An empirical study on accountability for promoting healthy food environments in England through the public health responsibility deal food network

Objective: In 2011, the United Kingdom launched five Public Health Responsibility Deal Networks inspired by ‘nudge theory’ to facilitate healthy-lifestyle behaviors. This study used Q methodology to examine stakeholders’ views about responsibility and accountability for healthy food environments to reduce obesity and diet-related chronic diseases. Design: A purposive sample of policy elites (n=31) from government, academia, food industry and civil society sorted 48 statements grounded in three theoretical perspectives (i.e., legitimacy, nudge and public health law). Factor analysis identified intra-individual statement sorting differences. Results: A three-factor solution explained 64 percent of the variance across three distinct viewpoints: food environment protectors (n=17) underscored government responsibility to address unhealthy food environments; partnership pioneers (n=12) recognized government-industry partnerships as legitimate; and the commercial market defenders (n=1) emphasized individual responsibility for food choices and rejected any government intervention. Conclusions: Building trust and strengthening accountability structures may help stakeholders navigate differences to engage in constructive actions. This research may inform efforts in other countries where voluntary industry partnerships are pursued to address unhealthy food environments.

The ethics of surrogate decision making in medicine : autonomy, paternalism, or a different approach?

Knowing who to involve in treatment decisions when a patient is incapacitated has been the subject of discussion in bioethical, health law and clinical research. The major issues tend to revolve around the tension between exercising a degree of medical paternalism and respecting patient autonomy. Patients are encouraged to exert their autonomy even when they may not be capable of doing so, by means of surrogate consent or advanced directives. While liberal concepts of autonomy are exemplified in western bioethics and legal systems, clinically these decisions remain difficult, and input from medical professionals is sought, raising the issue of paternalism. A framework of bioethics, which places the patient in a relational context rather than a strictly autonomous one, may be a more helpful way of deliberating these difficult decisions

Desistance from sex offending : motivating change, enriching practice

In this article we draw from desistance research and a strength-based rehabilitation theory, the Good Lives Model (GLM), to present a richer way of intervening with sex offenders. First, we define the concept of desistance and outline some of the major research findings concerning the factors that help offenders to cease offending. Second we briefly describe current best practice sex offender treatment and discuss its efficacy. Third, we explore the relationship between desistance research and the GLM, arguing that the GLM provides a useful conduit for desistance ideas into sex offender treatment programs. Fourth, we briefly consider the treatment implications of an integrated desistance-GLM approach.

A Q methodology study of stakeholders' views about accountability for promoting healthy food environments in England through the responsibility deal food network

In March 2011, the United Kingdom's (UK's) Government launched five Public Health Responsibility Deal Networks to address public health priorities. The Networks used voluntary partnerships to influence peoples' choice architecture to move them toward healthier behaviors. The purpose of this research was to conduct an exploratory study of diverse stakeholders' perspectives about perceived responsibility and accountability expectations to improve food environments in England through the Food Network partnerships. A purposive sample of policy elites (n=31) from government, academia, food industry and non-government organizations sorted 48 statements related to improving food environments in England. Statements were grounded in three theoretical perspectives (i.e., legitimacy, nudge and public health law). PQMethod 2.33 statistical software program used factor analysis to identify viewpoints based on intra-individual differences for how participants sorted statements. The results revealed three distinct viewpoints, which explained 64% of the variance for 31 participants, and emphasized different expectations about responsibility. The food environment protectors (n=17) underscored government responsibility to address unhealthy food environments if voluntary partnerships are ineffective; the partnership pioneers (n=12) recognized government-industry partnerships as legitimate and necessary to address unhealthy food environments; and the commercial market defenders (n=1) emphasized individual responsibility for food choices and rejected government intervention to improve food environments. Consensus issues included: protecting children's right to health; food industry practices that can and should be changed; government working with industry on product reformulation; and building consumer support for economically viable healthy products. Contentious issues were: inadequacy of accountability structures and government inaction to regulate food marketing practices targeting children. We conclude that understanding different viewpoints is a step toward building mutual trust to strengthen accountability structures that may help stakeholders navigate ideologically contentious issues to promote healthy food environments in England.

Critically impaired infants and end of life decision making : resource allocation and difficult decisions

Decisions to withdraw or withhold life-sustaining treatment are contentious, and offer difficult moral dilemmas to both medical practitioners and the judiciary. This issue is exacerbated when the patient is unable to exercise autonomy and is entirely dependent on the will of others.This book focuses on the legal and ethical complexities surrounding end of life decisions for critically impaired and extremely premature infants. Neera Bhatia explores decisions to withdraw or withhold life-sustaining treatment from critically impaired infants and addresses the controversial question, which lives are too expensive to treat? Bringing to bear such key issues as clinical guidance, public awareness, and resource allocation, the book provides a rational approach to end of life decision making, where decisions to withdraw or withhold treatment may trump other competing interests.The book will be of great interest and use to scholars and students of bioethics, medical law, and medical practitioners.

Enviromental health

Edited by two leading public health physicians with chapters written by 48 experts in various aspects of social injustice, this book addresses social injustice and its relationship to public health. Major sections of the book focus on how the health of specific population groups is affected by social injustice, how specific areas of public health and medical care are affected by social injustice, and what needs to be done to reduce social injustice and its impact on health. This book will be of value to a wide range of practitioners and students in health and human services, including medicine, nursing, and social services, as well as in law and other fields.

Fat and the law: who should take the blame?

The incidence of obesity in both adults and children is rising at a rapid rate in most developed countries, including in Australia. Some obese people are seeking to place the blame for their condition on the fast-food industry, as demonstrated by the recent litigation in the United States brought by two obese plaintiffs against McDonald's. This litigation was unsuccessful, and on existing Australian negligence principles any similar litigation commenced here is likely to suffer the same fate. Principles of personal responsibility, autonomy and free will should prevail to deny a negligence claim. The risk of obesity and concomitant health problems from eating fast food to excess is an obvious risk which the plaintiff should not have ignored and which he or she has voluntarily assumed. It is for the Australian Government, not the courts, to regulate the behaviour of the fast-food industry. The government should take action by requiring all major fast-food chains to label their products with nutritional information, and by imposing restrictions on the advertising of food to children.

Some care, little responsibility? Promoting directors'and managers' legal accountability for Occupational Health and Safety in the workplace

Health and safety at work remains a serious and under-recognised problem in Australia. This paper argues for the importance of increasing the individual responsibility and accountability of senior managers and directors of corporations for the development and maintenance of occupational health and safety (OHS) standards in the workplace. In order to do so, the paper first sets out the range of statutory and general law duties and liabilities to which directors and senior managers are subject, considers to what extent these obligations have relevance in the OHS area and argues for the extension of these duties and liabilities in some circumstances. The paper then goes on to argue for a better legislative model for the legal responsibility of managers and officers, supported by the increased prosecution of individuals in appropriate circumstances, as well as acknowledging the benefits of a broader range of non-legal strategies to improve board level commitment to OHS that will influence corporate compliance overall.

Not quite a brave new world: Victoria's occupational health and safety Act 2004

This article provides a concise overview ofthe Victoria's new Occupational Health and Safety Act 2004 ("OHSA 2004"). After outlining the Maxwell Report on which much ofthe OHSA 2004 is based, the article examines the principal legislative provisions of the Act, especially those that differ from the Occupational Health and Safety Act 1985 (Vic) ("1985 Act"). Analysis of the legislation evaluates some positive developments, as well as suggests amendments. Although the OHSA 2004 contains numerous alterations in its scheme as compared to the 1985 Act, these changes are unlikely to usher in a brave new world of occupational health and safety regulation in Victoria

Using domestic law in the fight against obesity : an introductory guide for the Pacific

Contents: Acknowledgements -- What is the purpose of this introductory guide? -- Why use domestic laws in the fight against obesity? -- What must be considered when using domestic laws in the fight against obesity? -- The Agreement on Agriculture -- The SPS Agreement -- The TBT Agreement -- Which approach is best used in the fight against obesity? -- Pricing controls -- Restrictions on supply -- Labelling requirement -- How might a regulatory approach be justified? -- Where to from here? -- Conclusion -- References

Nutrition, health and related claims

The article deals with food regulations controlling the use of nutrition, health and related claims in Australia and New Zealand. It relates how such regulation of claims are managed in several ways. Examples are the Code of Practice on Nutrient Claims, vitamin and mineral claims, claims about electrolyte drinks and sports food and the Australia New Zealand Food Standards Code.

'The witness who saw, /He left little doubt' : a comparative consideration of expert testimony in mental disability law cases in common and civil law systems

The question of how courts assess expert evidence - especially when mental disability is an issue - raises the corollary question of whether courts adequately evaluate the content of the expert testimony or whether judicial decision making may be influenced by teleology (cherry picking evidence), pretextuality (accepting experts who distort evidence to achieve socially desirable aims), and/or sanism (allowing prejudicial and stereotyped evidence). Such threats occur despite professional standards in forensic psychology and other mental health disciplines that require ethical expert testimony. The result is expert testimony that, in many instances, is at best incompetent and at worst biased. The paper details threats to competent expert testimony in a comparative law context - in both the common law (involuntary civil commitment laws and risk assessment criminal laws) and, more briefly, civil law. We conclude that teleology, pretextuality, and sanism have an impact upon judicial decision making in both the common law and civil law. Finally, we speculate as to whether the new United Nations Convention on the Rights of Persons with Disabilities is likely to have any impact on practices in this area. Copyright © 2009 John Wiley & Sons, Ltd.