Roles and Responsibilities of Government Towards the Public Health of Citizens - Essay Example

of Affiliation Introduction Public health, ideally, refers to a collective responsibility by people that seeks to promote and protect the health of a particular population. Institute of Medicine (IOM) defines this initiative as “what we, as a society, do collectively to assure the conditions in which people can be healthy” (IOM 1988, pg 56). In many instances, though not exclusively, the government plays the leading role in the collective interventions that seek to ensure population health. In the United Kingdom, for example, the Department of Health and its affiliated agencies work collaboratively to ensure public health. Public Health in England operates through its established four regions and 15 centres while performing the many different functions including collection of epidemiological information to help perform a population inspection for diseases and inspection of food service offered commercially (Holland, 2007 pg, 56-57). Collective initiatives in the U.K public health serve to protect and promote population health, a factor that is also exemplified in the wider global population through WHO activities. One approach presents the basic challenges of public health ethics in a different way by suggesting that public health moral foundation only seeks to achieve social justice. Here, public health approach is seen as seeking to not only balance individual liberties and promote social good for all but also depicts a broader commitment of securing the best possible heath levels for all in addition to narrowing the unjust inequalities(Powers & Faden, 2006, pg 18). Consequently, the other area of concern that depicts great importance is balancing of injunctions and the commitment to capitalize on results of collective heath. With such an understanding, public health ethic then presents a deep moral association to the broader question of poverty, social justice and systematic disadvantage. The other approach to public health ethics presents the public health moral basis as a restriction that seeks to maximize welfare, and thus health as a constituent of welfare (power &faden 2006, pg 7-9). Based on this view, the core moral challenge surrounding the public health subject is seen as balancing the outcomes of good health advancement with the demands of individual liberties. Take for example the manner in which liberties are addressed by government policies that compel persons with active, infectious TB to be treated or that which fluoridate drinking water provided by the municipal. UK citizen’s liberties are founded upon the Human Right Act 1998. This act did not create human rights for Britons, but instead it introduced into their domestic laws a number of rights included in the Universal Declaration of Human Right and related internationally accepted documents. Article 5 of these acts holds what is popularly referred to as “The right to liberty”. According to this article “Everyone has the right to liberty and security of person. No one shall be deprived of his liberty saves in some cases that are well detailed, and the deprivation should follow a procedure prescribed by law” (Right to liberty and security). Having developed the general framework, this work will now proceed with discussion of two ethics framework/models the U.K government needs to apply and why. Here, the work will differentiate between what the government should do and must do; developing an argument founded on the existing case of young people involved in binge drinking. In addition, this work will attempt to analyze the impact of government failure to intervene in the ethical issues raised and further explore the roles of the concerned parties. Lastly, the work provides a comparison between UK, US and /or other European countries that can also be made to explore the title question. The struggle between individual’s liberties and promotion of social good of the U.K population in the larger public health concern presents an unending debate that promises no end soon. On this account, the U.K government needs to adopt the following framework/models that will ensure public health is guaranteed, however proper consideration should be made to avoid overstepping. Ethics framework/models Paternalism is the first model and it refers to interfering with individuals liberty based on their actions with the intentions of promoting or protecting their welfare. In this case, interference is accomplished against the subjects will (Beauchamp, 2010, pg 23-25). Presently, few public health intrusions held in U.K are justified primarily or even exclusively on classic paternalistic reason, although many other public health initiatives may depict paternalistic effects. Paternalistic model is broadly dived into several classes including Weak paternalism, Soft paternalism, and libertarian paternalism. Weak and soft paternalism usually depict interchangeable interpretation, although in some cases they are used to denote dissimilar concepts. The best known interpretation describes this type of paternalism as “as interferences with choices that are compromised with regard to voluntariness or autonomy” (Buchanan, 2008, pg 50-52). In this case, an individual preference, which in most cases contradicts the one held in the spirit of public health, is not accorded a robust respect. This follows the reasoning that such preferences are founded on condition that compromises its voluntariness or autonomy including immaturity or cognitive disability, in few cases, false or ignorance. This model also assumes adaptive preferences as being compromised when considering ones autonomy: such is the case that in some cases young people change their preferences (turn to binge drinking) to adapt to unjust, difficult or undesirable situations such as rejection or poverty. Such preferences depict different standing when compared to those formed under ordinary circumstances and are thus taken as a subject to the interference. It is worth noting that in all these instances, justified intrusions by the government need to be founded on condition of rationality/autonomy that reflect the formation or sustenance of particular preferences. According to soft or weak paternalism, individuals might embrace all kinds of preferences with no attachment to their interests, however they remain unjustifiably interfered with for the reason of the relevant compromising circumstances failing to obtain. Soft paternalism is evoked in the public health policy to validate interventions that prohibit young people to cat on preference for binge drinking. Libertarian paternalism justifies interventions by U.K public health authorities in situations where persons decide and act making it easy for people to act in manners that reflect their best interests, in this case their health. Libertarian paternalism demands satisfaction of two important conditions. First, these interventions should steer individuals in ways that brings the best out of them based on self- assessment. For this reason, Libertarian paternalism shows no attempt that suggests contravention of individuals will. The other requirement is that the intervention not only excessively burden individuals wishing to exercise personal freedom in a manner that is antagonistic to welfare. For this reason, libertarian paternalism is seen as being liberty-preserving thus the name Libertarian. An important argument on paternalism subject is whether intrusion in individuals liberty should be against individuals will. If paternalism requires intrusion of individual’s liberty then libertarian paternalism is incorrectly titled. Taking the view held by public health ethics, this argument is not of great concern and only moral issues handled and how they are validated matter (Dawson, & Verweij, 2007, pg 16). Libertarian paternalism find its significance in the broad empirical literature proposed by decision sciences and cognitive psychology that support claims made about our bounded rationality, cognitive limitation and weakness of will. While it raises challenging political and epistemic questions on how the Government health agencies know what persons judge is in their best interest in particular situations, Libertarian paternalism fits in the public health situations that depict a broad public agreement supporting health –promoting acts young people staying drug-free. This model further holds a general view that it is hard for individuals to behave as prudentially as they really desire. Critics of Libertarian paternalism have faulted its applicability for failing to address the manipulative impacts on choice of particular market place drives. Additionally, this approach has been found to be having conditions that are too restrictive (hence too weak) to be adequate or applicable in many situations handled with regard to Public health. (Nuffield Council on Bioethics 2007; Ubel 2009, pg 78-80). The other model is what has come to be commonly known as “harm principle.” This model come be known following John Stuart Mills literature on public health ethics back in 1860s. According to this model it is permissible for the government to interfere with individuals liberty, against his/her will, when the activities being observed are seen as causing harm to others. The harm principle/model is relied upon when justifying actions taken against certain behaviors such as binge drinking amongst young people. When viewed in respect to liberal democracies, this model presents a more compelling excuse for public health policies known to infringe individual’s liberty. For instance, a prominent view in the U.K is that it was not until the general public became convinced of the detriments of anti social behaviors, economic burden as well as rising disease burden, that first significant intervention over Binge drinking, banning of binge drinking amongst young people became politically viable (Faden, 2007, pg 67). In part, this may have followed the model’s broad persuasiveness; it is usually the case that appeals are made concerning harm to others in such obvious contexts. Proponents of obligatory motorcycle helmets laws, for instance, argue that the severity of head injuries sustained by drunk, unprotected cyclists forced emergency room personnel’s to divert their limited resources and thus harm other patients (Jones & Bayer 2007, pg 102 ). Harm model has been understood to include well known threats that cause considerable economic harm to the general public and at the same time cause physical harm. Going back to binge drinking amongst young people, various prohibitions on the behaviors of alcoholics have been necessitated by appeal to the financial strain on the health care scheme for alcohol –related illnesses. Similarly to other models of such nature, questions about its specifications cannot be overlooked. These questions include; how serious must the problem be, when looking at the magnitude of its effect and its likelihood? Should the physical harm caused on the public health be given priority over the economic harm or related setback to interests? Irrespective of its interpretation, broadly or narrowly, public health cases should always depicts boundaries that can reasonably fall within the boundaries of harm model. Additionally, in the view of commitment to general welfare and social justice, and related justifications discussed above, government should never take an exclusive approach on the harm principle. Such is the case that such an approach will obviously undermine otherwise justifiable individuals liberties. On the other hand, the government should avoid approaches to this model that would undermine otherwise permissible government regulations and mandates. It is indisputable that individuals depict a much wider and more multi-facet interests when compared to narrowly self-driven physical ones. Consequently, it is advisable to encourage a fairly expansive interpretation of ‘ham’ with regard to public health position. Model Analysis These models were chosen because as opposed to other models they depict well defined boundaries found to apply well while handling people’s liberties. In both cases the government can only step in when, a person’s behavior is proven beyond doubt to be detrimental to his/her well being (in the case of paternalism) and that of others (harm principle). The two models present the best approach to handling cases of binge drinking among young children in the UK bearing in mind that such behavior does interfere with both their individual life and that of others. These two models also present another advantage of using Voluntary measure, a factor that makes them appealing to the cooperation of both the community and the particular people at risk. Voluntary approach in matters of public health has been found to be consistent with supporting UK teens to stop involving themselves in Binge drinking. Here, the two approaches encourage the targeted people to seek identify counsel and prescribe treatment and thus offer a lasting remedy. This is in contrast to approaches that offer a short time remedy and fail to tackle the problem from its roots. Writing about these approaches Goodman, (2006) says, “If a single value could be extrapolated from these traditions, it is that individuals are autonomous and have a strong claim to make decisions for themselves. Thus, if a person has the capacity to understand the nature and purposes of the decision at hand, she has an interest in making her own choice without any outside interference.” Impact of government failure to intervene in the ethical issues addressed U.K government has the mandate of ensuring a good public health for its population. Based on previous discussion, this initiative requires some level of interference with personal liberty, a factor that has and will always meet strong oppositions from supporters of personal liberty. Sadly, government failure to address these ethical issues in the most appropriate has varying effects to the government, the general public and the subject persons (young binge drinkers). For the government there are two sides to this issue; (1) the government decides to interfere with binge drinking among the young people without taking note of the individual liberties (2) the government allows the teen binge drinkers carry on with their unwelcomed behavior. In the first case, the government is bound to create a new trend where young people take on secrete drinking habits. Here, the government should not just employ force in accomplishing its agenda but instead it should engage the young population, teaching them the dangers of alcohol. For the second case, where the government fails to address the binge drinking, the results will be wide spread both to the government, the youths and the general public (Goodman, 2006, pg 33). To begin with, the government will be forced to meet huge costs of medication resulting from injuries, accidents and diseases related to binge drinking. Astonishing short- and long-term consequences have been reported with regard to underage alcohol with their impacts. These effects differ based on their range and magnitude. Based on the 2011/12 Crime Survey for England and Wales, 917,000 violent incidents were reported where the injured party believed the offender(s) was/were under the influence of alcohol (Feinberg, 2006, pg 44-50). This figure accounted for the 47% of all violent offences reported that year. Another effect regard the later cost of rehabilitating persons addicted to alcohol, a case that would have been avoided if appropriate measures are taken at an early stage. The youth carry the greater effects this failure contribute an increased sensation-seeking, risk-taking and erratic manners contributing to cases of violence, risky sexual behavior, unintentional injuries, homicide, and suicide. The most common of all is the risky sexual behavior that includes unintended, unwanted, and unprotected sexual affairs and sex with multiple partners. Such manners raise the risk of unplanned pregnancy and cases of sexually transmitted diseases, including HIV and AIDS The general public also feels the pinch of this failure as parents and relatives feel the pain of losing their young ones due to binge drinking. Additionally, it is the larger society that carries the burden of while putting up with the erratic behaviors from young binge drinkers. Collective Action/Efficiency Public health is a collective responsibility that seeks to benefit the general population. Pursuit of public health requires foundational rules that will guide the action involved and also allow near-universal participation. Based on this statement, public health is thus viewed as “having the structure of a coordination or collective efficiency problem” (Daniels, 2008, pg 28) In the case of binge drinking among the young people, it is the collective responsibility of both the government and the general public to ensure reduction and if possible eradication of this behavior. The government can help in the following ways: Educating young people on dangers of binge drinking. Presently UK government carries out a wide spread awareness/education programs and communication to address young people in schools and the general society. Through such program the government seeks to achieve a sustainable change in attitudes towards binge drinking. Establishment of a good health care system to address drinking problem among the young people and thus avoid future problems associated with alcohol addiction. The government through its law enforcing officers should address cases of alcohol related crimes and disorders, a factor that will stop the city and town problems ensuing from alcohol abuse. Lastly, the government should work hand in hand with alcohol industries and retailers and come up with plans that will ensure young people are not accessing alcohol (Benatar, 2002, pg 114). The general public that includes the parents, teachers, alcohol retailers and even religious leaders have their role to play. Such is the case that this group bears the greatest responsibility since they are always in contact with young people. This group, especially the elderly can play their role well when leading as role models for the young people. It should be the responsibility of each of these people to advice young people on the dangers of such behaviors. Parents should pay close attention to their children needs ensuring they know their whereabouts and correct them whenever they sense they are going astray. In all these cases , it will be prudent to know that at their age these young people may not really use well their personal liberties and as such all these parties have the responsibility to provide guidance and where possible correction. Comparison between UK, US and /or other European countries A comparison between UK, US and /or other European countries regarding the Government roles and responsibilities towards public health of its citizens and in particular children reveals amazing report. To better understand this it will be good to consider cases of binge drinking among the youths of these countries. According to one research provided by ESPAD (European School survey Project on Alcohol and Other Drugs), UK is third after Denmark and the Isle of Man (Understanding Society the UK Household Longitudinal Study). This report clearly depicts weaknesses in the UK government policies on public health. This report that was conducted in four waves;1995,1999,2003 and 2007 and included students from several secondary schools established that cases of binge drinking was much rampart in the two countries as well as in some other countries like Ireland, Belgium and Netherlands which are located in North Europe . Southern European countries depicted a lower rate. Here, UK, Denmark and Isle of Man scored highly on both unit-based heavy episodic drinking measures as well as in subjective self assessed drunkenness measure. Furthermore, this report established less negative and more positive attitudes to alcohol (HIbell et al, 2009, pg 20). Comparing UK and US, the latter is seen as faring poorly based on the same case of teen Binge drinking. According to a study conducted by the US U.S. Department of Justice, Office of Justice Programs and Office of Juvenile Justice and Delinquency Prevention United States and Europe many cases, the percentage of teens reporting drinking four or more drinks within in a row is much higher compared to that depicted in US. Here, Only Portugal (14%) depicted a considerably lower rate compared to US (24%). It is important to note that US rates still remain lower than that depicted by other European countries such as Greece (33 %), Italy (31%), and Spain (39%), countries located on the southern part of Europe. Conclusion Public health is a sensitive part of any population and as such issues raised with regard to this subject should always take priority in the UK government planning. It is true that public health issues raise some ethical problems, particularly regarding peoples liberties, that the government should tackle amicably. Using the two modalities, namely Paternalism and harm principle, the UK government can successfully balance the demands of individual liberties and the desire to promote social good for all. Looking at UK public health based on the issue of binge drinking among UK teens, it is clear that the government has much to do on its roles and responsibilities towards the public health of its citizens and in particular children. REFERENCE Britains binge drinking levels are among the highest in the world,2014, May 13, Retrieved November 22, 2014, from http://www.telegraph.co.uk/health/healthnews/10825449/Britains-binge-drinking-levels-are-among-the-highest-in-the-world.html Beauchamp, T, 2010, The concept of paternalism in biomedical ethics. In Beauchamp, T., Standing on principles. (pp. 101–119). New York: Oxford University Press. 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