 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
David R. Buchanan, DrPH, Cancer Prevention Fellowship Program, National Cancer Institute, 6130 Executive Blvd, Suite 3109, Bethesda, MD 20892, 301-594-1578, buchanad@mail.nih.gov
The potential risks of paternalism and coercion are serious ethical problems in health promotion programs designed to alter people’s behaviors, e.g., weight control, drug control, smoking cessation, teen birth control, alcohol control, exercise regimens, and violence prevention. Childress et al recently identified five criteria, or “justificatory conditions,” to determine whether or when public health interventions that infringe on other values such as individual autonomy are ethically acceptable. These criteria are: 1) effectiveness, 2) proportionality, 3) necessity, 4) least infringement, and 5) public justification. After describing these criteria, the presentation will examine the current state of health promotion programs and argue that the vast majority of behavior change programs fail to achieve these ethical standards. The shortcomings of these programs are then related to an over-emphasis on the value of effectiveness and the priority given to experimental research designs (randomized control trials) in setting research priorities. An alternative approach to health promotion research and practice will then be described, based on maximizing democratic participation in determining both the ends and the means of public health programs. The paper concludes with a discussion of the potential for participatory action research and other methods of self-help, mutual support, and social solidarity for fulfilling these ethical mandates more satisfactorily.
Learning Objectives:
Keywords: Ethics, Behavior Modification
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: N/A
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.