PoPulationand Public HealtH etHics

esearch
2 Inevitably children will be found who are “at risk.” Surveillance
does not normally include follow up of individuals as the focus is
on measuring the magnitude of trends and changes in populations,
while screening is intended to identify “at-risk” individuals with the
objective of ‘personal’ intervention. A screening program may follow
surveillance, but it would, arguably, be unethical to introduce one
without good evidence about the scale of the problem. Surveillance
is the initial priority to ensure good baseline statistics for future interventions,
which could include a screening program.
3 There are good reasons not to obtain active consent. The chances of
any risk of harm can be reduced so as to be minimal. Consent is often
not sought for routine surveillance and active consent will be difficult
to obtain in school settings. Such consent could have a negative impact
on participations rates and, therefore, on the robustness of the
data. Another option would be to not seek consent at all. However,
given that there is some risk of harm (e.g., stigmatization) passive
consent seems the best balance between the different considerations.
4 This problem can be addressed if key messages to children and parents
about healthy eating and physical activity continue.
Scenario shift
» Alternate study participants (adolescents): The program could be
implemented in high schools, changing the age of the surveillance
activity to an older population (13–18-year-old teenagers). Adolescents
may be capable of consenting to the surveillance themselves, reducing
or removing the need for parental consent. In this scenario active
consent could be sought.
» Alternate activity (screening): Each child would be given his or her results
and follow up would occur for children identified as being “at risk.”
» Alternate consent process (active consent): An active consent process
is implemented that will seek written consent from parents for each
child. This may result in fewer children participating, making the
sample not representative of the population.
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