PoPulationand Public HealtH etHics

when a program is encouraged by the province? Who is ultimately
accountable for appropriate use of funds? How do we challenge mandated
programmes or current “best practice”? How do we manage
the public/private partnerships when goals are conflicting?
2 Reach, equity and diversity: These contests have most impact with
young, female, white smokers who are highly motivated to quit. The
characteristics of the smokers in the case region differ substantially.
Ethically, should a local health authority deliver a program with such
low reach and which is unlikely to serve an ethnically diverse population
of smokers?
3 Cost effectiveness and valuation: There is an opportunity cost to
delivering an ineffective program, both in direct costs diverted from
something more effective, and in indirect costs of the resultant poorer
health impact. Local health departments have an important stewardship
function for public spending. Ethically, can money continue to
be spent on an ineffective program? Is it worth $40,000 of taxpayers’
money, plus an additional $40,000 of sponsor money, to have such a
small number of people sign up, and even fewer not smoking at 12
months? How can we have higher impact for dollars spent? Is a car
an appropriate incentive given implications for activity and carbon
emissions?
Scenario shift
An argument can be made that the purpose of these contests is to raise
awareness of smoking cessation as the first step to changing behaviour. If
the purpose of the contest is redefined as awareness raising, do the ethical
considerations of stewardship, quality, and cost effectiveness and reach disappear?
The larger issue is the role and valuing of research findings in decision making.
Should we expect program managers to ask the questions does it work
and for whom and consider research evidence when making program and
resource-allocation decisions?
Use of evidence for program decision making
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