Ethical issues in the development and implementation of nutrition-related public health policies and interventions: A scoping review

BackgroundThe limited integration of ethics in nutrition-related public health policies and interventions is one major concern for those who have the task of implementing them. Ethical challenges that are overlooked during the development of such interventions could raise serious ethical issues during their implementation and even after. As a result, these decision makers need technical support and ethical guidance for adaptation of interventions to local (cultural, social, economic, etc.) contexts.AimThe goal of this scoping review is to delineate and “map” the range of ethical issues in nutrition-related public health interventions, as well as the range of the various fields in which they may arise.MethodsA scoping review of empirical research and conceptual literature was conducted following the framework of Arksey and O’Malley. Searches using PubMed with Medical Subject Headings (MeSH) categories and Advanced Search Builder as well as in the Global Health Library were performed. The final sample consists of 169 publications.ResultsThe ethics of public health prevention or treatment of obesity and non-communicable diseases is the most explicitly and frequently discussed subject. In comparison, ethical issues raised by public health interventions in the fields of undernutrition, breastfeeding, vitamin/mineral supplementation and food fortification, food security, food sustainability and food safety are addressed in a lower proportion of the sample. The results illustrate the various natures, types, and scopes of existing public health nutrition-related interventions, and the various ethical issues that may be raised by these interventions, in addition to the numerous and different contexts in which they may be implemented.DiscussionThe ethical issues faced in the development and implementation of nutrition-related public health interventions are varied and cannot be equated with, nor generalized about, when dealing with specific activities in this field. More importantly, these ethical issues cannot be managed without a careful consideration for the complexity of contexts in which nutrition-related interventions are expected to be implemented. These interventions engage a variety of actors with diverse perspectives and interests. We discuss these challenges and also comment on the importance of considering ethical impacts in the monitoring and evaluation of such interventions.ConclusionGeneral ethical frameworks or recommendations–although useful–cannot be expected to provide policy makers, implementators and other public health personnel with sufficient practical ethical guidance as they cannot consider and anticipate the particularities of all specific nutrition-related public health interventions and the complexity of the contexts in which they are implemented. Further research is needed in order to develop more targeted ethical frameworks.背景 营养相关公共卫生政策与干预措施的伦理融入程度有限，是负责实施此类工作的人员面临的核心关切之一。此类干预措施开发阶段被忽视的伦理挑战，可能在实施过程乃至后续阶段引发严重伦理问题。因此，这些决策者需要技术支持与伦理指导，以将干预措施适配至当地（文化、社会、经济等）语境。 目标 本范围综述旨在厘清并“绘制”营养相关公共卫生干预措施所涉及的各类伦理问题，以及这些问题可能出现的多元领域范畴。 方法 本研究遵循Arksey与O’Malley提出的范围综述研究框架，针对实证研究与概念性文献开展范围综述。检索策略涵盖PubMed数据库（采用医学主题词表（Medical Subject Headings）分类与高级检索构建器）以及全球卫生图书馆（Global Health Library），最终纳入169篇文献作为分析样本。 结果 公共卫生领域针对肥胖与非传染性疾病的预防或治疗伦理，是被讨论得最为明确且频繁的主题。相较之下，营养不足、母乳喂养、维生素/矿物质补充与食品强化、粮食安全、粮食可持续性及食品安全领域的公共卫生干预措施所引发的伦理问题，在纳入样本中占比更低。研究结果阐明了现有营养相关公共卫生干预措施的多样属性、类型与实施范围，以及这些措施可能引发的各类伦理问题，同时涵盖了其可能落地的多元迥异语境。 讨论 营养相关公共卫生干预措施在开发与实施阶段面临的伦理问题纷繁复杂，无法与该领域的特定活动一概而论，亦不可泛泛而谈。更为关键的是，若未审慎考量营养干预措施预期落地语境的复杂性，则无法妥善应对这些伦理挑战。此类干预措施涉及持有各异视角与利益诉求的多元行动者。本研究对这些挑战展开探讨，并就伦理影响纳入此类干预措施的监测与评估环节的重要性进行评述。 结论 通用伦理框架或指南虽具备一定实用价值，但无法为政策制定者、实施人员及其他公共卫生从业人员提供充分的实践伦理指导，因其无法兼顾并预判所有特定营养相关公共卫生干预措施的特殊性，以及其落地语境的复杂性。未来需开展进一步研究，以开发更具针对性的伦理框架。