Minutes of the meeting held on 18 July 2006
Fri, 1 December 2006
NUFFIELD COUNCIL ON BIOETHICS WORKING PARTY ON PUBLIC HEALTH: ETHICAL ISSUES
Minutes of the meeting held at the Nuffield Foundation 28 Bedford Square, London WC1B 3JS on Friday 18 July 2006
PRESENT
Professor Sir John Krebs FRS (Chair)
Dr Raghib Ali
Professor Sir Kenneth Calman KCB FRCS DL FRSE
Professor Tom Baldwin
Professor Roger Brownsword
Professor Christine Godfrey
Professor Trisha Greenhalgh OBE
Professor Sally Macintyre OBE FRSE CBE
Professor Jonathan Montgomery
Ms Julia Unwin OBE CBE
APOLOGIES
Professor Anne Johnson FMedSci
Professor Sandy Thomas
SECRETARIAT
Mr Harald Schmidt, Ms Catherine Joynson, Ms Julia Trusler
INTRODUCTION BY THE CHAIR
1 The Chair welcomed the members of the Working Party, set out the aims of the meeting and reported on progress in the distribution of the consultation document, and on the collaboration with Ecsite.
MINUTES OF THE THIRD MEETING
2 The minutes were approved.
MATTERS ARISING
3 The Chair confirmed the date for the extra fact-finding meeting with experts on vaccination, alcohol and smoking in October 2006, and dates for the remaining meetings in 2007.
DISCUSSION OF DRAFT REPORT
Chapter 6 Smoking and alcohol
4 Professor Christine Godfrey provided a brief introduction to the chapter. In its present form the emphasis was on ‘scene-setting’ and less on seeking to argue particular points. The chapter started by justifying why these case studies had been chosen, went on to describe patterns of use, and then described different types of harms to others. An area that could possibly be explored further was differences in the public acceptance of policies on alcohol and smoking. In the discussion, a number of points were made, including those below.
5 The section on “scientific evidence” should be revised to comment more explicitly on what is known (a) about the causes that make people drink and smoke; (b) the health-related effects of drinking and smoking; (c) the policy options that might be developed in view of (a) and (b) and the evidence for their efficacy
6 The policy sections should also comment on public attitudes to different policy options (those currently implemented and those that might be implemented in the future), and on constraints on public attitudes arising from these. Other constraints (technical, economic, etc feasibility) should also be considered. International differences on the consumption of alcohol should be addressed.
7 Concerning benefits of smoking and alcohol, the role of ‘social glue’, especially in the case of alcohol, should be expanded. Discussion should be added on possible differences that might arise in a scenario where a total ban on smoking and alcohol was put in place – what would be ‘lost’?
8 It should be examined whether it was useful to differentiate between public order and public health concerns raised by smoking and alcohol. It appeared that in the case of alcohol, people were often more concerned with the former than with the latter. The special case of binge drinking should be addressed.
Chapter 5 Obesity
9 The Chair thanked members for their useful comments at the last meeting and reviewed the structure of the revised chapter. After a section on ‘facts and figures’ the point was made that evidence for why exactly people had, on average, gained weight was scant. The chapter considered the extent of harm caused and the role of different players involved. The question of whose responsibility it was to bring about change was discussed, and the table on page 10 illustrated the difficulties. After a brief section on economic issues some conclusions were sketched. In the discussion, the following points were made:
10 The discussion on self-harm and harm to others should be expanded. Could obesity ever be seen purely as self-harm? If so, would this be a public health issue?
11 The discussion of the role of obesogenic environments should be developed further, and the section on the importance and role of exercise should be strengthened, considering also the role of urban planning and design and practices such as driving children to school.
12 In the policy section, options of interventions and associated degrees of acceptability should be expanded. Psychosocial and legal issues surrounding ‘fat is the new race issue’ or ’fatism’ should be addressed (discrimination, stigmatisation, shame). Recent developments in the US might be analysed.
13 In the policy and/or ethics (sub-)section, drafting should be added on ‘the ethics of refusing/withholding treatment’ for obese people. One example that might be addressed would be the decision of the Suffolk PCT regarding hip and knee replacements. Discussion should be added on the conditions required to make such measures acceptable (if at all). Counselling would appear to play a role.
Chapter 2 Historical and socio-economic factors influencing public health
14 Professor Sally Macintyre described the structure of the chapter, as revised. After a general introduction each case study was addressed, followed by issues concerned with gender and ethnicity. Policy matters were addressed in the following section. It was highlighted that some case studies were especially complex, and did not follow commonly assumed intuitions. For example, the formula ‘health worsens with lower socio-economic status’ was not universally true in the case of alcohol and obesity. Professor Sir John Krebs had contributed new drafting on risk, evidence, uncertainty and choice, and Professor Trish Greenhalgh added a commentary.
15 Members agreed that Chapters 1 and 2 should remain distinct, but that Chapter 2 should be shortened. The decision on whether or not to move the more applied discussion relating to the case studies in the respective chapters was deferred. Drafting or a box could be added on the way the government had addressed public health issues in its various White Papers – it appeared that ‘personal responsibility’ was emphasised as early as 1976.
ANY OTHER BUSINESS
16 There was none.
Last Updated Fri, 15 December 2006