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This commentary takes up a challenge posed by Franklin Miller in a 2022 essay in Bioethics Forum. Dr. Miller queried whether bioethicists could be useful in public health policy contexts and while he refrained from issuing an ultimate opinion, did identify several challenges to such utility. The current piece responds to the challenges Dr. Miller identifies and argues that with appropriate training, public health ethicists can be of service in virtually any context in which public health policies are deliberated and decided.

Competing Interests: Competing interests: None declared.

The primary claim of this paper is that a widely used argument against obstructing, curtailing, or eliminating deep physician-industry relationships is deficient. The typical argument critiqued requires that proof that physician-industry relationships cause harm flows from randomized controlled trials. Chief among the deficiencies in this claim is the fact that this specific demand for proof of harm essentially guts the precautionary principle. In so doing, the typical argument neuters the basic justification for public health action. In place of this fallacious move, the paper argues that proof of harm can be demonstrated via evidentiary standards widely accepted within the knowledge communities of public health scientists and epidemiologists. The paper concludes by noting that while there may be good reasons to oppose curtailment of deep physician-industry relationships, the typical argument described here is not among them.

Application of fundamental cause theory to Powers and Faden's model of social justice highlights the ethical superiority of upstream public health interventions. In this article, I assess the ramifications of fundamental cause theory specifically in context of public health priority setting. Ethically optimal public health policy simultaneously maximizes overall population health and compresses health inequalities. The fundamental cause theory is an important framework in helping to identify which categories of public health interventions are most likely to advance these twin goals.

The framing of the risks of experiencing mild traumatic brain injury in American football and ice hockey has an enormous impact in defining the scope of the problem and the remedies that are prioritized. According to the prevailing risk frame, an acceptable level of safety can be maintained in these contact sports through the application of technology, rule changes, and laws. An alternative frame acknowledging that these sports carry significant risks would produce very different ethical, political, and social debates., (© 2014 American Society of Law, Medicine & Ethics, Inc.)

I criticize the concern over the politicization of public health policy as a justification for preferring a narrow to a broad model of public health. My critique proceeds along 2 lines. First, the fact that administrative structures and actors are primary sources of public health policy demonstrates its inescapably political and politicized nature. Second, historical evidence shows that public health in Great Britain and the United States has from its very inception been political and politicized. I conclude by noting legitimate ethical concerns regarding the political nature of public health policy and argue that open deliberation in a democratic social order is best served by acknowledging the constraints of the inescapably politicized process of public health policymaking.

BACKGROUND: Ambient nitrogen dioxide (NO2) and fine particulate matter with aerodynamic diameter ≤2.5 μm (PM2.5) threaten public health in the US, and systemic racism has led to modern-day disparities in the distribution and associated health impacts of these pollutants. OBJECTIVES: Many studies on environmental injustices related to ambient air pollution focus only on disparities in pollutant concentrations or provide only an assessment of pollution or health disparities at a snapshot in time. In this study, we compare injustices in NO2- and PM2.5-attributable health burdens, considering NO2-attributable health impacts across the entire US; document changing disparities in these health burdens over time (2010– 2019); and evaluate how more stringent air quality standards would reduce disparities in health impacts associated with these pollutants. METHODS: Through a health impact assessment, we quantified census tract-level variations in health outcomes attributable to NO2 and PM2.5 using health impact functions that combine demographic data from the US Census Bureau; two spatially resolved pollutant datasets, which fuse satellite data with physical and statistical models; and epidemiologically derived relative risk estimates and incidence rates from the Global Burden of Disease study. RESULTS: Despite overall decreases in the public health damages associated with NO2 and PM2.5, racial and ethnic relative disparities in NO2-attributable pediatric asthma and PM2.5-attributable premature mortality have widened in the US during the last decade. Racial relative disparities in PM2.5-attributable premature mortality and NO2-attributable pediatric asthma have increased by 16% and 19%, respectively, between 2010 and 2019. Similarly, ethnic relative disparities in PM2.5-attributable premature mortality have increased by 40% and NO2-attributable pediatric asthma by 10%. DISCUSSION: Enacting and attaining more stringent air quality standards for both pollutants could preferentially benefit the most marginalized and minoritized communities by greatly reducing racial and ethnic relative disparities in pollution-attributable health burdens in the US. Our methods provide a semi-observational approach to track changes in disparities in air pollution and associated health burdens across the US. [ABSTRACT FROM AUTHOR]

Despite improvements in ambient air quality in the US in recent decades, many people still experience unhealthy levels of pollution. At present, national‐level alert‐day identification relies predominately on surface monitor networks and forecasters. Satellite‐based estimates of surface air quality have rapidly advanced and have the capability to inform exposure‐reducing actions to protect public health. At present, we lack a robust framework to quantify public health benefits of these advances in applications of satellite‐based atmospheric composition data. Here, we assess possible health benefits of using geostationary satellite data, over polar orbiting satellite data, for identifying particulate air quality alert days (24hr PM2.5 > 35 μg m−3) in 2020. We find the more extensive spatiotemporal coverage of geostationary satellite data leads to a 60% increase in identification of person‐alerts (alert days × population) in 2020 over polar‐orbiting satellite data. We apply pre‐existing estimates of PM2.5 exposure reduction by individual behavior modification and find these additional person‐alerts may lead to 1,200 (800–1,500) or 54% more averted PM2.5‐attributable premature deaths per year, if geostationary, instead of polar orbiting, satellite data alone are used to identify alert days. These health benefits have an associated economic value of 13 (8.8–17) billion dollars ($2019) per year. Our results highlight one of many potential applications of atmospheric composition data from geostationary satellites for improving public health. Identifying these applications has important implications for guiding use of current satellite data and planning future geostationary satellite missions. Plain Language Summary: The systems historically used to monitor air pollution in the US have insufficient spatial coverage to observe all air pollution events. For example, smoke from western wildfires varies rapidly in space and time, making smoke‐sourced pollution difficult to track with surface monitors (spatially limited) or global satellites temporally limited to one daily snapshot. Here, we show that new satellites capturing hourly pollution changes over one world region can identify more person‐alerts (population × poor air quality alert days) in the US, compared with global satellites, enabling the public to take action to reduce exposure and avoid health consequences. Our results illustrate the health and economic benefits of one pathway to improve the integrated air pollutant monitoring strategy in the US. Key Points: Geostationary satellite data are able to identify 60% more person‐alerts (people × PM2.5 alerts) than polar‐orbiting satellite dataUse of geostationary, over polar obiting, satellite data to inform public action on PM2.5 alert days could avert an estimated 1,200 deathsPM2.5 health impacts averted by individual action on geostationary satellite identified alert days are valued at $13 billion ($2019) [ABSTRACT FROM AUTHOR]

Policy PointsMedicalization is a historical process by which personal, behavioral, and social issues are increasingly viewed through a biomedical lens and "diagnosed and treated" as individual pathologies and problems by medical authorities.Medicalization in the United States has led to a conflation of "health" and "health care" and a confusion between individual social needs versus the social, political, and economic determinants of health.The essential and important work of population health science, public health practice, and health policy writ large is being thwarted by a medicalized view of health and an overemphasis on personal health services and the health care delivery system as the major focal point for addressing societal health issues and health inequality.Increased recognition of the negative consequences of a medicalized view of health is essential, with a focus on education and training of clinicians and health care managers, journalists, and policymakers. [ABSTRACT FROM AUTHOR]

If funding allocation is an indicator of a field's priorities, then the priorities of the field of bioethics are misaligned because they perpetuate injustice. Social justice mandates priority for the factors that drive systematic disadvantage, which tend not to be the areas supported by funding within academic bioethics. Current funding priorities violate social justice by overemphasizing technologies that aim to enhance the human condition without addressing underlying structural inequalities grounded in racism, and by deemphasizing areas of inquiry most frequently pursued by Scholars of Color. This lack of attention to upstream determinants of health in bioethics research perpetuates a gap in the resources needed to understand the experiences of communities disproportionately experiencing poor health, which is itself a form of epistemic injustice. Both social and epistemic injustices are apparent in the impact of these funding priorities on people of color, both in the public and in the bioethics community. [ABSTRACT FROM AUTHOR]

The article presents the discussion on e-cigarettes not reducing the harms associated with tobacco consumption. Topics include public health ethics and population-level bioethics specifically focusing on the enormous burdens of noncommunicable disease; and field of public health law being the law in major social determinant of health.

Five international consensus statements on concussion in sports have been published. This commentary argues that there is a strong need for a new approach to them that foregrounds public health expertise and patient-centered guidance. Doing so will help players, parents and practitioners keep perspective about these potentially life-altering injuries especially when they recur. [ABSTRACT FROM AUTHOR]

Public health agencies regularly survey randomly selected anonymous students to track drug use, sexual activities, and other risk behaviors. Students are unidentifiable, but a recent project that included school-level analysis discovered a school with alarmingly prevalent student suicidality. Given confidentiality protocols typical of surveillance, the surveyors were uncertain whether and how to intervene. We searched literature for duties to warn at-risk groups discovered during public health surveillance, but we found no directly applicable guidance or cases. Reasoning by analogy, we conclude that surveyors should contact the school's leaders to call attention to its outlier status, but public warning is unwarranted. However, such an ad hoc decision to issue a warning, even if only to school leaders, raises significant practical, legal and ethical issues. National public health and education associations should produce guidance that clarifies ethical and legal duties owed to schools and students involved in population health-risk surveillance. [ABSTRACT FROM AUTHOR]

Pain policy is not drug policy. If society wants to improve the lives of people in pain and compress the terrible inequalities in its diagnosis and treatment, we have to tailor policy to the root causes driving our problems in treating pain humanely and equitably. In the United States, we do not. Instead, we have proceeded to conflate drug policy with pain policy, relying on arguably magical thinking for the conclusion that by addressing the drug overdose crisis, we are simultaneously addressing the pain crisis. This is a category error, decades of commitment to which have resulted mostly in a worsening of both public health problems. Disentangling our problems in treating pain fairly and equitably from our problems with drugs and substance use is the only path to humane and ethical policy for each. [ABSTRACT FROM AUTHOR]

The primary claim of this paper is that intellectual conflicts of interest (COIs) exist but are of lower ethical priority than COIs flowing from relationships between health professionals and commercial industry characterized by financial exchange. The paper begins by defining intellectual COIs and framing them in the context of scholarship on non-financial COIs. However, the paper explains that the crucial distinction is not between financial and non-financial COIs but is rather between motivations for bias that flow from relationships and those that do not. While commitments to particular ideas or perspectives can cause all manner of cognitive bias, that fact does not justify denying the enormous power that relationships featuring pecuniary gain have on professional behaviour in term of care, policy, or both. Sufficient reason exists to take both intellectual COIs and financial COIs seriously, but this paper demonstrates why the latter is of higher ethical priority. Multiple reasons will be provided, but the primary rationale grounding the claim is that intellectual COIs may provide reasons to suspect cognitive bias but they do not typically involve a loss of trust in a social role. The same cannot be said for COIs flowing from relationships between health professionals and commercial industries involving financial exchange. The paper then assumes arguendo that the primary rationale is mistaken and proceeds to show why the claims that intellectual COIs are more significant than relationship-based COIs are dubious on their own merits. The final section of the paper summarizes and concludes. [ABSTRACT FROM AUTHOR]

This paper addresses the relevance of medical folklore for vaccine policy intended to increase vaccination uptake. There are two primary claims of this paper: First, that dominant approaches to increasing US vaccination uptake have largely been based on deficient understandings of the root causes of anti-vaccination behavior; and second, that superior approaches to evidence-based policy must enlarge the scope of that evidence base to include crucial findings on belief formation, technical, and risk communication, and the folklore of vaccination. The failure to attend to this evidence results in interventions that are disconnected from the factors actually driving vaccination refusal. The paper describes the deficiencies in dominant approaches, and based on its analysis of the root causes of anti-vaccination behavior recommends superior evidence-based policies that emphasize upstream structural determinants of health behaviors. [ABSTRACT FROM AUTHOR]

This article defends a broad model of public health, one that specifically addresses the social epidemiologic research suggesting that social conditions are primary determinants of health. The article proceeds by critiquing one of the strongest arguments in favor of a narrow model, advanced by Mark Rothstein. The critique sets up the argument that a model of public health that does not address what actually causes health and disease is unlikely to improve public health. Assessing the substantial evidence regarding the social determinants of health, the article engages the policy paradox that precludes utopian prescriptions but demands more than mere expedience. [ABSTRACT FROM PUBLISHER]

Human ecology has played an essential role in the spread of mosquito-borne diseases. With standing water as a significant factor contributing to mosquito breeding, artificial containers disposed of as trash—which are capable of holding standing water—provide suitable environments for mosquito larvae to develop. The development of these larvae further contributes to the possibility for local transmission of mosquito-borne diseases in urban areas such as Zika virus. One potential solution to address this issue involves leveraging unmanned aerial vehicles that are already systematically becoming more utilized in the field of geospatial technology. With higher pixel resolution in comparison to satellite imagery, as well as having the ability to update spatial data more frequently, we are interested in investigating the feasibility of unmanned aerial vehicles as a potential technology for efficiently mapping potential breeding grounds. Therefore, we conducted a comparative study that evaluated the performance of an unmanned aerial vehicle for identifying artificial containers to that of conventionally utilized GPS receivers. The study was designed to better inform researchers on the current viability of such devices for locating a potential factor (i.e., small form factor artificial containers that can host mosquito breeding grounds) in the local transmission of mosquito-borne diseases. By assessing the performance of an unmanned aerial vehicle against ground-truth global position system technology, we can determine the effectiveness of unmanned aerial vehicles on this problem through our selected metrics of: timeliness, sensitivity, and specificity. For the study, we investigated these effectiveness metrics between the two technologies of interest in surveying a study area: unmanned aerial vehicles (i.e., DJI Phantom 3 Standard) and global position system-based receivers (i.e., Garmin GPSMAP 76Cx and the Garmin GPSMAP 78). We first conducted a design study with nine external participants, who collected 678 waypoint data and 214 aerial images from commercial GPS receivers and UAV, respectively. The participants then processed these data with professional mapping software for visually identifying and spatially marking artificial containers between the aerial imagery and the ground truth GPS data, respectively. From applying statistical methods (i.e., two-tailed, paired t-test) on the participants' data for comparing how the two technologies performed against each other, our data analysis revealed that the GPS method performed better than the UAV method for the study task of identifying the target small form factor artificial containers. [ABSTRACT FROM AUTHOR]

I agree entirely with Nir Eyal's perspective that denying treatment to obese patients is morally wrong. However, the reasons for this belief differ in some ways from Eyal's analysis. In this commentary, I will try to explain the similarities and differences in our perspectives. My primary claim is that the denial of treatment to obese patients is wrong principally because (i) it eschews a whole-population approach to the problem of poor nutrition and is therefore likely to be ineffective; (ii) it is likely to expand obesity-related health inequities; and (iii) it is likely to intensify stigma against already-marginalized social groups. I shall consider each in turn, and explore the extent to which Eyal would be likely to agree with my claims. [ABSTRACT FROM AUTHOR]

Letters to the editor referring to a recent Journal article are encouraged up to 3 months after the article's appearance. By submitting a letter to the editor, the author gives permission for its publication in the Journal. Letters should not duplicate material being published or submitted elsewhere. The editors reserve the right to edit and abridge letters and to publish responses. Text is limited to 400 words and 10 references. Submit online at www.editorialmanager.com/ajph for immediate Web posting or at ajph.edmgr.com for later print publication. Online responses are automatically considered for print publication. Queries should be addressed to the Editor-in-Chief, Mary E. Northridge, PhD, MPH, at men6@nyu.edu. [ABSTRACT FROM AUTHOR]