PoPulationand Public HealtH etHics

practice
harm is remote, the cost/benefit balance can shift in favor of the long term
advantages of prevention and promotion. In such instances, the challenge of
public health is twofold: to make the case that long term advantages outweigh
more immediate but less serious harms and costs, while at the same time not
losing sight of the fact that the success of prevention can lull one into forgetting
the importance of maintaining an adequate inspection system.
Responsibility for correcting the failure of the regulatory oversight system is
shared. 4 Elected officials are responsible for ensuring adequate funding. Public
health officials are responsible for implementing preventive measures and
for providing adequate training. But what is the role of the public? The public
has a duty to engage in responsible civic response to public health problems.
The role of civic responsibility has been widely discussed in the literature on
public health emergency preparedness and response, including obligations
of the public to be prepared for emergencies and to make informed choices. 5
Lessons learned from this literature need to be adapted and incorporated into
thinking about broader prevention issues, including how public health can
successfully engage the public on such matters and develop trust.
Scenario Shifts
The case asks us to consider how the ethical issues would change in the context
of the following hypothetical scenarios:
» The inspectors were well-trained, competent, and able to detect problems,
but they believed the organizational system in which they
worked placed the public at risk due to its ineffectiveness; or
» The system was functional and was able to identify the ineffective performance
of the inspectors through monitoring their performance; or
» The business involved was categorized as presenting a lower risk
to the public due to not servicing vulnerable groups (i.e, children,
through school lunches; hospital patients; and the elderly, through
nursing homes and meals-on-wheels).
In the original scenario, neither the food inspectors nor the system functioned
adequately. The first two scenario shifts, which represent situations where
either the inspectors or the system is functional, have the effect of shifting
both culpability and responsibility.
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