PoPulationand Public HealtH etHics

Allocating resources fairly is a complex process that involves comparative
cost/benefit evaluation of programs and a prioritization of stakeholder values
with reference to the local context. Health officials must weigh how to best
use funds — should they be used to target protecting the public from harm,
preventing harm, or promoting health?
One can readily imagine how much more disruptive and deadly the Welsh
outbreak might have been, had the public health department been unable to
quickly identify and contain the source of the outbreak. But it is unimaginable
that the public would have accepted the explanation that resources could not
be diverted to the outbreak, because they were being deployed elsewhere for
prevention or promotion. This consideration suggests that the public believes
that its protection in the sense of mitigating actual serious harms caused by
a breach in food safety should be the top priority. This judgment is in alignment
with the “rule of rescue” which demands taking all measures to rescue
victims of disaster or serious disease even when the rescue effort demands
a disproportionate expenditure of resources. 3
However, preventing harm through a food inspection system that monitors
key components of the existing food chain should also be a priority. Effective
prevention spares society the human costs associated with outbreaks.
Although quantifying harms that a food inspection system prevents is problematic,
the systemic costs of inspection can be compared to the costs of
outbreaks. The financial logic operating here is that the burden of paying
low incremental prevention costs is preferable to the burden of paying the
disproportionately large expenditures caused by outbreaks, even though
those incremental costs only reduce the number or possibility of outbreaks.
In the context of food safety, promotion involves changing food processing
procedures and the behaviors of people in the food industry. In the short
run, such transformations are expensive. Moreover, promotion faces the same
challenge as prevention in making palpable the harms that such promotion
will prevent. However, promotion efforts may achieve more prevention and
cost efficiency in the long run.
From an ethical perspective, prioritizing protection over prevention and promotion
is consistent with the common intuition that avoiding serious harm
generally takes precedent over acquiring a benefit. However, when the risk of
An E.coli outbreak in Wales
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