Screening for phenylketonuria in a totalitarian state.
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Living under a totalitarian regime has many effects on the structure, way of thinking, and relations in a society. However, it is the impact on neonatal genetic screening that we discuss in this paper. Genetic screening functions at the interface between health services and society at large. Being involved for over a decade in setting up the Bulgarian PKU screening programme, we have had to deal with ways and attitudes which may be difficult for the western mind to grasp. Yet comprehension is very much needed in the new world we are trying to create. (+info)
The usual suspects.
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Any scientist will think twice before reporting any discrepancy or possible theft of biohazardous material to either his or her institution or to the government. (+info)
Should public health respect autonomy?
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This paper suggests that public health, due to its community orientation, may be ignoring certain ethical principles--namely the rights of individuals and communities to self-determination. The expectation of individual rights as a member of a community is reviewed and the additional right of a community for self-determination is proposed. The influences on ethical evaluations by the legal and economic environments are suggested, using US examples. The conclusion argues that as the focus of health-care delivery changes, it will become more important to consider these questions of group ethics. (+info)
What does Latin Aamerican social medicine do when it governs? The case of the Mexico City government.
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Latin American social medicine (LASM) emerged as a movement in the 1970s and played an important role in the Brazilian health care reform of the 1980s, both of which focused on decentralization and on health care as a social right. The dominant health care reform model in Latin America has included a market-driven, private subsystem for the insured and a public subsystem for the uninsured and the poor. In contrast, the Mexico City government has launched a comprehensive policy based on social rights and redistribution of resources. A universal pension for senior citizens and free medical services are financed by grants, eliminating routine government corruption and waste. The Mexico City policy reflects the influence of Latin American social medicine. In this article, I outline the basic traits of LASM and those of the prevailing health care reform model in Latin America and describe the Mexico City social and health policy, emphasizing the influence of LASM in values, principles, and concrete programs. (+info)
Tobacco industry strategy to undermine tobacco control in Finland.
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OBJECTIVE: To identify and explain tobacco industry strategy in undermining tobacco control measures in Finland and results of these interferences in tobacco policy development during the 1980s and early 1990s. METHODS: Tobacco industry documents, which have been publicly available on the internet as a result of litigation in the USA, were analysed. Documents were sought by Finland and by names of organisations and tobacco control activists. Documents were accessed and assessed between September 2000 and November 2002. Tactics of the tobacco industry activities were categorised as presented by Saloojee and Dagli. RESULTS: The international tobacco companies utilised similar strategies in Finland as in other industrial markets to fight tobacco control and legislation, the health advocacy movement, and litigation. These activities slowed down the development and implementation of the Tobacco Act in Finland. However, despite the extensive pressure, the industry was not able to prevent the most progressive tobacco legislation in Europe from being passed and coming into force in Finland in 1977 and in 1995. CONCLUSION: Denying the health hazards caused by tobacco-despite indisputable scientific evidence-decreased the credibility of the tobacco industry. Strategy of denial was falsely chosen, as health advocacy groups were active both in society and the parliamentary system. The strong influence of the tobacco industry may have in fact increased the visibility of tobacco control in Finland as the litigation process was also drawing attention to negative health effects of tobacco. Therefore the tobacco industry did not manage to convince public opinion. However, the tobacco industry did obtain experience in Finland in how to object to tobacco control measures. (+info)
Dignity in older age: what do older people in the United Kingdom think?
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BACKGROUND: Dignity is a complex concept and there is little empirical research to show how older people view dignity. This study, using qualitative methods, explored the concept of dignity from the older person's perspective. METHODS: 15 focus groups and two individual interviews were conducted in 12 different settings, with a total of 72 participants. Participants were purposively sampled to ensure a mix of socio-economic status, ethnicity, gender, age (65+) and level of fitness. Focus groups were audio-taped and transcribed. The method of constant comparison was used to analyse the data. RESULTS: There was strong evidence to suggest that dignity was salient to the concerns of older people. Dignity was seen as a multi-faceted concept: (i). dignity of identity (self-respect/esteem, integrity, trust); (ii). human rights (equality, choice); and (iii). autonomy (independence, control). Examples of dignity being jeopardised rather than being enhanced were given. A loss of self-esteem arose from being patronised, excluded from decision-making, and being treated as an 'object'. Lack of integrity in society meant that there was an inability to trust others and an increased vulnerability. Equality was an important issue but many felt that government policies did not support their rights. CONCLUSIONS: This work identifies the different ways dignity is conceptualised by older people. The evidence showed that person centred care for older people needs to be specifically related to communication, privacy, personal identity and feelings of vulnerability. It provides evidence for policy makers and professionals to tailor policies and practices to the needs of the older person. (+info)
Clearing the airways: advocacy and regulation for smoke-free airlines.
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OBJECTIVE: To examine the advocacy and regulatory history surrounding bans on smoking in commercial airliners. METHODS: Review of historical documents, popular press articles, and other sources to trace the timeline of events leading up to the US ban on smoking in airliners and subsequent efforts by airlines and other nations. RESULTS: In early years, efforts by flight attendants and health advocates to make commercial airliners smoke-free were not productive. Advocacy efforts between 1969 and 1984 resulted in maintenance of the status quo, with modest exceptions (creation of smoking and non-smoking sections of aircraft, and a ban on cigar and pipe smoking). Several breakthrough events in the mid 1980s, however, led to an abrupt turnaround in regulatory efforts. The first watershed event was the publication in 1986 of the National Academy of Science's report on the airliner cabin environment, which recommended banning smoking on all commercial flights. Subsequently, following concerted lobbying efforts by health advocates, Congress passed legislation banning smoking on US domestic flights of less than two hours, which became effective in 1988. The law was made permanent and extended to flights of less than six hours in 1990. This landmark legislation propelled the adoption of similar rules internationally, both by airlines and their industry's governing bodies. Though the tobacco industry succeeded in stalling efforts to create smoke-free airways, it was ultimately unable to muster sufficient grassroots support or scientific evidence to convince the general public or policymakers that smoking should continue to be allowed on airlines. CONCLUSIONS: The movement to ban smoking in aircraft represents a case study in effective advocacy for smoke-free workplaces. Health advocates, with crucial assistance from flight attendants, used an incremental advocacy process to push for smoking and non-smoking sections on US commercial flights, then for smoking bans on short domestic flights, and finally for completely smoke-free domestic and international flights. Through the course of the battle, advocates from all quarters of tobacco control presented a unified message, exhibited remarkable focus on an attainable goal, and effectively leveraged their relationships with champions in both government and the private sector. (+info)
The Human Rights Act 1998 and medical treatment: time for re-examination.
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There was much speculation about the potential impact of the Human Rights Act 1998 on established principles of health care practice. Now the statute has been "bedded in", predictions that existing good practice would not fall foul of the legislation provided it was demonstrable, have proved to be broadly accurate. This paper illustrates the approach of the courts to areas of difficulty related to medical treatment and highlights, in particular, possible challenges under the Act by the mature minor whose refusal of treatment has been overridden. This includes a discussion of those with learning disabilities, and reference is also made to the implications of the legislation in relation to confidentiality and child protection. (+info)