Municipalities face ethical dilemmas in health initiatives
Denmark鈥檚 municipalities often face difficult decisions when prioritizing between long-term prevention efforts targeting the general population and specific interventions for residents with chronic illnesses or acute health problems. This is the finding of a new study from the National Institute of Public Health.
Should resources be allocated to creating health-promoting environments that strengthen public health over the long term or preventive programs targeted citizens with immediate needs?
This is a question that many municipalities struggle to answer in their health and prevention efforts.
According to the study, based on interviews with 21 decision-makers from 15 municipalities, such decisions are often made under financial constraints and against a backdrop of ethical dilemmas.
"When budgets are tight, many municipalities feel compelled to prioritize programs for individuals with chronic illnesses—for example, smoking cessation programs for people with COPD or exercise groups for heart patients," explains Calina Leonhardt, a research assistant and one of the study’s authors.
However, this prioritization often pushes early prevention efforts and health-promoting measures — such as building more bike paths, offering stress management courses, or smoking cessation programs for young people — to the background.
An ethical principle with consequences
The study reveals that many municipalities prioritize addressing the most urgent health needs, following an ethical principle of assisting those in greatest need here and now. This principle is well-known in the healthcare system, where the most critically ill are treated first.
"Several decision-makers expressed a desire to focus more on early prevention and health promotion. However, they also find it challenging to advocate for such initiatives because they do not produce visible results in the short term," Leonhardt explains.
According to the study, this prioritization comes at a cost. When long-term prevention efforts are deprioritized, the overall public health can suffer.
"There is a fundamental frustration among decision-makers because they recognize how important early prevention is. However, they feel they lack both the resources and the frameworks to prioritize it."
The need for clear guidelines and support
Several municipalities are calling for concrete guidelines from central authorities to better balance their efforts.
"The open wording of Section 119 of the Danish Health Act gives municipalities significant freedom to prioritize based on their residents' health challenges, but it also places a heavy responsibility on them. Many decision-makers are asking for frameworks and clearer guidance to help them make decisions that both strengthen public health and meet the needs of the most vulnerable citizens," says Calina Leonhardt.
The study, recently published in the journal Ethics and Social Welfare, analyzes municipalities' considerations through the lens of ethical theories on prioritization principles.
Contact: Research Assistant Calina Leonhardt, Tel.: +45 6550 1968, Email: cleo@sdu.dk or Research Leader Sigurd Lauridsen, Tel.: +45 6550 7810, Email: sila@sdu.dk . National Institute of Public Health, 糖果派对