Also obvious was the need for of an effective partnership between federal, state, and local officials. Local officials are almost always on the front lines of the (...) struggle against bioterrorism. They are the first to recognize a suspicious case and to provide testing and treatment for the affected population. At the same time, state officials are needed to support and coordinate local efforts, providing an expertise that may be lacking in many communities, especially smaller ones.But few would doubt that the federal government has a key role to play. The Centers for Disease Control and Prevention is expected to lead the epidemiological investigation and provide expertise on how to cope with diseases that remain unfamiliar to most physicians. (shrink)

In the fall of 2001, the need for a vigorous and effective public health system became more apparent than it had been for many decades. With the advent of the first widescale bioterrorist attack on the United States, the government's obligation to respond and take steps to protect the public health became self-evident.Also obvious was the need for of an effective partnership between federal, state, and local officials. Local officials are almost always on the front lines of the (...) struggle against bioterrorism. They are the first to recognize a suspicious case and to provide testing and treatment for the affected population. At the same time, state officials are needed to support and coordinate local efforts, providing an expertise that may be lacking in many communities, especially smaller ones.But few would doubt that the federal government has a key role to play. The Centers for Disease Control and Prevention is expected to lead the epidemiological investigation and provide expertise on how to cope with diseases that remain unfamiliar to most physicians. (shrink)

This paper is one of the four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and multi-disciplinary partners. Each of the action agenda papers deals with one of the four core elements of public health legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper (...) are for consideration by policy makers and practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.Advancing and protecting the public's health depends upon the coordination of actions by many, diverse partners. For effective public health preparedness, there must be effective coordination of legal tools and law-based strategies across local, state, tribal, and federal jurisdictions, and also across sectors such as public health, health care, emergency management, education, law enforcement, community design, and academia. (shrink)

The author has been involved in Christian Community Computer Centers or C4s since 1993 and has been researching the possibility of C4s' growth as part of a strategy in addressing the socio-economic situation in Africa. He asks if C4s, within the Information Communication Technology sector, can facilitate transformation in communities. The main thesis of this paper is that C4s play a significant role in community transformation as they have their greatest impact in poorer communities where more commercially (...) orientated enterprises are reluctant to invest in technological services. The author suggests that the one area that needs further attention concerns the question of making the Centers part of an intentional program of transforming communities especially supported by churches. (shrink)

Community health workers (CHW) are the backbone of the public health system in developing countries. Little is known about the practice of ethics and professionalism in their work. This study was conducted to explore the experiential wisdom of ethics and professionalism among CHWs in Tamil Nadu. We conducted a qualitative study among 125 CHWs in six districts of Tamil Nadu. We found that the CHWs went beyond the call of their duty to do good to the (...) class='Hi'>community. Their conceptualization of autonomy ranged from shared to full paternalistic decision making. The CHWs were sensitive to issues of privacy and confidentiality, but the discussion on these topics were limited. They reflected the societal norms of gender, class, and caste hierarchies in their work. They had to work amidst difficult power struggles and had their own innovative strategies to subvert power. In conclusion, there is a need for framing a code of ethics and professionalism for CHWs and training in ethics and professionalism for them to help them effectively deliberate on ethical issues. (shrink)

Systematic ethics support in community health services in Norway is in the initial phase. There are few evaluation studies about the significance of ethics reflection on care. The aim of this study was to evaluate systematic ethics reflection in groups in community health , - from the perspectives of employees participating in the groups, the group facilitators and the service managers. The reflection groups were implemented as part of a research and development project.

There is near universal agreement within the scientific and ethics communities that a necessary condition for the moral permissibility of cross-national, collaborative research is that it be responsive to the health needs of the host community. It has proven difficult, however, to leverage or capitalize on this consensus in order to resolve lingering disputes about the ethics of international medical research. This is largely because different sides in these debates have sometimes provided different interpretations of what this requirement (...) amounts to in actual practice. The goal of the discussion that follows is to clarify the nature of this important moral requirement. The first section explains the requirement for responsiveness to host community health needs in the context of international medical research. The second section examines various formulations of this requirement as they are enunciated in some of the core consensus documents in research ethics. The third section then defends a particular interpretation of this requirement, and the final sections examine more liberal alternatives with the aim of highlighting points of agreement and assessing the significance of areas of disagreement. (shrink)

Despite the recent increased emphasis on ethics in health care, the subject of community health care is rarely specifically addressed. Yet it is in the community that many ethical issues arise, both in the particular practice situation and in the wider social issues connected with changes in government policy. This edited text discusses these questions and looks at the whole range of community health nursing in the UK. The multidisciplinary group of contributors explore the (...) issues of theory and practice that arise in community health care. They encourage critical reflection on the differences between hospital-based care and community care. Everyday issues are addressed that confront health practitioners working in the community, such as discrimination, mental health, standard setting, rationing in health care, public health, health promotion and discharge decision making. This book will be essential reading for practitioners on post-registration courses in community health and students following courses in health care ethics and nursing studies. (shrink)

STORY L, MAYFIELD‐JOHNSON S, DOWNEY LH, ANDERSON‐LEWIS C, YOUNG R and DAY P. Nursing Inquiry 2010; 17: 373–384 Getting on Target with Community Health Advisors (GOTCHA): an innovative stroke prevention projectHealth disparities along with insufficient numbers of healthcare providers and resources have created a need for effective and efficient grassroots approaches to improve community health. Community‐based participatory research (CBPR), more specifically the utilization of community health advisors (CHAs), is one such strategy. The Getting (...) on Target with Community Health Advisors (GOTCHA) project convened an interdisciplinary team to answer the call from 10 counties in the rural Mississippi Delta area of ‘The Stroke Belt’ to meet the region’s identified health needs, and to impact the health of a disparaged state. This article explores this CBPR project including the community involvement strategies, innovative CHA training curriculum, evaluation plan, and implications to healthcare professionals, particularly nurses. (shrink)

Background:Nurses exposed to community health nursing commonly encounter situations that can be morally distressing. However, most research on moral distress has focused on acute care settings and very little research has explored moral distress in a community health nursing setting especially among nursing students.Aim:To explore the moral distress experiences encountered by undergraduate baccalaureate nursing students in community health nursing.Research design:A descriptive qualitative design was employed to explore the community health nursing experiences of (...) the nursing students that led them to have moral distress.Participants and research context:The study included 14 senior nursing students who had their course in Community Health Nursing in their sophomore year and stayed in the partner communities in their junior year for 6 and 3 weeks during their senior year.Ethical considerations:Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.Findings:Nursing students are vulnerable and likely to experience moral distress when faced with ethical dilemmas. They encounter numerous situations which make them question their own values and ideals and those of that around them. Findings of the study surfaced three central themes which included moral distress emanating from the unprofessional behavior of some healthcare workers, the resulting sense of powerlessness, and the differing values and mindsets of the people they serve in the community.Conclusion:This study provides educators a glimpse of the morally distressing situations that often occurs in the community setting. It suggests the importance of raising awareness and understanding of these situations to assist nursing students to prepare themselves to the “real world,” where the ideals they have will be constantly challenged and tested. (shrink)

The purpose of public and community health is to improve the health of populations or groups rather than concentrating on individuals. This book examines the ethical issues associated with public and community health. The contributors analyse the major ethical issues in public health - prioritisation, public participation, health promotion and screening - all of which reflect current practice in the UK. They examine what health services should be available, who should have access (...) to which health services, what are the best strategies for preventing disease, how can professional and public views be reconciled and when can an individual's health needs override the choice of a community. The contributors apply up-to-date ethical theory to practical examples in public health practice to provide a comprehensive and accessible introduction to the key issues in public health ethics. (shrink)

The purpose of public and community health is to improve the health of populations or groups rather than concentrating on individuals. This book examines the ethical issues associated with public and community health. The contributors analyse the major ethical issues in public health - prioritisation, public participation, health promotion and screening - all of which reflect current practice in the UK. They examine what health services should be available, who should have access (...) to which health services, what are the best strategies for preventing disease, how can professional and public views be reconciled and when can an individual's health needs override the choice of a community. The contributors apply up-to-date ethical theory to practical examples in public health practice to provide a comprehensive and accessible introduction to the key issues in public health ethics. (shrink)

A book chapter exploring the potential consquences and ethical ramifications of using coercive measures within community mental healthcare. We argue that, althogh the move towards 'care in the community' may have had liberalising motivations, the subsequent reduction in inpatient or other supported residential provision, means that there has been an increasing move towards coercive measures outside of formal inpatient detention. We consider measures such as Community Treatment Orders, inducements, and other forms of leverage, explaining the underlying concepts, (...) aims, and exploring adverse consequences and ethical difficulties. (shrink)