In order to maximize human performance, defence forces continue to explore, develop, and apply human performance enhancement (HPE) methods, ranging from pharmaceuticals to (bio)technological enhancement. This raises ethical, legal, and societal concerns and requires organizing a careful reflection and deliberation process, with relevant stakeholders. We discuss a range of ethical, legal, and societal aspects (ELSA), which people involved in the development and deployment of HPE can use for such reflection and deliberation. A realistic military scenario with proposed HPE application can (...) serve as a starting point for such an iterative and participatory process. Stakeholders can discuss this application, modify its features, and design appropriate processes around it – for instance, procedures for informed consent. We propose that organizing aspects into these three categories – ethical, legal, and societal – can help involve appropriate interlocutors at different moments: legal aspects with people in strategy or management roles, from the start of a project; ethical aspects with people in operations and medical roles, during development; and societal aspects with people in communication and personnel roles, during deployment. Notably, we developed and discussed this framework and the three aspects in close collaboration with personnel from the military. (shrink)

The terms “health promotion” and “disease prevention” refer to professional activities. But a “health promoter” has also come to denote a profession, with an alternative agenda compared to that of traditional public health work, work that by some is seen to be too medically oriented, too reliant upon prevention, risk-elimination and health-care. But is there really a sharp distinction between these activities and professions? The main aim of the paper is to investigate if (...) these concepts are logically different, or if they are just two extremes of one dimension. The central concepts, health promotion and disease prevention, are defined, and it is concluded that health promotion and disease prevention are logically distinct concepts, although they are conceptually related through a causal connection. Thus, logically, it is possible to promote health without preventing disease, even if this is not so common, in practice, but it is not possible to prevent disease without promoting health. Finally, most health promoting interventions target basic health, not manifest health, and often also thereby reduce future disease. (shrink)

As occupational health management (OHM) and work health promotion (WHP) become increasingly prominent in companies worldwide, little is known about consumers' attitudes towards work health‐related issues. Do consumers consider the health of employees in German companies to be important? Do German companies consider consumers to be relevant stakeholders in voluntary occupational health (OH) and well‐being activities? In the first of two qualitative interview studies, German consumers were asked which actors they consider to (...) be responsible in OH contexts and whether or not they prefer OH‐related product attributes to other socially desirable ones. During a second qualitative interview study with representatives from German companies, suppliers, institutions, and organizations concerned with voluntary and legally mandatory OH, participants were asked about their expectations regarding whether or not consumers are interested in such OH activities. Both studies highlight the difference between the consumers' perspective on OH issues and responsibilities on the one hand and what companies and stakeholders believe consumers think about OH issues and responsibilities on the other. The findings show that consumers can recognize non‐mandatory OH and well‐being activities as elements of their own social responsibility (ConSR), while companies usually do not consider this perspective in their corporate social responsibility (CSR). (shrink)

There is a large literature exploring the concept of ‘health promotion’. However, the meaning of the term remains unclear and contested. This is for at least two reasons. First, any definition of ‘health promotion’ is going to have to outline and defend an account of the notoriously controversial concept of ‘health’, and then suggest how (and why) we should promote it. Second, health promotion clearly has some overlap with ‘public health’, but it (...) is far from clear how they are related. Is health promotion part of public health or is health promotion a radically different type of activity from public health? Answering this question requires engaging with tricky professional as well as contentious conceptual issues. Some advocates of health promotion talk as though public health is problematic: seen as medical, physiological in focus and reductionist in approach, whereas health promotion, on this view, is focused on the whole person in a social environment. However, to an outsider this looks more like an attempt to artificially (and rather crudely) define and protect professional boundaries, rather than a contribution to conceptual analysis. There seems no good reason why public health cannot take into account the role of social, political, economic and cultural factors and their impact on health. Indeed, much work in public health does precisely this, and uses a wide range of methodologies drawn from non-medical disciplines such as geography, sociology and psychology, not just epidemiology. It seems much more sensible to see health promotion as being one vitally important aspect of the work of public health, rather than something markedly distinct. We will assume here that this is the case and focus instead on the first issue: what is health promotion? (shrink)

The relationship between pleasure and asceticism has been at the core of debates on western subjectivity at least since Nietzsche. Addressing this theme, this article explores the emergence of ‘non-authoritarian’ health campaigns, which do not propagate abstention from harmful substances but intend to foster a ‘well-balanced subject’ straddling pleasure and asceticism. The article seeks to develop the Foucauldian analytical framework by foregrounding a strategy of subjectivation that integrates desire, pleasure and enjoyment into health promotion. The point of (...) departure is the overwhelming emphasis in the governmentality literature on ‘prudence’, ‘self-responsibility’ or ‘risk calculation’, such that pleasure and desire remain largely absent from the framework. Some insights from Žižek’s work are introduced to help us obtain a firmer grasp on the problematic of ‘the well-balanced subject’. The article argues that, in order to analyse the transformation of interpellation in recent health promotion, we must recognize the mechanism of self-distance or dis-identification as an integral part of the procedure of subjectification. (shrink)

This paper describes PluriVox, a user-friendly program aimed to improve group process and dynamics and to promote the health of undeserved population. PluriVox is grounded in psychoeducation, and it can be used in public health efforts to encourage service consumers (“patients”) to become more active in realizing their own health-related needs through participation in health promotion groups. We suggest PluriVox as a strategy to help service providers (e.g., physicians, nurses, community health workers) and consumers (...) to work as co-producers of health. PluriVox contains five competencies to help group facilitators: (1) observation protocol; (2) strategies to support group facilitation; and (3) group facilitator training. Training uses participatory methods that take only 15 hours. Herein we provide a description of how PluriVox was developed using group work theories. A preliminary evaluation suggests that PluriVox has potential to improve health professionals' capacity to facilitate health promotion groups in a Unified Health System. (shrink)

It is generally wrong to manipulate. One leading reason is because manipulation interferes with autonomy, in particular the component of autonomy called ‘independence’, that is, freedom from intentional control by others. Manipulative health promotion would therefore seem wrong. However, manipulative techniques could be used to counter-manipulation, for example, playing on male fears of impotence to counter ‘smoking is sexy’ advertisements. What difference does it make to the ethics of manipulation when it is counter-manipulation? This article distinguishes two powerful (...) defences of counter-manipulative health promotion: that the counter-manipulation would prevent manipulation occurring, leaving people unmanipulated; and that the counter-manipulation would make people healthier without being any more manipulated than they would otherwise be. The article explains how counter-manipulation might work and the limits to its scope. The upshot is that counter-manipulative health promotion could respect the independence people are owed in virtue of their autonomy. However, autonomy is not the only consideration, and the article discusses further potential problems. Counter-manipulative health promotion might be misapplied, it might undermine trust, it might infringe on some norms for role behaviour and it might encourage a regrettable social practice. These objections are likely to be decisive against the counter-manipulation in some but not all cases. (shrink)

Background: Since presenteeism is related to numerous negative health and work-related effects, measures are required to reduce it. There are initial indications that how an organization deals with health has a decisive influence on employees’ presenteeism behavior.Aims: The concept of health-promoting collaboration was developed on the basis of these indications. As an extension of healthy leadership it includes not only the leader but also co-workers. In modern forms of collaboration, leaders cannot be assigned sole responsibility for (...) employees’ health, since the leader is often hardly visible or there is no longer a clear leader. The study examines the concept of health-promoting collaboration in relation to presenteeism. Relationships between health-promoting collaboration, well-being and work ability are also in focus, regarding presenteeism as a mediator.Methods: The data comprise the findings of a quantitative survey of 308 employees at a German university of applied sciences. Correlation and mediator analyses were conducted.Results: The results show a significant negative relationship between health-promoting collaboration and presenteeism. Significant positive relationships were found between health-promoting collaboration and both well-being and work ability. Presenteeism was identified as a mediator of these relationships.Conclusion: The relevance of health-promoting collaboration in reducing presenteeism was demonstrated and various starting points for practice were proposed. Future studies should investigate further this newly developed concept in relation to presenteeism. (shrink)

In this paper two fears about health promotion are identified. The first concerns the ability to choose between proliferating expert advice, and the second concerns the fear of government interference in personal life. The paper goes on to outline the current place of health promotion in British health policy, and to discuss the relevance of recent research on health beliefs. The paper argues that work on ‘lay epidemiology’ has been overlooked by both critics (...) and supporters of health promotion. From this vantage point the fears about health promotion can be seen to be exaggerated. (shrink)

In this article, we provide a description of the good in health promotion based on an empirical study of health promotion practices in New South Wales, the most populous state in Australia. We found that practitioners were unified by a vision of the good in health promotion that had substantive and procedural dimensions. Substantively, the good in health promotion was teleological: it inhered in meliorism, an intention to promote health, which was (...) understood holistically and situated in places and environments, a commitment to primary rather than secondary prevention and engagement with communities more than individuals. Procedurally, the good in health promotion arose from qualities of practices that they developed over time in respectful relationships, were flexible and responsive to communities, built capabilities in communities and were sustainable. We discuss our findings with reference to Martha Nussbaum’s normative list of functional capabilities for a good human life, David Buchanan’s vision for health promotion ethics and common concerns in health promotion ethics regarding the relationship between paternalism and freedom. Our thick, vague conception of the good in health promotion, founded in the values and practical reason of people engaged daily in health promotion work, contributes to the development of a more complete theory of health promotion ethics. (shrink)

This paper brings together ideas from two perspectives on ethics and health promotion. A discussion of the ethical dimension of the health promotion practice of community nurses is set in the wider context of health policy, with particular reference to health gain and individual responsibility. It is widely held that nurses have a key role to play in health promotion and that this is particularly the case for nurses working in primary (...) class='Hi'>health care. This assumption is reinforced by policy documents from the World Health Organization, the Department of Health and statutory bodies such as the United Kingdom Central Council for Nursing, Midwifery and Health Visiting. The approach of many nurses to health promotion has tended on the one hand to be somewhat naive and on the other to be authoritarian and didactic; there has been little discussion in the nursing literature of the ethical aspects of health promotion. However, recent developments in nurse education, such as Project 2000 and the consequent changes to preregistration programmes, have resulted in increased attention to both ethics and health promotion within the curriculum. (shrink)

Este trabajo tiene como objetivo fundamentar la necesidad de la promoción y educación para la salud en la prevención de las infecciones respiratorias agudas. Se realizó una revisión bibliográfica de los últimos diez años que incluyó 53 artículos publicados en bases de datos biomédicas. Se concluye que las acciones educativas propuestas para la promoción y prevención las infecciones respiratorias agudas permitirán una labor educativa, para intervenir en la población con el fin de formar o modificar el estilo de vida y (...) prevenir la aparición de estas enfermedades, basado en la educación, a la vez que se le transfiere al individuo la responsabilidad de su propia salud. The objective of this work was to establish the need for health promotion and education in the prevention of acute respiratory infections. A literature review of the last ten years was made, which included 53 articles published in biomedical databases. It is concluded that the educational actions proposed for the promotion and prevention of acute respiratory infections will allow an educational task, to intervene in the population in order to form or modify the lifestyle and prevent the appearance of these diseases, based on education, transferring responsibility for their own health to the individual. (shrink)

This study describes the theoretical assumptions and the application for health‐promoting conversations, as a communication tool for nurses when talking to patients and their families. The conversations can be used on a promotional, preventive and healing level when working with family‐focused nursing. They are based on a multiverse, salutogenetic, relational and reflecting approach, and acknowledge each person's experience as equally valid, and focus on families’ resources, and the relationship between the family and its environment. By posing reflective questions, reflection (...) is made possible for both the family and the nurses. Family members are invited to tell their story, and they can listen to and learn from each other. Nurses are challenged to build a co‐creating partnership with families in order to acknowledge them as experts on how to lead their lives and to use their own expert knowledge in order to facilitate new meanings to surface. In this way, family health can be enhanced. (shrink)

In this article we illustrate, and argue for, the importance of researching the social context of health professionals’ ethical agendas and concerns. We draw upon qualitative interview data from 20 nurses working in two occupational health sites, and our discussion focuses mainly upon aspects of the shifting ‘ethical context’ for those nurses with a health promotion remit who are working in the British National Health Service. Within this discussion we also raise a number of potentially (...) substantive issues, including the risks of colluding in ‘double standards’, and the tensions between the practitioner and managerial roles in nursing. Overall, we hope to pose questions about the best ways to understand the ethical agency and responsibilities of health professionals. (shrink)

Empowerment is a prominent ideal in health promotion. However, the exact meaning of this ideal is often not made explicit. In this paper, we outline an account of empowerment grounded in the human capacity to adapt and adjust to environmental and societal norms without being completely determined by those norms. Our account reveals a tension at the heart of empowerment between (a) the ability of self-governance and (b) the need to adapt and adjust to environmental and societal norms. (...) We address this tension by drawing from the work of Freud, Canguilhem, and Lacan. First, we clarify through a discussion of Freud’s notion of sublimation that it is difficult to assess empowerment independent of any social valuations, but also that it is no less problematic to make it dependent on social valuations alone. Second, we draw from the work of Canguilhem to show how empowerment can be understood in terms of the individual’s capacity to tolerate the aggressions of a multiplicity of environments. Third, using Lacan, we show how empowerment requires incorporation of social and symbolic norms, without necessarily rendering ourselves a mere product of these norms. Finally, we demonstrate how the views of these authors can complement one another, resulting in a more sophisticated understanding of empowerment. (shrink)

This article presents a critique of the health promotion policy of Japan, which is based on an examination of the social importance of and justification for health promotion. This is done to suggest the proper direction that the future Japanese policy could take, and to question the adequacy of the term of ‘health promotion’. We find the ‘social progress’ characterization of the ‘Second Term of National Health Promotion Movement in the Twenty-First Century (...) - Health Japan 21 ’ to be problematic. While there are clear restraints found in terms of social costs related to the policy, the aims toward social justice provided by the policy are not clear. Considering the social importance and justification of health promotion, and the present conditions seen in Japan, we believe that it is necessary clearly to position health promotion as a form of social justice. Having said this, the term ‘health promotion’ is in itself misleading and can belie the range of activities required to action these policies. Therefore, we propose considering the selection of a different and more appropriate term for health promotion that concretely defines policies that actively work toward definitive health equity. (shrink)

Feminist scholars have identified how race and gender discourses influence the creation and implementation of school-based sexual health education and the provision of health care, yet there are few studies that examine how race and gender work in sexual health promotion as it occurs through community-based public health efforts. Drawing on three years of ethnographic research in a low-income Puerto Rican community, this article demonstrates how a gendered racial project of essentializing Latinx culture surrounding (...) young women’s sexuality and reproduction works to both obscure and reinforce race and racism in sexual health promotion. Professional stakeholders mobilize culture as an explanation for high birth rates among young Latinas in the city and reproduce a “Latino culture narrative” in which Latina gender and sexuality is understood as deterministic and homogenous. Simultaneously, an ideology of colorblindness enables the uncritical promotion of long-acting reversible contraception and obscures the history of reproductive oppression experienced by women of color. I consider how colorblindness and culture narratives allow stakeholders to abdicate responsibility for gendered racial inequality and conclude by advocating for the incorporation of racial and reproductive justice frameworks in sexual health promotion. (shrink)

In the face of what has been referred to as a crystal methamphetamine ‘‘epidemic’’ among gay men in North America, a number of health promotion efforts have been developed. While these efforts vary in approach, a core feature is the assumption that a user’s health depends on distinguishing accurate truths about CMA from inaccurate beliefs about CMA. Drawing on insights developed by Bruno Latour, this article unravels how this distinction plays out in the context of one expression (...) of CMA health promotion. I suggest that CMA health promotion may be more usefully understood as form of collective work in which various players throw up different knowledge practices for debate rather than an effort to mark the difference between truth and belief. In doing so, I suggest that of Latour, and science studies more generally, offers an opportunity for rethinking the nature of health promotion writ large. (shrink)

A number of experiences have demonstrated how digital solutions are effective in improving quality of life (QoL) and health outcomes for older adults. Smart Health Age-Friendly Environments (SHAFE) is a new concept introduced in Europe since 2017 that combines the concept of Age-Friendly Environments with Information Technologies, supported by health and community care to improve the health and disease management of older adults and during the life-course. This chapter aims to provide an initial overview of the (...) experiences available not only in Europe, based on the research work of the participants of the International Interdisciplinary Network on Health and Well-being in an Age-Friendly Digital World (NET4Age-Friendly), which could be of interest to preventive, health and social authorities. The chapter reports good practices, pain points, and bottlenecks that may require a collaborative, interdisciplinary research approach to facilitate the transformations towards smart, sustainable, health and age-friendly cities and communities. (shrink)

HALLETT C and WAGNER L. Nursing Inquiry 2011; 18: 359–368 Promoting the health of Europeans in a rapidly changing world: a historical study of the implementation of World Health Organisation policies by the Nursing and Midwifery Unit, European Regional Office, 1970–2003The World Health Organisation (WHO) was inaugurated in 1948. Formed in a period of post‐war devastation, WHO aimed to develop and meet goals that would rebuild the health of shattered populations. The historical study reported here examined (...) the work of the Nursing and Midwifery Unit (NMU) of WHO’s European Regional Office during the later part of the twentieth century. The study examined archive sources lodged at the NMU archive. The sources included manuscripts relating to important NMU initiatives, reports and papers published by WHO, and a range of secondary sources. The study identified three main driving forces in the work of the NMU of the European Regional Office of WHO. One of the strongest of these was a drive to develop and promote the nursing profession within the countries of the European Region. The second was the promulgation and implementation of the positive public health strategies of WHO, particularly its ‘38 Targets for Health for All by the Year 2000’. The third focussed on securing equity across the European continent and on promoting the development of the nursing professions in poorer and less‐developed countries. The study concludes that the nursing professions in European states grew in strength and influence, and that the health of populations improved throughout the continent between 1970 and 2003. It discusses the extent to which the role of the NMU in these advances may have been significant. (shrink)

The Hill Burton Act, which was signed into law in 1946 and ended in 1997, was one of the most significant forces that shaped the health care system we have today. Providing grants and loans for the construction and expansion of hospitals across the country, it required beneficiary hospitals to give some amount of uncompensated care to the poor and uninsured in return.The act not only led to our health care system's current emphasis on the acute‐care hospital as (...) the primary site of health care delivery, but it also had a profound effect on nursing, fully involving the profession in an acute‐care world. The act created jobs for nurses at an unprecedented level. There are over 3.4 million nurses in the United States, and in 2013, 63 percent of all nurses worked for hospitals. Nursing education continues to emphasize acute care, despite the calls for shifting the curriculum to more community‐based content and experiences that focus on health promotion and wellness for individuals, families, and communities. It is my premise that the nursing profession and all who profess to be committed to promoting health have a moral obligation to help the nation adopt a Hill‐Burton Act of the twenty‐first century that will focus on building healthy communities, supporting families in ways that promote health, and helping individuals to live healthier lives. This would require a shift in resources from a costly health care system to investing in community development, whether job creation, building safe places to play and exercise, providing access to affordable and nutritious foods, advancing the quality of education, or other approaches to addressing and improving the social determinants of health. Making this kind of investment would speak to the principles of beneficence, least harm, and justice, particularly for socioeconomically stressed communities. (shrink)

This timely book examines the interaction of health research and regulation with law through empirical analysis and the application of key anthropological concepts to reveal the inner workings of human health research. Through ground-breaking empirical inquiry, Regulatory Stewardship of Health Research explores how research ethics committees (RECs) work in practice to both protect research participants and promote ethical research.This thought-provoking book provides new perspectives on the regulation of health research by demonstrating how RECs and other (...) regulatory actors seek to fulfil these two functions by performing a role of 'regulatory stewardship'. This involves guiding researchers through stages of research approval, as well as seeking to maximise benefits for participants and society while minimising risks. Arguing that participant protection and research promotion should rightly be treated as twin objectives for health research regulators, this book asserts that there is a need for more overt recognition of the importance and function of the deliberative space in which RECs can negotiate the risks relevant to a research application.This book is a key resource for academics and students interested in health research and regulation, and the dynamic interaction of ethics and the law. Regulators and policy-makers will also find it to be an insightful and illuminating text for the practical insights that it reveals about research governance in action. (shrink)

Health systems research is widely identified as an indispensable means to achieve the goal of health equity between and within countries. Numerous health systems research consortia comprised of institutions from high-income countries and low and middle-income countries are currently undertaking programs of research in LMICs. These partnerships differ from collaborations that carry out single projects in the multiplicity of their goals, scope of their activities, and nature of their management. Recent conceptual work has explored what features (...) might be necessary for health systems research consortia and their research programs to promote health equity. Identified features include selecting research priorities that focus on improving access to high-quality health services and/or financial protection for disadvantaged populations in LMICs and conducting research capacity strengthening that promotes the independent conduct of health systems research in LMICs. Yet, there has been no attempt to investigate whether existing consortia have such characteristics. This paper describes the results of a survey undertaken with health systems research consortia leaders worldwide to assess how consistent current practice is with the proposed ethical guidance. The findings suggest that consortia may be fairly well organised to promote health equity, but have scope for improvement, particularly in terms of achieving inclusive priority-setting. (shrink)

In this article, we draw upon the notion that employees’ work characteristics are an important pathway through which leaders influence employee well-being and propose a theoretical framework that integrates perspectives on leadership, occupational stress, and job design. Based on this integrative approach, we developed the health- and development-promoting leadership behavior questionnaire (HDLBQ) for assessing job demands emanating from and job resources provided through the leader. Validation of the measure in German, French, and English using an overall sample of (...) 2,934 employees demonstrated adequate psychometric properties. An examination of the factorial structure revealed three higher-order factors: demanding, development-oriented, and support-oriented leadership. Multigroup confirmatory factor analysis indicated structural equivalence across the three language versions of the HDLBQ. Correlations with employee well-being were moderate, and the HDLBQ explained unique variance in employee well-being beyond that explained by transformational leadership. Suggestions for applications of the HDLBQ and approaches to enhance employee well-being at the workplace are discussed. (shrink)

In this article, we develop a non-rights-based argument based on beneficence (i.e., the welfare of individuals and communities) and justice as the disposition to act justly to promote equity in health care resource allocation. To this end, we structured our analysis according to the following main sections. The first section examines the work of Amartya Sen and his equality of capabilities approach and outlines a framework of health care as a fundamental human need. In the subsequent section, (...) we provide a definition of health equity based on the moral imperative to guarantee that every individual ought to have the freedom to pursue health goals and well-being. In the later part of the article, we outline a non-right approach to health care based on three pillars: (1) human flourishing, (2) justice as a disposition not a process, and (3) solidarity. (shrink)

Population health has recently grown from a series of loosely connected critiques of twentieth-century public health and medicine into a theoretical framework with a corresponding field of research—population health science. Its approach is to promote the public’s health through improving everyday human life: affordable nutritious food, clean air, safe places where children can play, living wages, etc. It recognizes that addressing contemporary health challenges such as the prevalence of type 2 diabetes will take much more (...) than good hospitals and public health departments. -/- Blending philosophy of science/medicine, public health ethics and history, this book offers a framework that explains, analyses and largely endorses the features that define this relatively new field. Presenting a philosophical perspective, Valles helps to clarify what these features are and why they matter, including: searching for health’s “upstream” causes in social life, embracing a professional commitment to studying and ameliorating the staggering health inequities in and between populations; and reforming scientific practices to foster humility and respect among the many scientists and non- scientists who must work collaboratively to promote health. -/- Featuring illustrative case studies from around the globe at the end of all main chapters, this radical monograph is written to be accessible to all scholars and advanced students who have an interest in health—from public health students to professional philosophers. (shrink)

It is often said that the health promoter must be an expert in generalisation and Debates and Dilemmas in Promoting Health is an illustration of the vast range of issues influencing practice and policy health promotion today.The publication is part of The Open University undergraduate course “Promoting Health: Skills, Perspectives and Practice”. It presents a collection of articles by an impressive range of authors, and although the preface states that these aim to challenge preconceptions and (...) evoke a critical understanding of current health issues, some of these are drawn from other publications and are some years old.The book is divided into four sections and the introduction to each section from the editors attempts to summarise the key points and common themes. Overall, the reader should be left in no doubt about the complexity and lack of definitive answers in modern health promotion.In the years since the defining events of the 1970s and 1980s that gave rise to the Alma Ata Declaration and the Ottawa Charter, health promotion has been increasingly subject to debates, dilemmas, and criticisms. The knowledge base for health advice becomes seemingly ever more complex and the balance between individual, community, and government responsibility appears to be in continual flux. The all-embracing definitions of health with which we work present enormous challenges in a climate of increasing need to demonstrate output and cost effectiveness.The first section, “Key issues in health promotion”, aims to explore some of the current thinking at the heart of health promotion, and offers a number of different perspectives on this thinking. Charles Webster and Jeff …. (shrink)

Character strengths research has the potential to imply that youth have character deficits or moral failings that cause their problematic behavior. This ignores the impact of context, especially for youth who are members of historically marginalized groups in under resourced communities. On the other hand, framing youth who are members of underrepresented groups solely as products of oppression undermines their agency and the power of collective action. It may be possible to promote character development in a contextually relevant, culturally grounded (...) way through a transdisciplinary, participatory action approach. We engaged in this work in three phases: goal specification; logic model identification; and intervention development and testing. Lessons learned included the need for intensive trust-building and identifying the limitations in scope and capacity. Overall, a transdisciplinary, participatory action approach is a promising strategy to overcome the existing bias in virtue development research and to leverage positive psychology to address health disparities. (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)

Funding agencies in Canada are attempting to break down the organizational boundaries between disciplines to promote interdisciplinary research and foster the integration of the social sciences into the health research field. This paper explores the extent to which biomedical and clinician scientists’ perceptions of social science research operate as a cultural boundary to the inclusion of social scientists into this field. Results indicated that cultural boundaries may impede social scientists’ entry into the health research field through three modalities: (...) (1) biomedical and clinician scientists’ unfavourable and ambivalent posture towards social science research; (2) their opposition to a resource increase for the social sciences; and (3) clinician scientists procedural assessment criteria for social science. The paper also discusses the merits and limitations of Tom Gieryn’s concept of boundary-work for studying social dynamics within the field of science. (shrink)

Health-related quality of life is the ultimate general goal for medicine, health care and public health, including health promotion and health education. The other important general goal is health-related welfare. The aim of the paper is to explain what this means and what the consequences of these assumptions are for health work. This involves defining the central terms “health”, “quality of life” and “welfare” and showing what their conceptual relations are. (...) Health-related quality of life has two central meanings: health-related well-being, which constitutes quality of life, and health as ability, which contributes causally to quality of life. Four meanings of health-related welfare are put forward: general well-being, health as ability, other inner properties of the individual, and external factors. States and processes covered by these categories contribute causally to health-related quality of life. Finally, using these distinctions, some more specific goals for medicine and health care, on the one hand, and for public health and health promotion, on the other, are outlined. In the former fields work is primarily directed towards changing the health-related quality of life of the individual through direct measures, “manipulating” the individual, whereas public health work and health promotion primarily use indirect measures and further health through various sorts of health-related welfare changes, e.g. through changing the environment. (shrink)

The question of whether free will exists has been debated extensively for centuries. Instead of debating this complex issue, recent work in psychology has sought to understand the consequences of beliefs in free will. That is, how are people’s behaviors influenced when they either believe or do not believe in free will? Amongst many outcomes, research has identified free will beliefs to influence achievement, perseverance, and aggressiveness. We believe that beliefs in free will could also exert influence on (...) class='Hi'>health behaviors. Health promotion from a psychological perspective has typically adopted social cognitive models to understand and predict health behaviors. We contend that free will beliefs could be included in these models to understand and change health behavior. We provide examples of how a popular social cognition theory, the theory of planned behavior, could be aligned with beliefs in free will. We suggest that the relationship between free will beliefs and theory constructs (attitude, subjective norm, perceived behavioral control, intention) could be positive in health enhancing behaviors and negative in health risk behaviors. Experimentally testing these relationships is needed in future research. This may provide further insights into the consequences of free will and contribute to the explanation of health behavior. (shrink)

BackgroundPsychological support was provided by the Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol within the hospitals in the Northern Italy in favor of healthcare workers during the COVID-19 pandemic. This study aimed at evaluating the effectiveness of treatment in terms of symptomatology reduction related to peri- and post-traumatic stress; clinical improvement over time; and the maintenance of the achieved outcome over time.MethodsThe population was composed of healthcare workers who spontaneously requested psychological intervention in both the first and the (...) second emergency waves. Statistical analyses were carried out to highlight the differences in Impact of Event-Revised and Post-Traumatic Growth Inventory before and after the group intervention.ResultsIn both the first and the second waves, pre-treatment values are higher than post-treatment values for all dimensions of the IES-R. The results show that there are no significant differences between the first and the second wave with regard to the treatment effect. Healthcare workers maintained positive changes over time despite their prolonged exposure to an emergency and the possibility of retraumatization at the onset of a new emergency phase, irrespective of their working place. Healthcare workers who were treated in the first wave showed at the beginning of the second emergency wave less vulnerability and more resilience than those who were treated only in the second wave.Pre-treatment scores of healthcare workers affected by COVID-19 are discussed.ConclusionCOVID-19 had a significant impact on the well-being of healthcare workers who were working in hospitals. Psychological support in case of emergency is needed. (shrink)

RESUMEN Las investigaciones en el campo de la teoría de la comunicación apuntan a que en la actualidad el proceso es, desde lo social, una vía para el logro de las relaciones interpersonales y posee sus potencialidades estratégicas para la construcción social y cultural del hombre. Se realizó una revisión bibliográfica para el acercamiento inicial al estudio de las temáticas de la comunicación social en salud y la prevención de enfermedades en la comunidad. Por ello el objetivo del presente trabajo (...) estriba en establecer los fundamentos teóricos que sustentan el estudio de las relaciones entre la comunicación en salud y la concreción del trabajo preventivo desde la comunidad. Se defiende que la comunicación social en salud promueve el diálogo y el intercambio de información y es un componente imprescindible de todos los servicios de salud. ABSTRACT Research on the theoretical basis of communication point to the fact that nowadays, the process is, from a social point of view, a means of achieving interpersonal relationships and it has strategic potential toward men’s social and cultural construction. A bibliographic review was carried out in order to approach the study of subject matters related to social communication in health and disease prevention in the community. Therefore, this paper aims at stablishing the theoretical basis that support the study of the relationship between communication in health and the implementation of precautionary work from the community. It is defended that social communication in health promotes dialogue and information exchange and it is an essential element in all health services. (shrink)

Strong evidence shows that exposure and engagement with the natural world not only improve human wellbeing but can also help promote environmentally friendly behaviors. Human-nature relationships are at the heart of global agendas promoted by international organizations including the World Health Organization’s “One Health” and the United Nations “Ocean Decade.” These agendas demand collaborative multisector interdisciplinary efforts at local, national, and global levels. However, while global agendas highlight global goals for a sustainable world, developing science that directly addresses (...) these agendas from design through to delivery and outputs does not come without its challenges. In this article, we present the outcomes of international meetings between researchers, stakeholders, and policymakers from the United Kingdom and Brazil. We propose a model for interdisciplinary work under such global agendas, particularly the interface between One Health and the UN Ocean Decade and identify three priority research areas closely linked to each other: human-nature connection, conservation-human behavior, and implementation strategies. We also discuss a number of recommendations for moving forward. (shrink)

Achieving equity in international research is one of the pressing concerns of the twenty-first century. In this era of progressive globalization, there are many opportunities for the deliberate or accidental export of unethical research practices from high-income regions to low- and middle-income countries and emerging economies. The export of unethical practices, termed “ethics dumping,” may occur through all forms of research and can affect individuals, communities, countries, animals, and the environment. Ethics dumping may be the result of purposeful exploitation but (...) often arises from lack of awareness of good ethical and governance practice. This chapter describes the work of the TRUST project toward counteracting the practice of ethics dumping through the development of tools for the improvement of research governance structures. Multi-stakeholder consultation informs all of TRUST’s developments. Most importantly, this gives voice to marginalized vulnerable groups and indigenous people, who have been equal and active partners throughout the project. At the heart of the TRUST project is an ambitious aim to develop a Global Code of Conduct for Research in Resource-Poor Settings. Uniquely, the Code provides guidance across all research disciplines in clear, short statements, focusing on research collaborations that entail considerable imbalances of power, resources and knowledge and using a new framework based on the values of fairness, respect, care, and honesty. The code was recently adopted by the European Commission as a reference document for Horizon 2020 and Horizon Europe. (shrink)

For decades, health professionals have asserted the importance of public participation in interventions for health. Medicine has pursued patient participation in clinical decision-making. In the public health realm, target groups have been asked to assist in the design and implementation of initiatives for health. In practice, however, patients and populations expect health professionals to give advice and - in some cases - to make decisions on their behalf. This implies limits to the ideal of participation. (...) In this innovative work, the author contrasts public and professional understandings of health and the best ways to achieve health. The result is a model of lay participation in the structuring of medical and public health activity. The book is unique due to its policy-applicable, quantitative studies and its theoretical analysis of works by René Dubos and Aaron Antonovsky. It will be of value to professionals in health promotion, health education, medical anthropology, and social epidemiology. (shrink)

Contemporary health care relies on electronic devices. These technologies are not ethically neutral but change the practice of care. In light of Sennett's work and that of other thinkers one worry is that "e-care"aEuro"care by means of new information and communication technologies-does not promote skilful and careful engagement with patients and hence is neither conducive to the quality of care nor to the virtues of the care worker. Attending to the kinds of knowledge involved in care work (...) and their moral significance, this paper explores what "craftsmanship" means in the context of medicine and health care and discusses whether today the care giver's craftsmanship is eroded. It is argued that this is a real danger, especially under modern conditions and in the case of telecare, but that whether it happens, and to what extent it happens, depends on whether in a specific practice and given a specific technology e-carers can develop the know-how and skill to engage more intensely with those under their care and to cooperate with their co-workers. (shrink)

In this chapter, I propose a minimal construal of philosophical health that contains two core elements: variegated coherence and intentional directedness at a trans-subjective good. Combining elements from the works of Iris Murdoch and Marshall Rosenberg, I sketch a practice I dub non-violent just communication and argue that it promotes philosophical health as per the minimal construal and that we can derive from it a principle of philosophical health to complement the list of five principles of philosophical (...) health that have been proposed by Luis de Miranda. I then show that the practice of non-violent just communication promotes what Miranda Fricker has characterized as hermeneutic virtue and testimonial sensibility and, finally, suggest that my minimal notion of philosophical health is a useful tool to contrast various conceptions of philosophical counselling. (shrink)

_Health Education: Critical perspectives_ provides a socio-cultural and critical approach to health education. The book draws together international experts in the fields of health and education who deconstruct contemporary discourses and practices, and re-imagine a health education that both connects with young people and offers a way forward in addressing issues of health and wellbeing. Chapters within specifically link academic work on neoliberalism, healthism, risk and the body to wider discourses of health and (...) class='Hi'>health education. They challenge current practices and call for a re-thinking of current health programs in education settings. A unique feature of this book is the analyses of health education from both political and applied levels across a range of international contexts. The book is divided into three sections: the social and political contexts informing health education how individual health issues articulate in education in complex ways alternative ways to think about health and health education pedagogy. The overall theme of the book offers a perspective that the current approach to health education – promoting a fear of ill health, self-surveillance and individual responsibility – can become a form of health fascism, and we need to be cognisant of this potential and its consequences for young people. The book will be of key interest to academics and researchers exploring the political context of health education. (shrink)

International research is an essential means of reducing health disparities between and within countries and should do so as a matter of global justice. Research funders from high-income countries have an obligation of justice to support health research in low and middle-income countries that furthers such objectives. This paper investigates how their current funding schemes are designed to incentivise health systems research in LMICs that promotes health equity. Semi-structured in-depth interviews were performed with 16 grants officers (...) working for 11 funders and organisations that support health systems research: the Alliance for Health Policy and Systems Research, Comic Relief, Doris Duke Foundation, European Commission, International Development Research Centre, Norwegian Agency for Development Cooperation, Research Council of Norway, Rockefeller Foundation, UK Department of International Development, UK Medical Research Council, and Wellcome Trust. Thematic analysis of the data demonstrates their funding schemes promote health systems research with five key features that advance health equity: being conducted with worst-off populations, focusing on research topics that advance equitable health systems, having LMIC ownership of the research agenda, strengthening LMIC research capacity, and having an impact on health disparities. The different types of incentives that encouraged proposed projects to have these features are identified and classified by their strength. It is suggested that research funders ought to create and maintain funding schemes with strong incentives for the features identified above in order to more effectively help reduce global health disparities. (shrink)

This article describes implementation of a longitudinal curriculum in public health law, building on doctrinal coursework with skills-based coursework and opportunities for interdisciplinary, community-based engagement and service learning. It specifically describes development of a Policy Practicum, giving an example of how law students can learn policy skills and skills of effective community coalition work through a healthy homes partnership, highlighting areas where the curriculum can incorporate interdisciplinary education. It offers lessons learned during the curriculum-building process, and concludes with (...) a more intensive service-learning strategy through the development of a Policy Lab. (shrink)

This article draws upon clinical experience of GPs working in a deprived area of the North East of England to examine the potential contribution of Universal Basic Income to health by mitigating ‘patient-side barriers’ among three cohorts experiencing distinct forms of ‘precariousness’: 1) long-term unemployed welfare recipients with low levels of education (lumpenprecariat); 2) workers on short-term/zero-hours contracts with low levels of education (‘lower’ precariat); 3) workers on short-term/zero-hours contracts with relatively high levels of education (‘upper’ precariat). We argue (...) that any benefits must be accompanied by robust institutions capable of promoting health. (shrink)

This paper reflects on the needs for close interaction between psychiatry and all partners in international mental health for the improvement of mental health and advancement of the profession, with a particular view to the relationships between mental health, development and human rights. The World Health Organisation identifies strong links between mental health status and development for individuals, communities and countries. In order to improve population mental health, countries need effective and accessible treatment, prevention, (...) and promotion programmes. Achieving adequate support for mental health in any country requires a unified approach. Strong links between psychiatrists, community leaders and patients and families that are based on negotiation and respect, are vital for progress. When strong partnerships exist, they can contribute to community understanding and advancement of psychiatry. This is the first step towards scaling up good quality care for those living with mental illnesses, preventing illnesses in those at risk, and promoting mental health through work with other community sectors. Partnerships are needed to support education and research in psychiatry, and improvements in quality of care wherever psychiatry is practiced, including primary health and community mental health services, hospitals and private practice. There are important roles for psychiatry in building the strength of organisations that champion the advocacy and support roles of service users and family carers, and encouraging partnerships for mental health promotion in the community. (shrink)

In this article, we present an ethics framework for health practice in humanitarian and development work: the ethics of engaged presence. The ethics of engaged presence framework aims to articulate in a systematic fashion approaches and orientations that support the engagement of expatriate health care professionals in ways that align with diverse obligations and responsibilities, and promote respectful and effective action and relationships. Drawn from a range of sources, the framework provides a vocabulary and narrative structure for (...) examining the moral dimensions of providing development or humanitarian health assistance to individuals and communities, and working with and alongside local and international actors. The elements also help minimize or avoid certain miscalculations and harms. Emphasis is placed on the shared humanity of those who provide and those who receive assistance, acknowledgement of limits and risks related to the contributions of expatriate health care professionals, and the importance of providing skillful and relevant assistance. These elements articulate a moral posture for expatriate health care professionals that contributes to orienting the practice of clinicians in ways that reflect respect, humility, and solidarity. Health care professionals whose understanding and actions are consistent with the ethics of engaged presence will be oriented toward introspection and reflective practice and toward developing, sustaining and promoting collaborative partnerships. (shrink)

Public health nursing is grounded in public health ideologies and fundamental nursing values. Researchers have argued that ethical responsibility from the perspective of the nurse is an understudied phenomenon. This meta-ethnography provides in-depth knowledge of how public health nurses (PHNs) experience ethical responsibility when working to prevent injury and disease, and promote health and well-being in children, young people and their families. There are reciprocal findings across the 10 included studies. The findings reveal that these nurses (...) often feel alone, have worries and uncertainties and are afraid of doing wrong. They describe unclear boundaries in their work, creating a heightened sense of responsibility. PHNs fight lonely battles. Yet they show courage and commitment and are ready to stand up and fight for children and families who do not receive adequate care. A line of argument is developed and the metaphorical phrase Chivalrous knights in moral armour is used to express the authors’ overall interpretations of the findings. Reflection on the findings shows how the different dimensions of ethical responsibility are interconnected. The nurses’ ethical sensitivity enables them to feel compassion for others and they show indignation when vulnerable others are not treated with dignity and respect. Indignation and compassion are interrelated, and when human life and dignity are threatened, the ethical demand to respond emerges. Indignation is a precursor to moral courage, and the nurses’ moral sensitivity and respect for their clients emboldens them to stand up for vulnerable others. The findings also illustrate the paradoxical nature of freedom. Freedom of choice due to unclear boundaries heightens the nurses' sense of responsibility. This research is an important step in theory development and has implications for further research, education and practice. (shrink)

COVID-19 has created additional challenges in mental health services, including the impact of social distancing measures on care and treatment. For situations where a detention under mental health legislation is required to keep an individual safe, psychiatrists may consider whether to conduct an assessment in person or using video technology. The Mental Health (Care and Treatment) (Scotland) Act 2003 does not stipulate that an assessment has to be conducted in person. Yet, the Code of Practice envisions that (...) detention assessments would be conducted face to face in all circumstances. During the pandemic, the Mental Welfare Commission for Scotland, a statutory body with a duty to promote best practice of the Act, has been asked whether it may be acceptable and indeed preferable for some assessments to be conducted via video technology. Where an assessment is needed to determine if a patient needs to be detained, and where there is a need for social distancing or the need for ‘shielding’, remote assessments may in some circumstances be preferable. In this article, we outline the modification of the Mental Welfare Commission’s previous outright rejection of virtual assessments as the pandemic progressed and discuss the ethical and legal issues the possibility of remote assessments has exposed. We also discuss the limits and when a virtual assessment is not considered ethical. As the pandemic moves from a state of emergency into a ‘new normal’ in psychiatric services during second, or subsequent, waves, the use and place (if any) of remote assessments for detention needs to be considered. (shrink)

Professor Bartha Maria Knoppers stepped down from the Canada Research Chair in Law and Medicine at McGill University in April 2024, a post she held for more than 20 years. Professor Knoppers consistently prioritized "humanity" in her academic work and in policymaking. As such, she forged a strong intellectual legacy, notably through her work on the human right to science, genomic and health-related data sharing, genome editing, human reproductive technologies, stem cell research, the rights of children, and (...) population health. This collection of essays honours her extraordinary academic contributions to law, policy, and medicine. (shrink)