Lecture 9 (Wednesday, November 7, 2012) – Public Health
World limit: 1800 max
Only reputable secondary sources
Killed more people than all wars
Still cause of majority of death in low income countries
Historical – plague, cholera, smallpox, measles, typhus, and even the flu were major killers
Today – HIV/AIDS, Malaria, TB (and the flu)
In the 19 century, it killed a quarter of the population of Europe
Today 1/3 of the world population is infected with TB, but this doesn’t mean that they die from it
Mostly in Subsaharan Africa in modern day
HIV arose in the 1970s and got to North America in the early 80s
Today 3.4 million people live with it and 1.7 million people died from it last year
A large population of the people from Canada who have it are migrants
1918 pandemic: 25 – 50 million (2% world population) died
Worldwide: 250 000 – 500 000 deaths each year
Canada: 4 000 – 10 000 deaths each year but 5 – 10% population gets sick
Modern flu pandemics
1. 2003 SARS
2. 2009 H1N1
1 Lecture 9 (Wednesday, November 7, 2012) – Public Health
1. Not making a single argument about what we should do in a pandemic but the feature of the
2. Four levels of ethical consideration during pandemics
b) Frontline healthcare and practitioner – patient relationships
c) Resource allocation
d) Coercive measures
3. Common Concerns
Severity and breadth of outbreak
Rights and liberties impinged
Global and local inequalities
Fear and stigma
4. Personal Responsibility and Endangering Others
What to do when you are infectious?
What to do when you are not infectious?
5. Obligation to avoid infecting others
Proportionality (risk = severity x infectiousness)
2 Lecture 9 (Wednesday, November 7, 2012) – Public Health
Shortages of drugs, vaccines, hospital beds, healthcare workers, and equipment
Who if anyone should get priority access?
1. Risk (HCPs)
2. Vulnerable (elderly, already sick, kids, pregnant)
What is Fair?
Most at risk
First come first served
Most likely to recover
Decrease symptoms, severity, and duration
Prophylactic use (often for HCPs, counterproductive?)
Which HCPs? (frontline, what are necessary services?)
Questions about effectiveness
Company won’t release data
British Medical Journal (BMJ) probe
How good is the evidence…
3 Lecture 9 (Wednesday, November 7, 2012) – Public Health
Coercive Social Distancing
Conflict between public good and individual (i.e. freedom of movement and freedom of speech)
“How great must the threat to public health be for the confinement of an individual to be justified.”
Selgelid’s Ethical Quarantine Requires
Evidence of significant impact
1. What type of evidence?
2. How much impact?
3. What type of quarantine?
4. On who?
HIV and Social Coercion
Legal prosecution for intended transmission
Definition includes non – disclosure
A different level of social coercion but still (public good versus personal freedoms)
Selgelid’s Ethical Quarantine Also Requires
Minimal necessary restrictions
How to know?
Minimally burdensome impact
Burdensome on who?
4 Lecture 9 (Wednesday, November 7, 2012) – Public Health
How to collect?
Scope of application?
Distribution of burden/balance
Is he being charitable about the intentions of the state?
Is the right to freedom of movement/liberty that important?
Reid – “Deminishing Returns? Risk and the Duty to Care in the SARS