Bridging the gap from science to implementation: Overview of ethical considerations for noncommunicable disease interventions

Science and data are the foundation of public health, but data alone are not sufficient to achieve important public health goals. Moving from science to implementation involves collective action and acceptance by the public, an understanding of competing moral claims, and the development of counter claims and policy rationales that resonate ethically with the public. This tension between science and values is especially evident in recent debates about restrictive or regressive policies for chronic diseases and injuries. When is it appropriate for public health to limit individual choice either directly (e.g., requiring use of helmets or prohibiting use of food vouchers for soft drinks) or indirectly (e.g., increasing taxes on cigarettes)? Unlike infectious disease control where there is more support for government authority, judicious use of authority is key for the implementation of noncommunicable disease (NCD) interventions. Approaches to NCDs are especially challenging because they often involve behavior change in the population, which leads to concerns about the role of government. This presentation will provide an overview of ethical considerations for NCD interventions and will explore approaches for translating scientific knowledge to implementation of interventions that protect the public, prevent disease and injury, and promote health. Cases relating to tobacco control measures, sanctions and enforcement for injury prevention, and incentives and nudges will illustrate the value of ethical analysis in public health and how having information about social values and norms and the competing claims of various stakeholders is critical for the successful implementation of public health interventions for NCDs.