BACKGROUND:Since the original publication of the Seven Principles of Public Health Ethics, the world has gone through a global pandemic. Rising nationalism, and political tensions have become increasingly heated. In other words, we are in a state of turmoil. This paper aims to restate the principles for the current context and introduces a practical tool for public health professionals to apply to guide ethical reflection. METHODS:The seven-principle approach is reviewed in light of feedback received personally, at academic events and from the literature over the last more than ten years. Two revised original tools specifying the principles are integrated into one. RESULTS:The case for explicit and transparent public health ethics is made, followed by an overview of important philosophical ethical theories. Then, each revised principle is explained and one practical tool for ethical decision-making is presented. CONCLUSIONS:The authors suggest that this tool can contribute to improving public health decision making by laying out a clear and simple framework for ethical decision-making, which is helpful to contribute to public trust and reasonable public health practice in a world of turmoil.

BACKGROUND:Public health is tasked with preventing harm, promoting health and ensuring equitable access to care. Yet, increasing sociopolitical and economic turmoil is creating barriers to public health delivering its core roles. Whilst moral dilemmas are inherent in public health polycrises and their resultant ongoing impacts has thrust consideration of the moral harms that may be experienced when we are prevented in the delivery of care into discourses about the future priorities of public health. Experiencing moral harms can result in profound impacts for the individual and the delivery and outcomes of care and are emerging as a public health concern. At a time when public health and healthcare are facing interconnected challenges in funding, workforce attrition, erosions in public trust and quality, it is critical we identify the pertinent drivers of moral harms. METHODS:This commentary explores five different perspectives representing varied geographical locations and health infrastructures. RESULTS:Specifically, we explore the critical roles of economic status, social anthropological considerations, fiscal, organisational and individual factors to outline key drivers to formulate public health policy responses, going forward. CONCLUSIONS:Addressing the moral harms is a public health imperative and associated solutions have a critical role to play in dampening the flames of current turmoil.

Background: Codes of conduct are a vital lever of the public health workforce professionalization in Europe. The absence of genuine Public Health Codes of Ethics (PHCOE) hampers full professionalization, leading practitioners to conduct that does not reflect public health norms and values. Methods: A scoping review embedded in Constructivist Grounded Theory searched the PubMed, Web of Science and EMBASE data bases and websites of professional organizations, public health institutions and public health governance bodies for norms, values, duties and principles to develop a theoretical model on the creation of public health codes of conduct. Results: Three studies and 25 PHCOEs have been included. The codes overlap in respect, honesty, accountability, responsibility, collaboration and flexibility. Values that are crucial to public health practice including justice, equity, public trust, common good, cultural awareness, social progress and stewardship were less well-represented. The theory which emerged from the data includes ethical considerations, purposes and benefits, themes, content and barriers. Conclusion: We have proposed a prototype for a PHCOE that can be used by public health institutions and organizations to create codes of conduct. We urge stakeholders to raise awareness on the importance of empowering the workforce to excel at their responsibilities by investing in development and adoption of ethical guidance and training.

This paper aims to explain how political culture has influenced the scope of prevention measures, disease surveillance, and health data integration strategies in the German health system to date. Political culture is a major determinant of national health policies in countries, defining the means and scope of governmental authority for ensuring population health. This paper explains the role of political culture in shaping prevention and health promotion measures in the German health system, based on a public policy theory. During the post-war period, the structure of the German health system was (re-)designed to focus on curative medicine at the expense of public health. Current prevention and health promotion measures, often characterised as ‘too little, too late’, lead to medical treatments that are ‘too costly, too risky’. Linking data sources in Germany today is much more challenging than in other European countries, with health-relevant data often remaining in isolated silos that could be used for population health. The analysis suggests that the national heritage shaping the political culture in Germany had a great influence on the limited role of government intervention, the interpretation of public health, and the state’s role in collecting and processing health data of citizens for research and policymaking.

Knowledge Translation (KT) aims to convey novel ideas to relevant stakeholders, motivating their response or action to improve people’s health. Initially, the KT literature focused on evidence-based medicine, applying findings from laboratory and clinical research to disease diagnosis and treatment. Since the early 2000s, the scope of KT has expanded to include decision-making with health policy implications. This systematic scoping review aims to assess the evolving knowledge-to-policy concepts, that is, macro-level KT theories, models and frameworks (KT TMFs). While significant attention has been devoted to transferring knowledge to healthcare settings (i.e. implementing health policies, programmes or measures at the meso-level), the definition of 'context' in the realm of health policymaking at the macro-level remains underexplored in the KT literature. This study aims to close the gap. A total of 32 macro-level KT TMFs were identified, with only a limited subset of them offering detailed insights into contextual factors that matter in health policymaking. Notably, the majority of these studies prompt policy changes in low- and middle-income countries and received support from international organisations, the European Union, development agencies or philanthropic entities.

Hintergrund: Die sogenannten Einrichtungsbezogene COVID-19 Impfpflicht (EBI) galt bundesweit zwischen dem 16.03.2022 und dem 31.12.2022 für Personen, die im medizinischen und pflegerischen Sektor tätig waren und wurde kontrovers diskutiert sowie in unterschiedlichem Maße in den Bundesländern und deren Kommunen umgesetzt. In Hamburg wurde gegenüber Personen, die nach entsprechender Aufforderung keinen gültigen Impfnachweis vorlegen konnten, im Rahmen einer Ermessensentscheidung des zuständigen Gesundheitsamtes (GA) ein Betretungsverbot ausgesprochen oder die weitere Tätigkeit unter Auflagen gestattet, sofern durch ein Betretungsverbot ein Versorgungsengpass drohte. Die Präsentation stellt am Beispiel der Umsetzung der EBI im Gesundheitsamt Hamburg-Eimsbüttel die behördlichen, medizinischen und ethischen Herausforderungen und den Umgang mit diesen dar.

OBJECTIVE:To explore the experiences of midwives in Indonesia on the provision of maternal health services during the COVID-19 pandemic. DESIGN AND METHODS:A qualitative descriptive study using focus group discussions was undertaken. A conventional content analysis was used to analyze the data. Coding categories were generated from the transcripts. SETTING AND PARTICIPANTS:Twenty-two midwives from five community health centers of three regions in the Province of Jambi, Indonesia were included. FINDINGS:The interviewees shared similar barriers and facilitators in delivering the services, including the unavailability of adequate protective equipment, the limitation of the number of services, and dealing with the new public health measures related to the COVID-19. Overall, midwives demonstrated a continued commitment to provide maternal health services during the pandemic. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:Significant changes in service delivery have been made to comply with pandemic related restrictions. Despite the unprecedentedly difficult working environment, the midwives continue to provide adequate services to the community by implementing a strict health protocol. Findings from this study contribute to a better understanding of how the quality of the services changed, as well as how new challenges can be addressed and positive changes can be reinforced.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Zusammenfassung Public Health als wissenschaftliche Multidisziplin („Gesundheitswissenschaften“) und Institution orientiert sich an Werten. Werte sind das, was Menschen anstreben und als moralisch gut ansehen, beispielsweise „Gesundheit“ und „Öffentlichkeit“. Werte liegen moralischen Urteilen zugrunde. Muss man moralische Urteile begründen und Handeln rechtfertigen? Dieser Artikel plädiert für eine positive Antwort. Institutionelles und professionelles Handeln in Public Health braucht ethische Reflexion.

Einleitung Von Ärzt*innen wird erwartet, dass sie – traditionell im Sinne des Hippokratischen Eids – ihren Patient*innen keinen Schaden zufügen ((primum) nil nocere), sondern alles daran setzen, ihnen zu helfen (bonum facere). Gleichwohl sind Ärzt*innen, die in Behörden – wie beispielsweise dem Gesundheitsamt oder im Polizeiärztlichen Dienst – arbeiten, nicht mehr (vorrangig) in einer klassischen Arzt-Patient-Beziehung; beispielsweise wenn es um Begutachtungen bei Einstellungen oder zur Dienstunfähigkeit geht. Vielmehr begegnen sich Amts- und Polizeiärzt*innen und die sie zu begutachtenden Personen in einer anderen Situation als der, die die Werte des Hippokratischen Ethos festschreibt. Aber was bedeutet diese Verschiebung in normativ-ethischer Hinsicht? Darf sich eine Ärztin an das Hippokratische Ethos gebunden fühlen? Was ist, wenn dieses Ethos mit dem selbst geleistet Amtseid bzw. den Erwartungen der Verwaltung, für die sie arbeitet, konfligiert?

Background For children with life-limiting conditions home care is a key component of pediatric palliative care. However, poor information is available on service coverage and in particular on country-specific pediatric palliative home care characteristics. The aim of the study was therefore to describe the association between pediatric palliative care coverage and national activities and obtain detailed information on the pediatric palliative home care structure in different European countries. Methods Online survey with in-country experts from N = 33 European countries. Results Pediatric palliative home care (65.6%) represented the most pediatric palliative care units (15.6%) and the least common services. National documents constituted the most widespread national pediatric palliative care activity (59.4%) and were associated with available services. Pediatric palliative home care could be mostly accessed as a service free of charge to families (95.2%) from the time of a child's diagnosis (85.7%). In most countries, oncological and non-oncological patients were cared for in pediatric palliative home care. Only a minority of home care teams covered home-ventilated children. Pediatric palliative home care usually comprised medical care (81.0%), care coordination (71.4%), nursing care (75.0%) and social support (57.1%). Most countries had at least two professional groups working in home care teams (81.0%), mostly physicians and nurses. In many countries, pediatric palliative home care was not available in all regions and did not offer a 24 h-outreach service. Conclusions Pediatric palliative care provision in Europe is heterogeneous. Further work on country-specific structures is needed.

The reduction of Maternal Mortality Ratio (MMR) remains a global health issue. Although major progress has been achieved in the past 15 years, the ratio is still high, especially in Low Middle-Income Countries. In the Southeast Asian region, most of the countries have not reached the Sustainable Development Goals target yet. Although the countries have several similarities in many aspects, such as community characteristics, cultural context, health systems, and geographical proximity, the MMR in the region presents interesting variations. The scope of this systematic review is to explore published literature on the utilization of maternal health services at the community healthcare centre setting in Southeast Asian countries. The databases PubMed, Web of Science, and Google Scholar were searched systematically to identify quantitative, qualitative and mixed methods studies published in 2000-2020. A total of 1876 records were found, out of which 353 full text were screened. Finally, 27 studies on utilization of maternal health services met the inclusion criteria and were selected for analysis from seven Southeast Asian countries: Cambodia, Indonesia, Lao PDR, Myanmar, The Philippines, Timor Leste and Vietnam. Most of the articles focused on the utilization of maternal health services at primary health care setting. Several themes on maternal health services utilization in the countries emerged, including cultural and socioeconomic factors contributed to the utilization of maternal health services, factors associated with the low utilization of ANC, determinants affected place of delivery and delivery assistance choice. The utilization of maternal health services at primary healthcare setting in seven Southeast Asian countries was identified in a small number of studies. Sociocultural barriers and disparities of health services provision are the major factors associated with low utilization of the services. Further research on strengthening the role of primary healthcare in maternal health services provision is required.

Information is clearly vital to public health, but the acquisition and use of public health data elicit serious privacy concerns. One strategy for navigating this dilemma is to build 'trust' in institutions responsible for health information, thereby reducing privacy concerns and increasing willingness to contribute personal data. This strategy, as currently presented in public health literature, has serious shortcomings. But it can be augmented by appealing to the philosophical analysis of the concept of trust. Philosophers distinguish trust and trustworthiness from cognate attitudes, such as confident reliance. Central to this is value congruence: trust is grounded in the perception of shared values. So, the way to build trust in institutions responsible for health data is for those institutions to develop and display values shared by the public. We defend this approach from objections, such as that trust is an interpersonal attitude inappropriate to the way people relate to organisations. The paper then moves on to the practical application of our strategy. Trust and trustworthiness can reduce privacy concerns and increase willingness to share health data, notably, in the context of internal and external threats to data privacy. We end by appealing for the sort of empirical work our proposal requires.

BACKGROUND:The ability to successfully transfer knowledge across international boundaries to improve health across the European Region is dependent on an in-depth understanding of the many factors involved in policy creation. Across countries we can observe various approaches to evidence usage in the policy-making process. This study, which was a part of the Models of Child Health Appraised (MOCHA) project assessing patterns of children's primary care in Europe, focused on how and what kind of evidence is used in child health policy-making processes in European countries and how it is applied to inform policy and practice.METHOD:In this study, a qualitative approach was used. The data were analysed in accordance with the thematic analysis protocol. The MOCHA project methodology relies on experienced country agents (CA) recruited for the project and paid to deliver child health data in each of 30 European countries. CAs are national experts in the child health field who defined the country-specific structured information and data. A questionnaire designed as a semi-structured survey instrument asked CAs to indicate the sources of evidence used in the policy-making process and what needed to be in place to support evidence uptake in policy and practice.RESULTS:In our data we observed two approaches to evidence usage in child health policy formulation. The scientific approach in our understanding refers to the so-called bottom-up initiatives of academia which identify and respond to the population's needs. Institutional approaches can be informed by scientific resources as well; however, the driving forces here are governmental institutions, whose decisions and choices are based not only on the population needs but also on political, economic and organizational factors. The evidence used in Europe can also be of an external or internal nature. Various factors can affect the use of evidence in child health policy-making. Facilitators are correlated with strong scientific culture development, whereas barriers are defined by a poor tradition of implementing changes based on reliable evidence.CONCLUSIONS:Focusing on the facilitators and actively working to reduce the barriers can perceivably lead to faster and more robust policy-making, including the development of a culture of scientific grounding in policy creation.

Aim: Antimicrobial resistance (AMR) is one of the major health challenges of the future, but the concrete impact of counteracting measures is still unclear. To study possible outcomes within the European Union, a scenario analysis for the year 2050 was performed on the possible influence of the European Commission (EC). Methods: Scenario planning and development of strategies based on different scenarios. Results: Rational use of antimicrobials in animals and humans, surveillance and monitoring, new antimicrobial therapies, travel and globalization, exposure to the environment, and awareness were recognized as the main driving elements. Four Scenarios were developed: An efficient and impli-cated EC sorts out AMR; An implicated but unsuccessful EC withstands AMR; AMR is managed regardless of the EC disinterest; and A neutral and inefficient EC fails to manage AMR. Conclusion: All the strategies developed on the basis of the four scenarios probe for an increase in European Union's dedication to achieve positive outcomes. These include the development of effective legislation and international coordination. Acknowledgment: Peter Schröder-Bäck, Helmut Brand and Kiranjeet Kaur’s contribution is co-funded through a grant of the European Commission within the Erasmus+ programme (Project: Prevent it. Project reference: 598515-EPP-1-2018-1-IN-EPPKA2-CBHE-JP). Conflict of interests: None declared.

ZusammenfassungDieser Beitrag stellt aus ethischer Perspektive Herausforderungen für die polizeiliche Arbeit zur Zeit der „Coronakrise“ in Deutschland dar. Spannungsfelder der konkreten (alltäglichen und möglichen) Polizeiarbeit vor dem Hintergrund dieser Pandemie werden ebenso beschrieben wie moralische Normen und Werte sowie ethische Theorien, die berufliches Polizeihandeln und die Setzung staatlicher Rahmenbedingungen für polizeiliches Handeln in dieser Phase leiten können und sollen. Public-health-ethische Ansätze werden dabei mit Perspektiven der polizeilichen Berufsethik kohärent integriert. Die Priorisierung von knappen Ressourcen, darunter auch Vakzinen, wird diskutiert und es wird argumentiert, dass es aus ethischer Sicht gute Gründe gibt, Polizistinnen und Polizisten bei der Verfügbarwerdung sicherer und effektiver Impfstoffe eine hohe Prioritätsstufe zu geben.

BACKGROUND:Evidence about the magnitude and determinants of medication intake adherence among patients and the general population in Southeastern Europe is scant.AIMS:To assess the prevalence and sociodemographic correlates of medication intake adherence among adult primary health-care (PHC) users in Albania.METHODS:A cross-sectional study was conducted in 2018-2019 in a representative sample of 1553 adult PHC users (response: 94%) selected probabilistically from 5 major regions of Albania. There were 849 (55%) women and 704 (45%) men, with a mean age 54.6 (16.4) years. A structured interviewer-administered questionnaire inquired about medication intake adherence prescribed by family physicians, and sociodemographic characteristics. Binary logistic regression was used to assess the sociodemographic correlates of medication intake adherence.RESULTS:Three hundred (19.8%) participants did not take the prescribed medication. In multivariable-adjusted logistic model, significant correlates of nonintake of medication included rural residence, low educational level, unemployment and low economic level. Among these 300 participants, 273 (91%) considered the high cost of the drugs as a reason for not taking the medication.CONCLUSION:We found a high prevalence of nonintake of medication prescribed by family physicians. Decision-makers and policy-makers in Albania and elsewhere should consider the provision of essential drugs free of charge or at low cost to low socioeconomic groups and other vulnerable and marginalized population categories, because the costs of noncompliance will eventually be higher.